First data on antimicrobial susceptibility patterns of Moraxella catarrhalis isolates in Lebanon

Authors

  • Monzer Hamze Laboratoire Microbiologie Santé et Environnement (LMSE), Ecole Doctorale des Sciences et de Technologie, Faculté de Santé Publique, Université Libanaise, Tripoli, Lebanon
  • Marwan Osman
  • Hassan Mallat
  • Marcel El Achkar

DOI:

https://doi.org/10.3823/833

Keywords:

Moraxella catarrhalis, Antimicrobial Resistance, Epidemiology, Lebanon

Abstract

Background. Moraxella catarrhalis is an important bacterial pathogen. Although national data have shown an increase in the levels of antimicrobial resistance in clinical settings in Lebanon, there is a lack of data regarding this human pathogen. This study aimed to determine for the first time the antimicrobial susceptibility profiles of M. catarrhalis isolates in Lebanon.

Methods. A total of 34 M. catarrhalis strains were isolated from clinical specimens during the period from November 2010 to March 2019. Bacterial identification was carried out using matrix assisted laser desorption ionization–time of flight mass spectrometry. Antibiotic susceptibility of all isolates was performed according the recommendations of the European Committee on Antimicrobial Susceptibility Testing (EUCAST).

Results. A total of 34 non-duplicated M. catarrhalis strains were isolated from nose (n=19), ear (n=7), sputum (n=5), blood (n=1), eye (n=1), and throat (n=1) of patients referred to Nini Hospital in Tripoli, North governorate of Lebanon. Regarding antibiotic susceptibility rates, the percent susceptibility is 100% to the majority of antibiotics, except ampicillin (7.4%), trimethoprim-sulfamethoxazole (85.3%), nalidixic acid (85.3%), and ciprofloxacin (97.1%).

Conclusion. To our knowledge, this study is the first investigation regarding the antimicrobial susceptibility patterns of M. catarrhalis isolates in Lebanon. In addition to the high level of resistance to ampicillin, our findings showed the emergence of resistance to trimethoprim-sulfamethoxazole, nalidixic acid and ciprofloxacin. Even if this study provides useful information to develop effective empirical treatment, we recommend the implementation of reliable diagnostic tools to guide appropriate treatment.

References

Spaniol V, Bernhard S, Aebi C. Moraxella catarrhalis AcrAB-OprM efflux pump contributes to antimicrobial resistance and is enhanced during cold shock response. Antimicrob Agents Chemother. 2015;59(4):1886-94. doi: 10.1128/AAC.03727-14. PubMed PMID: 25583725; PubMed Central PMCID: PMC4356836.

Hsu SF, Lin YT, Chen TL, Siu LK, Hsueh PR, Huang ST, et al. Antimicrobial resistance of Moraxella catarrhalis isolates in Taiwan. J Microbiol Immunol Infect. 2012;45(2):134-40. doi: 10.1016/j.jmii.2011.09.004. PubMed PMID: 22154675.

Aebi C. Moraxella catarrhalis - pathogen or commensal? Adv Exp Med Biol. 2011;697:107-16. doi: 10.1007/978-1-4419-7185-2_9. PubMed PMID: 21120723.

Gumerova NI, Al-Sayed E, Krivosudsky L, Cipcic-Paljetak H, Verbanac D, Rompel A. Antibacterial Activity of Polyoxometalates Against Moraxella catarrhalis. Front Chem. 2018;6:336. doi: 10.3389/fchem.2018.00336. PubMed PMID: 30155460; PubMed Central PMCID: PMC6102686.

Khan MA, Northwood JB, Levy F, Verhaegh SJ, Farrell DJ, Van Belkum A, et al. bro {beta}-lactamase and antibiotic resistances in a global cross-sectional study of Moraxella catarrhalis from children and adults. J Antimicrob Chemother. 2010;65(1):91-7. doi: 10.1093/jac/dkp401. PubMed PMID: 19889789.

Al Omari S, Al Mir H, Wrayde S, Merhabi S, Dhaybi I, Jamal S, et al. First Lebanese Antibiotic Awareness Week campaign: knowledge, attitudes and practices towards antibiotics. J Hosp Infect. 2019;101(4):475-9. doi: https://doi.org/10.1016/j.jhin.2018.07.009.

Jamal S, Al Atrouni A, Rafei R, Dabboussi F, Hamze M, Osman M. Molecular mechanisms of antimicrobial resistance in Acinetobacter baumannii, with a special focus on its epidemiology in Lebanon. J Glob Antimicrob Resist. 2018;15:154-63. doi: https://doi.org/10.1016/j.jgar.2018.05.022.

El Moujaber G, Osman M, Rafei R, Dabboussi F, Hamze M. Molecular mechanisms and epidemiology of resistance in Streptococcus pneumoniae in the Middle East region. J Med Microbiol. 2017;66(7):847-58. doi: 10.1099/jmm.0.000503. PubMed PMID: 28650313.

