Medical research centre, Hawler medical university, Erbil, Iraq.

Nosocomial infections occur worldwide and also in the Kurdistan region. Frequently patients colonized with multiresistant Pseudomonas aeruginosa isolates are encountered in many hospitals. As information is lacking with respect to the mechanisms of resistance responsible for the multiresistant character of the P. aeruginosa isolates and their genetic relationship, isolates were prospectively collected and characterized with respect to their mechanism of resistance. During 2012 and 2013, 81 P. aeruginosa isolates were collected from three teaching hospitals in the city of Erbil, Iraq. Susceptibility testing was performed using the VITEK-2 system. Isolates were screened for the presence of extended-spectrum β-lactamases (ESBLs) and for the presence of metallo β-lactamases (MBLs). The presence of serine carbapenemases was detected by PCR. The genetic relationship of the isolates was demonstrated by amplified fragment length polymorphism (AFLP). Susceptibility results revealed high rates of resistance against all classes of antibiotics except polymyxins. Genetic characterization demonstrated the presence of ESBL-genes, that is, bla (30%) and bla (17%), also ESBL bla was detected in four isolates. AFLP typing revealed clonal spread of bla, bla, and three clusters of bla-positive isolates. Only one isolate was MBL (bla) positive. Of a selected number of isolates (n = 11), whole-genome sequencing analysis revealed that these isolates belonged to "high-risk" MLSTs ST244, ST235, ST308, and ST654. This study reveals the presence and clonal spread of widely resistant high-risk clones of P. aeruginosa in Iraqi Kurdistan. As far as we are aware, this is the first report of multiple, polyclonal, PME producing P. aeruginosa outside the Arabian Peninsula.

In addition to intrinsic resistance in Acinetobacter baumannii, many different types of acquired resistance mechanisms have been reported, including the presence of VIM and IMP metallo β-lactamases and also of bla and bla enzymes. In the Kurdistan region of Iraq, the multiresistant A. baumannii-calcoaceticus complex is prevalent. We characterized the different mechanisms of resistance present in clinical isolates collected from different wards and different hospitals from the Kurdistan region. One hundred twenty clinical nonduplicate A. baumannii-calcoaceticus complex isolates were collected from four hospitals between January 2012 and October 2013. The identification of the isolates was confirmed by MALDI-TOF. The susceptibility to different antibiotics was determined by disk diffusion and analyzed in accordance to EUCAST guidelines. By PCR, the presence of bla, bla, bla, and bla genes was determined as well as the presence of the insertion element ISAba1. Clonal diversity was analyzed by pulsed-field gel electrophoresis (PFGE) using the restriction enzyme ApaI and, in addition, multilocus sequence typing (MLST) was performed on a selected subset of 15 isolates. All 120 A. baumannii isolates harbored bla genes. One hundred one out of 110 (92%) imipenem (IMP)-resistant A. baumannii-calcoaceticus complex isolates additionally carried the bla gene and four isolates (3%) were positive for bla All 101 bla-positive isolates had the ISAba1 insertion sequence, 1,600 bp upstream of the bla gene. The bla gene was not detected in any of the 110 IMP-resistant strains. Eight different PFGE clusters were identified and distributed over the different hospitals. MLST analysis performed on a subset of 15 representative isolates revealed the presence of the international clone ST2 (Pasteur). Besides ST2 (Pasteur), also many other STs (Pasteur) were encountered such as ST136, ST94, ST623, ST792, and ST793, all carrying the bla gene. In clinical A. baumannii-calcoaceticus complex isolates from Kurdistan-Iraq, the bla gene in combination with the upstream ISAba1 insertion element is largely responsible for carbapenem resistance. Several small clusters of identical genotypes were found from patients admitted to the same ward and during overlapping time periods, suggesting transmission within the hospital. Identification of source(s) and limiting the transmission of these strains to patients needs to be prioritized.

Background and objectives: Brucellosis is an acute or chronic illness manifested principally by chills and fever. Occasionally, chronic relapsing febrile episodes occur. Brucellosis is endemic in animal and humans are infected incidentally. The aim of the study was to examine the incidence of brucellosis in Erbil City, study the relation between the rate of infection and a number of predisposing factors. Methods: Blood samples were collected from (2085) patients suspected of having brucellosis attending, Erbil Teaching Hospitals and Rizgary. The sera were examined using Rose Bengal test. Results: Serum samples from patients showed (10.7%) of positive reaction indicating the presence of anti-brucella antibodies. Seropositivity of brucellosis in female (12.48%) was significantly higher than male (8.02%), and in rural area was (40.98%) and in urban area was (9.44%). The highest seropositivity of brucellosis occurred among age group (21-30) years. The infection rate with B. miletensis and Brucella abortus was (71.75%) and (28.25%) respectively. The highest seropositivity occurred among individuals who were in contact with animals (37.34%), and in occupations was the highest among the farmers and dairy workers (37.5% and 37.28%) respectively. In Monthly distribution showed the highest sero-positivity occurred in October (12.72%). Conclusion: Sero-posivity of brucellosis in Erbil City is somehow similar to the neighboring countries. There are variations in the incidence of brucellosis in relation to sex, age, area, occupation, source of infection and seasons.

