Antibiotic resistance patterns in nosocomial infections: preliminary data from Hospital of Al-Hoceima, Morocco.

INTRODUCTION: Nosocomial infections or healthcare-associated infections (HCAIs) represent a public health problem. The burden of antibiotic resistance in these infections is still unclear in Morocco. The objective of this study was to describe antibiotic susceptibility of the main bacteria responsible for nosocomial infections in order to propose prevention measures. METHODOLOGY: Data were collected from 1519 laboratory records including hospital inpatients suspected of nosocomial infections in Mohamed V Hospital of Al-Hoceima between January 2016 and December 2020. The data were analyzed using SPSS software version 25. RESULTS: Bacteriological test samples included 65.5% of urine, 27.2% of pleural fluid, 4.5% of pus, and 2.8% of protected distal swab. Two hundred and twenty-seven (15%) samples were culture-positive. The bacteria isolated were mainly enterobacteria (Escherichia coli, 43.6% and Klebsiella pneumoniae, 13%), non-fermentative Gram-negative bacteria (Pseudomonas aeruginosa, 10.8%), and Staphylococcus aureus (24.3%). Extended spectrum beta-lactamases (ESBLs)-producing Enterobacteriaceae represented 25.4% and those resistant to other families of antibiotics accounted for 12.5%. In our study, we reported 17% ESBL producers among urinary infections. Methicillin-resistant Staphylococcus aureus accounted for 22.2%. Pseudomonas aeruginosa that were resistant to ticarcillin, ceftazidime, and imipenem represented 29% of the cases. CONCLUSIONS: Our results showed a higher frequency of resistance. A microbiological surveillance system is highly needed to identify bacterial niches in the hospital environment at Mohamed V Hospital.

A 6-Year Update on the Diversity of Methicillin-Resistant Staphylococcus aureus Clones in Africa: A Systematic Review.

Background: Methicillin-resistant Staphylococcus aureus (MRSA) is a leading cause of hospital-associated (HA) and community-associated (CA) infections globally. The multi-drug resistant nature of this pathogen and its capacity to cause outbreaks in hospital and community settings highlight the need for effective interventions, including its surveillance for prevention and control. This study provides an update on the clonal distribution of MRSA in Africa. Methods: A systematic review was conducted by screening for eligible English, French, and Arabic articles from November 2014 to December 2020, using six electronic databases (PubMed, EBSCOhost, Web of Science, Scopus, African Journals Online, and Google Scholar). Data were retrieved and analyzed according to the Preferred Reporting Items for Systematic Review and Meta-Analysis guidelines (registered at PROSPERO: CRD42021277238). Genotyping data was based primarily on multilocus sequence types (STs) and Staphylococcal Cassette Chromosome mec (SCCmec) types. We utilized the Phyloviz algorithm in the cluster analysis and categorization of the MRSA STs into various clonal complexes (CCs). Results: We identified 65 studies and 26 publications from 16 of 54 (30%) African countries that provided sufficient genotyping data. MRSA with diverse staphylococcal protein A (spa) and SCCmec types in CC5 and CC8 were reported across the continent. The ST5-IV [2B] and ST8-IV [2B] were dominant clones in Angola and the Democratic Republic of Congo (DRC), respectively. Also, ST88-IV [2B] was widely distributed across the continent, particularly in three Portuguese-speaking countries (Angola, Cape Verde, and São Tomé and Príncipe). The ST80-IV [2B] was described in Algeria and Egypt, while the HA-ST239/ST241-III [3A] was only identified in Egypt, Ghana, Kenya, and South Africa. ST152-MRSA was documented in the DRC, Kenya, Nigeria, and South Africa. Panton-Valentine leukocidin (PVL)-positive MRSA was observed in several CCs across the continent. The median prevalence of PVL-positive MRSA was 33% (ranged from 0 to 77%; n = 15). Conclusion: We observed an increase in the distribution of ST1, ST22, and ST152, but a decline of ST239/241 in Africa. Data on MRSA clones in Africa is still limited. There is a need to strengthen genomic surveillance capacity based on a "One-Health" strategy to prevent and control MRSA in Africa.

Salivary Cytokines as Potential Diagnostic Biomarkers for Systemic Lupus Erythematosus Disease.

