Phenotypic and Molecular Screening of Nasal S. aureus from Adult Hospitalized Patients for Methicillin- and Vancomycin-resistance.

INTRODUCTION: Nasal carriers of Staphylococcus aureus are common and play an important role in the transmission of infections. The aim of this study is a phenotypic and molecular investigation of nasal methicillin- and vancomycin-resistant S. aureus in hospitalized patients. METHODS: 202 nasal swabs were collected from patients at Prince Hamzah Hospital, Jordan, through 2016-2017. Swabs were processed according to standard microbiological procedures to isolate Staphylococci. Antibiotic susceptibility testing was performed using disk diffusion, E-test, microdilution and Vitek 2. Methicillin resistance was confirmed by testing for the mecA gene, while vancomycin resistance was screened by testing for the vanA and vanB genes. RESULTS: The mean age of participants was 50.17±18.18 years and 59.4% were females. Nasal Staphylococci was isolated in 64/202 (31.7%), S. aureus was isolated from 33 samples (16.3%), MRSA was isolated from 13 samples (6.4%) and constitutive Macrolide-lincosamidestreptogramin B (MLSB) was isolated from 12 samples (5.9%). All MRSA isolates harbored the mecA gene. All isolates were sensitive to vancomycin using E-test and the microdilution test and were negative for the vanA and vanB genes. The highest resistance rate was observed for benzylpenicillin (>90%), while the lowest resistance rate was for tobramycin (<5%) among all isolates. Nasal Staphylococci, S. aureus and MRSA colonization significantly correlate with increased number of family members and previous hospitalization (P<0.05), while nasal S. aureus significantly correlates with a history of skin infection (P=0.003). CONCLUSION: Nasal colonization by mecA-mediated MRSA is common among hospitalized patients, while vanA- and vanB-mediated vancomycin resistance was not detected in any nasal isolates.

Methicillin and vancomycin resistance in coagulase-negative Staphylococci isolated from the nostrils of hospitalized patients.

INTRODUCTION: Nasal colonization by coagulase-negative Staphylococci (CoNS) play an important role in nosocomial infections. This study aims to determine antibiotics susceptibility pattern and molecular screening of methicillin- and vancomycin-resistant nasal CoNS among hospitalized patients. METHODOLOGY: Nasal swabs were collected from 202 inpatients at Prince Hamzah Hospital, Jordan. Swabs were processed according to standard microbiological procedures to isolate Staphylococci. Antibiotic susceptibility testing was performed using disk diffusion, E-test, microdilution, and Vitek 2. Molecular analysis was performed using PCR for the detection of mecA, vanA, and vanB genes. RESULTS: Nasal Staphylococci was isolated in 64/202 (31.7%) samples. Thirty isolates (14.8%) were CoNS, including S. haemolyticus (n = 17, 8.4%), S. sciuri (n = 6, 3%), S. epidermidis (n = 2, 1%), S. warneri (n = 2, 1%), S. hominis (n = 2, 1%), and S. lentus (n = 1, 0.5%). Twenty-two (10.9%) isolates were MR-CoNS harboring mecA gene. CoNS and MR-CoNS isolates were highly resistant to benzylpenicillin, erythromycin, fosfomycin, and imipenem. All isolates were sensitive to vancomycin by E-test and microdilution test and were negative for vanA and vanB genes. Nasal CoNS colonization was associated with an increased number of family members living with the participant (P = 0.04) and with admission to the orthopedic department (P = 0.03), while MR-CoNS colonization was associated with smoking (P = 0.03). CONCLUSIONS: Nasal colonization by unusual CoNS species and mecA-positive MR-CoNS are common among hospitalized patients. Absence of vanA and vanB genes suggests little contribution of nasal CoNS to vancomycin resistance transmission.

Erratum to "Association of Tissue Transglutaminase Antibody Titer with Duodenal Histological Changes in Children with Celiac Disease".

[This corrects the article DOI: 10.1155/2016/6718590.].

Redefined clinical spectra of diabetic foot syndrome.