Introduction disseminated gonococcal infection which presents with arthralgias, tenosynovitis, or arthritis and rush. 1 Gonorrhea control strategies have relied on the use of highly effective and often single dose therapy administered at the time of diagnosis. 2 The appearance and subsequent increased incidence of penicillinase producing Neisseria gonorrhoeae 3 and chromosomally mediated penicillin and tetracycline resistant Neisseria gonorrhoeae 4 in the advanced countries heralded the end of an era in which gonorrhea could be confidently treated with relatively inexpensive antibiotics such as penicillin and tetracycline. The broad spectrum Background and objective: Gonorrhea is a sexually transmitted disease caused by Neisseria gonorrhoeae. The bacteria can be passed from one person to another through vaginal, oral, or anal sex. It can also be passed from mother to her baby during birth. The symptoms in adult male include a burning sensation when they urinate and a yellowish-white discharge may ooze out of the urethra. Gonorrhea can spread to epididymis causing pain and swelling in the testicular area. This can create scar tissue that can lead to infertility. The aim of this study was to determine the prevalence of gonorrhea in adult male in Erbil Governorate and the susceptibility of isolated Neisseria to antibiotics. Methods: Urethral discharge obtained from adult male aged between 19-49 years were examined for the presence of Neisseria gonorrhoeae using direct smear gram staining and cultural technique. The susceptibility of isolated bacteria to antibiotics was tested using disc diffusion method. Results: This study showed that the incidence of gonorrhea among 312 adult male with urethritis in Erbil city was (8.97%) while (91.03%) of patients examined had nongonococcal urethritis. The higher percentage of infection with Neisseria gonorrhoeae (14%) occurred among age group (19-29) years and the lower (3.48%) in the age group (39-49) years. Among the 210 unmarried patients, 26 (12.38%) had gonorrhea and 184 (87.62%) had nongonococcal urethrits. All Neisseria gonorrhoeae were sensitive to ceftriaxone, spectinomycin and azithromycin. The isolates showed low sensitivity (21.42%) to penicillin. Conclusion: It seems that gonorrhea is common among symptomatic adult male. The emergence of resistance to some antibiotics is worrying. Appropriate prevention strategies should be of highest priority of the policy makers.

A total of 154 isolates of Streptococcus pneumoniae obtained from 8 different centres in the province of Hainaut were included in this study. The susceptibilities to penicillin, amoxicillin, cefuroxime, ciprofloxacin, moxifloxacin, erythromycin and tetracycline were determined by a microdilution technique following NCCLS recommendations. Decreased susceptibility to penicillin was 32.5% (23.4% intermediate and 9.1% high-level). The other insusceptibility rates were as follows: amoxicillin 1.9% [0% Resistance (R)], cefuroxime 23.4% (R 22.1%), ciprofloxacin 9.1% (R 1.3%), erythromycin 39.6% (R 38.3%), and tetracycline 31.8% (R 30.5%). No decreased susceptibility was found for moxifloxacin. MICs of amoxicillin, cefuroxime, erythromycin and tetracycline rose with those of penicillin for penicillin-insusceptible isolates. Most penicillin-insusceptible isolates remained fully susceptible to amoxicillin (94%), while moxifloxacin and ciprofloxacin kept an activity on 100% and 92% of these isolates respectively. Phenotypes with triple or quadruple insusceptibility were present in 31.2% of the isolates. Penicillin-insusceptible isolates showed a co-insusceptibility of 36.7% to erythromycin, 30.0% to tetracycline and 3.3% to ciprofloxacin.

Introduction Antibiotic resistance is a daunting phenomenon with a growing impact on patient safety, particularly for nosocomial infections. 1 The nosocomial strains of P. aeruginosa are frequently resistant to a broad range of commercially available antibiotics. Their prevalence appears to be increasing worldwide, especially as a cause of ventilator-associated pneumonia and in patients with severe burn injuries. 2 Critically ill patients are prone to colonization and infection by antibioticresistant bacteria because of the frequent exposure of these patients to antibiotics. This dangerous array increased the need for broad-spectrum antibiotics, reduced antimicrobial efficacy, and increased antibiotic resistant strains. 3 These infections are complicated to treat due to the occurrence of multidrugresistant (MDR) organisms, which include resistance to beta-lactams, aminoglycosides, fluoroquinolones, and carbapenems. 4 Carbapenems were subsequently introduced as the last resorts of antibiotics due to their high potency and the exceptional broad spectrum of antimicrobial activity, but the carbapenemases, are capable of causing resistance to a wide variety of β-lactam antibiotics, including carbapenems. 5 P. aeruginosa can become resistant to the carbapenems through a number of mechanisms mainly due to the production of OXA-type carbapenemases (class D) Background and objective: Pseudomonas aeruginosa is an opportunistic pathogen and inherently resistant to many antibiotics and can mutate to even more resistant strains during therapy. Resistance to the antibiotics in this group of bacteria increased due to the activity of β-lactamase genes and one of the most important groups of genes, blaOXA gene producing enzymes. The current study aimed to determine the prevalence of Ambler class D β-lactamases, including OXA-10 gene among P. aeruginosa isolated from patients in Erbil, Kurdistan. Methods: Different clinical specimens were taken from patients with clinical symptoms of infection during one year. Identification was carried out on all isolates by Vitek2 system. Antibiotic susceptibility for antimicrobial agents was performed according to the clinical and laboratory standards institute (CLSI) guidelines. Production of Ambler class D β-lactamases was confirmed by polymerase chain reaction technique. Results: A total of 100 isolates of P. aeruginosa, 57 isolates (57%) had shown resistance to six or more than six antibiotics, and 15 isolates showed resistance to one antibiotic. Also, none of the resistant isolates were showed complete resistance to all antibiotics. Out of 89 P. aeruginosa, 38.2% of isolates possessed the blaOXA-10 gene. Conclusion: The results revealed the occurrence of extended-spectrum β-lactamases producing Pseudomonas aeruginous, and proper infection control practices are crucial to avert the spreading of ESBL-producing isolates in hospitals.