Class 1 Integrons in Clinical Multi Drug Resistance E. coli, Sana’a Hospitals, Yemen

Al-Hammadi, Mukhtar Abdullah; Al-Shamahy, Hassan Abdulwahab; Ali, Abdulaziz Qaid; Abdulghani, Mahfoudh; Pyar, Hassan; AL-Suboal, Ibrahim

doi:10.3923/pjbs.2020.231.239

Cited by 5 publications

(11 citation statements)

References 32 publications

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“…Akya et al in Iran found that the highest rate of resistance was noticed for ceftriaxone, cefotaxime, and cotrimoxazole [23] which agrees with a previous study in Iran [24]. A higher percentage of MDR (87.9%) among E. coli isolates was reported by Al-Hammadi and colleagues in Yemen [25].…”

Section: Discussionsupporting

confidence: 79%

“…A study conducted in Sudan by Ibrahim et al reported that the percentage of class 1 integrons was 40.6% and the MDR E. coli isolates carrying this class of integrons showed high level resistance to trimethoprim-sulfamethoxazole (98.1%), tetracycline (88.9%), ciprofloxacin (70.4%), amoxicillin-clavulanic acid (66.7%), ceftazidime (46.3 %) and chloramphenicol (29.6%) [30]. Al-Hammadi et al showed that the presence of class 1 integron was observed to be significantly higher in ciprofloxacin (p=0.0002), amoxicillinclavulanic acid (p=0.003), aztreonam (p=0.006), cefepime (p=0.01), cefotaxime (p=0.0003), ceftazidime (p=0.002), ceftriaxone (p = 0.03), norfloxacin (p=0.0002) and trimethoprimsulfamethoxazole (p<0.0001) [25].…”

Section: Discussionmentioning

confidence: 99%

“…In Yemen, Al-Hammadi et al found that class 1 integron was found in 67% of the MDR E. coli isolates [25]. In Jazan area Kingdom of Saudi Arabia, Abdelhaleem et al reported that class 1 integrons value was 54.4 % [29].…”

Section: Discussionmentioning

confidence: 99%

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The Relation between Class I Integrons and Multidrug-Resistance in Extended-Spectrum Beta Lactamase Producing Escherichia coli Isolates.

Marei

Hamady

2020

Microbes and Infectious Diseases

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Background: Escherichia coli (E.coli) is responsible for over 80 percent of urinary tract infections (UTI). The emergence and development of multi-drug resistant (MDR) strains is due to inappropriate use of antibiotics and the horizontal gene transfer between bacteria. The MDR strains of E. coli are highly associated with the presence of integrons; also, extended-spectrum beta lactamase (ESBL) producing isolates are usually resistant to various antibiotics. This study aimed to determine the incidence of class 1 integrons and its association with drug resistance in ESBL producing E. coli isolated from patients who were suffering from UTI. Methods: This study was conducted on 232 hospitalized patients with UTI, from which 160 E. coli strains were isolated. Antibiotic susceptibility testing and screening for ESBL production were performed by Kirby-Bauer disk diffusion method on Mueller-Hinton agar. Confirmation for ESBL production was performed by combined disc diffusion test. All the MDR ESBL producing E. coli isolates were examined by conventional polymerase chain reaction (PCR) for the presence of intI1 gene and related gene cassettes. Results: One hundred sixty E. coli strains (69%) were isolated from 232 hospitalized patients. The highest percentage of resistance was to aztreonam (92%) followed by ceftazidime and cefotaxime (90%) then ciprofloxacin (79 %). Seventy-two E. coli isolates (45%) were found to be ESBL producers and out of them, 61 isolates (84.7%) were MDR. Out of the 61 MDR ESBL-producing isolates, class I integron was identified in 56 isolates (91.8%). Conclusion: Our findings indicate a high rate of MDR. Most ESBL-producing isolates are MDR and the high prevalence of class 1 integrons and gene cassettes suggests possible risk for the dissemination of resistance genes and the spread of MDR bacteria.

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Section: Discussionsupporting

confidence: 79%

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

The Relation between Class I Integrons and Multidrug-Resistance in Extended-Spectrum Beta Lactamase Producing Escherichia coli Isolates.

