Antibiotic Resistance Profile of Pathogenic Bacteria from Mosul Government Hospital, Iraq PDF

Article presented at 3rd Int Sci Conf of Med and Biol Tech of Al-Furat Al-Awsat Tech Univ and Du...

Article presented at 3rd Int Sci Conf of Med and Biol Tech of Al-Furat Al-Awsat Tech Univ and Duhok Polytech Univ., Duhok, Iraq (3rd ISCMBT 2023) Original Article Antibiotic Resistance Profile of Pathogenic Bacteria Isolated from Healthcare Rooms in the Mosul Government Hospital, Iraq Downloaded from http://journals.lww.com/mjby by BhDMf5ePHKav1zEoum1tQfN4a+kJLhEZgbsIHo4XMi0hCywCX1AW Marwah Ali Oudah Department of Techniques of Health management, Aldiwanyah Technical Institute, Al-Furat Al-Awsat Technical University, Aldiwanyah, Iraq nYQp/IlQrHD3i3D0OdRyi7TvSFl4Cf3VC1y0abggQZXdtwnfKZBYtws= on 10/28/2024 Abstract Background: Healthcare-associated infections (HAIs) pose a serious risk to patient safety because they are the most frequent adverse event in the healthcare industry and have a high rate of morbidity and mortality. Practices for preventing infections have improved. All medical professionals must take steps to prevent infections. Objectives: This study investigated the microbiology of health care infections (HCRI) in the intensive care units (ICUs) of public hospitals in Mosul, Iraq. Materials and Methods: The resistance profile of bacteria found in the ICU of Mosul’s Government General Hospital was evaluated using bacterial profiles on surfaces, equipment, and surveillance cultures. In an ICU, samples were taken from the patient’s bed and infusion pump. Samples were taken with swabs dipped in saline. Following the passage, samples were gathered, put in tubes, and brought to the lab for microbial evaluation. Results: The results revealed that all of the beds, equipment, and surfaces examined contained 134 different bacteria, 15 of which were oxacillin- resistant and could result in nosocomial infections. Intermediate resistance to ampicillin and vancomycin is 20%. Human isolates of Staphylococcus aureus, Enterobacter, Acinetobacter, and Pseudomonas aeruginosa were resistant to oxacillin, extended spectrum Betalactamases, and carbapenems. Conclusion: This study concludes that to stop the spread of highly resistant bacteria, it is necessary to use surveillance, isolation, and rational antibiotic use. Keywords: Antibiotic resistance, healthcare-associated infections, ICU, Mosul, pathogenic bacteria Introduction Many hospitals do not aggregate their data, making it impossible to assess the national problem. HAI rates for Hospital infection (HI), also known as healthcare- ICU patients range from 10% to 30% depending on the associated infection (HAI), is any disease acquired in a facilities and demographics. These infections cause 25% hospital, outpatient care in a day hospital, or at home of deaths. Hazard variables favor HAI in ICU patients. related to a therapeutic or diagnostic care process.[1,2] ICU patients are more susceptible to HAI compared HAI is diagnosed by the onset of clinical manifestations with patients in other hospital units due to the significant (signs and symptoms) and laboratory confirmation immune response impairment caused by both the (microbiological, histopathological, and serological infection and the diagnosis and the treatment procedures. tests) 72 h after the patient’s hospitalization, but invasive In ICUs, complex invasive procedures, surgeries, procedures may cause the infection to occur sooner. immunosuppressive drugs, and direct contact with the Developing nations have more HAIs compared with health team can increase infection risk. Broad-spectrum industrialized nations. Iraq has a 22.8% HAI prevalence, compared with 9% in European industrialized countries. HAI data by region in Iraq shows the southeast (16.4%), northeast (13.1%), north (11.5%), south (9%), and central- Address for correspondence: Dr. Marwah Ali Oudah, Department of Techniques of Health management, Aldiwanyah Technical west (7.2%) regions. Institute, Al-Furat Al-Awsat Technical University, Aldiwanyah, Iraq. HAIs are the fourth-leading cause of intensive care unit E-mail: [email protected] (ICU) deaths in Iraq. Data are unclear or outdated. Submission: 01-Mar-2023 Accepted: 24-May-2024 Published: 24-Jul-2024 This is an open access journal, and articles are distributed under the terms of the Access this article online Creative Commons Attribution-NonCommercial-ShareAlike 4.0 License, which allows Quick Response Code: others to remix, tweak, and build upon the work non-commercially, as long as Website: appropriate credit is given and the new creations are licensed under the identical terms. https://journals.lww.com/mjby For reprints contact: [email protected] DOI: How to cite this article: Oudah MA. Antibiotic resistance profile of 10.4103/mjbl.mjbl_228_23 pathogenic bacteria isolated from healthcare rooms in the Mosul Government Hospital, Iraq. Med J Babylon 2024;21:S70-80.        