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Article ; Online: Susceptibility of urinary Enterobacteriaceae to selected antimicrobials in an out-patient setting in Wallonia-Belgium: retrospective analysis over 5 years period (2018-2022).

Azar, Nadim / Khodor, Moustapha / Choucair, Jacques / Hamze, Monzer / Pirenne, Henri

2023 Volume 81, Issue 1, Page(s) 52–60

Abstract: Objective: Increasing antimicrobial resistance in urinary tract infection is a major healthcare concern. In this study, we evaluate the patterns of resistance exhibited by the most implicated microorganisms in urine infections. This approach is a ... ...

Abstract	Objective: Increasing antimicrobial resistance in urinary tract infection is a major healthcare concern. In this study, we evaluate the patterns of resistance exhibited by the most implicated microorganisms in urine infections. This approach is a prerequisite for an appropriate and successful empiric therapy in ambulatory patients. Methods: A retrospective study was carried out from January 2018 to September 2022 in Synlab-Collard laboratory, Liège, Belgium; a total of 129,939 Enterobacteriaceae isolated from 120,616 positive urine sample were included. Results: Sex ratio is 81.6% female and 18.4% male. E. coli is the most common urinary pathogen (70.4% of cases), followed by Klebsiella spp. (13.5%), Proteus spp. (8.5%), and Citrobacter spp. (2.5%). Ampicillin shows the highest resistance at 56%. Nitrofurantoin, the recommended antimicrobial treatment for cystitis in Belgium, expresses an overall resistance rate of 19% in females and 32% in males peaking at 43% in males over 80 years. Fosfomycin and ciprofloxacin display higher resistance rates in subjects over the age of 80 (18%, 24% in females, and 25%, 35% in males respectively). Trimethoprim shows 24% and 29% resistance rate in females and males over the age of 80 respectively. Conclusion: Even if empiric treatment of suspected UTIs may be of benefit in some cases, it is important for healthcare providers to carefully consider its limitations and evaluate its potential failure rate based on the resistance profiles of urinary Enterobacteriaceae. Susceptibility tests should be performed, and treatments adjusted especially in elderly populations.
MeSH term(s)	Humans ; Male ; Female ; Aged ; Anti-Bacterial Agents/pharmacology ; Anti-Bacterial Agents/therapeutic use ; Retrospective Studies ; Enterobacteriaceae ; Escherichia coli ; Outpatients ; Belgium/epidemiology ; Urinary Tract Infections/drug therapy ; Urinary Tract Infections/epidemiology ; Urinary Tract Infections/urine ; Anti-Infective Agents ; Microbial Sensitivity Tests ; Drug Resistance, Bacterial
Chemical Substances	Anti-Bacterial Agents ; Anti-Infective Agents
Language	English
Publishing date	2023-01-03
Publishing country	France
Document type	Journal Article
ZDB-ID	418098-7
ISSN	1950-6112 ; 0003-3898
ISSN (online)	1950-6112
ISSN	0003-3898
DOI	10.1684/abc.2023.1780
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Article ; Online: An Unusual Case of High 6-Monoacetylmorphine and Low Morphine in Urine: Heroin Abuse or Analytical Error?

Choucair, Ibrahim / Cassella-Mclane, Gina / Rogers, Katherine / Durant, Thomas J S / El-Khoury, Joe M

Clinical chemistry

2023 Volume 68, Issue 10, Page(s) 1344–1345

MeSH term(s)	Humans ; Morphine ; Heroin Dependence/diagnosis ; Morphine Derivatives ; Body Fluids
Chemical Substances	6-O-monoacetylmorphine (M5E47P1ZCH) ; Morphine (76I7G6D29C) ; Morphine Derivatives
Language	English
Publishing date	2023-08-22
Publishing country	England
Document type	Case Reports ; Journal Article
ZDB-ID	80102-1
ISSN	1530-8561 ; 0009-9147
ISSN (online)	1530-8561
ISSN	0009-9147
DOI	10.1093/clinchem/hvac110
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Article ; Online: Breaking barriers: Assessing pre-exposure prophylaxis awareness and willingness to use in the Lebanese community.

