In recent years, Lebanon has been struggling with a socioeconomic crisis exacerbated by population displacement after the Syrian crisis, which put a significant burden on its healthcare system. An ...additional challenge has been the response to a cholera outbreak- a deadly waterborne disease transmitted through the fecal-oral route that usually manifests as severe watery diarrhea and can rapidly progress to death. After reports of a cholera outbreak in Syria were disclosed in September 2022, the Northern Governorate of Lebanon too began reporting cases immediately after, and the first case was confirmed on October 6, 2022. The outbreak rapidly spread to other parts of the country. As of December 9, 2022, a total of 5105 suspected cholera cases with 23 associated deaths were reported across Lebanon. An estimated 45% of these cases were of children and adolescents below the age of 15 years. With the start of the vaccination campaign, awareness programs emphasizing adequate sanitation and clean water sources have become an urgent need.
Chlorine dioxide is a powerful disinfectant with strong antibacterial properties. We conducted a study at different sites of the Lebanese American University Medical Center-Rizk Hospital to determine ...the efficacy of the ECOM air mask in decreasing the particle load. Air cultures were obtained from three different locations, namely the patients' elevator, visitors' elevator and mobile clinic and the number of colonies grown on each type of agar was determined. We also measured particle counts at the three sites both at baseline and after placement of the ECOM air mask. After 7 days of ECOM air mask use, the numbers of colonies grown on all types of media was decreased by 20-100% versus the baseline values. The counts of particles of different diameters (0.3, 0.5 and 5 µm) were decreased at all three sampled sites. This study highlighted the efficacy of the ECOM air mask. The utility of the gaseous form of ClO
as an antiseptic in the hospital setting appears promising.
COVID-19 infection in patients with type 2 diabetes mellitus (T2DM) -a chronic illness in Lebanon-is not well described. This was a single-centre retrospective observational study of 491 patients, ...including 152 patients with T2DM, who were hospitalised for COVID-19 between 20 August 2020 and 21 April 2021. Data on clinical characteristics, laboratory and radiological findings and outcomes were collected from the electronic medical records. Clinical characteristics and in-hospital mortality between patients with and without T2DM infected with COVID-19 using multivariate analysis were compared. Among patients hospitalised for COVID-19, those with T2DM were older, presented with milder symptoms and had more comorbidities and higher troponin T levels compared with those without T2DM. Despite the worse clinical course, the patients with T2DM had lower odds of mortality than those without T2DM.
•C. glabrata hospital isolate shows decreased susceptibility to micafungin.•C. glabrata harbors novel amino acid substitutions in chitin synthases.•C. glabrata exhibits increased cell wall chitin ...content.•C. glabrata showed increased resistance to a cell surface disrupting agent.
This study aimed to identify the resistance mechanisms to micafungin and fluconazole in a clinical isolate of Candida glabrata.
The isolate was whole-genome sequenced to identify amino acid changes in key proteins involved in antifungal resistance, and the isolate was further characterised by pathogenicity-related phenotypic assays that supported the sequencing results.
Amino acid substitutions were detected in 8 of 17 protein candidates. Many of these substitutions were novel, including in CHS3, CHS3B, and KRE5, which are involved in the development of micafungin resistance. Regarding fluconazole resistance, overexpression of efflux pumps was observed. Our isolate did not exhibit an increased virulence potential compared with the control strain; however, a significant increase in chitin content and potential to resist the cell surface disruptant sodium dodecyl sulphate was observed.
This clinical Candida glabrata isolate experienced a change in cell wall architecture, which correlates with the development of micafungin resistance.
Following the Beirut explosion, our university hospital received at least 350 casualties. Subsequently, infection control standard practices were compromised. Concerns for Multi-Drug Resistant ...Organisms (MDROs) infections in injured patients and a resulting hospital outbreak were raised. The objectives of the study were to compare the rate of hospital growing MDROs 6 months before and 6 months after the Beirut explosion, to identify emerging microorganisms and to evaluate the change in surgical infection prevention practices.
This is a retrospective chart review of patients with hospital acquired infections (HAI) admitted to the hospital before and after the Beirut explosion. The study was conducted between February 4, 2020 and January 4, 2021. Excluded patients were those transferred from other hospitals and those with community acquired infections. The primary outcome was to identify the rate of growing MDROs post explosion. The secondary outcomes were identifying antibiotics used for surgical prophylaxis in patients requiring surgeries and patients diagnosed with a HAI. Therefore, patients were divided in three groups. Control group included patients admitted with explosion-related injuries on that same day. Patients admitted and between February 4 and August 4 and diagnosed with HAI were compared to those admitted post August 4 with explosion-related HAI and to patients diagnosed with non-explosion-related HAI between August 4 and January 4, 2021. An estimated rate of 18-22% MDRO was needed to achieve a statistical significance with 80% power and 0.05 α. Pearson Chi square test was used to analyze the primary outcome.
A total of 82 patients with 150 cultures were included in this study. Data showed an increase in the rate of MDRO after the explosion with 37.1% of the cultures taken before the explosion and 53.1% after the explosion (p = 0.05). When comparing the types of HAI in both groups, culture sites were significantly different between pre- and post-explosion patients (p = 0.013). However, both groups had similar types of microbes (p = 0.996) with an increase in candida related infections.
