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.