Spread of Antibiotic-Resistant Potentially Pathogenic Bacteria in

Hospitals and the Community: Role of the Housefly and

German Cockroach

Ghenghesh KS, Elgaderi R, Rahuma N, Berbash N,

Abeid S and Tawil KA.

Faculty of Medicine, Faculty of Sciences,

Tripoli and Faculty of Arts and

Sciences, Misurata

Please be Kind toNATURE

INTRODUCTION

• Flies and cockroaches have been implicated as vectors or transporters of various human pathogens.

• The biology and ecology of these vectors makes them particularly effective transmitters of such pathogens.

• Studies from different countries have shown that houseflies and German cockroaches collected from hospitals and the community carry antimicrobial-resistant bacteria that may potentially be pathogenic to humans.

Sit back and enjoy the show

Housefly

Don’t be taken by the photos

The Common Species of Cockroaches

You’ve been warned!

German Cockroach

Adult female with ootheca

I’ve told you!

Pathogenic Organisms Isolated either from Houseflies or Cockroaches or from Both

• Bacteria:– Salmonella, Shigella, Yersinia pestis, Mycobacterium leprae,

Diarrheagenic E. coli, Vibrio spp., MRSA, etc.• Viruses:

– Poliomyelitis, Coxsackievirus, Enteroviruses. • Protozoa:

– Entamoeba histolytica, Giardia , Cryptosporidium, Toxoplasma, etc..

• Fungi:– Up to 16 different species of fungi that include – Asperigillus fumigatus and A. niger,

Too many, aren’t they?

Spread of potentially pathogenic bacteria by houseflies and German

cockroaches

Here we go!

I am not with them!

Disgusting!

The Housefly and German Cockroach in Libya

Here we go again!

Bacteria Isolated from Hospital, City Streets and Abattoir Houseflies in Misurata

No (%) positiveOrganism Hospital City Abattoir All

(n=50) (n=50) (n=50) (n=150)-----------------------------------------------------------------------------------------------------------------------------------Escherichia coli 21 (42) 21 (42) 16 (32) 58 (38.7)Salmonella sp 0 (0) 3 (6) 1 (2) 4 (2.7)Shigella sonnei 0 (0) 0 (0) 1 (2) 1 (0.7)Yersinia enterocolitica 0 (0) 2 (4) 1 (2) 3 (2)Edwardsiella tarda 0 (0) 2 (4) 1 (2) 3 (2)Klebsiella spp 35 (70)* 25 (50) 31 (62) 91 (60.7)Enterobacter sp 9 (18) 21 (42)* 10 (20) 40 (26.7)Citrobacter sp 10 (20) 12 (24) 8 (16) 30 (20)Proteus sp 47 (94)* 13 (26) 21 (42) 81 (54)Providencia sp 3 (6) 7 (14) 6 (12) 16 (10.7)Serratia sp 2 (4) 3 (6) 1 (2) 6 (4)Aeromonas sp 1 (2) 10 (20)* 5 (10) 16 (10.7)Flavobacterium sp 1 (2) 1 (2) 1 (2) 3 (2) Pseudomonas sp 48 (96)* 18 (36) 17 (34) 78 (52)Xanthomonas sp 1 (2) 0 (0) 1 (2) 2 (1.3)Weeksella zoohlecum 0 (0) 1 (0) 0 (0) 1 (0.7)Pasteurella sp 0 (0) 1 (2) 2 (4) 3 (2)Staphylococcus sp 10 (20)*# 6 (12) 8 (16) 24 (16)Streptococcus sp 12 (24) 11 (22) 9 (18) 32 (21.3)

Misrata is still nice city!

#2 isolates were MRSA

Antimicrobial Resistance of Gram-Negative Bacilli Isolated from Hospital, City Streets and Abattoir houseflies in Misurata.

No. (%) resistantHospital City streets Abattoir All

Antibiotic (n=108) (n=71) (n=85) (n=264)--------------------------------------------------------------------------------------------------------------------Amoxicillin 86 (79.6) 49 (69) 59 (69.4) 194 (73.5)Amoxicillin–clavulanic acid 55 (50.9)* 25 (35.2) 24 (28.2) 104 (39.4)Cephaloridine 87 (80.6)* 40 (56.3) 46 (54.1) 173 (65.5)Ceftriaxone 33 (30.6)* 3 (4.2) 7 (8.2) 41 (16.5)Chloramphenicol 40 (37.0)* 12 (16.9) 22 (25.9) 67 (27.0)Amikacin 10 (9.3) 2 (2.8) 6 (7.1) 14 (5.7)Kanamycin 37 (34.3)* 10 (14.1) 8 (9.4) 48 (19.4)Norfloxacin 4 (3.7) 0 (0.0) 1 (1.2) 5 (2.0)Nalidixic acid 22 (20.4)* 7 (9.9) 8 (9.4) 37 (14.9)Doxycycline 80 (74.1)* 28 (39.4) 54 (63.5) 146 (58.9)Trimethoprim– 43 (39.8)* 17 (23.9) 14 (16.5) 66 (26.6)

sulphamethoxazole

Too much resistance, not good!