S70 © 2024 Medical Journal of Babylon | Published by Wolters Kluwer - Medknow  Oudah: Antibiotic resistance of pathogenic bacteria isolated from healthcare rooms in Mosul antimicrobials, which select multiresistant bacteria, also Materials and Methods aggravate ICU patients. Quantitative, descriptive exploratory, secondary data Infections are common in ICU patients. Pneumonia, study. This study used secondary data from Mosul urinary tract infections, bacteremia, and surgical wound General Hospital’s two 10-bed ICUs. Approximately 200 infections make up 80% of HAI. HAIs are associated of the Hospital’s 1200 beds are sensible, whereas the rest with Staphylococcus aureus, Klebsiella pneumonia, are not yet qualified by the National Register of Health Downloaded from http://journals.lww.com/mjby by BhDMf5ePHKav1zEoum1tQfN4a+kJLhEZgbsIHo4XMi0hCywCX1AW Pseudomonas aeruginosa, and Candida spp., which may Establishments. Adult, pediatric, and orthopedic emergency concern immunocompromised patients. ICUs cause the rooms are available 24/7. Clinical Nutrition, Speech most antibiotic resistance.[7,8] Therapy, Physiotherapy, Dentistry (Oral Health), Social Most ICU pathogens are methicillin-resistant S. aureus Work, Psychology, Acute Hemodialysis, and Hyperbaric and Transfusion Agencies are also available. The Mosul nYQp/IlQrHD3i3D0OdRyi7TvSFl4Cf3VC1y0abggQZXdtwnfKZBYtws= on 10/28/2024 (MRSA), quinolone-resistant P. aeruginosa, vancomycin- resistant enterococci (VRE), Gram-negative aerobic General Hospital ICU hosted the experiment. This cross- bacilli ESBL, and fluconazole-resistant Candida. Gram- sectional and descriptive study investigates whether surfaces positive bacteria cause 57% of the bloodstream and 39% and equipment harbor HI-associated bacteria. of surgical infections. MRSA is 50% and oxacillin-resistant staphylococci 70%. Iraqi hospitals have lower VRE. Sample collection National labs need help strain-identifying. Gram-negative Human samples bacilli cause respiratory, urinary tract infections (UTI), The collections were done on 114 patients in Mosul bloodstream, and postoperative stomach infections. P. General Hospital’s ICUs of all ages and diagnoses, with aeruginosa causes most respiratory infections, followed by the only inclusion criterion being a 7-day hospital stay. Enterobacter sp. and K. pneumoniae. Epidemiological data Patients were provided nasal, axillary, and rectal swabs. on Staphylococcus spp. in Iraq concludes. Hospitalized Nasal swabs were collected by inserting a sterile saline- patients’ oxacillin-resistant nasal swabs had 86% oxacillin- soaked swab at least 1 cm into the nostrils and rotating it. resistant S. aureus (ORSA) compared with isolated Rotating axillary swabs were collected with a sterile saline S. aureus and 89% to all isolated coagulase-negative solution. Rectal swabs were collected by inserting a sterile Staphylococcus (CNS). ORSA-colonized patients were saline-soaked swab 1 cm into the rectum and rotating it in 56% and 29% of them were colonized with oxacillin- the mucosa. The medical record provided age, length of resistant Staphylococcus Coagulase-Negative (SCN). stay, diagnosis, and antibiotic type for each patient. The State epidemiological surveillance cultures should study patient’s family or caretaker signed the informed consent hospital patient colonization rates and resistant bacteria.. form before sample collection. To improve control, Mosul State Hospital ICUs must be monitored for HAIs. The World Health Organization has Surfaces and equipment analyzed in ICU declared antimicrobial resistance a global public health Mechanical ventilator, cardiac monitor command buttons, crisis, citing an increase in resistant bacteria rather than stethoscope diaphragm, bedside table, serum/food dispenser, the decrease in antimicrobial development over the last bed curtains, bed wall, and continuous infusion pump. three decades. Multidrug-resistant nosocomial infections Swab samples were collected from surfaces and equipment reduce treatment options, increase hospital costs, and most using saline solution and a 1 cm2 filter paper mold. Swabbed importantly, increase mortality. Urgent and emergency surfaces and equipment were placed in a tube with a 5 mL care specialists recognize critical patients. Accidents, brain heart infusion (BHI) liquid medium. The