Epidemiology of extended-spectrum β-lactamase producing Escherichia coli from hospital settings in Yemen

Introduction: Infection with Extended spectrum β-lactamases (ESBLs) producing bacteria is considered as serious health problem worldwide. The aim of this cross-sectional study was to investigate the prevalence of ESBL producing Escherichia coli in hospitalized patients and the risk factors contributed for its nosocomial infections in addition to the antibiotics susceptibility patterns of isolates from 130 inpatients collected in Al Thawra General Hospital and Al-Kuwait University Hospital in Sana’a city. Methodology: Antibiotic susceptibility testing and confirmation of ESBL production were performed according to the Clinical and Laboratory Standards Institute guidelines. Results: Out of 130 E. coli isolates, 44 (33.8%) were ESBLs producers, the majority of ESBLs producers were in wound exudates samples (52.2%). The highest significant rates were among the elderly, patients with previous hospitalization, patients who have stayed in hospital more than 22 days, patients who have taken third generation cephalosporins as treatment and diabetic patients. All ESBL-producing isolates were resistant to amoxicillin, trimethoprim-sulfamethoxazole and the third generation cephalosporins (100%). Resistance to other antimicrobial agents among these isolates was: amoxicillin-clavulanic acid (90.9%), nalidixic acid (95.5%), ciprofloxacin (90.9%), ofloxacin (88.6%) and tetracycline (54.5%). The most effective antibiotics in vitro for both types of isolates (ESBL producing and non ESBL producing E. coli) were Imipenem (100%), Amikacin (75%) and (93.0%), respectively, and Pipracillin-tazobactam (68.2%) and (88.4%), respectively. Conclusion: ESBLs detection tests must be performed as routine work in all hospitals and laboratories. Furthermore, a strict adherence of infection control policies and procedures with continuous antibiotics resistance surveillance are important to prevent nosocomial infections

Genomic insights into the 2016-2017 cholera epidemic in Yemen.

Yemen is currently experiencing, to our knowledge, the largest cholera epidemic in recent history. The first cases were declared in September 2016, and over 1.1 million cases and 2,300 deaths have since been reported1. Here we investigate the phylogenetic relationships, pathogenesis and determinants of antimicrobial resistance by sequencing the genomes of Vibrio cholerae isolates from the epidemic in Yemen and recent isolates from neighbouring regions. These 116 genomic sequences were placed within the phylogenetic context of a global collection of 1,087 isolates of the seventh pandemic V. cholerae serogroups O1 and O139 biotype El Tor2-4. We show that the isolates from Yemen that were collected during the two epidemiological waves of the epidemic1-the first between 28 September 2016 and 23 April 2017 (25,839 suspected cases) and the second beginning on 24 April 2017 (more than 1 million suspected cases)-are V. cholerae serotype Ogawa isolates from a single sublineage of the seventh pandemic V. cholerae O1 El Tor (7PET) lineage. Using genomic approaches, we link the epidemic in Yemen to global radiations of pandemic V. cholerae and show that this sublineage originated from South Asia and that it caused outbreaks in East Africa before appearing in Yemen. Furthermore, we show that the isolates from Yemen are susceptible to several antibiotics that are commonly used to treat cholera and to polymyxin B, resistance to which is used as a marker of the El Tor biotype

Electronic Integrated Disease Early Warning System Surveillance System Evaluation, Sana'a Capital, Yemen, 2021 (Preprint)

BACKGROUND The Electronic Integrated Disease Early Warning System (eIDEWS) is an essential system; it contributes to the better prevention and management of epidemics. Through the collection of complete, accurate, and timely data, countries are able to determine the priorities for suitable interventions that save the lives of communities. Regardless of the conflict in Yemen, the system is still functioning and is expanding to be the most effective epidemiological surveillance program. OBJECTIVE We aimed to determine the usefulness of the eIDEWS, assess its performance, and identify the strengths and weaknesses of its implementation. METHODS The usefulness and performance attributes of the eIDEWS were evaluated using the Centers for Disease Control and Prevention’s updated guidelines for evaluating public health surveillance systems. The evaluation was carried out in Sana’a capital from January to March 2021 by interviewing 25 stakeholders at 3 levels—the central, governorate, and health district levels—and using a semistructured questionnaire. Attributes of the system were ranked as poor (&amp;lt;60%), average (60% to &amp;lt;80%), good (80% to &amp;lt;90%), and excellent (≥90%) on the basis of indicators to calculate the final scores. RESULTS The eIDEWS’ overall usefulness and performance score was 90%—an excellent rank. The mean score of system attributes was 100% for acceptability, completeness, and timeliness. The flexibility was good (83%), since the change in reporting method was applied difficultly. The system depends completely on foreign funds; thus, the system’s stability was average (75%). However, the eIDEWS was expanded recently to add new health facilities; its representativeness was average (76%). CONCLUSIONS The system is working effectively at evaluated sites. The overall system performance was excellent; however, flexibility and stability were good due to the negative adaptation of the system with regard to the reporting method and the absence of other fund resources. Therefore, evaluating the newly upgraded system, strengthening its stability by finding other supporting resources, and further expanding coverage to include all public and private health care facilities are recommended. </sec