PURPOSE: The aim of this study was to present the redefined clinical spectra of diabetic foot syndrome (RCS-DFS) and determine whether the RCS-DFS can be used to predict amputations. PATIENTS AND METHODS: This is a retrospective study of type 2 diabetic patients referred with DFS for management at King Abdullah University Hospital (KAUH) between January 2014 and December 2015. Data collection form and diabetic foot (DF) characteristic chart were used to document the following: demographic data, diabetes-related parameters, DF characteristics, surgical interventions and amputations. The predominant clinical presentations of DF problems (ulcer, sepsis or gangrene) were integrated with the clinical criteria for diabetic foot infection (DFI) diagnosis and classification of Infectious Diseases Association of America (IDSA)/International Working Group on Diabetic Foot (IWGDF) to redefine the clinical spectra of DFS. Related risk characteristics and amputation rate at all levels were compared between the three RCS. RESULTS: In this study, there were 95 (47.0%) septic DFS (SDFS) patients, 65 (32.2%) ulcerative DFS (UDFS) patients and 42 (20.8%) gangrenous DFS (GDFS) patients. Poor glycemic control (HbA1c >7.5%), hypertension, history of the same foot problems, duration of symptoms, revascularizations and ischemic severity were significantly different between the three RCS. UDFS had the highest rate of limb salvage without amputations (70.8%). GDFS had the highest rate for final toe amputations (52.4%) and major amputations (23.8%). Final minor amputation rate was around 20% for both SDFS and GDFS. CONCLUSION: Redefining DFS into ulcerative, septic and gangrenous by integration of the predominant clinical presentation and the clinical criteria for DFI diagnosis and classification of IDSA/IWGDF showed significant differences in amputation rate. Therefore, it can be used clinically to categorize patients with DFS to predict amputations and to help in planning their management. Further prospective studies are suggested to validate these results.

Nasal colonization by methicillin-sensitive and methicillin-resistant Staphylococcus aureus among medical students.

INTRODUCTION: Nasal carriers of methicillin-resistant Staphylococcus aureus (MRSA) are common and play an important role in nosocomial infections. The prevalence rate and characterization of nasal carriers of MRSA among medical students in Jordan has not been investigated before. METHODOLOGY: The resistance of S. aureus to several antibiotics was tested using disc diffusion method, automatic Vitek 2, and penicillin binding protein (PBP) 2 slide test. Bacterial species and resistance genes were confirmed using molecular analysis of three relevant genes by real-time PCR. Two hundred ninety nasal swabs were collected from medical students at Hashemite University from June 2015 to August 2016. All participants signed a voluntary consent form and filled a predesigned questionnaire. RESULTS: The mean age of participants was 19.7 ± 2 years and 61.7% of them were males. 63 out of the 290 (21.7%) samples were identified to have S. aureus, 56 (19.3%) were methicillin-sensitive S. aureus (MSSA) and 7 (2.4%) were MRSA. S. aureus nasal colonization significantly associates with male gender (OR = 1.7, CI = 0.94-3.18, P = 0.049) and chronic illnesses (OR = 4.0, CI = 1.52-10.65, P = 0.006). Consistency between disc diffusion, Vitek 2, and PBP 2 methods for MRSA screening were satisfactory compared to molecular analysis. All MRSA samples were positive for SCCmec:orfx junction gene (MRSA-specific), nuc gene (S. aureus- specific), mecA gene (PBP-mediated resistant), and PBP2 production. All MRSA isolates were multi-drug resistant and were sensitive to Linezolid, Vancomycin, and Tigecycline. CONCLUSIONS: This study confirms that nasal colonization by MRSA among medical students necessitates further attention to prevent nosocomial infections.

Assessment of genotoxicity of pyrethrin in cultured human lymphocytes.