Hospital’s urban violence, and a weak public health system in Iraq Clinical Analysis/Microbiology Department performed drive emergency service demand. Due to the high cost of microbiological tests. Surfaces and equipment were sampled hospitalization, ICU care, and hospital stays, urgent and four times. BHI broths cultured for 48 h at 37°C. Sample emergency services are one of the most problematic areas of seeds were grown on blood agar for a day at 37°C to cultivate the Health System. Critical patients need antimicrobials, bacteria. Gram staining and biochemical tests identified especially newer ones, due to multiple invasive procedures species after incubation. Catalase detected Gram-positive and immune system damage. These determine multiresistant cocci. If catalase was positive and coagulase was negative, strain infection rates. Multiresistance threatens society, the Enterococcus Kit for bacitracin and optochin identified especially the pharmaceutical industry. the species. Enterobacteriaceae and glucose nonfermenters This study examined the prevalence of multiresistant were identified using PROBAC® (INDO-FRENCH bacteria in patients hospitalized in the ICU of Mosul LABORATORIES LTD, Chennai, Tamil Nadu, India) General Hospital in Mosul, Iraq, from February 2021 to kits. After identifying the bacteria, we selected antibiotics March 2022, as well as the frequency of essential resistant using Clinical and Laboratory Standards Institute (CLSI) bacteria in the hospital context isolated from ICU patients, guidelines and submitted them to the antibiogram using an their etiology, and their resistance. agar diffusion disk. Excel collected and analyzed data.       Medical Journal of Babylon ¦ Volume 21 ¦ Supplement 1 ¦ June 2024 S71    Oudah: Antibiotic resistance of pathogenic bacteria isolated from healthcare rooms in Mosul Bacterial isolation The swabs were collected and transported in Stuart transport media to our university’s Department of Microbiology and Parasitology, where they were analyzed at the Mycobacteria Laboratory. To obtain considerable bacterial growth for effective isolation, the collected swabs were seeded in broth BHI medium and Downloaded from http://journals.lww.com/mjby by BhDMf5ePHKav1zEoum1tQfN4a+kJLhEZgbsIHo4XMi0hCywCX1AW cultured at 35°C–37°C for roughly 1–2 h. Following this, the samples were planted on Mannitol Agar, Blood Agar (BHI agar mixed with 5% defibrinated sheep blood), and Mac Conkey Agar for the isolation of Gram-negative Figure 1: OXA-25 test of two strains. Strain 2 is negative to the test, nYQp/IlQrHD3i3D0OdRyi7TvSFl4Cf3VC1y0abggQZXdtwnfKZBYtws= on 10/28/2024 bacilli and Staphylococcus spp. In this study, all media showing no growth on the plate. Strain 3 is positive, showing growth were obtained from HiMedia Leading BioSciences over the plate Company, India. ORS sensitivity test against other antimicrobials Staphylococcus genus identification For each Staphylococcus isolate resistant to oxacillin, Bacterial colonies that grew on mannitol agar and that the susceptibility to antimicrobial agents was determined showed morphotinctorial characteristics of Gram-positive using disk diffusion test (DDT) on Muller-Hinton agar cocci, positive catalase test, and resistance to bacitracin (India, Himedia). The following antimicrobial agents were disc 0.04 μg were confirmed as belonging to the genus obtained from (Oxoid, U.K), as standard reference disks Staphylococcus. To differentiate these microorganisms as known potency for laboratory use penicillin 10 μg, between S. aureus and SCN, the tube coagulase test was chloramphenicol 30 μg, gentamicin 10 μg, ciprofloxacin performed: bacteria that were positive for this test were 05 μg, sulfamethoxazole–trimethoprim 25 μg (SUT), classified as S. aureus, whereas those that were negative for linezolid 30 μg, teicoplanin 30 μg, mupirocin 5 μg, this test were classified as SCN. erythromycin 15 μg, and clindamycin. These plates were incubated at 35°C for 18h for S. aureus and 24h for SCN. Staphylococcus spp. oxacillin resistance by disc A ruler was used for measuring the growth inhibition zone diffusion method around each antibiotic disc after this period. Cutoff A 30 μg cefoxitin disc was tested for each Staphylococcus points classified the bacteria as sensitive, intermediate, or spp. (a drug used as a marker of oxacillin resistance). resistant to the antimicrobials. Distension in Muller–Hinton agar seeded the bacterial E-tests were used to determine mupirocin disk-resistant samples: Colonies of similar appearance from each strains’ minimum inhibitory concentrations (MICs) bacterial sample were diluted in saline