Variation in Progesterone Levels and Urinary Tract Infections in Pregnant Women Attending Moi Teaching and Referral Hospital, Eldoret, Kenya

Background and Aims: Urinary tract infections (UTIs) are common among pregnant women and major predisposing factors for pyelonephritis linked to obstetrical complications including preterm labour and low infants’ birth weights. This study sought to determine the relationship(s) between pregnancy trimesters, UTIs and changes in progesterone levels among pregnant women. Materials and Methods: The study was conducted in 2016 at Moi Teaching and Referral Hospital (MTRH) antenatal clinic which is a referral facility that attends to patients from most Counties in western region of Kenya. A cross-sectional study design was used to collect blood and urine specimens from 78 participants. Blood was used to determine progesterone levels using ELISA technique and urine cultures with bacterial colony counts ≥ 105 were appropriately identified to species level. Trimester periods and participants’ demographic information were obtained using a structured questionnaire. Results: Culture results showed that the most abundant bacterial species isolated in urine from the pregnant women was Escherechia coli (63.7%). The more affected age-group was women between 30 - 39 years during trimester three, suggesting that bacterial colonization of genital track occurred more frequently in older compared to the younger women. There was an exponential increase in progesterone levels among the pregnant women during trimester three compared to other trimesters, although these increases occurred independent of age. However, high levels of progesterone among pregnant women in third trimester corresponded with increased number of E. coli causing UTI. Conclusion: The results showed that progesterone levels increase with trimester and the most prevalent bacteria associated with this was E. coli even though age and increase in progesterone levels had no significant impact on E. coli infection.

<i>In Vitro</i>Evaluation of Bacterial Adhesion to Dental and Stainless-Steel Surfaces

This study aimed to describe the factors associated with biofilms formation in dental pathology by comparison of bacterial growth on dental and stainless-steel surfaces. We studied in vitro the behavior of Staphylococcus aureus Métis in order to observe the capacity of adhesion, to evaluate quantitatively the potential of proliferation and to compare the behavior of this germ in contact with the two surfaces. The biomaterials used were cylinders in Stainless steel (AISI 316L), dental fragments and stainless-steel fragments, all were disinfected for 15 minutes and then sterilized in a wet autoclave at 120˚C for 30 min. Macroscopic observation with a binocular magnifier of bacterial proliferation was carried out regularly after 6 h and 24 h of incubation. Observation by optical microscope based on GRAM staining made it possible to visualize the presence or absence of bacteria and to differentiate them. The adhesion of Staphylococcus aureus Méti S on dental fragments was compared to the one obtained on stainless steel fragments. We also carried a Bacterial count by optical dosing. The results show that the ability of this germ to colonize and develop biofilms on surfaces depends mainly on the characteristics of the surface. Rough surfaces as dental surface are more likely to developing biofilms than smooth surfaces like stainless-steel surface.

Prevalence and Antibiotic Resistance of <i>Salmonella</i>spp. in Turkey

The current study was conducted to investigate the prevalence of Salmonella spp. in turkey and to determine the antimicrobial resistance pattern of the isolated Salmonellae. Two hundred and fifty turkeys were randomly selected for cloacal soab samples preparation, and the samples were investigated for Salmonella isolation. Identification of the isolated Salmonella was performed using standard bacteriological and biochemical procedures. The prevalence of Salmonella in turkey was about 14.8%. Disc diffusion tests on Muller-Hinton agar were used to determine the sensitivity to antibacterial agents. Ten antibiotics were studied: lincospectin, colistin, cephalexin, ciprofloxacin, chloramphenicol, gentamycin, furazolidone, streptomycin, co-trimoxazole (trimethoprim-sulfamethoxazole) and tetracycline. The highest resistant was observed against cephalexin (89.2%), tetracycline (86.5%), colistin (83.8%), and furazolidone (73%). The Highest sensitivity was found to gentamycin (86.5%), ciprofloxacin (83.8%), chloramphenicol (51.4%) and streptomycin (40.6%). The results showed high prevalence of Salmonella spp. in turkey and high levels of antimicrobial resistance pattern of the isolated Salmonellae were observed.