Systemic lupus erythematosus (SLE) is a complex autoimmune inflammatory disease characterized by an unknown etiology and a highly variable clinical presentation. This clinical heterogeneity might be explained by dysregulation of tolerance to self and apoptotic mechanisms, overproduction of autoantibodies, and abnormal cytokine levels. Cytokine imbalance levels have been associated with disease activity and severity in SLE patients. In the last years, salivary cytokines related to SLE have gained significant attention and researchers have begun to focus on the identification of cytokines in the saliva of SLE patients using it as a diagnostic fluid for the inflammatory process underlying SLE. This review highlights and summarizes recent studies revealing the cytokines that have been identified in the saliva of individuals with SLE. Data reported and discussed in this report may provide useful additional information to better understand the mechanisms associated with the disease.

Nasal carriage of Staphylococcus aureus in farm animals and breeders in north of Morocco.

BACKGROUND: The objectives of this study were to determine for the first time, in Morocco, the nasal carriage rate, antimicrobial susceptibility profiles and virulence genes of Staphylococcus. aureus isolated from animals and breeders in close contact. METHODS: From 2015 to 2016, 421 nasal swab samples were collected from 26 different livestock areas in Tangier. Antimicrobial susceptibility phenotypes were determined by disk diffusion according to EUCAST 2015. The presence of nuc, mecA, mecC, lukS/F-PV, and tst genes were determined by Polymerase Chain Reaction (PCR) for all isolates. RESULTS: The overall S. aureus nasal carriage rate was low in animals (9.97%) and high in breeders (60%) with a statistically significant difference, (OR = 13.536; 95% CI = 7.070-25.912; p < 0.001). In general, S. aureus strains were susceptible to the majority of antibiotics and the highest resistance rates were found against tetracycline (16.7% in animals and 10% in breeders). No Methicillin-Resistant S. aureus (MRSA) was detected in animals and breeders. A high rate of tst and lukS/F-PV genes has been recovered only from animals (11.9 and 16.7%, respectively). CONCLUSION: Despite the lower rate of nasal carriage of S. aureus and the absence of MRSA strains in our study, S. aureus strains harbored a higher frequency of tst and lukS/F-PV virulence genes, which is associated to an increased risk of infection dissemination in humans. This highlights the need for further larger and multi-center studies to better define the transmission of the pathogenic S. aureus between livestock, environment, and humans.

Nasal carriage of sequence type 22 MRSA and livestock-associated ST398 clones in Tangier, Morocco.

INTRODUCTION: This study aimed to provide data of Staphylococcus aureus and methicillin-resistant Staphylococcus aureus (MRSA) nasal carriage as well as to determine the genetic lineages of this circulating MRSA in the Tangier community. METHODOLOGY: Between 2012 and 2013 two subpopulations consisting of randomly chosen healthy volunteers and outpatients in 11 healthcare facilities were screened. The antibiotic resistance phenotype was determined by disk diffusion. Toxin Panton-Valentin Leukocidin (PVL), toxic shock syndrome toxin-1 gene (tst), and mecA were detected by polymerase chain reaction (PCR). Nasal swabs were obtained from persons with no identified risk factors for MRSA acquisition. MRSA molecular typing was performed by pulsed-field gel electrophoresis (PFGE), staphylococcal chromosomal cassette mec, and Staphylococcus protein A (spa) typing. RESULTS: A total of400 subjects (33.3%) were nasally colonized with S. aureus, and 17 (1.4%) were nasal carriers of MRSA. The analysis did not identify age, gender, and the two subpopulations as predictors for MRSA colonization. MRSA were more likely to harbor the tst gene (p < 0.05). This work highlighted a low prevalence of nasal MRSA carriage, with 52.94% belonging to sequence type (ST) ST22. The remaining isolates were distributed as singletons (ST8, ST1, and ST398), whereas approximately one-third of MRSA was not identified, including three novel spa-types (t13247, t13248, and t13249). CONCLUSIONS: Although we highlighted the current clones present in the Tangier community, they are limited in space and time. Therefore, further studies would be required to obtain a comprehensive picture of the dissemination of MRSA in the community, hospital, and livestock.