solution, adjusted (Biomerieux, Lyon, France). According to item 3.4.1, to 0.5 on the Mac Farland scale (approximately 1.5 × 108 bacterial samples were sown by distention on Muller– CFU/mL), and streaked by distention through a sterile Hinton agar plates with a swab. After this, sterile tweezers swab onto a Muller–Hinton agar plate. After that, the were placed on the mupirocin E-test strip in the center cefoxitin disc was placed on the plate and incubated for of the plate. A bacteriological oven incubated the plates 24 h in an oven at 35°C–37°C to detect oxacillin resistance. for 18 h at 35°C–37°C. After this, the test was read by After this period, the antibiotic disk’s growth inhibition visualizing the MIC at the intersection of the E-test zone was measured. The cutoff points classified the strip and the bacterial growth. High-mupirocin-resistant samples as sensitive, intermediate, or resistant to the strains had MIC ≥512 μg/mL. Those with MICs between antibiotic. 8 and 256 μg/mL were resistant to intermediate levels of mupirocin, whereas those with MICs 1024 μg/mL) environmental bacteria 25 Staphylococcus coagulase 89 K. pneumoniae 1 S. aureus 7 Enterococcus sp 5 A. baumannii 7 0 10 20 30 40 50 60 70 80 90 100 Figure 5: Occurrence of bacteria on ICU surfaces and equipment Results of ICU surface analysis dispensers analyzed, two (beds 2 and 5) were contaminated A total of 134 bacteria were found on all of the beds, with S. aureus, as well as the mechanical ventilator in bed 01 pieces of equipment, and surfaces that were examined; 20 and the cardiac monitor buttons in bed 2 were contaminated of these are strongly considered to be HI-causing bacteria. by this microorganism. On bedside tables, Enterococcus sp. The remaining 89 isolates consist of coagulase-negative and S. aureus, bed 1 and 2, respectively. In bed 4, both in Staphylococci, which typically colonize the skin but can the diaphragm of the stethoscope and in the mechanical become pathogens in specific patient circumstances, and ventilator, isolates of A. baumannii were identified. environmental bacteria (25 isolates), which were given this As for infusion pumps, isolates of Enterococcus sp. and name in the current study because the biochemical tests A. baumannii in bed 1 and 2, respectively, and in the used for the routine identification of bacteria of clinical curtain around bed 2, Enterococcus sp., S. aureus, and A. interest were unable to identify them even though they had baumannii were found. There was no bacterial growth on bacterial morphology. the wall around the bed, on the curtain of bed 1, and the Among the bacteria possibly causing HI identified on wall around bed 6. ICU equipment and surfaces, the highest occurrence was The place where most contamination by bacteria that cause Acinetobacter baumannii and Staphylococcus aureus with HI was identified was on the stethoscope’s diaphragm, where a total of seven isolates of each, followed by Enterococcus Enterococcus sp., K. pneumoniae, A. baumannii, and S. aureus sp. with five isolates and K. pneumoniae with one isolate were identified. It is essential to point out that the stethoscope found [Figure 5]. is one of the most manipulated pieces of equipment in the It is observed in Table 2 that in all analyzed beds, possible bed of critically ill patients due to the physical examination bacteria that cause HI were isolated. Of the six serum by the professionals who assist the patient.        S76 76  Medical Journal of Babylon ¦ Volume 21 ¦ Supplement 1 ¦ June 2024  Oudah: Antibiotic resistance of pathogenic bacteria isolated from healthcare rooms in Mosul Table 3: Resistance and sensitivity profile of bacteria isolated from ICU surfaces and equipment Tested antibiotics Staphylococcus aureus Enterococcus sp. K. pneumoniae Acinetobacter baumannii R S R S R S R S Clindamycin 100% 0% — — — — — — Tetracycline 100% 0% — — 0 100% 58% 42% Vancomycin — — 0% 81% — — — — Downloaded from http://journals.lww.com/mjby by BhDMf5ePHKav1zEoum1tQfN4a+kJLhEZgbsIHo4XMi0hCywCX1AW Cefepime — — — — 0% 100% 58% 42% Ampicillin and sulbactam — — — — 100% 0 58% 42% Ciprofloxacin — — — — 0 100% 58% 42% Gentamicin 87% 13% — — 0 100% 58% 42% nYQp/IlQrHD3i3D0OdRyi7TvSFl4Cf3VC1y0abggQZXdtwnfKZBYtws= on 10/28/2024 Ceftriaxone — — — — 0 100% 58% 42% Ampicillin — — 20% 80% 0 100% — — Cefoxitin — — — — 0 100% — — Oxacillin 100% 0% — — — — — — Chloramphenicol 100% 0% — — — — — — Levofloxacin 100% 0% — — — — — — Penicillin 100% 0% — — — — — — Piperacillin sodium + — — — — 0% 100% 58% 42% tazobactam Colistin — — — — 0% 100% — — Meropenem — — — — 0% 100% 58% 42% (—) indicates no test was carried out Table 