<i>Borrelia</i><i>burgdorferi</i>: Cell Biology and Clinical Manifestations in Latent Chronic Lyme

Chronic Lyme disease is predicated by an infection with Borrelia burgdorferi via tick vector. B. burgdorferi has been extensively researched with regard to its genome and cell biology. There are many unique characteristics to the bacteria itself;however, serological diagnostics and diagnosis based on symptoms can be complicated and potentially misleading. Other promising diagnostics were also evaluated in this review. Treatment of the chronic Lyme disease can be complicated and at times ineffective. The purpose of this review is to examine B. burgdorferi from a biological and clinical perspective.

Activity of Fosfomycin in Extended-Spectrum Beta-Lactamases Producing Klebsiella pneumonae from Hospital Acquired Urinary Tract Infections

Treatment of hospital acquired urinary tract infections (UTIs) caused by extended-spectrum beta-Lactamases producing Klebsiella pneumonae is a major problem. This organism expresses a high level of resistance to many groups of antibiotics. Fosfomycin is an agent which is recommended for treatment of UTIs caused by ESBLs producers. The aim of this study is to determine the sensitivity pattern of ESBLs producing urinary K. pneumonae to antimicrobial agents including fosfomycin in patients of MUHs and determine the prevalence of fosfomycin resistance mediated by plasmid mediated fosfomycin modifying enzymes fosA, fosB and fosA3. Methods: Klebsiella pneumonae urinary isolates were collected from patients with hospital acquired UTIs in Mansoura University Hospitals (MUHs). The susceptibility pattern was determined by Kirby Baur method. Isolates resistant to extended spectrum cephalosporins were tested for ESBLs production by double disc diffusion method. Fosfomycin resistance was determined by broth dilution method. Isolates resistant to fosfomycin were tested for fosA, fosB and fosA3 by PCR. Results: A total of 128 ESBLs producing K. pneumonae isolates were collected. The highest sensitivity was to imipenem (94.5%). The lowest was to trimethoprime-sulphamethoxazole (21.8%). Co-resistance of ESBLs isolates with fosfomycin was 23.2%. Eighteen fosfomycin resistant isolates (18/30) were positive to fosA. Conclusion: ESBLs producing urinary Klebsiella pneumonae express moderate sensitivity to fosfomycin. Resistance is mainly mediated by plasmid mediated fosfomycin modifying enzymes fosA.

Antiplasmodial Efficacy of Crude Cocoa Powder Extract on CD4+ T-Cell Counts of <i>Plasmodium berghei</i>Infected BALB/c Mice

Background: Drug resistance in malaria warrants the need for alternative therapy from plant food nutrients. The search for novel anti-malarial control spurred a great interest in cocoa which has been portrayed as immune booster against malaria. This study was geared towards estimation of CD4+ cells of P. berghei infected mice treated with cocoa powder extract (CPE) to provide substantive scientific evidence to authenticate the anecdotal report. Methods: Brine shrimp toxicity assay was done to determine LC50 of crude cocoa powder extract. The mice were infected with 1 × 107 of ANKA and NK65 strains of Plasmodium berghei intraperitoneally, while graded doses of the extract were administered by an intra-gastric intubation based on the body weight of mice. Blood samples were analyzed for microscopy and flow cytometry for CD4+ cell counts. Results: The onset of infection was delayed in the group treated before inoculations on day 3 and the level of P. berghei parasitemia was positively associated with induction of CD4+ cells while the negative control group that received normal saline had progressive increase of parasitemia. The mean survival time could not go beyond day14 in ANKA, though both strains responded to CPE in a similar way with chloroquine as a positive control. The CD4+ cells counted increased in both strains treated before and during inoculations and the episodes of malaria was suppressed compared with the control. Conclusion: This study has demonstrated that the antiplasmodial activity of CPE was associated with the level of CD4+ T-cells proliferation which initiated the protective immune response. This therefore calls for efforts to ensure adequate intake of cocoa powder to boost immunity against malaria.

