Molecular determination, serotyping, antibiotic profile and virulence factors of group B Streptococcus isolated from invasive patients at Arabcare Hospital Laboratory, Palestine.

BACKGROUND: Streptococcus agalactiae (group B Streptococcus) is beta-hemolytic, catalase negative, gram-positive cocci, recognized as main bacterial pathogen causing infections in newborns, infants, adults, and elderly people around the world. The aim of this study is to investigate group B Streptococcus samples recovered from invasive patients and determine serotype, virulent genes, and antibiotic-resistant profile of Streptococcus agalactiae in Palestine. METHODS: A total of 95 group B Streptococcus strains were isolated from neonates, infants, pregnant and non-pregnant women and males at Arabcare Hospital Laboratory, Palestine, between the period of June 2018 and September 2020. Species identification was carried out through cultivation and conventional biochemical tests. A conventional Polymerase Chain Reaction (cPCR) was used to determine the 5 serotypes and virulent genes of the Streptococcus agalactiae strains. The antibiotic resistance test of group B Streptococcus was evaluated using Kirby-Bauer disk susceptibility. Sequencing and BLAST analysis were used to determine the relationship of the isolates in this study to worldwide isolates. RESULTS: Serotype III (35%) was the major group B Streptococcus strains serotype causing invasive infections in neonates, infants, pregnant and nonpregnant women, and males, followed by serotypes V (19%), Ia, and II (15%), Ib (6%), respectively. All our isolates encoding for surface protein virulent factors, including a highly virulent gene (HvgA) were mostly found in strains isolated from pregnant women (12%). These group B Streptococcus strains exhibited a high rate of resistance to clindamycin (26%). The overall percentage of levofloxacin resistance was 11%, while vancomycin and ampicillin showed higher resistance, at 14.7 and 16% respectively. In addition, the phylogenetic relationship dendrogram illustrates that Streptococcus agalactiae isolated from an invasive patient (newborn) in Palestine was similar to strains found in China and Japan. CONCLUSIONS: The outcomes of this study demonstrate that resistant group B Streptococcus strains are common in Palestine, therefore, evidence-based infection prevention and antibiotic stewardship efforts are necessary.

Molecular characterization of Escherichia coli isolates from patients with urinary tract infections in Palestine.

Antibiotic resistance of Escherichia coli isolated from urinary tract infections (UTIs) is increasing worldwide. A total of 41 E. coli isolates were obtained from urine samples from hospitalized patients with a UTI in three hospitals in the northern districts of the West Bank, Palestine during March and June 2011. Resistance rates were: erythromycin (95 %), trimethoprim-sulfamethoxazole (59 %), ciprofloxacin (56 %), gentamicin (27 %), imipenem (22 %), amoxicillin (93 %), amoxicillin-clavulanic acid (32 %), ceftazidime (66 %) and cefotaxime (71 %). No meropenem-resistant isolates were identified in this study. Among the isolates, phylogenetic group B2 was observed in 13 isolates, D in 12 isolates, A in 11 isolates and B1 in five isolates. Thirty-five of the isolates were positive for an extended-spectrum ß-lactamase phenotype. Among these isolates, the blaCTX-M gene was detected in 25, and eight harboured the blaTEM gene. None of the isolates contained the blaSHV gene. Transformation experiments indicated that some of the ß-lactamase genes (i.e. blaCTX-M and blaTEM) with co-resistance to erythromycin and gentamicin were plasmid encoded and transmissible. Apart from this, enterobacterial repetitive intergenic consensus-PCR (ERIC-PCR) revealed that the 41 isolates were genetically diverse and comprised a heterogeneous population with 11 ERIC-PCR profiles at a 60 % similarity level.

Molecular analysis and susceptibility patterns of methicillin-resistant Staphylococcus aureus strains causing community- and health care-associated infections in the northern region of Palestine.

BACKGROUND: Community acquired methicillin-resistant Staphylococcus aureus (CA-MRSA) is a major global problem. This study attempted to investigate the prevalence of nasal carriage of Staphylococcus aureus and methicillin-resistant Staphylococcus aureus (MRSA) strains among 360 healthy university students at An-Najah National University, Palestine. For the purpose of comparing the staphylococcal cassette chromosome methicillin resistant determinant (SCCmec) type of MRSA, 46 clinical MRSA isolates were also included in this study. METHODS: Susceptibility testing was performed by the disc diffusion method. The genetic association of MRSA isolates was investigated by SCCmec typing. A selected number of isolates were also used to amplify and sequence mecA. RESULTS: Nasal carriage of S aureus was found in 86 of 360 students (24%). MRSA accounted for 9% of S aureus isolates. All 86 strains of S aureus were sensitive to vancomycin. Resistance to penicillin G, amoxicillin/clavulanic acid, ciprofloxacin, erythromycin, and clindamycin was found in 98%, 93%, 33%, 23%, and 12% of the isolates, respectively. Resistance rates of the MRSA isolates were as follows: 100% resistant to penicillin G and amoxicillin/clavulanic acid, 96% to ethromycin, 52% to clindamycin, and 48% to ciprofloxacin. No vancomycin-resistant isolates were identified. In our study, nearly half (52%) of the MRSA isolates belonged to SCCmec types IVa and V. However, SCCmec types II and III are represented by 48%, whereas SCCmec type I was completely absent. CONCLUSION: The findings of this study indicate the existence of SCCmec type IVa in both student nasal carriers and health care settings. This emphasizes the need for implementation of a revised set of control measures in both settings. Moreover, the rational prescription of appropriate antibiotics should also be considered.