Azzi, Akel / Chartouni, Carine / Ibrahim, Racha / Chebel, Zeina Bou / Haddad, Elie / Chehata, Nabil / Choucair, Jacques / Saliba, Gebrael

International journal of STD & AIDS

2024 , Page(s) 9564624241240799

Abstract: Background: In the evolving HIV landscape, the Middle East and Northern Africa (MENA) grapples with data gaps, hindering the 95-95-95 targets. Lebanon, despite progress, falls short. Our study addresses Pre-exposure Prophylaxis (PrEP) gaps for effective ...

Abstract	Background: In the evolving HIV landscape, the Middle East and Northern Africa (MENA) grapples with data gaps, hindering the 95-95-95 targets. Lebanon, despite progress, falls short. Our study addresses Pre-exposure Prophylaxis (PrEP) gaps for effective HIV prevention. Methods: Surveying 410 participants via snowball sampling and an online questionnaire, we analyzed data with chi-square and regression over 5 months for insights into PrEP awareness and readiness. Results: Summarizing the pivotal statistical outcomes of the study, 22.2% reported awareness of PrEP, showcasing diverse knowledge levels about its purpose and usage. Out of them, 57.1% expressed a willingness to use it; while a mere 5.5% have utilized it. The study reveals diverse demographic profiles, with age influencing PrEP awareness and willingness to use. Positive correlations exist between PrEP discussions within social circles, increased information availability, and elevated willingness. Financial considerations and accessibility at pharmacies emerge as critical determinants, guiding the development of targeted interventions. Conclusions: This analysis emphasizes tailored education, community initiatives, and policy enhancements to address PrEP challenges in Lebanon. Guiding public health initiatives, our study considers age, social dynamics, education, and accessibility in HIV prevention.
Language	English
Publishing date	2024-03-27
Publishing country	England
Document type	Journal Article
ZDB-ID	1018089-8
ISSN	1758-1052 ; 0956-4624
ISSN (online)	1758-1052
ISSN	0956-4624
DOI	10.1177/09564624241240799
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Article: Lack of regulation over antibiotic prescription and dispensation: A prospective cohort in a community setting.

Choucair, Jacques / Haddad, Elie / Saliba, Gebrael / Chehata, Nabil / Makhoul, Jennifer

Journal of infection prevention

2021 Volume 22, Issue 6, Page(s) 289–292

Abstract: Background: The emergence of bacterial resistance caused health authorities to attempt to implement strict regulations for rational antibiotic prescription. However, supervision is often neglected in low- and middle-income countries, leading to ... ...

Abstract	Background: The emergence of bacterial resistance caused health authorities to attempt to implement strict regulations for rational antibiotic prescription. However, supervision is often neglected in low- and middle-income countries, leading to inappropriate administration of antibiotics. The objective of our study is to highlight the lack of monitoring in the community setting of a middle-income country. Material and methods: We asked 68 patients presenting to an infectious diseases consultation office to report the antibiotic courses they had taken in the three months preceding their visit. We assessed for treatment indication, molecule choice, dosing and duration, as well as microbial cultures, demographics and specialty of the prescriber. Results: Among the 68 patients included in our study, we counted a total of 95 outpatient antibiotic courses, mostly composed of quinolones (36%), followed by amoxicillin-clavulanate (21%). The prescriber was most commonly a primary care physician, but we reported several cases of auto-medication and dispensation of antibiotics by pharmacists. Only 30% of cases had true indications for antibiotics. Conclusion: In sum, our results indicate an evident lack of regulation over the administration of antibiotics. This easy accessibility needs to be promptly addressed as we run the risk of inevitable bacterial resistance.
Language	English
Publishing date	2021-08-28
Publishing country	England
Document type	Journal Article
ZDB-ID	2595000-9
ISSN	1757-1782 ; 1757-1774
ISSN (online)	1757-1782
ISSN	1757-1774
DOI	10.1177/17571774211033347
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Article ; Online: Intravesical Bacillus Calmette-Guérin (BCG) treatment's severe complications: A single institution review of incidence, presentation and treatment outcome.