Trend of <i>Cryptosporidium</i>Infection among Children below 24 Months in an Informal Urban Settlement, Kenya

Cryptosporidium infection is estimated to cause 2.9 million diarrheal cases yearly among children aged under 24 months in sub-Saharan Africa. Studies have shown long-term climatic variations can affect infectious diseases. The burden of cryptosporidiosis in rural areas of sub-Saharan Africa is well characterized. However, the trend of Cryptosporidium infection is not known, especially in informal urban settings. This study therefore sought to determine cryptosporidiosis trends, and further explore the association between year and Cryptosporidium infection among children below 24 months in Kibera urban informal settlement in Kenya. Data collected by the Kenya Medical Research Institute longitudinal study in Tabitha clinic in Kibera from 2009 to 2015 were used. At least 3000 children aged < 24 months receive free health care at the clinic. In the longitudinal study, children presenting with diarrhea were eligible for stool sample collection (n = 477), out of which 421 stool samples were tested using TaqMan™ Array Card (TAC) polymerase chain reaction panel that included a target for Cryptosporidium genus. Data for the 421 children were included in the analysis. Logistic regression was used to explore the difference between the seven years and cryptosporidiosis. Overall, the pooled data indicated that 23.5% of the children who were tested had Cryptosporidium infection, with the highest proportions of Cryptosporidium-positive cases observed in 2015 (45.2%). The logistic regression results also indicated that children who were tested in the year 2015 were more likely to have Cryptosporidium infection (OR = 3.39;95% CI: 1.44 - 7.96;p = 0.005) than those in 2009. Watery stool was also found to be an important symptom of cryptosporidiosis. There was a high prevalence of Cryptosporidium infection among young children, especially in the most recent year. Routine testing of Cryptosporidium infection using molecular methods, constant monitoring and identification of the infection sources is therefore necessary towards reducing the disease burden in the low resource settings.

Human Rhinoviruses in Korean with Acute Low Respiratory Tract Infections

Human rhinovirus (HRV) must be viewed as a significant etiological agent of acute low respiratory tract infections (ALRIs) in infants and young children. The present study has been carried out to investigate the prevalence of recently identified respiratory viruses and determine the phylogenetic composition of HRV strains. In total, 923 nasopharyngeal aspirates (NPAs) collected from hospitalized patients with ALRIs between January and December 2010 (453 females and 470 males) at five referral hospitals in Seoul were tested for respiratory viruses. Viruses were detected by RT-PCR (Reverse transcription polymerase chain reaction) in 501 (54.3%) of the 923 positive samples obtained. Overall, HRV was detected in 7.9%, ADV in 10.2%, IFV in 21.9%, RSV in 3.6%, hMPV in 2.7%, HCoV in 2.5%, HEV in 1.6%, HBoV in 1.6%, and PIV in 2.4% of the samples. HRV infections occurred throughout the year, with peaks in January, May, July, and November of 2010. Phylogenetic analyses using the VP4/VP2 cording region showed that among the 27 isolates with HRV, 14 (52%) were infected with species A, 2 (7%) were infected with species B, and 11 (41%) were infected with the strains from HRV-C. HRV-C sequences are genetically distinct, sharing only 32% to 33% of their amino acids with HRV-A and HRV-B, while retaining 46% to 100% identity with each other. HRV-A, B, and C were co-circulating in children hospitalized with ALRIs in Korea in 2010. These findings indicated that HRV-C was the important causative agent of HRV associated with ALRIs.

Detection and Characterization of Methicillin Resistant Staphylococcus aureus from Toilet and Classroom Door Handles in Selected Secondary Schools in Nairobi County

Background: Staphylococcus aureus is found on all surfaces especially in public areas like hospitals and schools and on frequently touched areas like toilet and classroom door handles. Methicillin resistant Staphylococcus aureus (MRSA) is a strain of Staphylococcus aureus which is resistant to methicillin. There are two types of MRSA: Community acquired methicillin resistant Staphylococcus aureus (CA-MRSA) and hospital acquired methicillin resistant Staphylococcus aureus (HA-MRSA). MRSA in the community presents a significant reservoir that could enter into healthcare facilities and spread among patients and also a risk for immune compromised persons in the community. Methodology: The study aimed at determining the prevalence of MRSA isolated from toilet and classroom door handles as a potential source of infection to the students and the workers in selected schools in Nairobi, Kenya. The study also compared the prevalence of MRSA between boarding and non-boarding girls, boys and mixed (both girls and boys in the same school) secondary schools. Twelve secondary schools in Nairobi County were randomly selected and 306 samples from both the toilet and classroom door handles were collected using sterile swabs and transported to the laboratory. Isolation of Staphylococcus aureus was done by the use of selective media Mannitol salt agar, antibiotic susceptibility of isolates was done by disk diffusion method, and molecular detection of mecA and PVL genes were done by polymerase chain reaction (PCR). Results: The prevalence of S. aureus was 20% and 15% were MRSA positive by both Antimicrobial Susceptibility Test and PCR detection. 20% showed the presence of PVL genes, 8% showed the presence of both genes and 56% of isolates with mecA gene had PVL genes. Conclusion: The presence of MRSA in this study emphasizes the need to formulate hygiene measures to prevent possible spread of MRSA and other transmissible pathogens to students and workers in the schools.