3 illustrates the resistance and sensitivity profile of decolonization of ORSA patients by hospital staff may bacteria isolated from ICU surfaces and equipment. have had an impact on the prevalence of S. aureus in this study. A nasal swab is used to check for this pathogen after ICU admission. Discussion On day seven of hospitalization, ORSA nasal mupirocin Bacterial resistance has risen as a result of excessive antibiotic decolonization was performed, and samples were use. According to this study, resistant bacteria are common. collected. For 12 weeks, topical treatment eradicates S. Oxacillin-resistant SCN presented in significant amounts in aureus nose carriers. Ninety-seven percent (97/98) of the global samples. Approximately, 80%–90% depending on the ORS strains identified by disc diffusion tested positive for species. Around 79.5%, 89.6%, and 96% of S. epidermidis, oxacillin resistance using the additional test OXA-25. Staphylococcus haemolyticus, and Staphylococcus cohnii had oxacillin resistance, respectively. Hospital-derived Staphylococcus spp. resistant to oxacillin is resistant to several groups of antimicrobials SCN species are found on human mucous membranes because of the SCCmec chromosomal cassette, which and skin. In the nose, inguinal area, and armpits, contains the mecA gene and genes that confer resistance microorganisms are present. Through intravenous to many antimicrobials.[20,21] These strains have additional catheters and valve prostheses, skin microorganisms can resistance genes, so additional antimicrobial sensitivity enter the bloodstream. Septicemia strikes ICU patients tests are required. at risk for infections. Blood infections are harder to treat Globally, resistance varies. S. aureus resistance in India was because of oxacillin-resistant bacteria in SCN. Treatment 6% compared with 13.2% in the United States.[22,23] Around options are limited by lactam resistance. 7.8% of SCN was discovered in a French tertiary hospital Due to the rise in the number of hospitalized study, and 28% in an Indian one. In Iraq, 12% of nosocomial immunosuppressed patients and the use of these S. haemolyticus strains were drug-resistant. All S. aureus invasive medical devices, CNS has emerged as a major strains were mupirocin-sensitive, but 13% (12/92) of SCN blood infection etiology. Staphylococcus epidermidis is resistant to oxacillin were as well, which is comparable with responsible for 50%–70% of infections in medical devices Fowler et al. and the average across all global surveys. (central venous catheters, osteoarticular prostheses, and S. aureus and other Staphylococcus spp. may inherit the heart valves). resistance gene from mupirocin-resistant SCN strains. Nine S. aureus out of 114 patients with colonization Nasal decolonization is more difficult because mupirozin (7.8%). Around 30% of the anterior nostrils of healthy no longer kills ORSA strains. The number of ESBLs adults are colonized by this species. Mupirocin nasal in the isolated enterobacteria, 39.09% (52 of 133), was       Medical Journal of Babylon ¦ Volume 21 ¦ Supplement 1 ¦ June 2024 S77    Oudah: Antibiotic resistance of pathogenic bacteria isolated from healthcare rooms in Mosul higher than in other nations. The prevalence of ESBLs do not ferment are more resistant to carbapenems. It is varies by geography. France had 22.3% and Uganda had challenging to treat resistant microorganisms because 62.1% of enterobacteria that produced ESBLs. The use many β-lactams are ineffective. of antibiotics and local antibiotic-resistant bacteria make MBL, a carbapenemase enzyme, is the source of carbapenem ESBL and other pathogens heterogeneous. With drug use, resistance in non-fermenting bacteria. MHT positivity was antimicrobial resistance increases. found in 16/24 carbapenem-resistant enterobacteria. Since Downloaded from http://journals.lww.com/mjby by BhDMf5ePHKav1zEoum1tQfN4a+kJLhEZgbsIHo4XMi0hCywCX1AW A total of 144 patients (36.2%) had ESBL. This resistance 2009, CLSI has advised testing for carbapenemases such as mechanism was visible in ICU rectal swabs. Korea had Klebsiella pneumoniae carbapenemase, KPC, (sensitivity 28.2% ESBL in its ICU patients. In Sweden, 1–30 of 90%) and carbapenemase OXA-48 (sensitivity of 93%). days of hospitalization were required for 56% of ESBL- Antibiotic use, length of hospital stay, patient age, and clinical condition are all associated with highly resistant nYQp/IlQrHD3i3D0OdRyi7TvSFl4Cf3VC1y0abggQZXdtwnfKZBYtws= on 10/28/2024 colonized neonatal ICU patients. Our colonization rate is in line with the global average. bacteria. In this study, clinical variables, patient