Waked, R / Choucair, J / Chehata, N / Haddad, E / Saliba, G

Journal of clinical tuberculosis and other mycobacterial diseases

2020 Volume 19, Page(s) 100149

Abstract: Objectives: Intravesical Bacillus Calmette-Guérin (BCG) treatment for superficial bladder cancer is interrupted in approximatively 8% of cases as a result of complications. The objective is to report the severe related complications of Bacillus Calmette- ...

Abstract	Objectives: Intravesical Bacillus Calmette-Guérin (BCG) treatment for superficial bladder cancer is interrupted in approximatively 8% of cases as a result of complications. The objective is to report the severe related complications of Bacillus Calmette-Guérin (BCG) following an intravesical instillation for bladder tumor encountered at our institution for the past 5 years. Methods: Medical records of a tertiary teaching hospital, located in Beirut, Lebanon, were retrospectively analyzed from June 2014 to June 2019 searching for severe related complications of BCG. A comprehensive review of articles on this subject was conducted. Results: The incidence of severe systemic adverse events related to BCG instillation was 1.5% (5 out of 332 patients). A total of five patients were found to have a severe BCG related complication, with fever, chills, and irritative urinary signs being the most frequent symptoms. All patients received antituberculosis therapy (Isoniazid, Rifampin and Ethambutol). Two were put on add-on corticosteroids. Three patients had a computed tomography scan image in favor of an infection. Two patients had a favorable outcome, three patients died. Conclusion: BCG severe adverse events were mostly seen in patients with a traumatic instillation. Treatment used at our institution was similar to most cases reported in the literature. A standardized diagnostic and treatment approach should be implemented to help physicians tackle these life-threatening complications.
Language	English
Publishing date	2020-02-03
Publishing country	England
Document type	Case Reports
ISSN	2405-5794
ISSN (online)	2405-5794
DOI	10.1016/j.jctube.2020.100149
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Article ; Online: Corrigendum. Non-invasive pre-implantation genetic testing of human embryos: an emerging concept.

Farra, C / Choucair, F / Awwad, J

Human reproduction (Oxford, England)

2018 Volume 34, Issue 3, Page(s) 590

Language	English
Publishing date	2018-12-29
Publishing country	England
Document type	Journal Article ; Published Erratum
ZDB-ID	632776-x
ISSN	1460-2350 ; 0268-1161 ; 1477-741X
ISSN (online)	1460-2350
ISSN	0268-1161 ; 1477-741X
DOI	10.1093/humrep/dey385
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Article ; Online: Non-invasive pre-implantation genetic testing of human embryos: an emerging concept.

Farra, C / Choucair, F / Awwad, J

Human reproduction (Oxford, England)

2018 Volume 33, Issue 12, Page(s) 2162–2167

Abstract: The accurate genetic screening of pre-implantation embryos currently entails the use of technically challenging and biologically invasive biopsies of the human embryos. Investigating a more conservative sampling approach has emerged as a timely and ... ...

