First report on class 1 integrons and Trimethoprim-resistance genes fromdfrAgroup in uropathogenicE. coli(UPEC) from the Aleppo area in Syria

A summary and appraisal of existing evidence of antimicrobial resistance in the Syrian conflict

“…Since the first use of armed force and subsequent expansion of violence, data on the availability and efficacy of antimicrobial therapy within Syria have become increasingly limited. Six studies from inside Syria since late 2011 have reported concerns over the increasing burden ofresistant Gram-negative infections and methicillin-resistant Staphylococcus aureus (MRSA), four of these being focused on Aleppo (Alheib et al, 2015;Mahfoud et al, 2015;Al-Assil et al, 2013;Tabana et al, 2015). It is notable that few datasets from within Syria have reported on war-related injuries and their infectious complications; this is likely driven by several factors including political sensitivities and the overwhelmed health systems.…”

“…Mahfoud and colleagues tested 177 Pseudomonas aeruginosa urinary and lower respiratory isolates from patients in three intensive care units in Aleppo and showed significant resistance to common anti-pseudomonal agents (piperacillin-tazobactam: 46%; meropenem: 41%; ceftazidime 73%) with colistin as the most reliable antibiotic (11% resistance) (Mahfoud et al, 2015). Al-Assil reviewed 104 patients with positive urine samples to understand the risk factors for the development of ESBL infections and isolated ESBL E. coli in 52% of cases (Al-Assil et al, 2013). Co-resistance to other antibiotics was found in 82% of cases.…”

“…Co-resistance to other antibiotics was found in 82% of cases. Risk factors identified as increasing the risk of ESBL acquisition in that study included older age (>52 years), hospitalization, urinary catheterization, and previous exposure to third-generation cephalosporins or quinolone antibiotics (Al-Assil et al, 2013).…”

Multidrug-Resistant Pathogens in Hospitalized Syrian Children

“…This finding probably implies a high carriage rate of MDR pathogens (especially ESBL) among healthy children in Syria and acquisition of MDR pathogens (especially CRE and MDR-AB) in the healthcare system in Syria. Indeed, before the Syrian war, prevalence of ESBL urinary tract infections associated with wide use of antimicrobial drugs was high ( 6 ). In addition, sale of antimicrobial drugs without prescriptions was common in Damascus and other areas ( 7 ).…”

Carriage of Class 1 and 2 Integrons in Quinolone, Extended-Spectrum-β-Lactamase-Producing and Multi Drug Resistant E.coli and K.pneumoniae: High Burden of Antibiotic Resistance

“…[16][17][18] Our hospital is a tertiary University teaching institution, and a reference health care center for North West Iran. Similar to any hospital elsewhere worldwide, E. coli and K. pneumoniae are the two most isolated organisms from patient's samples in the hospital's microbiology section and for the last five years an upward trend in the incidence of quinolone resistance was observed in these clinical isolates.…”