Methicillin-Resistant Staphylococcus aureus (MRSA): Prevalence and Antimicrobial Sensitivity Pattern among Patients-A Multicenter Study in Asmara, Eritrea.

BACKGROUND: Methicillin-resistant Staphylococcus aureus (MRSA) is a well-recognized public health problem throughout the world. The evolution of new genetically distinct community-acquired and livestock-acquired MRSA and extended resistance to other non-ß-lactams including vancomycin has only amplified the crisis. This paper presents data on the prevalence of MRSA and resistance pattern to other antibiotics on the selected specimen from two referral hospitals in Asmara, Eritrea. METHOD: A cross-sectional study was conducted among 130 participants recruited from two referral hospitals in Asmara, Eritrea. Isolation of S. aureus was based on culture and biochemical profiles. Standard antimicrobial disks representing multiple drug classes were subsequently set for oxacillin, gentamicin, erythromycin, and vancomycin. Data were analyzed using SPSS version 20 software. RESULTS: S. aureus isolation rate from the 130 samples was 82 (63.1%). Patients <18 years of age were more likely to be colonized by S. aureus compared to patients above 61 years. The proportion of MRSA among the isolates was 59 (72%), methicillin-intermediate S. aureus (MISA) was 7 (8.5%), and methicillin-sensitive S. aureus (MSSA) was 15 (19.5%). The isolates were mostly from the pus specimen in burn, diabetic, and surgical wound patients. Antimicrobial susceptibility test showed that 13 (15.9%) of the isolates were resistant to vancomycin, 9 (11.0%) to erythromycin, and 1 (1.2%) to gentamicin. Coresistance of MRSA isolates to some commonly used antibiotics was also noted: oxacillin/erythromycin 5 (6.1%) and oxacillin/vancomycin 9 (11%). A few isolates were resistant to oxacillin/vancomycin/erythromycin 2 (2.4%) and oxacillin/gentamicin and erythromycin 1 (1.2%). CONCLUSION: This study reports a relatively high prevalence of MRSA. Isolates that are resistant to other tested antibiotics including vancomycin are also reported. The data have important implication for quality of patients care in the two settings: antibiotic selection and infection control practices, and the need for additional studies.

Increased D-dimer and fibrin degradation product levels as potential indicators for evaluating infection-related acute urticaria: a case-case-control study.

About 20% of world population suffer from acute urticaria at some stage in their lives. Recent studies showed coagulation dysfunction in chronic urticaria. The involvement of coagulation changes in acute urticaria remains unclear. Fifty-eight acute urticaria patients were enrolled in this study and divided into two groups (referred to throughout as infection-related and infection-unrelated acute urticaria). The routine laboratory parameters including coagulation tests between the two groups were compared. The correlation between coagulation tests and CRP at acute phase was also assessed. Dynamic change of routine coagulation test results at acute phase and resolving phase was compared. The potential performance of coagulation for infection indication was tested. We found D-dimer, fibrin degradation product (FDP), and fibrinogen (Fg) increased in the acute phase of infection-related acute urticaria patients. D-dimer, FDP, Fg, and APTT are positively correlated with CRP in the acute phase. D-dimer and FDP decreased in the resolving phase of infection-related acute urticaria patients. Higher D-dimer (> 0.48 mg/L) and FDP (> 3.84 mg/L) may indicate infection-related acute urticaria. In conclusion, in acute urticaria with low venous thromboembolism risk, D-dimer level and dynamic change can be potentially used for the infection-related clinical practice management.

Development and Evaluation of an Anti-Biotin Interference Method in Biotin-Streptavidin Immunoassays.

The strong non-covalent interaction between biotin and streptavidin places streptavidin-based assays, used by many laboratories, at an increased risk of interference by biotin. At present, a few manufacturers have developed fully automated anti-biotin interference methods, although compared with many detection platforms, these remain insufficient. Additionally, there is a need for more methods that can achieve fully automated anti-biotin interference. We sought to develop and evaluate a new biotin interference-resisting method based on a biotin-streptavidin chemiluminescence immunoassay. Streptavidin-coated magnetic microparticles (M) of different concentrations were prepared and tested for their biotin-resistance capabilities in an automated setting (Cobas e 601). The precision, accuracy, and detection capability were also assessed. Higher concentrations of M were found to have a stronger ability to resist biotin interference. A 2.16 mg/mL concentration of M was able to resist 500 ng/mL of biotin in samples while simultaneously having a relatively weak shielding effect on the optical signals. Moreover, the total precision and accuracy of this method, designated as M3, met acceptable standards. M3 has an improved ability to resist biotin interference, can achieve full automation, and its detection performance can meet the general laboratory quality requirements.