Abstract	The accurate genetic screening of pre-implantation embryos currently entails the use of technically challenging and biologically invasive biopsies of the human embryos. Investigating a more conservative sampling approach has emerged as a timely and desired alternative. Circulating cell-free embryonic DNA is present in the blastocoel fluid and spent culture media of blastocysts, and this has lately been sought as an attractive source of genetic information. The genetic analysis of cell-free embryonic DNA has been reported, to be useful in evaluating the genetic constitution of embryos; thus, providing a potential alternative to conventional biopsy-derived pre-implantation genetic testing (PGT). In this review, we have summarized these non-invasive alternative applications of PGT and discussed their current limitations and future clinical implications.
MeSH term(s)	Blastocyst ; Embryo Culture Techniques ; Female ; Fertilization in Vitro ; Genetic Testing ; Humans ; Pregnancy ; Preimplantation Diagnosis
Language	English
Publishing date	2018-10-23
Publishing country	England
Document type	Journal Article ; Review
ZDB-ID	632776-x
ISSN	1460-2350 ; 0268-1161 ; 1477-741X
ISSN (online)	1460-2350
ISSN	0268-1161 ; 1477-741X
DOI	10.1093/humrep/dey314
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Article ; Online: Antibiotics in treatment of COVID-19 complications: a review of frequency, indications, and efficacy.

Chedid, Marie / Waked, Rami / Haddad, Elie / Chetata, Nabil / Saliba, Gebrael / Choucair, Jacques

Journal of infection and public health

2021 Volume 14, Issue 5, Page(s) 570–576

Abstract: Objectives: To report available information in the literature regarding frequency, indications, types of antibiotic usage, duration, and their efficacy in Covid-19 infected patients.: Methods: The search was conducted on April 30 and May 7, 2020, ... ...

Abstract	Objectives: To report available information in the literature regarding frequency, indications, types of antibiotic usage, duration, and their efficacy in Covid-19 infected patients. Methods: The search was conducted on April 30 and May 7, 2020, using Ovid database and Google search. Patients' characteristics, clinical outcomes, as well as selected characteristics regarding antibiotic use (indication, class used, rates and types of bacterial secondary and co-infection, and duration of treatment) were analyzed. Results: Nineteen clinical studies reporting data from 2834 patients were included. Mean rate of antibiotic use was 74.0 % of cases. Half the studies reported occurrence of a bacterial co-infection or complication (10 studies). Amongst the latter, at least 17.6 % of patients who received antibiotics had secondary infections. Pooled data of 4 studies show that half of patients receiving antibiotics were not severe nor critical. Detailed data on antibiotic use lack in most articles. Conclusions: The present review found a major use of antibiotics amongst Covid-19 hospitalized patients, mainly in an empirical setting. There is no proven efficacy of this practice. Further research to determine relevant indications for antibiotic use in Covid-19 patients is critical in view of the significant mortality associated with secondary infections in these patients, and the rising antimicrobial resistance.
MeSH term(s)	Anti-Bacterial Agents/therapeutic use ; Bacterial Infections/drug therapy ; Bacterial Infections/epidemiology ; COVID-19 ; Humans ; SARS-CoV-2
Chemical Substances	Anti-Bacterial Agents
Language	English
Publishing date	2021-02-09
Publishing country	England
Document type	Journal Article ; Review
ZDB-ID	2467587-8
ISSN	1876-035X ; 1876-0341
ISSN (online)	1876-035X
ISSN	1876-0341
DOI	10.1016/j.jiph.2021.02.001
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Article ; Online: A preliminary study of hydrocodone and hydromorphone to oxycodone ratios for distinguishing impurities from independent opioid use.

Choucair, Ibrahim / Villalba, Cristina Figueroa / Vera, Michael A / Cassella-Mclane, Gina / Durant, Thomas J S / El-Khoury, Joe M

Clinical biochemistry

2022 Volume 112, Page(s) 6–10

Abstract: Background: Urine drug testing (UDT) monitors prescription compliance and/or drug abuse. However, interpretation of UDT results obtained by liquid chromatography-tandem mass spectrometry (LC-MS-MS) can be complicated by the presence of drug impurities ... ...