Antimicrobial Resistance of Pseudomonas Isolated from Hospital, City Streets and Abattoir houseflies in Misurata

No. (%) resistantHospital City Abattoir All

Antibiotic (n=48) (n=18) (n=17) (n=83)-------------------------------------------------------------------------------------------------------------Amoxicillin 46 (95.8) 18 (100) 16 (94.1) 80 (96.4)Amoxicillin–clavulanic acid 40 (83.3) 18 (100) 14 (82.4) 72 (86.7)Cephaloridine 45 (93.8) 17 (94.4) 15 (88.2) 77 (92.8)Ceftriaxone 31 (64.6) 13 (72.2) 10 (58.8) 54 (65.1)Chloramphenicol 37 (77.1) 18 (100)* 14 (82.4) 69 (83.1)Amikacin 1 (2.1) 2 (11.1) 0 (0.0) 3 (3.6)Kanamycin 25 (52.1) 14 (77.8) 8 (47.1) 47 (56.6)Norfloxacin 2 (4.2) 0 (0.0) 0 (0.0) 2 (2.4)Nalidixic acid 34 (70.8) 17 (94.4)* 8 (47.1) 59 (71.1)Doxycycline 30 (62.5) 15 (83.3) 15 (88.2) 60 (72.3)Trimethoprim– 35 (72.9) 18 (100)* 9 (52.9) 62 (74.7)

sulphamethoxazole

Not good at all

Bacteria Isolated from Hospital and Household Cockroaches in Tripoli

No (%) positiveOrganism Hospital Community

(n=253) (n=150)--------------------------------------------------------------------------------Escherichia sp 4 (1.6) 5 (3.3)Klebsiella sp 38 (15.0) 84 (56)*Enterobacter sp 32 (12.6) 78 (52)*Citrobacter sp 22 ( 8.7) 29 (19.3)*Serratia sp 147 (58.1)* 28 (18.7)Proteus sp 6 (2.4) 3 (2)Hafnia alvei 2 (0.8) 0 (0.0)Buttiauxlla agrestis 1 (0.4) 2 (1.3)Aeromonas sp 2 (0.8) 8 (5.3)*Pseudomonas sp 28 (11.1) 11 (7.3)Xanthomonas maltophilia 5 (2.0) 0 (0.0)Acinetobacter sp 2 (0.8) 0 (0.0)Streptococcus sp 157 (62.1) 105 (70.3)

I still love Tripoli!

Antimicrobial Resistance of Gram-Negative Bacilli Isolated from Hospital and

Household Cockroaches in Tripoli No (%) resistant from:Antibiotic Hospital Community Total

(n=193) (n=246) (n=439)-----------------------------------------------------------------------------------------------------------------------

Ampicillin 141 (73) 208 (85)* 349 (80)Amoxicillin-clavulanic acid 85 (44) 88 (36) 173 (39)Ceftazidime 28 (11) 53 (22) 81 (19)Cephalothin 144 (75) * 145 (59) 289 (66)Chloramphenicol 51 (26)* 39 (16) 90 (21)Gentamicin 16 (8)* 0 (0) 16 (4)Nalidixic acid 36 (19)* 19 (8) 55 (13)Nitrofurantoin 89 (46)* 53 (22) 142 (32)Norfloxacin 0 (0) 1 (0.4) 1 (0.2)Tetracycline 59 (31) 62 (25) 121 (28)Trimethoprim- 48 (25)* 16 (7) 64 (15) sulphamethoxazole

We are in trouble!

Resistance of Pseudomonas Isolated from Hospital and Household Cockroaches in Tripoli to Antibiotics

No. (%) resistantAntibiotic Hospital Community Total

(n=34) (n=9) (n=43)----------------------------------------------------------------------------------------------------------------------Ampicillin 33 (97) 9 (100) 42 (98)Amoxicillin- clavulanic acid 33 (97) 9 (100) 42 (98)Ceftazidime 0 (0.0) 0 (0.0) 0 (0.0)Cephalothin 34 (100) 9 (100) 43 (100)Chloramphenicol 33 (97) 9 (100) 42 (98)Gentamicin 4 (12) 0 (0.0) 4 (9.0)Nalidixic acid 34 (100) 9 (100) 43 (100)Norfloxacin 0 (0.0) 0 (0.0) 0 (0.0)Nitrofurantoin 34 (100) 9 (100) 43 (100)Tetracycline 32 (94) 9 (100) 41(95.3)Trimethoprim- 34 (100) 9 (100) 43 (100) sulphamethoxazole

Too much trouble

SUMMARY

• More than 40% of enterobacteria isolated from houseflies and cockroaches from different hospitals were resistant to at least 4 different antimicrobial agents.

• Also, resistance to at least 9 antimicrobial agents was detected in more than 65% of Pseudomonas species isolated from these pests in Libya.

I‘ve had enough!

CONCLUSION• In Libya, these nuisance insects may play an

important role in the spread of antimicrobial-resistant bacteria in both, within and between hospitals and surrounding households.

• This may have serious implications on the treatment of infections caused by these organisms in hospitals and the community.

• The local and health authorities in Libya and other countries should take proper measures to quickly and effectively control these pests.

Wait, not finished yet

HELP! Get me out of here#*$

Where is my motorbike?

He is cool, isn’t he?