Review: The Molecular Basis of Resistance in <i>Mycobaterium tuberculosis</i>

Tuberculosis is a serious global public health problem and its high prevalence is strongly associated with the increase of drug resistance. This steady increase in the frequency of M. tuberculosis strains resistant to one or more agents commonly used to treat tuberculosis has drawn worldwide attention to understanding the molecular basis of resistance in M. tuberculosis. TB resistance is a great concern in the antibiotic resistance pandemic due to the high risk of death, as patients can remain infected for months or years and also because of the difficulty of the treatment. A molecular understanding of the series of events that render M. tuberculosis multi-drug resistant is very important in order to find a fast and appropriated diagnosis as well as a new target for new drugs.

Pulmonary Tuberculosis among Suspected Sudanese Patients in Wad Madani Tuberculosis Center

Background: Tuberculosis is a health problem in Sudan and may become a greater challenge in the future due to the weakness in infection prevention measures, increase in cases of drug-resistant and the difficulty of diagnosis. Objective: The aim of this study was to detect Mycobacterium tuberculosis (MTB) from sputum of clinically suspected patients using the three available techniques. Methods: Three hundred participants referred to Wad Madani Tuberculosis Center during 2017-2019 were included. Early morning fresh sputum samples were subjected to Mycobacterium tuberculosis examination by Ziehl-Neelsen (ZN) stain without concentration, ZN stain with centrifugation and geneXpert assay. Results: Of the 300 suspected cases;Mycobacterium tuberculosis detected in 17% (51/300) by ZN stain without concentration, 20% (59/300) by ZN stain with centrifugation and 34% (103/300) by geneXpert. The two techniques of ZN stains possessed 100% specificity and relative differences in sensitivity when compared to geneXpert assay. The significant association observed between ZN stains and geneXpert results indicated validity of ZN techniques for detection. Conclusions: The study confirmed that geneXpert is better for identification of Mycobacterium tuberculosis when compared to ZN techniques which are also important for diagnosis in poor places and where the geneXpert assay is not available.

Antimicrobial Resistance and Plasmid Profiles of Campylobacter Species from Infants Presenting with Diarrhoea in Osun State, Nigeria

Antibiotic resistance among enteric bacterial pathogens complicates the heavy diarrhoea disease burden. Antimicrobial resistance of Campylobacter spp. to fluoroquinolones, which are generally used for the treatment of bacterial gastroenteritis, has increased during the past two decades, mainly as a result of the approval of this group of antimicrobials for use in food-producing animals. The aim is to determine the frequency of resistance of campylobacter to various antimicrobial agents and the relationship between antimicrobial agents of the isolates and the presence of plasmid. Twenty five Campylobacter isolates gotten from humans were subjected to antibiotics testing using Kirby Bauer disc diffusion method as well as standard E-test method. The plasmid profile of the isolates was determined using the Alkaline phosphatise procedure. The antimicrobial susceptibility testing of these isolates showed that all were sensitive to Erythromycin and Ciprofloxacin while none was sensitive to co-trimoxazole. The standard organisms were sensitive to co-trimoxazole (80%) and ciprofloxacin (65%) but were resistant to erythromycin (70%). No plasmid was found in streptomycin and ampicillin resistant strains, with the exception of four isolates which were co-trimoxazole-resistant and which contained around 24.4kb plasmids.