ORS, and Rcarb bacterial colonization were investigated. For nonfermenters including Acinetobacter and P. aeruginosa, patients in ICUs P. aeruginosa causes bacteremia, Highly resistant strains are a result of the improper use UTIs, and lower respiratory tract infections (LUTIs). Along of antibiotics in prescription drugs. This study found a with overexpressing AmpC, it also rejects carbapenems. statistically significant correlation between patient use of carbapenem and Rcarb, highlighting the danger of bacteria Similar to a study conducted in a southern nation, 23/40 that are resistant to antibiotics. Using antimicrobials P. aeruginosa strains produced AmpC at a rate of 57.5%. carelessly and frequently favors resistant bacteria while AmpC-lactamase was present in 42.8% of Indian ICU- reducing sensitive bacteria. As previously mentioned, isolated Pseudomonas species. A higher prevalence was carbapenems selectively favored Rcarb bacteria until discovered in this study. It is concerning that this bacterium their population grew, increasing the likelihood that has the AmpC enzyme, which confers resistance to almost carbapenem users would become colonized by them. all beta-lactam antibiotics other than carbapenems. To address this issue, cut back on the use of antibiotics, It naturally has more β-lactam resistance genes than rationalize prescriptions, and shorten treatment. enterobacteria, which restricts its access to antibiotics. Age, length of stay, and diagnosis did not show any Accurate AmpC beta-lactamase production testing statistically significant results in this study because it was is required for P. aeruginosa and other organisms due not possible to select samples “randomly” (as advised to the possibility of treatment-induced resistance. for statistical research). All eligible patients couldn’t be Microorganisms that produce AmpC beta-lactamase, swabbed due to medical restrictions. Convenient collection which is cephalosporin-resistant, may produce excessive was determined by patient availability. amounts of it while being treated. The control committees of nosocomial infection debate Acinetobacter bacilli that do not ferment colonize both whether the statistical outcomes of these variables are people and their environment. For 30 years,[5,6] they have impacted by the transfer of resistant bacteria between significantly increased morbidity and mortality in ICU patient beds by healthcare professionals. patients with bacteremia. Around 65.5% of patients with Thus, the clinical factor that was directly correlated with bloodstream infections in Iraq die from this bacterium. the increase in the colonization of patients by resistant Due to the microorganism’s inherent resistance to many bacteria in this study was the use of carbapenems in antibiotics, treatment options are limited, which increases the antibiotic therapy. This suggests the need to prevent mortality rate. Drug-resistant mobile genetic elements can be and control the emergence and dissemination of these quickly acquired by opportunistic bacteria. This genus faces microorganisms through measures that reduce the action a health risk due to widespread carbapenem resistance.[1,2] of this risk factor in the emergence of resistant bacteria. In an ICU, where HI rates are high, microorganisms on In this study, 81% of the Acinetobacter species were surfaces, stethoscopes, and medical records can cause carbapenem-resistant. In a local study, 73.3% of isolates cross-infection. In Mosul, Iraq, 91.9% of stethoscopes of this species were carbapenem-resistant. Only a few were contaminated. Acinetobacter spp., S. aureus, treatments are effective against highly resistant bacteria. CNS, saprophyticus, enterococcus, K. pneumoniae, and Polymyxin B and colistin are among the drugs under Streptococcus viridans were found on 95% of ICU consideration. These antibiotics are efficient against equipment. In this study, bacteria-infected 93.8% of bacteria, particularly colistin-resistant bacteria.[10,22] equipment. Most microorganisms on bed rails, faucets, Nonfermenters (Acinetobacter spp., 81%; P. aeruginosa, keyboards, and monitors may have come from the 40%) outperformed Enterobacteriaceae (18%) in terms operating room and ICU, critical hospital settings. This of carbapenem resistance. Gram-negative bacteria that supports the current study’s finding of risky bacteria.        