Magnitude of Multidrug Resistance among Bacterial Isolates from Surgical Site Infections in Two National Referral Hospitals in Asmara, Eritrea.

BACKGROUND: The World Health Organization has emphasized the importance of understanding the epidemiology of MDR organisms from a local standpoint. Here, we report on a spectrum of bacteria associated with surgical site infections in two referral hospitals in Eritrea and the associated antibiotic susceptibility patterns. METHODS: This survey was conducted between February and June 2017. A total of 83 patients receiving treatment for various surgical conditions were included. Swabs from infected surgical sites were collected using Levine technique and processed using standard microbiological procedures. In vitro antimicrobial susceptibility testing was performed on Mueller-Hinton Agar by the Kirby-Bauer disk diffusion method following Clinical and Laboratory Standards Institute guidelines. The data were analyzed using SPSS version 20. RESULTS: A total of 116 isolates were recovered from 83 patients. In total, 67 (58%) and 49 (42%) of the isolates were Gram-positive and Gram-negative bacteria, respectively. The most common isolates included Citrobacter spp., Klebsiella spp., Escherichia coli, Proteus spp., Pseudomonas aeruginosa, Salmonella spp., Enterobacter spp., and Acinetobacter spp. In contrast, Staphylococcus aureus, CONS, and Streptococcus viridians were the predominant Gram-positive isolates. All the Staphylococcus aureus isolates were resistant to penicillin. MRSA phenotype was observed in 70% of the isolates. Vancomycin, clindamycin, and erythromycin resistance were observed in 60%, 25%, and 25% of the isolates, respectively. Furthermore, a high proportion (91%) of the Gram-negative bacteria were resistant to ampicillin and 100% of the Pseudomonas aeruginosa and Escherichia coli isolates were resistant to >5 of the tested antibiotics. The two Acinetobacter isolates were resistant to >7 antimicrobial agents. We also noted that 4 (60%) of the Klebsiella isolates were resistant to >5 antimicrobial agents. Possible pan-drug-resistant (PDR) strains were also isolated. CONCLUSION: Due to the high frequency of MDR isolates reported in this study, the development and implementation of suitable infection control policies and guidelines is imperative.

In Vitro Inhibition of α-Amylase and α-Glucosidase by Extracts from Psiadia punctulata and Meriandra bengalensis.

BACKGROUND: This research assessed the in vitro antidiabetic activity and phytochemical constituents of the traditionally used medicinal plants, Psiadia punctulata and Meriandra bengalensis. METHOD: The leaves of both plants were subjected to cold extraction method using 70% ethanol and hot Soxhlet extraction using n-hexane, chloroform, methanol, and distilled water. The extracts were studied for their effect on glucose transport across yeast cells and inhibition of α-amylase and α-glucosidase enzyme activities. Thin-layer chromatographic analysis of ethanol extract was also undertaken. RESULTS: The results of yeast glucose uptake assay revealed that extracts from both plants had a maximum increase in glucose uptake at the 25mM glucose concentration with a maximum dose of 2000µg/ml plant extract. The ethanol extract of P. punctulata and aqueous extract of M. bengalensis showed a high activity of 68% and 96%, respectively, at 25mM and 2000µg/ml of glucose and extract concentration. P. punctulata exerted peak inhibition activity of α-amylase of 37.5 ± 3% mg/dl (IC50 = 0.523 mg/dl) for methanol and distilled water extract at 0.5 mg/dl, respectively. M. bengalensis methanol extract exhibited the highest inhibition activity of 38 ± 8 % mg/dl (IC50 = 0.543 mg/dl) at 0.5 mg/dl. In the α-glucosidase inhibition assay, the methanolic extract of P. punctulata exhibited the highest inhibitory activity of 17.29 ± 9% mg/dl (IC50 = 0.761 mg/dl) at 0.5mg/dl. The chloroform extract of M. bengalensis had the highest inhibitory activity of 30 ± 5% mg/dl (IC50 = 0.6mg/dl) at 0.5 mg/dL. Phytochemical analysis of the different extracts of P. punctulata and M. bengalensis revealed the presence of flavonoids, alkaloids, tannins, saponins, phytosterols, and carbohydrates. Thin-layer chromatography analysis of ethanolic extract of both plants indicated presence of 15 and 17 spots for P. punctulata and M. bengalensis respectively. CONCLUSION: P. punctulata and M. bengalensis extracts have moderate inhibitory activity against pancreatic α-amylase and relatively low inhibitory activities against α-glucosidase. The observed effects may be associated with the presence of flavonoids, saponins, and alkaloids. Additional in vivo analysis, toxicological studies, isolation, and structural characterization of the phytomolecules identified in this study and molecular docking studies should be undertaken.