Background and objective: Hypertension is a multifactorial disease where numerous constitutive, genetic and environmental factors interplay. Among the constitutive factors, age is a major determent continuously reported to be associated with a significant increase in the prevalence of hypertension. In addition to age, Helicobacter pylori (H. pylori) infection was also shown to be associated. On the other hand, Vitamin D (Vit D) plays an important role against the development of hypertension. In the current study, we investigated whether H. pylori interacts with Vit D levels to influence hypertension. Methods: This cross-sectional study was conducted on seven hundred eighty-two “a priori” healthy individuals equally divided according to hypertension status. To study the association between Vit D, H. pylori and hypertension, a multivariate logistic regression model was used while correcting for different confounding factors. Power analysis was also performed. Results: Approximately half of the participants were hypertensive and had Vit D insufficiency, they were also matched for age. Using a multiple logistic regression model, our results showed an inversely proportionate association between H. pylori infection and the risk of hypertension (OR=0.37, P<0.001). On the other hand, a proportionate association between Vit D deficiency and hypertension was observed (OR=2.76, P=0.004). Furthermore, Vit D and H. pylori status interacted to affect the risk of hypertension (OR=0.973, P=0.004). Stratification according to Vit D status showed that 59.1% of Vit D deficient participants were infected with H. pylori organisms (P<0.001). When taking hypertension, Vit D, and H. pylori statuses into account, we found that the prevalence of hypertension was doubled when the participants were negative for H. pylori infection but had Vit D deficiency (P<0.001). Conclusion: H. pylori infection and Vit D deficiency could predict hypertension. The odds of hypertension development were double when the participants were negative for H. pylori infection and had vitamin D deficiency.
Introduction: Extended-spectrum – beta lactamases (ESBLs) are increasingly detected globally among Escherichia coli and Klebsiella pneumoniae. The correlation between antibiotics use and resistance, though not fully described, has been addressed and shown in several studies. In this study, the profiles of ESBLs in E. coli and K. pneumoniae isolated from two Lebanese hospitals and their relationship to antibiotic consumption were determined. Methodology: A total of 205 E. coli and 67 K. pneumoniae isolates resistant to third- or fourth-generation cephalosporins were collected between January 2011 and January 2012. Antibiotic susceptibility and consumption data were also collected from 2010–2012. Double-disk synergy and Etest ESBL assays were performed, followed by PCR for ESBL genes. Pulsed-field gel electrophoresis (PFGE) was performed for representative isolates. Statistical analysis for consumption and susceptibility data over 3 years was performed. Results: As expected, CTX-M-15 was predominant. In both hospitals, strains of E. coli and K. pneumoniae harbored at least one ESBL, and in some cases (23%) harboured four different ESBLs. A significant correlation was detected between total use of antimicrobial agents and resistance to various antibiotics. This was obvious for the use of penicillins and resistance to aztreonam, ceftazidime and ciprofloxacin, and use of third- and fourth-generation cephalosporins and resistance to ceftazidime, cefuroxime, cefoxitin and ciprofloxacin in both bacteria. Conclusions: This study shows the predominance of CTX-M-15 among cephalosporin-resistant E. coli and K. pneumoniae in Lebanese hospitals and highlights the direct relationship between the use of antibiotics and the emergence of resistance in bacteria.
Background. ESBL-producing Escherichia coli and Klebsiella pneumoniae have rapidly spread worldwide creating a severe threat. The development of resistance in these bacteria is multi-factorial; antibiotic consumption is a major factor. In view of both significant increase in ESBL production and lack of efficient control of antibiotic use in Lebanon (Middle East), we conducted a study to determine the epidemiology of ESBL-related genes in E.coli and K.pneumoniae, and analyzed the correlation of antibiotic use with bacterial resistance in 3 major medical centers.Methods. Three medical centers located in the north, south, and capital (Beirut) of Lebanon were chosen for this study. All ESBL producing E.coli and K.pneumoniae from inpatients were collected between January 2, 2012 and January 2, 2013. Only the first isolate per patient was included. Antibiotic consumption was expressed in DDD/100 bed days and Kirby-Bauer technique was used for antibiotic resistance testing. For the phenotypic detection of ESBL, double disk synergy test and E-test were performed. PCR and multiplex PCR were used for the detection of the genes bla TEM , bla SHV , bla CTX-M, and bla OXA. The identification of bla CTX-M15 was done by sequencing of the gene. The association between consumption and resistance was analyzed using Spearman correlation coefficient. Pulsed Field Gel Electrophoresis (PFGE) was used to determine the clonality of the different isolates.Results. A total of 1002 E.coli and 233 K.pneumoniae isolates were analyzed. 29.9% of E.coli strains and 31.1% of K.penumoniae were ESBL producers. Use of 3rd and/or 4th generation cephalosporins and resistance to these antibiotics were strongly correlated. In addition, the correlation factor of cephalosporin consumption vs susceptibility to ciprofloxacin in E.coli (Hospital 1) was as low as -0.899 and -0.886 in K. pneumoniae (Hospital 3). bla CTX-M was produced by 97% of E.coli and 96.7% of K.pneumoniae. Specifically, bla CTX-M15 was commonly found. 22.3% of E.coli and 37.4% of K.pneumoniae co-produced the 4 studied beta-lactamases. PFGE analysis demonstrated that there was no major clonal relationship among these ESBL producers.Conclusion. Our data show the urgent need for antimicrobial stewardship programs in the country to control the use of antibiotic and the spread of bacterial resistance.
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