S78 78  Medical Journal of Babylon ¦ Volume 21 ¦ Supplement 1 ¦ June 2024  Oudah: Antibiotic resistance of pathogenic bacteria isolated from healthcare rooms in Mosul HI-causing microorganisms have resistance mechanisms, baumannii, and S. aureus. Antibiotic-resistant bacteria are so environmental cleaning and seasonal conditions present on ICU surfaces and inanimate objects. (natural physical phenomena) that favor microorganism replication and cross-infection must be monitored. Financial support and sponsorship A. baumannii was the most common Gram-negative Nil. microorganism on surfaces and equipment and in blood cultures of Iraqi hospital patients. Due to its antibiotic Conflicts of interest Downloaded from http://journals.lww.com/mjby by BhDMf5ePHKav1zEoum1tQfN4a+kJLhEZgbsIHo4XMi0hCywCX1AW resistance and adaptability, this bacterial genus worries There are no conflicts of interest. hospitals. A. baumannii resists carbapenems by producing OXA-23 carbapenems, the most common resistance mechanism. This microorganism’s high resistance rate References nYQp/IlQrHD3i3D0OdRyi7TvSFl4Cf3VC1y0abggQZXdtwnfKZBYtws= on 10/28/2024 reflects the ICU mortality rise. 1. Lee W, Park S, Bang D, Chu E, Park S, Kim Y, et al. Analysis on the Causes of Hospital-Acquired Infections in the Intensive Care Unit Carbapenems can treat A. baumannii infections, but of Medical City in Iraq. 4th International Inter Science Conference on Infection and Chemotherapy & 12th International Symposium resistance rates are rising. Polymyxin B, tigecycline, on Antimicrobial Agents and Resistance, Dubai, UAE; 2019. ampicillin + sulbactam, and colistin are carbapenem 2. Alwan F, Salih Mahdi K, Hussein D. Evaluation of nosocomial alternatives. bacteria in Babylon province, Iraq. Int J Health Sci 2022;6:5219-27. 3. Monegro AF, Muppidi V, Regunath H. Hospital Acquired The study found that most S. aureus, are a leading cause Infections. Treasure Island, FL: StatPearls Publishing; 2022. of human infections. MRSA is a hospital issue. The mecA 4. Ali WI, Fawzi HA, Lafta H, Mohammed S, Ameer N. Point gene encodes PBP2a, which confers resistance. prevalence of healthcare associated infection and its risk factors among patients admitted to the intensive care unit in Baghdad In bed 1, Enterococcus sp. was found on the curtains and Medical City. Indian J Public Health Res Dev 2019;10:535. 5. Asadi S. An Investigation into the type of bacteria causing stethoscope, a species linked to several human infections healthcare associated infections (HAIs) in hospital departments and VRE. Vancomycin-binding peptidoglycan precursors and areas- in Karbala. Sci J Med Res 2017;01:119-24. in Enterococcus’ cell walls make it resistant. Vancomycin- 6. Suksatan W, Jasim SA, Widjaja G, Jalil AT, Chupradit S, Ansari resistant genes include vanA and vanB, with vanB1, vanB2, MJ, et al. Assessment effects and risk of nosocomial infection and needle sticks injuries among patents and health care worker. and vanB3 being the most common. To prevent resistant Toxicol Rep 2022;9:284-92. strains from spreading, plasmid-transmitted genes must 7. Alzaidi JR, Mohammed AS. First record of dissemination of be prevented. K. pneumoniae, a Gram-negative bacillus in BLBLI-resistant Enterobacter cloacae from public hospitals in the intestinal flora, was found on surfaces and equipment. Baghdad, Iraq. Open Microbiol J 2022;16:e187428582201310. 8. Sultan F, Latef S. Prevalence of Staphylococcus aureus toxins Pneumonia, urinary tract infections, soft tissue infections, genes in clinical and food isolates in Iraq. J Pharm Sci Res 2019 and gastrointestinal tract infections are all possible from ;11:636-42. these bacteria. K. pneumoniae outbreaks have been caused 9. Toner E, Adalja A, Gronvall G, Cicero A, Inglesby T. by medically difficult strains and infections. K. pneumoniae Antimicrobial resistance is a global health emergency. Health Secur 2015;13:153-5. has become a hospital threat due to virulence factors 10. Abd Ghani MK, Jaber MM, Aboobaider BM, Russin H, and bacterial evolution. K. pneumoniae carbapenems Mohammed MA, Yaacob NM, et al. Analysis of healthcare system must be identified to stop its spread. ICU staff disinfect in Iraq. Soc Sci 2016;11:2877-84. surfaces and wash their hands to reduce HI-causing 11. Artim S, Sheh A, Burns M, Fox J. Evaluating rectal swab collection method for gut microbiome analysis in the common marmoset microorganisms.[2,29] Knowing which microorganisms (Callithrix jacchus). PLoS One 2019;14:e0224950. are on surfaces and equipment is crucial to providing 12. Larsson M, Karlsson E, Woksepp H, Frölander K, Mårtensson A, adequate care for critically ill patients in the studied unit. Rashed F, et al. Rapid identification of pneumococci, enterococci, beta-haemolytic streptococci and S. aureus from positive blood cultures enabling early reports. BMC Infect Dis 2014;14. Conclusion doi:10.1186/1471-2334-14-146. 