Marei

Hamady

2020

Microbes and Infectious Diseases

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“…The high level of AMR in Yemen perceived by participants indicates awareness among physicians and pharmacists, considered frontline health workers, in this survey and is corroborated by the earlier mentioned studies reporting laboratory investigations. [24][25][26][27][28][29][30] In Yemen, IDPs may not necessarily be distinguished from the non-displaced. Since 2020, displacement has been more marked among four, out of a total of 22 governates (Marib, Al Hudaydah, Al Dhale'e, Taizz, and Al Jawf)mostly in the northwith the greater proportion moving in with relatives or other non-family hosts, rather than into any settlement camps.…”

Section: Amr Prevalence: Perception and Solutionsmentioning

confidence: 99%

“…22,23 Several studies already suggest a high AMR burden. [24][25][26][27][28][29][30] In 2018, for example, among patients admitted to the Médecins Sans Frontiers (MSF) hospital in Aden, more than 60% had a drug resistant infection. 31 These conditions coincide with the current COVID-19 pandemic to further exacerbate the problem.…”

Section: Introductionmentioning

confidence: 99%

Assessing antimicrobial resistance, utilization and stewardship in Yemen: An exploratory mixed-methods study

Orubu

Najwa²,

Ching

et al. 2021

Preprint

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Antimicrobial resistance (AMR), largely driven by irrational use of antimicrobials, is a global, multi-faceted problem calling for a complete understanding of all contributory factors for effective containment. In conflict settings, war-wounds and malnutrition can combine with existing social determinants to increase demand for antibiotics, compounding irrational use. In this study, we focus on Yemen, a low-income country with active conflict for the last five years, and analyze the current status of awareness and stewardship efforts regarding AMR. We performed a survey of prescribers/physicians and pharmacists to describe perceptions of AMR prevalence, antibiotic use practices and stewardship in Yemen, supported by a non-systematic scoping literature review and a key informant interview. Participants (96%, n=57) reported a perceived high AMR prevalence rate. Prescribers (74%, 20/27) reported pressure to prescribe broad-spectrum antibiotics. In the majority of cases (81%, 22/27), Antimicrobial Sensitivity Tests (AST) were not performed to inform antibiotic choice. The main barrier to AST was cost. Most pharmacists (67%, 18/27) sold antibiotics without prescriptions. Amoxicillin (including amoxicillin-clavulanate) was the most-commonly prescribed (63%, 17/27) or dispensed (82%, 22/27) antibiotic. AST was rated the least important solution to AMR in Yemen. While there was awareness of a high AMR rate, stewardship is poor in Yemen. We note that barriers to the use of AST could be addressed through the deployment of low-cost AST kits. Compulsory continuing education emphasizing the use of AST to guide prescribing and patients’ awareness programs could help avoid irrational use.

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Analyzing Yemen’s health system at the governorate level amid the ongoing conflict: a case of Al Hodeida governorate

Al Waziza,

Sheikh,

Ahmed

et al. 2023

Discov Health Systems

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Background Yemen is regarded as one of the Middle East’s poorest countries. Decades of political, economic, and social difficulties have culminated in the current protracted conflict. As a result, the globe experienced its worst humanitarian catastrophe. The ongoing war has affected several public services, notably the health sector, which is operating at less than half its capacity. This study aims to examine Yemen’s health system at the governorate level (Al Hodeida) amidst the current conflict. It analyzes current challenges and produces suggestions for enhancement. Methods The study used qualitative research methods such as Key Informant Interviews (KIIs) and document analysis. The study used WHO’s health systems framework to measure health system performance. Twelve KIIs were conducted via Skype with several health stakeholders. In addition, documents were analyzed to inform the subject guide, generate themes, and aid in the triangulation of results. Results According to the study findings, the governorate health system managed to offer a minimum level of healthcare services while making some advances in outbreak control jointly with other partners. One of the main difficulties confronting the governorate’s health system is a severe lack of financial resources forcing it to rely entirely on external aid. Furthermore, other significant deficiencies include inadequate health system organogram, low reporting capacities, insufficient funding, and scarcity of health professionals. Conclusion Yemen’s frail health system has been weakened by almost eight years of insecurity and conflict. If the current scenario continues, most of Yemen’s health system’s operations and indicators will likely deteriorate. On the other hand, progress in some areas, such as primary healthcare (PHC) services and disease management, is remarkable. However, for better performance, Yemen’s health system leadership and stakeholders should seek a holistic strategy to improve the entire dimensions of the health system.

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Class 1 Integrons in Clinical Multi Drug Resistance E. coli, Sana’a Hospitals, Yemen

Cited by 5 publications

References 32 publications

The Relation between Class I Integrons and Multidrug-Resistance in Extended-Spectrum Beta Lactamase Producing Escherichia coli Isolates.

The Relation between Class I Integrons and Multidrug-Resistance in Extended-Spectrum Beta Lactamase Producing Escherichia coli Isolates.

Assessing antimicrobial resistance, utilization and stewardship in Yemen: An exploratory mixed-methods study

Analyzing Yemen’s health system at the governorate level amid the ongoing conflict: a case of Al Hodeida governorate

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