Background: Extended spectrum β-lactamases (ESBLs) have emerged as a major threat worldwide, with limited treatment options available. Objectives: The present study aimed to estimate the prevalence, possible types of ESBL genes and antibiotic resistant patterns of ESBLproducing Escherichia coli (E. coli) and Klebsiella pneumoniae (K. pneumoniae). Materials and Methods: A total of 199 clinical isolates of E. coli and K. pneumoniae, collected between October 2010 to March 2012, at three University Hospitals in Aleppo city center, in north Syria, were examined phenotypically and genotypically for ESBL production. Results: The ESBLs were found in (62.89%) of E. coli and (67.5%) of K. pneumoniae isolates. The majority of the typeable isolates harbored two or more ESBL genes (73%). Overall, bla CTX-M-1 was the commonest genotype (81.74%). Resistances of ESBL isolates to other antibiotics were measured: tremithoprim/sulfamethoxazole (72%), nalidixic acid (72%), tetracycline (66%), gentamicin (54%) and ciprofloxacin (53%). Conclusions: Our study showed high ESBL incidence, with CTX-M genotype as the emerging strain in our hospitals. High co-resistance to other non-β-lactam antibiotics is a major challenge for the management of ESBL infections.

Background Neonatal sepsis is a global concern with increasing morbidity and mortality. The burden of neonatal sepsis is highest in developing countries, especially in those lacking proper surveillance systems. The causative pathogens and their drug-resistance levels vary between countries with emergence of multidrug resistance organisms. Thus, accurate records on the recent trends of organisms causing neonatal sepsis will provide vital information for appropriate intervention. We aimed to investigate neonatal sepsis, identify its associated factors and causative pathogens and to assess the antibiotic susceptibility patterns in Sana’a city, Yemen. Methods A cross-sectional study was conducted on neonates admitted to intensive care units of six hospitals in Sana’a city, Yemen, in the period from January 15, to March 30, 2020. Natal and prenatal medical data were collected using well-structured questionnaire. Neonates were subjected to sepsis work-up including blood culture, complete blood count and C-reactive protein. Organisms were identified by Gram staining and analyzed by the VITEK II system for bacterial bio-typing and antibiotic susceptibility testing. Findings Of the 199-neonates with suspected neonatal sepsis, 154 (77.38%) had culture-proven sepsis. Early-onset neonatal sepsis (EOS) was higher (50.25%; 100/199) than late-onset neonatal sepsis (LOS) (27.13%; 54/199). Multivariable analysis identified vaginal delivery as an independent risk factor for neonatal sepsis p = 0.005. Majority of isolated bacteria (74.39%) were gram-negative with Burkholderia cepacia (39%) and Klebsiella oxytoca (13%) being the most common pathogens of EOS and LOS. The most common gram-positive pathogens were Staphylococcus haemolyticus (9.1%) and Staphylococcus epidermidis (7.1%). B. cepacia showed multidrug resistance except for cefepime. All Klebsiella species isolates (100%) and most Pantoea species (93%) were ESBL and carbapenemase positive. All Escherichia coli and Acinetobacter baumannii isolates were ESBL positive. A significant number of gram-positive bacteria showed resistance to vancomycin. Conclusion The study findings show a high proportion of neonatal sepsis among neonates admitted to hospitals in Sana’a city with antibiotic-resistant B. cepacia being the single most common pathogen causing EOS and LOS. Findings also emphasize the emerging threat of multidrug-resistant bacteria in neonatal units and will help develop evidence-based management of neonatal sepsis in Yemen.

Background: Neonatal infection with group B Streptococcus (GBS) is still a threat to the life of fetus and mother, especially in developing countries that do not adopt a prenatal screening test policy such as Yemen. Objective: This study aimed to determine the vaginal colonization rates and antibiotic susceptibility pattern of group B Streptococcus among pregnant Yemeni women. Methods: We conducted a cross-sectional study over a four-month period involved 210 pregnant women who visited Gaza medical center (a primary health center in Sana’a city, Yemen) at the 35th to 39th gestational weeks. A vaginal swab from each pregnant woman was inoculated in Todd-Hewitt enrichment broth and after 24h incubation; the subculture on a 5% human blood agar plate was performed from inoculated Todd-Hewitt enrichment broth. All positive cultures identified as group B streptococcus were subjected to antibiotic susceptibility test using the disk-diffusion method. Results: Out of 210 recruited pregnant women, 23 (10.95%) were GBS vaginal carriers. All isolates showed no resistance to penicillin, ampicillin, levofloxacin, cefotaxime, and vancomycin. However, we observed decreased sensitivity to clindamycin (82.8%) and tetracycline (30.5%). Conclusion: Based on the study results; approximately eleven out of every 100 pregnant women were vaginal colonized by GBS in Sana'a governorate. Beta-lactam antibiotics remain the drug of choice for treatment and prophylaxis of GBS infections. Therefore, we recommend implementing a screening policy to detect GBS in Yemeni pregnant women.

Background. Infection with group B Streptococcus (GBS) is still a neonatal life-threatening illness, especially in developing countries such as Yemen. Objective. This study was aimed at determining the vaginal colonization rate and antibiotic susceptibility pattern of GBS among Yemeni pregnant women. Methods. We conducted a cross-sectional study over a four-month period involving 210 pregnant women at the 35th to 39th gestational weeks who visited Gaza medical center in Sana’a city, Yemen. The collected vaginal swab specimen was inoculated in the Todd-Hewitt enrichment broth and incubated for 24 h and then subcultured on a 5% human blood agar plate. All positive cultures identified as GBS were subjected to antibiotic susceptibility tests using the disk diffusion method. Results. Out of 210 recruited pregnant women, 23 (10.95%) were GBS vaginal carriers. All GBS isolates were sensitive to penicillin, ampicillin, levofloxacin, cefotaxime, and vancomycin. Conclusion. Based on the study’s results, approximately eleven out of every 100 pregnant women in Sana’a city are vaginally colonized by GBS. Beta-lactam antibiotics remain the drug of choice to treat and prevent GBS infections. A prenatal screening policy is urgently needed for Yemeni pregnant women.

Background: Neonatal infection with group B Streptococcus (GBS) is still a threat to the life of fetus and mother, especially in developing countries that do not adopt a prenatal screening test policy. Objective: This study aimed to estimate the prevalence of group B Streptococcus in pregnant Yemeni women between the 35th and 39th weeks of gestation and also to assess group B Streptococcus sensitivity pattern to several antibiotics. Methods: The fieldwork was performed in a primary health centre and a private modern medical laboratory at Sana'a city, Yemen. The study was limited to taking one vaginal swab from each participant of 210 pregnant women, and it relied on the cultural characteristics and biochemical tests for identifying the bacteria as group B Streptococcus. Antibiotic susceptibility testing was performed using the Kirby-Bauer test. Results: Among the 210 pregnant women who were participating in this study, 23 (10.95%) were vaginally colonized with group B Streptococcus. Beta-lactam antibiotics and vancomycin were completely effective against group B Streptococcus. Conclusion: Based on this study results, at least one out of every ten Ymenei pregenant women is GBS vaginally colonized therefore we recommend routine prenatal GBS screening among pregnant women in the third trimester in Yemen and conducting extensive epidemiological studies in other Yemeni cities to detect the extent prevalence of GBS among pregnant mothers in Yemen in order to develop an appropriate preventive strategy.