These findings confirmed that the Beirut explosion impact on antimicrobial resistance was similar to combat zone incidence, where an increase in MDROs rate such as Escherichia coli (E.Coli) and Stenotrophomonas maltophilia, in addition to the increase in candida related infections.
Highlights • A retrospective study was performed to better describe the antimicrobial susceptibility pattern of bacterial isolates in Lebanon. • The susceptibility testing results of a total 20 684 ...Gram-positive and 55 594 Gram-negative bacteria were analyzed. • The prevalence rate of methicillin-resistant Staphylococcus aureus was 27.6% and of vancomycin-resistant enterococci was 1%. • The extended-spectrum beta-lactamase production rate of Escherichia coli and Klebsiella spp was 32.3% and 29.2%, respectively. • Pseudomonas susceptibilities to piperacillin–tazobactam and imipenem were lower than 80%. • Acinetobacter showed high resistance to most antibiotics. • Streptococcus pneumoniae had susceptibilities of 56% to penicillin, 63% to erythromycin, and 98% to levofloxacin. • Streptococcus pyogenes had susceptibilities of 93% to erythromycin and 94% to clindamycin. • The mean ampicillin susceptibility of Haemophilus influenzae , Salmonella, and Shigella isolates was 79%, 81.3%, and 62.2%, respectively..
The spread of multidrug-resistant organisms (MDRO) is associated with additional costs as well as higher morbidity and mortality rates. Risk factors related to the spread of MDRO can be classified ...into four categories: bacterial, host-related, organizational, and epidemiological. Faced with the severity of the MDRO predicament and its individual and collective consequences, many scientific societies have developed recommendations to help healthcare teams control the spread of MDROs. These international recommendations include a series of control measures based on surveillance cultures and the application of barrier measures, ranging from patients' being isolated in single rooms, to the reinforcement of hand hygiene and implementation of additional contact precautions, to the cohorting of colonized patients in a dedicated unit with or without a dedicated staff. In addition, most policies include the application of an antimicrobial stewardship program. Applying international policies to control the spread of MDROs presents several challenges, particularly in low-to-middle-income countries (LMICs). Through a review of the literature, this work evaluates the real risks of dissemination linked to MDROs and proposes an alternative policy that caters to the means of LMICs. Indeed, sufficient evidence exists to support the theory that high compliance with hand hygiene and antimicrobial stewardship reduces the risk of MDRO transmission. LMICs would therefore be better off adopting such low-cost policies without necessarily having to implement costly isolation protocols or impose additional contact precautions.
There is a lack of official national antimicrobial resistance (AMR) data in Lebanon. Individual hospitals generate their own antibiotic susceptibility data in the form of yearly pamphlets.
In this ...study, antibiotic susceptibility data from 13 hospitals distributed across different governorates of Lebanon were collected to conduct a compilation-based surveillance of AMR in Lebanon for the years 2015-2016. The findings were compared with those of a previous nationwide study in this country conducted between 2011 and 2013 as well as with similar data obtained from the 2015 and 2016 European surveillance reports of AMR. To provide a clear presentation of the AMR situation, mean percent susceptibility of different antibiotic-microbe combinations was calculated.
During 2015-2016, the percent susceptibility of
to third-generation cephalosporins and to carbapenems was 59 and 97%, respectively. Among
and
spp., carbapenem susceptibility reached 70 and 12%, respectively. Among Gram positive organisms, the percent susceptibility to methicillin in
was 72%, that to vancomycin in
spp. was 98% and that to penicillin in
was 75%. Compared with results of 2011-2013, there was an overall trend of decreased susceptibility of bacteria to the tested antibiotics, with a variation of 5 to 10%. The antibiotic susceptibility data from Lebanon were found to be comparable with those from Eastern and South-eastern European countries.
This study highlights the need to establish a robust national AMR surveillance system that enables data from Lebanon to be included in global AMR maps.
The Economic Research Service of the US Department of Agriculture (USDA) has estimated that the losses amount to almost a third of the egg-laying hens, resulting in a 210% increase in egg prices from ...the end of 2020 to the end of 2021 7. Since late 2003 these highly pathogenic H5N1 avian influenza virus have spread throughout 48 countries and a relationship of the appearance of these outbreaks shortly after a drop in temperature in each affected Eurasian region has been described; furthermore, in China between 2005 and 2006 it is described that the dust storms that affected Qinghai Lake in May 2005 were related to greater dissemination of the outbreaks in that period, supposing a possible climatic role related to the outbreaks in these areas 8. The high prevalence of avian flu in wild birds can result in severe devastation of fowl populations and endanger the sustainability and biodiversity of the ecosystems. ...in the Scotland coast during the summer season of 2021-2022 the clade 2.3.4.4b was isolated from Greats skuas affected, an important wild bird species considered of epidemiological concern 9. According to Gregorio Torres of the WOAH, the bird flu virus may be more likely to change into a more pathogenic and transmissible form. The prolonged and unprotected interaction with domesticated birds is the primary reason for the increased likelihood of human bird flu inflexion.
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