Pyrethrin is an insecticide that is obtained from the Chrysanthemum flower (Pyrethrum). In this study, we examined the genotoxic effects of pyrethrin on cultured human lymphocytes using sister chromatid exchanges (SCEs) and 8-hydroxy deoxyguanosine (8-OHdG) assays. Cultures were treated with different concentrations of pyrethrin (25, 50, and 100 µg/mL), which was dissolved in in dimethyl sulfoxide (DMSO). The results showed that treatment of cultured lymphocytes with pyrethrin at 50 µg/mL and 100 µg/mL induced significant elevation in SCEs (p < 0.05). In addition, the 100 µg/mL concentration significantly affected both mitotic and proliferative indices (p < 0.05). Finally, pyrethrin induced significant elevation in the oxidative stress marker 8-OHdG in a dose-dependent manner (p < 0.001). In conclusion, the results suggest that pyrethrin is genotoxic as measured by two independent assays on genetic toxicity.

Association of Tissue Transglutaminase Antibody Titer with Duodenal Histological Changes in Children with Celiac Disease.

Celiac disease is usually diagnosed by demonstrating gluten enteropathy in small bowel biopsy. Celiac specific antibodies are used as an initial screening test. The goal of this study is to test the relationship of the anti-tTG titer and severity of histological changes in Jordanian children with celiac disease. Method. The medical records of 81 children who had elevated anti-tTG titer and had duodenal biopsies available were retrospectively reviewed. Result. Assessing the association of anti-tTG titer with duodenal histopathological changes, 94% of those with high anti-tTG titer (≥180 U/mL) had histological evidence of celiac disease. There was statistically significant positive association between high anti-tTG titer and Marsh grading as 82% of patients with Marsh III had high anti-tTG titer (Chi2 18.5; P value 0.00; Odds Ratio 8.5). The fraction of patients with Marsh III who were correctly identified as positive by anti-tTG titer ≥ 180 U/mL was high (sensitivity = 81.6). Moreover, the fraction of patients with anti-tTG titer ≥ 180 U/mL who had Marsh III was also high (positive predictive value = 78.4). Conclusion. Anti-tTG titer ≥ 180 U/mL had significant positive association with Marsh III histopathological changes of celiac disease.

Comparison between once weekly, twice weekly, and daily oral iron therapy in Jordanian children suffering from iron deficiency anemia.

The efficacy of daily versus twice weekly and once weekly oral iron therapy was analyzed to optimize a protocol for treatment of IDM among Jordanian children. One hundred and forty-eight children aged between 6 and 60 months with Hb estimate less than 11 gm/dl were screened. They were randomly divided into three regimens of oral iron therapy for a period of 12 weeks; a group was supplemented with a single weekly dose of iron; a second group received two doses weekly; and a third group had a daily dose of iron. Hb was assayed 3 and 12 weeks after therapy, while ferritin was assayed after 12 weeks of treatment. A significant rise in Hb concentration was observed which was most significant 12 weeks after treatment. Iron supplementation after 3 weeks was similar in all treated groups, and no significant difference in Hb concentration among the three groups was noticed. By the end of the third week, the anemia had respectively resolved by 18, 11.8 and 23.4% in the daily, twice weekly, and once weekly groups. On the other hand, the percentage of recovery of anemia respectively was 78, 90.2 and 74.5% at the end of 12 weeks of iron therapy. Hb recovery percentage was comparable in the three treated groups, and no significant difference was reported between them either at 3 or at 12 weeks of therapy. Ferritin levels in the daily and twice weekly treated groups were similar after 12 weeks of iron therapy and were significantly higher than the ferritin levels of weekly treated group. Although the anemia in the three treated groups was resolved after 3 and 12 weeks of oral iron therapy, we conclude that the regimen of two doses per week is the most effective in resolving anemia with less cost and fewer side effects.

Congenital Type 1C Choledochal Cyst: Clinical Presentation and Surgical Treatment.

Choledochal cysts are uncommon developmental anomalies involving intrahepatic and extrahepatic biliary ducts, and their immediate complete excision is recommended to prevent chronic inflammatory and malignant changes. A diagnosis of a congenital type 1C choledochal cyst was made in an 8-year-old female patient admitted to the emergency unit with complaints of severe upper abdominal pain and vomiting. Under laparotomy, resection of the whole segment of choledochal cyst and gallbladder, assisted Roux-en-Y hepaticojejunostomy was performed. The laparotomy approach involving fine dissection and resection of choledochal cysts with Roux-en-Y hepaticojejunostomy remains superior to the endoscopic approach.