Low and High Risk Human Papillomavirus in the Oral Mucosa of Mexican Women with Genital Papillomavirus

Background: Human papillomaviruses (HPV) are implicated in cervical cancer and, recently in oral cancer. In Mexico, there are few studies on oral cancer, therefore the interest in identifying the HPV frequency of low and high risk in samples of the oral and cervical cavities, and determining some risk factors. Objective: To determine the frequency of high and low risk HPV infection in the oral cavity of women with cervical HPV, and to correlate the infection site with risk factors. Materials and Methods: Eighteen female patients between 24 and 53 years, with antecedents of genital HPV infection were included. Both samples of oral cavity and cervix were obtained. DNA extraction from the epithelial cells was performed using the Qiagen kit. PCR was done and the amplicon was observed in 2% agarose gels stained with ethidium bromide. A correlation of HPV infection and risk factors was done. Results: HPV-DNA was detected in the 67% of both samples. The frequency of oral and cervix low risk HPV-DNA was 50%, while high risk HPV-DNA in oral cavity was detected in 17%, and 39% in the cervix. The study of the risk factors involved in HPV infection showed that the participants had the habits of smoking 39%;alcohol drinking 28%;and 78% oral sex. Conclusion: The results showed a high frequency of HPV (67%) infection in the oral and genital mucosas, suggesting that patient’s habits could contribute to the infection;the presence of HPV in the oral mucosa may act as reservoir for new HPV infections.

Antimicrobial Susceptibility of Multidrug-Resistant <i>Acinetobacter baumanii</i>in a Teaching Hospital: A Two-Year Observation

Multidrug-resistant (MDR) Acinetobacter baumanii (A. baumanii) caused hospital acquired infection, typically in critical-ill patients with medical devices. This is a retrospective descriptive study on epidemiology and microbiology data to determine the antimicrobial susceptibility pattern of MDR-Acinetobacter baumanii isolates from a teaching hospital in Tangerang, Indonesia from Januari 2013 to December 2014. A total of 84 A. baumanii were collected. Patients suffering from respiratory tract infection had the highest number (41.7%) of A. baumanii isolate. There were 39 (46.6%) patients admitted in critical care. A. baumanii isolates in this study mostly were multidrug-resistant organisms with low susceptibility level to 11 antibiotic tested, 44% - 69% in 2013 and 26% - 67% in 2014. A high susceptibility level was observed to amikacin (80% and 79% in 2013, 2014 consecutively) and trimethoprim-sulfamethoxazole (73% and 72% in 2013, 2014 consecutively). A. baumanii is a hospital acquired pathogen in critically-ill patients. The susceptibility pattern of this study result showed MDR organism. There was a sharp decrease of susceptibility in all antibiotics studied from 2013 to 2014 except amikacin and trimethoprim-sulfamethoxazole.

Multi Drug Resistance Bacterial Isolates of Surgical Site Infection

Multi drug resistance microorganism is considered to be one of the major health problems. The aim of this study was to determine antibiotic susceptibility pattern of bacterial pathogens of surgical site infection. A total 250 samples were included, out of which 62.4% showed significant bacterial growth. Gram negative bacteria were 85.25% and gram positive bacteria were 14.75%;among them 65.38% of the total isolates were multi drug resistance (MDR). The age group between 31 - 40 found the highest number of isolates 22.4%. Among gram negative bacilli, the highest production of MDR was found in Acinetobacter spp. followed by Pseudomonas aeruginosa, Klebsiella pneumoniae and Escherichia coli. In gram positive cocci, the highest production of MDR was found in Staphylococcus aureus. Acinetobacter spp. was found highly susceptible to amikacin and gentamycin 20.1% followed by ofloxacin and ciprofloxacin 18.6% and 16.2% respectively. Staphylococcus aureus showed 100% sensitive to clindamycin whereas penicillin showed 100% resistance followed by amoxycillin (93.75%). Amikacine and clindamycin were drugs of choice for gram negative and gram positive bacteria respectively. This study showed that alarming increase of infections was caused by multi drug resistance bacterial organisms. It increases length of stay and may produce lasting sequelae and requires extra resources for investigations, management and nursing care. Surveillance of surgical site infection is a useful tool to demonstrate the magnitude of the problem and find out appropriate preventive methods.