Abstract	Background: Urine drug testing (UDT) monitors prescription compliance and/or drug abuse. However, interpretation of UDT results obtained by liquid chromatography-tandem mass spectrometry (LC-MS-MS) can be complicated by the presence of drug impurities that are detected by highly sensitive methods. Hydrocodone is a drug impurity that can be found as high as 1% in oxycodone pills. Objectives: We evaluated the frequency and concentration of hydrocodone and its metabolite, hydromorphone, in patients taking oxycodone to check if the ratio of hydrocodone or hydromorphone to oxycodone could distinguish between oxycodone only use from those consuming additional opiates. Design & methods: We correlated LC-MS/MS results with medication records of 319 patients with positive oxycodone results over 7 months (4/2021-11/2021). Results: Fifteen of 319 patients with positive oxycodone results were taking oxycodone only. For these 15 patients, the mean ratio of hydrocodone to oxycodone was 0.57% (range 0.05%-3.35%), and the mean ratio of hydromorphone to oxycodone was 0.81% (range 0.18-3.51%). Conclusions: Hydrocodone and/or hydromorphone are detectable in patients taking only oxycodone and can likely be identified as an impurity if their calculated ratio to oxycodone is <1 %. Further validation of the ratios in a larger sample size is recommended.
MeSH term(s)	Humans ; Hydrocodone/analysis ; Hydromorphone/analysis ; Oxycodone ; Analgesics, Opioid ; Chromatography, Liquid/methods ; Oxymorphone ; Tandem Mass Spectrometry/methods ; Opioid-Related Disorders
Chemical Substances	Hydrocodone (6YKS4Y3WQ7) ; Hydromorphone (Q812464R06) ; Oxycodone (CD35PMG570) ; Analgesics, Opioid ; Oxymorphone (9VXA968E0C)
Language	English
Publishing date	2022-12-16
Publishing country	United States
Document type	Journal Article
ZDB-ID	390372-2
ISSN	1873-2933 ; 0009-9120
ISSN (online)	1873-2933
ISSN	0009-9120
DOI	10.1016/j.clinbiochem.2022.12.009
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Zs.A 624: Show issues

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Article ; Online: Contamination of clinical blood samples with crystalloid solutions: An experimental approach to derive multianalyte delta checks.

Choucair, Ibrahim / Lee, Edward S / Vera, Michael A / Drongmebaro, Chime / El-Khoury, Joe M / Durant, Thomas J S

Clinica chimica acta; international journal of clinical chemistry

2022 Volume 538, Page(s) 22–28

Abstract: Background: Laboratorians are left unguided by a paucity of literature on how to configure rules for the detection of intravenous (IV) fluid contamination in blood samples. We designed a study to determine the in vitro effect of increasing blood sample ... ...

Abstract	Background: Laboratorians are left unguided by a paucity of literature on how to configure rules for the detection of intravenous (IV) fluid contamination in blood samples. We designed a study to determine the in vitro effect of increasing blood sample contamination from commonly used crystalloid solutions and how these observations can guide the derivation of multianalyte delta checks to detect such pre-analytical error. Methods: In this study, we spiked increasing volumes of commonly used IV fluids (normal saline (NS), lactated ringers (LR), and 5% dextrose) into blood samples that were collected from healthy donors. Routine chemistry analytes were measured and compared between neat and contrived samples. From these observations, we derived several permutations of multianalyte delta checks using the basic metabolic panel framework and evaluated rule performance using retrospective data. Results: The wet chemistry experiments showed that increasing the volume of crystalloid solution contamination significantly changed several analytes. Subsequently derived multianalyte delta check procedures were applied to retrospective data. For all IV fluids tested, smaller magnitudes of analyte change resulted in more samples flagged. Conclusion: Multianalyte delta checks may be an effective method for the detection of IV fluid contamination.
Language	English
Publishing date	2022-10-26
Publishing country	Netherlands
Document type	Journal Article
ZDB-ID	80228-1
ISSN	1873-3492 ; 0009-8981
ISSN (online)	1873-3492
ISSN	0009-8981
DOI	10.1016/j.cca.2022.10.011
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