electronic Integrated Disease Early Warning System Evaluation: Surveillance System Evaluation (Preprint)

BACKGROUND electronic Integrated Disease Early Warning System (eIDEWS) is an essential system, it contributes to better prevention and management of epidemics. Through the collection of complete, accurate, and timely data, countries are able to determine the priorities for suitable interventions that save the life of communities. Regardless of the conflict in Yemen, the system is still functioning and expanding to be the most effective epidemiological surveillance program. OBJECTIVE To determine the usefulness of the eIDEWS, assess its performance, and identify the strengths and weaknesses of its implementation METHODS The usefulness and performance attributes of eIDEWS were evaluated using CDC’s updated guidelines for evaluating public health surveillance systems. The evaluation was carried out in Sana’a capital from January to March 2021, by interviewing 25 stakeholders in three levels: central, governorate, and health district using a semi-structured questionnaire. Attributes of the system were ranked as poor (&lt;60), average (60- &lt;80), good (80- &lt;90), and excellent (≥90) on the basis of indicators to calculate the final scores. RESULTS The eIDEWS overall usefulness and performance score was (90%) with an excellent rank. The mean of system attributes was 100% for acceptability, completeness, and timeliness. The flexibility was good (83%) since the change in reporting method is applied difficultly. The system is depending completely on foreign funds thus system’s stability was average (75%), However, eIDEWS was expanded recently to add new health facilities, the representativeness was average (76%). CONCLUSIONS The system is working effectively at evaluated sites. The overall system performance was excellent, however, flexibility and stability were good due to the negative adaptation of the system with the reporting method and the absence of other fund resources. Therefore, evaluating the new upgrade system, strengthening the stability by finding other supporting resources, moreover further expand coverage to include all public and private healthcare facilities are recommended. </sec

Electronic Integrated Disease Early Warning System Surveillance System Evaluation, Sana'a Capital, Yemen, 2021

Background The Electronic Integrated Disease Early Warning System (eIDEWS) is an essential system; it contributes to the better prevention and management of epidemics. Through the collection of complete, accurate, and timely data, countries are able to determine the priorities for suitable interventions that save the lives of communities. Regardless of the conflict in Yemen, the system is still functioning and is expanding to be the most effective epidemiological surveillance program. Objective We aimed to determine the usefulness of the eIDEWS, assess its performance, and identify the strengths and weaknesses of its implementation. Methods The usefulness and performance attributes of the eIDEWS were evaluated using the Centers for Disease Control and Prevention’s updated guidelines for evaluating public health surveillance systems. The evaluation was carried out in Sana’a capital from January to March 2021 by interviewing 25 stakeholders at 3 levels—the central, governorate, and health district levels—and using a semistructured questionnaire. Attributes of the system were ranked as poor (&lt;60%), average (60% to &lt;80%), good (80% to &lt;90%), and excellent (≥90%) on the basis of indicators to calculate the final scores. Results The eIDEWS’ overall usefulness and performance score was 90%—an excellent rank. The mean score of system attributes was 100% for acceptability, completeness, and timeliness. The flexibility was good (83%), since the change in reporting method was applied difficultly. The system depends completely on foreign funds; thus, the system’s stability was average (75%). However, the eIDEWS was expanded recently to add new health facilities; its representativeness was average (76%). Conclusions The system is working effectively at evaluated sites. The overall system performance was excellent; however, flexibility and stability were good due to the negative adaptation of the system with regard to the reporting method and the absence of other fund resources. Therefore, evaluating the newly upgraded system, strengthening its stability by finding other supporting resources, and further expanding coverage to include all public and private health care facilities are recommended. </jats:sec

Bacterial Contamination of Intensive Care Units, Sana’a City, Yemen, 2019 (Preprint)