The Influence of Jia Wei Cang Er San on the Postoperative Bacteriology of Chronic Rhinosinusitis: A Randomized, Placebo-Controlled, Double-Blind Study

Background: Antibiotics have been used routinely for postoperative care in patients with chronic rhinosinusitis (CRS). However, increased bacterial growth was found after antibiotic treatment. In traditional Chinese medicine, Jia Wei Cang Er San has been used to treat CRS. This study was to investigate the influence of Jia Wei Cang Er San on the postoperative bacteriology of CRS. Methods: Ninety-seven CRS patients who underwent functional endoscopic sinus surgery (FESS) were included. They were randomly divided into 3 groups. In the group of Chinese herbal medicine (CHM), patients were given a capsule of Jia Wei Cang Er San tid for 8 weeks and a placebo capsule for amoxicillin q8h for 4 weeks after FESS. In the amoxicillin group, patients were given a capsule of amoxicillin 250 mg q8h for 4 weeks and a placebo capsule for Jia Wei Cang Er San tid for 8 weeks. In the placebo group, patients were given both placebo capsules. Bacterial cultures were performed from bilateral middle meati before FESS, and 8 and 12 weeks after FESS. Results: In the CHM group, bacteria grew in 21 (46%) of 46 specimens pre-operatively, in 23 (50%) specimens 8 weeks and in 17 (37%) specimens 12 weeks after surgery. In the amoxicillin group, bacteria grew in 15 (28%) of 54 specimens pre-operatively, in 30 (56%) specimens 8 weeks and in 32 (59%) specimens 12 weeks after surgery. In the placebo group, bacteria were found in 13 (34%) of 38 specimens pre-operatively, in 16 (42%) specimens 8 weeks and in 12 (32%) specimens 12 weeks after surgery. The rates of bacterial growth did not change by Jia Wei Cang Er San 8 or 12 weeks after surgery, but increased significantly by amoxicillin 8 and 12 weeks after surgery. Conclusion: Our study showed that Jia Wei Cang Er San did not induce bacterial growth after FESS as amoxicillin.

Phytochemical Profiling with Antioxidant and Antimicrobial Screening of <i>Amaranthus viridis</i>L. Leaf and Seed Extracts

Methanol extracts of the dried leaves and seeds of Amaranthus viridis were collected and used for phytochemicals and antibacterial analysis. By detecting the MIC and zone inhibition, the antibacterial activity was determined against different bacterial and fungal strains. The extract yields from the leaves and seeds ranged 5.5-6.1 and 2.42%-3.72% w/w, respectively. Phytochemical investigation of this plant determines that tanins (6.07%-5.96%), saponins (53%-32%), alkaloids (13.14% - 11.42%), protiens (16.76%-24.51%) and glycosides (63.2%-32.3%) were rich in leaves. The extracts also contained appreciable levels of total phenolic contents (2.81-3.61 GAE, g/100 g), total flavanoid contents (18.4-5.42 QE, g/100 g) and DPPH free radical scavenging activity, showing IC50 (83.45-75.95 μg/mL) along with reducing power was calculated. The MIC of extracts ranged 178 - 645 μg/mL. The results of this study suggest the possibility of using the methanolic extracts in treating the diseases caused by the test organisms.

Phenotypic Characterization of Carbapenemase-Producing Enterobacteriaceae Strains in a Referral Teaching Hospital in Yaoundé, Cameroon

Background: Carbapenemase-producing Enterobacteriaceae (CPE) are an important and increasing threat to global health. They are nowadays more encountered routinely in hospitals and cause high morbidity and mortality due to limited therapeutic alternatives. This study sought to determine the prevalence of CPE in Yaoundé teaching hospital, Cameroon, and the associated risk factors. Materials and Method: To achieve this goal, a descriptive cross-sectional study coupled to an analytical component with consecutive collection of Enterobacteria strains was carried out during a three-month period (from 27th July to 24th October 2018) in the University Teaching Hospital of Yaoundé, Cameroon. The oxidase and biochemical identification tests using a miniaturized Api 20 E system were performed on colonies grown on Eosin Methylene Blue (EMB) medium and subcultured on nutrient agar. Drug susceptibility testing was carried out according to the Antibiogram Committee of the French Society of Microbiology (CA-SFM 2018.V.2.0). The detection of carbapenemase production was performed by the CA-SFM 2018 algorithm for the screening of carbapenemase-producing enterobacteriaceae and its classification by inhibitory synergy tests. Results: Out of the 104 isolates, Escherichia coli (50%) was the most prevalent species, followed by Klebsiella pneumoniae (37.5%) and Citrobacter frendii (12.5%). Drugs susceptibility patterns showed a high resistance to penicillins group (97.4% to amoxicillin), cephalosporins (68.4% to cefotaxim, 58.1% to cefixim, 60.7% to ceftazidim, 57.1% of cefoxitin) and aztreonam (55.7%). However, 11.9% carbapenems related resistance was noticed: 14.4% to imipenem, 13.8% to ertapenem and 7.5% to meropenem. Numerous co-resistance to quinolones (65.8%), fluoroquinolones (49.6%), aminoglycosides (49.6%) and cotrimoxazole (71.8%) were also observed. From 104 isolates, AmpC production represented 23.08% (25/104) and 36.54% (38/104) were ESBL-isolates. The overall prevalence of CPE was 25% (26/104) with K.pneumoniae predominant (61.53%). Besides, Class A and class B carbapenemase were mainly produced with respectively 20% (21/104) and 5% (5/104). Univariate analysis revealed a significant association of carbapenemase production to Klebsiella pneumoniae (p = 0.01), ESBL and AmpC production ((P = 0.01 and P = 0.001 respectively) while that association was only significant to Klebsiella spp (p = 0.04) and AmpC production (p = 0.02) in multivariate analysis. Conclusion: The multi-resistance of Enterobacteriaceae to antibiotics in Cameroon has considerably increased. More attention should be paid to those bacteria to stall antimicrobial resistance spread.