Osman M, Al Mir H, Rafei R, Dabboussi F, Madec JY, Haenni M, et al. Epidemiology of Antibiotic Resistance in Lebanese Extra-Hospital Settings: an overview. J Glob Antimicrob Resist. 2018. doi: 10.1016/j.jgar.2018.11.019. PubMed PMID: 30553113.

Hamze M, Osman M, Mallat H, Nasr S, BouRaad E, Achkar M. Epidemiology and antibiotic susceptibility patterns of carbapenem-resistant Gram-negative bacteria isolated from two tertiary care hospitals in North Lebanon. Int Arab J Antimicrob Agents. 2018;8(2:3). doi: 110.3823/823.

Osman M, Mallat H, Hamze M, Achkar M. Prevalence and antibiotic susceptibility patterns of bacteria causing urinary tract infections in Youssef Hospital Center: first report from Akkar governorate, North Lebanon. Int Arab J Antimicrob Agents. 2017;7(1:2). doi: 10.3823/0802.

Moghnieh R, Araj GF, Awad L, Daoud Z, Mokhbat JE, Jisr T, et al. A compilation of antimicrobial susceptibility data from a network of 13 Lebanese hospitals reflecting the national situation during 2015-2016. Antimicrob Resist Infect Control. 2019;8:41. doi: 10.1186/s13756-019-0487-5. PubMed PMID: 30828445; PubMed Central PMCID: PMC6381724.

Shaikh SB, Ahmed Z, Arsalan SA, Shafiq S. Prevalence and resistance pattern of Moraxella catarrhalis in community-acquired lower respiratory tract infections. Infect Drug Resist. 2015;8:263-7. doi: 10.2147/IDR.S84209. PubMed PMID: 26261422; PubMed Central PMCID: PMC4527568.

Murphy TF, Parameswaran GI. Moraxella catarrhalis, a human respiratory tract pathogen. Clin Infect Dis. 2009;49(1):124-31. doi: 10.1086/599375. PubMed PMID: 19480579.

Doern GV, Jones RN, Pfaller MA, Kugler K. Haemophilus influenzae and Moraxella catarrhalis from patients with community-acquired respiratory tract infections: antimicrobial susceptibility patterns from the SENTRY antimicrobial Surveillance Program (United States and Canada, 1997). Antimicrob Agents Chemother. 1999;43(2):385-9. PubMed PMID: 9925540; PubMed Central PMCID: PMC89085.

Srifuengfung S, Tribuddharat C, Phoomniyom S, Chuanphung S. Prevalence and antimicrobial susceptibility of Haemophilus influenzae and Moraxella catarrhalis isolated from patients in Bangkok, Thailand. J Glob Antimicrob Resist. 2016;5:86-7. doi: 10.1016/j.jgar.2015.11.001. PubMed PMID: 27436474.

Harrison CJ, Woods C, Stout G, Martin B, Selvarangan R. Susceptibilities of Haemophilus influenzae, Streptococcus pneumoniae, including serotype 19A, and Moraxella catarrhalis paediatric isolates from 2005 to 2007 to commonly used antibiotics. J Antimicrob Chemother. 2009;63(3):511-9. doi: 10.1093/jac/dkn538. PubMed PMID: 19174454.

Bandet T, Whitehead S, Blondel-Hill E, Wagner K, Cheeptham N. Susceptibility of clinical Moraxella catarrhalis isolates in British Columbia to six empirically prescribed antibiotic agents. Can J Infect Dis Med Microbiol. 2014;25(3):155-8. PubMed PMID: 25285112; PubMed Central PMCID: PMC4173978.

Shi W, Wen D, Chen C, Yuan L, Gao W, Tang P, et al. beta-Lactamase production and antibiotic susceptibility pattern of Moraxella catarrhalis isolates collected from two county hospitals in China. BMC Microbiol. 2018;18(1):77. doi: 10.1186/s12866-018-1217-5. PubMed PMID: 30029595; PubMed Central PMCID: PMC6054730.

Mulu W, Yizengaw E, Alemu M, Mekonnen D, Hailu D, Ketemaw K, et al. Pharyngeal colonization and drug resistance profiles of Morraxella catarrhalis, Streptococcus pneumoniae, Staphylococcus aureus, and Haemophilus influenzae among HIV infected children attending ART Clinic of Felegehiwot Referral Hospital, Ethiopia. PLoS One. 2018;13(5):e0196722. doi: 10.1371/journal.pone.0196722. PubMed PMID: 29746496; PubMed Central PMCID: PMC5944927.

Khemiri H, Smaoui H, Kechrid A. [Antimicrobial susceptibility of 80 Moraxella catarrhalis strains isolated in the children's hospital of Tunis]. Pathol Biol (Paris). 2008;56(3):158-61. doi: 10.1016/j.patbio.2007.09.021. PubMed PMID: 18178028.

