Background: Diabetic foot infection (DFI) is a common and costly complication of diabetes that may be caused by various bacteria with multi-resistant genes. The aim of this study is to evaluate the efficacy of phenotypic methods for identification of methicillinresistant Staphylococcus aureus (MRSA) with genotypic detection of MRSA-related genes. Methods: In this cross-sectional study, swab samples were collected from patients with DFI from hospitals in Sulaimani/Iraq in April-July 2019. All the samples were processed for microbiological assessment and further MRSA phenotypic and genotypic testing. Results: A total of 46 swab samples were collected from diabetic foot ulcers of 29 males and 17 females. Most samples (93.5%) showed positive growth, with higher proportions of monomicrobial (23; 53.5%) than mixed-bacterial infections (20; 46.5%) and S. aureus as the predominant pathogen. Conventional methods of MRSA detection, such as cefoxitin disc diffusion, can predict methicillin resistance in 45.8% of the cases. Real-time/conventional PCR showed that 41.6% of Staphylococcus aureus were positive for the mecA gene, while none of the isolates was positive for PVL. Conclusion: Staphylococcus aureus was the predominant pathogen in DFI. Although cefoxitin and oxacillin disc diffusion methods can help in the prediction of MRSA, realtime PCR is a reliable method for MRSA detection and confirmation.

Background Integrons are bacterial mobile genetic components responsible for mediating the antibiotic resistance process by carrying and spreading antimicrobial resistance genes among bacteria through horizontal gene transfer. Objectives This cross-sectional hospital-based study aimed to find the prevalence of antibiotic resistance patterns and to detect integrons classes (I, II, and III) among bacterial isolates in patients with urinary tract infections (UTI) in Sulaimani, Iraq. Patients and Methods Mid-stream urine samples (no. = 400) were collected from patients with UTI at three different Hospitals from Sulaimani, Iraq, between September 2021 to January 2022. Urine samples were cultured on various agar media, and grown bacteria were isolated. Antibiotic susceptibility test (AST) and an extended-spectrum β-lactamase (ESBL) screen were done for isolated bacteria. Then, integrons classes were screened using conventional PCR with gene sequencing and uploaded to the National Center for Biotechnology Information (NCBI). Results The frequency rate of Enterobacteriaceae was 67.03% among positive urine cultures. E. coli (no. = 86) and Klebsiella pneumoniae (no. = 32) isolates were identified. The most sensitive antibiotics were the carbapenem group (85.3%) and nitrofurantoin (NFN) (64.2%), while the most resistant antibiotics were nalidixic acid (NA) and 3rd generation cephalosporin. The occurrence rate of ESBL was 56.6% with a predominance of class I integron (54.2%), then class II (15.8%) and no positive record for class III integron were observed. Conclusion Most bacterial isolates from patients with UTI produced class I and II integrons genes with favourable ESBL properties.

Background  Methicillin-resistant Staphylococcus aureus is a pathogen that is associated with nosocomial and community- burn wound infection. S aureus produces Panton-Valentine -Leukocidin which results in the destruction of leukocytes. Resistance of S. aureus to macrolides, lincosamides, and streptogramin B is associated with the presence of an efflux pump, encoded by Methionine Sulfoxide Reductase A (msrA or msrB) genes.  Objectives To isolate, determine the antibiotic susceptibility pattern, and to detect the presence of pvl and msrA genes from Staphylococcus aureus, isolated from burn wounds. Materials and Methods A total of 423 burn wound samples (218 from hospitalized and 205 from outpatients) were cultivated on different bacteriological media. Isolates were identified and S. aureus were further subjected to antibiotic susceptibility testing using disk diffusion method. Susceptibility to methicillin, oxacillin or cefoxitin, were used to determine methicillin-resistant Staphylococcus aureus strains. Polymerase chain reaction was used to detect mecA, pvl, and msrA genes in S. aureus isolates. Results Bacterial growth was detected from 170 (77.9%) of hospital samples and from 183 (89.26%) community-burn wounds. The predominant isolates were Gram-negative bacilli (71.76%) among hospitalized patients followed by S. aureus (22.35%). From the community samples, Staphylococcus epidermidis was the predominant isolate (86.9%), while few species of other Gram-positive organisms were also detected but no Gram-negatives were isolated. Among the 41 S. aureus isolates, the prevalence of methicillin-resistant S. aureus strains determined by oxacillin disk diffusion method was 58.53%, 65.85% by cefoxitin, whereas, 87.8% were positive for mecA gene by PCR. Pvl was detected in 3 (7.31%), while mrsA gene was detected among 17 (41.46%) of S. aureus isolates.  Conclusions Infection with Methicillin-resistant Staphylococcus aureus was common in burn wounds. The prevalence of msrA gene among nosocomial and community-burn wound isolates of S. aureus was high, while few S. aureus isolates were found to carry pvl gene.