A total of one hundred and forty two swab samples (92 clinical and 50 from hospital environment) were collected for the detection of Pseudomonas aeruginosa. Out of the total samples, 29 isolates of P. aeruginosa were isolated and recorded an overall prevalence rate of 20.42% (29/242) of which 18 (19.56%) were from wounds and burns swabs of patients, and 11 (22%) were from hospital environment. The highest rate of P. aeruginosa (60%) identified from hospital environmental specimens were from door handles followed by ward sinks (57.15%) and the least (10.53%) from patients' beds and table tops. According to gender and age group, the study showed the highest rate of P. aeruginosa in the male (55.6%), and in young patients (38.9%) between the ages of 5 and 25 years compared to the elderly; while the lowest rate 27.8% were from those age 45 years and above. Results showed that all isolates from patients and hospital environment were resistant to ticarcillin and ceftazidime (100%). Also, P. aeruginosa from patients demonstrated high resistance to cefepime, ofloxacin, gentamycin, tobramycin, ciprofloxacin, lomefloxacin, norfloxacin, levofloxacin and amikacin in the following order respectively :88.8, 77.7, 61.1, 50.0, 44.4, 44.4, 38.8, 38.8 and 33.3%; whereas showed low resistance (16.6 and 11.1%) to each of ticarcillin/clavulanate and meropenem, and only 5.5% to imepenem. Generally, this study pointed that P. aeruginosa isolates from hospital environment were more resistant to particular antibiotics than that of clinical isolates. It was also revealed that P. aeruginosa have high sensitivity to imepenem, meropenem and ticarcillin /clavulanate and these should be considered in the treatment of this bacterium.

Background: Enterobacter cloacae are most frequently isolated from human clinical specimens. Objective: This cross-sectional study aimed to investigate the dissemination of E. cloacae clinical isolates resistant to β-lactam-β-lactamase inhibitor (BLBLI) combinations from different clinical specimens of hospitalized patients. Methods: E. cloacae isolates were recovered from different clinical samples of hospitalized patients in three main hospitals in Baghdad city. E. cloacae isolates were identified based on their morphology and biochemical tests, and the identification was confirmed using Vitek-2 system. The antibiotic susceptibility testing of E. cloacae isolates to a variety of antibiotics was achieved using disc diffusion test (DDT) and Vitek-2 system. Results: Results found that among 335 culture-positive samples, 30 isolates (8.9%) belonged to E. cloacae. A high rate of isolation was observed in urine isolates (46.6%), followed by wounds (burns) isolates (26.6%). Out of 30 E. cloacae strains isolated during this study, 18 (60%) showed reduced susceptibility to BLBLI combinations. TEM genes (TEM-1 and TEM-2) were successfully amplified from 7/18 isolates (38.8%) and high rate of BLBLI genes was detected (CTX-M, bla-SHV, SHV-2, and OXA-1). However, no BLBLI genes of bla-AmpC, bla- OXA-2, and bla- OXA-10 were found in E. cloacae isolates when tested using specific primers for bla-AmpC and bla-OXA genes. Conclusion: From this study, we can conclude that the production of inhibitor-resistant β-lactamases by E. cloacae isolates could be increasingly common in nosocomial pathogens other than E. coli or K. pneumoniae in public hospitals in Baghdad, Iraq.

To compare the culture screening protocols for detection of methicillin-resistant Staphylococcus aureus (MRSA) in the surgical wards, one hundred and forty eight samples (116 nasal swabs from 116 patients and 32 environment items swabs) were examined. 96 (64.8%) of the samples stowed S. aureus, 75 (64.6%) from patients, and 21(65.6%) from hospital environment. The detection of MRSA among the isolates of the S. aureus was carried out using direct culture and subculture from mannitol salt agar on HiCrome MeReSa agar medium compared with FOX, OX and ME DD test. Among the 96 S. aureus isolates, 63 (65.6%) were HA-MRSA of which 50 (66.6%) and 13 (61.9%) from the patients and environment, respectively. There is no significant difference in the detection rate of MRSA between HiCrome MeReSa Agar and DD test as each showed 63 isolates (50 from patients and 13 from environment). The prevalence of MRSA in both was 42.5% (63/148) and 22.3% (33/148) of MSSA. Lower detection of 47 and 11 MRSA isolates with prevalence 39.1% (58/148) was obtained after 24 h of incubation by direct culture method on HiCrome Agar, respectively. The report time was fastest (24 h) in direct culture on HiCrome agar and the slowest (48 h) in subculture on HiCrome Me ReSa Agar and OX, FOX, ME disc diffusion test. In the patients screening samples, the sensitivity, specificity, positive predictive value PPV and negative predictive value NPV between direct culture on HiCrome Agar medium and DD test were 94, 100, 100 and 95.6%, respectively, while in the environment samples were 84.6, 100, 100 and 90.4%, respectively. Patient's samples demonstrated higher sensitivity and NPV than environment samples but the same rate in specificity and PPV. In contrast, no observed differences between results from subculture on HiCrome Agar medium and (OX, FOX and ME) DD test, which agreed in their sensitivity, specificity, PPV and NPV. The study also revealed that all MRSA isolates were multidrug resistant (MDR) and they were highly resistant (100%) to Beta-lactam antibiotics: oxacillin, cefoxitin, methicillin, ampicillin and amoxicillin.

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