Pingault NM, Bowman JM, Lehmann D, Riley TV. Antimicrobial susceptibility of Moraxella catarrhalis isolated from children in Kalgoorlie-Boulder, Western Australia. Pathology. 2010;42(3):273-9. doi: 10.3109/00313021003631270. PubMed PMID: 20350222.

Zhanel GG, Karlowsky JA, Low DE, Hoban DJ. Antibiotic resistance in respiratory tract isolates of Haemophilus influenzae and Moraxella catarrhalis collected from across Canada in 1997-1998. J Antimicrob Chemother. 2000;45(5):655-62. doi: 10.1093/jac/45.5.655. PubMed PMID: 10797089.

Maraki S, Papadakis IS. Antimicrobial resistance trends among community-acquired respiratory tract pathogens in Greece, 2009-2012. ScientificWorldJournal. 2014;2014:941564. doi: 10.1155/2014/941564. PubMed PMID: 24592201; PubMed Central PMCID: PMC3925540.

Khoramrooz SS, Mirsalehian A, Emaneini M, Jabalameli F, Aligholi M, Saedi B, et al. Frequency of Alloicoccus otitidis, Streptococcus pneumoniae, Moraxella catarrhalis and Haemophilus influenzae in children with otitis media with effusion (OME) in Iranian patients. Auris Nasus Larynx. 2012;39(4):369-73. doi: 10.1016/j.anl.2011.07.002. PubMed PMID: 21868180.

Hamze M, Osman M, Mallat H, Achkar M. Prevalence and antibiotic susceptibility of ear pathogens isolated from patients in Tripoli, north of Lebanon. Int Arab J Antimicrob Agents. 2017;7(1:1). doi: 10.3823/0801.

Christophy R, Osman M, Mallat H, Achkar M, Ziedeh A, Moukaddem W, et al. Prevalence, antibiotic susceptibility and characterization of antibiotic resistant genes among carbapenem-resistant Gram-negative bacilli and yeast in intestinal flora of cancer patients in North Lebanon. J Infect Public Health. 2017;10(6):716-20. doi: 10.1016/j.jiph.2016.10.009. PubMed PMID: 28216021.

El Achkar S, Demanche C, Osman M, Rafei R, Ismail MB, Yaacoub H, et al. Drug-Resistant Tuberculosis, Lebanon, 2016 - 2017. Emerg Infect Dis. 2019;25(3):564-8. doi: 10.3201/eid2503.181375. PubMed PMID: 30789124; PubMed Central PMCID: PMC6390733.

El Ashkar S, Osman M, Rafei R, Mallat H, Achkar M, Dabboussi F, et al. Molecular detection of genes responsible for macrolide resistance among Streptococcus pneumoniae isolated in North Lebanon. J Infect Public Health. 2017;10(6):745-8. doi: 10.1016/j.jiph.2016.11.014. PubMed PMID: 28215918.

Hamze M, Osman M, Achkar M, Mallat H, Dabboussi F. Alarming increase in prevalence of Neisseria gonorrhoeae infections associated with a high level of antibiotic resistance in Tripoli, Lebanon. Int J Antimicrob Agents. 2016;48(5):576-7. doi: 10.1016/j.ijantimicag.2016.08.003. PubMed PMID: 27667565.

Hamze M, Osman M, Mallat H, Achkar M. Antibiotic Susceptibility of Salmonella spp., Shigella spp. and enteropathogenic Escherichia coli strains isolated from diarrheic children in Tripoli, North Lebanon. Int Arab J Antimicrob Agents. 2016;6(2:2). doi: 10.3823/787.

Osman M, Al Nasbeh A, Rafei R, Mallat H, Achkar M, Dabbousi F, et al. Characterization of resistance genes to macrolides, lincosamides and streptogramins (MLS) among clinical isolates of Staphylococcus aureus in North Lebanon. Int Arab J Antimicrob Agents. 2015;5(4:3). doi: 10.3823/780.

Pfaller MA, Farrell DJ, Sader HS, Jones RN. AWARE Ceftaroline Surveillance Program (2008-2010): trends in resistance patterns among Streptococcus pneumoniae, Haemophilus influenzae, and Moraxella catarrhalis in the United States. Clin Infect Dis. 2012;55 Suppl 3:S187-93. doi: 10.1093/cid/cis561. PubMed PMID: 22903951.

Melo-Cristino J, Fernandes ML, Serrano N, Portuguese Surveillance Group for the Study of Respiratory P. A multicenter study of the antimicrobial susceptibility of Haemophilus influenzae, Streptococcus pneumoniae, and Moraxella catarrhalis isolated from patients with community-acquired lower respiratory tract infections in 1999 in Portugal. Microb Drug Resist. 2001;7(1):33-8. doi: 10.1089/107662901750152747. PubMed PMID: 11310801.

Downloads

Published

2019-07-14

Issue

Section

Articles

Most read articles by the same author(s)