13. Clinical and Laboratory Standards Institute. Performance This study demonstrated the need for hospitals to take Standards for Antimicrobial Susceptibility Testing, M100. 31st ed. additional precautions to stop the spread of coagulase- Wayne, PA: Clinical and Laboratory Standards Institute; 2021. 14. Weinstein MP, Lewis JS, II. The Clinical and Laboratory Standards negative Staphylococcus spp. resistance to mupirocin and to Institute Subcommittee on antimicrobial susceptibility testing: ensure nasal decontamination. Most carbapenem-resistant Background, organization, functions, and processes. J Clin enterobacteria in the modified Hodge test produced Microbiol 2020;58:e01864-19. KPC enzyme or OXA-48, whereas, in the MBL test, the 15. Lee A, de Lencastre H, Garau J, Kluytmans J, Malhotra-Kumar S, Peschel A, et al. Methicillin-resistant Staphylococcus aureus. Nat Rev majority of nonfermenting bacteria produced metallo- Dis Primers 2018;4:18033. doi: https://doi.org/10.1038/nrdp.2018.33. lactamase. The high prevalence of resistant bacteria in this 16. Khulaif M, Al-Charrakh AH. Detection of class 1 integron and study demonstrates the need for improved ICU antibiotic antibiotic resistance of β-lactamase-producing Escherichia coli isolated from four hospitals in Babylon, Iraq. Med J Babylon monitoring and rationalization at Mosul Hospital if we are 2023;20:375-82. to stop the occurrence and spread of these diseases. ICU 17. Gupta G, Tak V, Mathur P. Detection of ampc β lactamases in isolates contained Enterococcus species, K. pneumoniae, A. gram-negative bacteria. J Lab Physicians 2014;6:1-6.       Medical Journal of Babylon ¦ Volume 21 ¦ Supplement 1 ¦ June 2024 S79    Oudah: Antibiotic resistance of pathogenic bacteria isolated from healthcare rooms in Mosul 18. Sader HS, Jones RN. Antimicrobial activity of daptomycin in 24. Kim J, Lee JY, Kim SI, Song W, Kim J-S, Jung S, et al. Rates of comparison to glycopeptides and other antimicrobials when tested fecal transmission of extended-spectrum β-lactamase-producing against numerous species of coagulase-negative Staphylococcus. and carbapenem-resistant Enterobacteriaceae among patients in Diagn Microbiol Infect Dis 2012;73:212-4. intensive care units in Korea. Ann Lab Med 2014;34:20-5. 19. Fowler VG Jr, Chen LF, Tong SYC. Colonization, pathogenicity, 25. Nordberg V, Quizhpe Peralta A, Galindo T, Turlej-Rogacka host susceptibility and therapeutics for Staphylococcus aureus: A, Iversen A, Giske CG, et al. High proportion of intestinal What is the clinical relevance? Sem Immunopathol 2012;34:185-200. colonization with successful epidemic clones of ESBL-producing 20. Lelièvre H, Lina G, Jones M, Olive C, Forey F, Roussel-Delvallez Enterobacteriaceae in a neonatal intensive care unit in Ecuador. Downloaded from http://journals.lww.com/mjby by BhDMf5ePHKav1zEoum1tQfN4a+kJLhEZgbsIHo4XMi0hCywCX1AW M, et al. Emergence and spread in French hospitals of methicillin- PLoS One 2013;8:e76597-7. resistant Staphylococcus aureus with increasing susceptibility 26. Gupta R, et al. Incidence of Multi-drug Pseudomonas spp. In ICU to gentamicin and other antibiotics. J Clin Microbiol 1999;37. patients with special reference in ESBL, AMPC, MBL and biofilm doi:10.1128/JCM.37.11.3452-3457.1999. production. J Glob Infect Dis 2016;8:25-31. 21. Shore A, Coleman D. Staphylococcal cassette chromosome mec: 27. Radhi SH, Al-Charrakh AH. Occurrence of MBLs and Recent advances and new insights. Int J Med Microbiol 2013:303. carbapenemases among MDR and XDR Acinetobacter baumannii nYQp/IlQrHD3i3D0OdRyi7TvSFl4Cf3VC1y0abggQZXdtwnfKZBYtws= on 10/28/2024 doi:10.1016/j.ijmm.2013.02.002. isolated from hospitals in Iraq. Indian J of Public Health Res Dev 22. Gadepalli R, Dhawan B, Mohanty S, Kapil A, Das B, Chaudhry 2019;10:668-74. R, et al. Mupirocin resistance in Staphylococcus aureus in an 28. Alzaidi JR. Prevalence of OXA genes responsible for carbapenem- Indian hospital. Diagn Microbiol Infect Dis 2007;58. doi:10.1016/j. resistance among Acinetobacter baumannii isolated from clinical diagmicrobio.2006.10.012. samples in Iraq. Med J Babylon 2023;20:632-7. 23. Jones JC, Rogers TJ, Brookmeyer P, Dunne WM, Storch GA, 29. Jebur HQ, Al-Charrakh AH. The effect of carbonyl cyanide Coopersmith CM, et al. Mupirocin resistance in patients colonized m-chlorophenyl-hydrazine on antibiotic susceptibility in MDR with methicillin-resistant Staphylococcus aureus in a surgical Enterobacteriaceae isolates in Babylon, Iraq. Med J Babylon intensive care unit. Clin Infect Dis 2007;45:541-7. 2024;21:179-85.        S80 80  Medical Journal of Babylon ¦ Volume 21 ¦ Supplement 1 ¦ June 2024