Epidemiology of <i>Staphylococcus aureus</i>Infections in Kenya: Current State, Gaps and Opportunities

Staphylococcus aureus has maintained its clinical relevance as a major cause of hospital and community acquired infections globally with a high burden of antimicrobial resistance (AMR). Though reported, the burden of infection, antimicrobial resistance and molecular epidemiology of S. aureus are not well defined in Kenya. This descriptive review evaluated reported data on the detection and characterization of S. aureus infections in Kenya. Published data between 2000 and 2020 were evaluated. S. aureus isolation frequencies varied from 1% in blood specimens to 52.6% among skin and soft tissues infections while MRSA rates ranged from 1% to 84.1%. While penicillin resistance has consistently been high, last line and recent antibiotics such as vancomycin, linezolid, teicoplanin and daptomycin have retained their efficacy. Data on MRSA carriage in the community, among HCWs and inpatients is limited. Global clones (CC1, CC5, CC8, CC22, CC30, CC45 and CC239) alongside a few novel MRSA strains have been reported with staphylococcal protein A (spa) sequence based clustering yielding four major clusters (spa CC359, spa CC005, spa CC121 and spa CC021) in circulation. MRSA strain ST239/241 (t037) seems predominant in the country. Despite a clear paucity of data, the present analysis points to a high infection and AMR burden in S. aureus with global MRSA clones in circulation. Standardized national surveillance and reporting incorporating molecular tools for identification and characterization will help fill existing gaps in the understanding of the evolving epidemiology of MRSA infections.

Prevalence of Class 1 Integron, Resistance Gene Cassettes and Antimicrobial Susceptibility Profiles among Isolates of Pseudomonas aeruginosa in Iran

Pseudomonas aeruginosa is one of the most important opportunistic human pathogens worldwide. High prevalence of Multi Drug Resistant P. aeruginosa (MDRPa) in Iran is a serious problem for antimicrobial therapy. Several studies have reported the MDRPa in Europe and Asia. Due to the use of broad-spectrum antibiotics, bacterial resistance is increasing in Iran, located in Middle East. The present cross-sectional study was designed to investigate the prevalence of class1 integron, resistance gene cassettes and antimicrobial susceptibility profiles among isolates of P. aeruginosa in Al-Zahra Hospital, Isfahan City, central part of Iran from Jan-Sep 2014. The aim of this study was to determine the antimicrobial susceptibility, the prevalence of Class1 integron, resistance gene a measuring in Iran. A total of 231 P. aeruginosa isolates were collected from clinical specimens including urine (50.6%), tracheal tube (25.5%), wound (13.4%), blood (6.1%), catheter (2.2%), cerebrospinal fluid (1.7%) and sputum (0.4%) isolates from hospitalized patients (mean age: 50.27 ± 24.12 years).The majority of patients (68%) were male. Isolates were collected from different parts of the hospital as follows: ICU, Internal Medicine, Emergency care, Pediatrics, Nephrology, Transplant Center, General surgery and Infectious. Revealed data show a high rate of MDR P. aeruginosa isolates in the studied area;also, the result signifies the spread of aadA6 among clinical isolates in hospitalized patients.