BACKGROUND Bacterial contamination of the intensive care unit (ICU) is one of the risk factors responsible for the high incidence of nosocomial infections that can significantly increase the mortality among ICU patients. OBJECTIVE The aim of this study was to investigate the bacterial contamination and pathogen isolates from the ICU environment of hospitals in Sana’a city, Yemen. METHODS A descriptive cross-sectional study was performed in Sana’a city hospitals from December 5 to December 15, 2019. All hospitals that frequently reported mortality among ICU patients were included. A sterile swab moistened in sterile normal saline was used for sample collection. Seven ICU sites were targeted, including the patient’s bed, bedside table, masks of the oxygen-supplying apparatus, intravenous (IV) stand, door knob, wall, and floor, and two samples from each site were collected. The samples were transported to the National Center of Public Health Laboratory for microbiological culture. RESULTS A total of 112 swabs were collected from the ICUs of eight hospitals. Among these, 87 (77.7%) yielded positive bacterial growth and 109 bacterial strains were isolated, including 62.4% (n=68) gram-positive and 37.6% (n=41) gram-negative bacteria. Coagulase-negative &lt;i&gt;Staphylococcus&lt;/i&gt;, &lt;i&gt;Staphylococcus aureus&lt;/i&gt;, and &lt;i&gt;Bacillus cereus&lt;/i&gt; were the predominant gram-positive bacteria isolated, which accounted for 27.5% (n=30), 21.1% (n=23), and 10.1% (n=11) of all 109 bacterial isolates, respectively. &lt;i&gt;Klebsiella&lt;/i&gt; species, &lt;i&gt;Pseudomonas&lt;/i&gt; species, and &lt;i&gt;Acinetobacter&lt;/i&gt; were the main gram-negative isolates obtained, accounting for 12.8% (n=14), 12.8% (n=14), and 11.9% (n=13) of all 109 bacterial isolates, respectively. The common contaminated sites were the patients’ beds/bedside tables (40/109 strains, 36.7%), floors (24/109 strains, 22.0%), walls (15/109 strains, 13.8%), and masks of the oxygen-supplying apparatus (12/109 strains, 11.0%). The door knobs and IV stands were contaminated by 9 strains, representing 8.3% of the total isolated bacteria. CONCLUSIONS The contamination of ICU environments was high and patients’ surroundings were the most contaminated areas. Implementations of strict quality standards of hygienic practices and effective cleaning of inanimate surfaces by the hospitals’ infection control units along with periodic monitoring by the health authority are highly recommended. </sec

Bacterial Contamination of Intensive Care Units, Sana’a City, Yemen, 2019

Background Bacterial contamination of the intensive care unit (ICU) is one of the risk factors responsible for the high incidence of nosocomial infections that can significantly increase the mortality among ICU patients. Objective The aim of this study was to investigate the bacterial contamination and pathogen isolates from the ICU environment of hospitals in Sana’a city, Yemen. Methods A descriptive cross-sectional study was performed in Sana’a city hospitals from December 5 to December 15, 2019. All hospitals that frequently reported mortality among ICU patients were included. A sterile swab moistened in sterile normal saline was used for sample collection. Seven ICU sites were targeted, including the patient’s bed, bedside table, masks of the oxygen-supplying apparatus, intravenous (IV) stand, door knob, wall, and floor, and two samples from each site were collected. The samples were transported to the National Center of Public Health Laboratory for microbiological culture. Results A total of 112 swabs were collected from the ICUs of eight hospitals. Among these, 87 (77.7%) yielded positive bacterial growth and 109 bacterial strains were isolated, including 62.4% (n=68) gram-positive and 37.6% (n=41) gram-negative bacteria. Coagulase-negative Staphylococcus, Staphylococcus aureus, and Bacillus cereus were the predominant gram-positive bacteria isolated, which accounted for 27.5% (n=30), 21.1% (n=23), and 10.1% (n=11) of all 109 bacterial isolates, respectively. Klebsiella species, Pseudomonas species, and Acinetobacter were the main gram-negative isolates obtained, accounting for 12.8% (n=14), 12.8% (n=14), and 11.9% (n=13) of all 109 bacterial isolates, respectively. The common contaminated sites were the patients’ beds/bedside tables (40/109 strains, 36.7%), floors (24/109 strains, 22.0%), walls (15/109 strains, 13.8%), and masks of the oxygen-supplying apparatus (12/109 strains, 11.0%). The door knobs and IV stands were contaminated by 9 strains, representing 8.3% of the total isolated bacteria. Conclusions The contamination of ICU environments was high and patients’ surroundings were the most contaminated areas. Implementations of strict quality standards of hygienic practices and effective cleaning of inanimate surfaces by the hospitals’ infection control units along with periodic monitoring by the health authority are highly recommended. </jats:sec