Rima Hanna-Wakim

American University of Beirut, Beyrouth, Beyrouth, Lebanon

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Publications (7)40.98 Total impact

  • The Journal of allergy and clinical immunology 04/2014; 133(6). DOI:10.1016/j.jaci.2014.03.032 · 11.25 Impact Factor
  • The Journal of allergy and clinical immunology 04/2014; DOI:10.1016/j.jaci.2014.02.023 · 11.25 Impact Factor
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    ABSTRACT: Objectives: Carbapenem-resistance among Gram-negative bacilli (GNB) has caused growing concern, particularly in our region, given its high incidence and the limited therapeutic options available. Data from the American University of Beirut Medical Center (AUBMC) show that as much as 70% of Acinetobacter isolates and 20% of Pseudomonas aeruginosa isolates recovered during 2011 were carbapenem-resistant. The present study was set to define the clinical characteristics of patients infected with carbapenem-resistant non-fermenting GNB, and to determine the outcomes of these infections. Methods: Adult patients with infections caused by carbapenem-resistant Acinetobacter or Pseudomonas spp. were prospectively enrolled between January 2009 and April 2012. We excluded patients who had an infection with the same organism during the preceding year. Baseline characteristics of the patients as well as co-morbid conditions were identified. Patients were followed for complications and outcomes during their index admission. Results: Our cohort included a total of 64 patients with a mean age of 61.7 years (SD 19.4). Most of the infections were hospital acquired (92%), and 74% were caused by carbapenem-resistant Acinetobacter spp. The leading primary site of infection was the respiratory tract (63%) followed by wound (20%), bloodstream and urinary tract (3.5% each). Most patients had received antibiotics within 24 hours (75.5%) and 30 days (83%) of the infection. The most common complications were sepsis (58.5%), acute kidney injury (41.5%), respiratory failure (25%) and admission to the intensive care unit (18.9%). In one third of the patients the infection persisted or progressed despite adequate antimicrobial therapy. Mortality rate was 37.7%, of which 60% was attributable to the infection itself. Conclusion: The morbidity and mortality of infections caused by carbapenem-resistant non-fermenters at AUBMC are significant, prompting adequate and early identification of patients at risk. Since treatment of established infection might not be effective, preventive strategies should be highly considered in order to decrease the disease burden.
    European Congress of Clinical Microbiology and Infectious Diseases, Berlin, Germany; 04/2013
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    ABSTRACT: Objectives: Bacteremia caused by Extended Spectrum Beta-Lactamase (ESBL)-producing Enterobacteriaceae has limited therapeutic options and increased mortality. The community spread of these pathogens in Lebanon has prompted the need to redefine the clinical characteristics of patients with bacteremia. We conducted a prospective matched case-control study at the American University of Beirut Medical Center (AUBMC) to determine the risk factors and outcomes of these infections. Methods: Adult patients with bacteremia caused by ESBL-producing Escherichia coli (E. coli) and Klebsiella pneumoniae (K. pneumoniae) and admitted to AUBMC were prospectively enrolled between January 2009 and April 2012. We excluded patients who had an infection with the same organism during the preceding year. Patients matched for year of hospitalization and primary site of infection with non-ESBL-producing E. coli and K. pneumoniae infections constituted the control group. Patients were then followed for complications and outcome during their index admission. Results: 42 patients with ESBL-producing E. coli (90%) or K. pneumoniae (10%) bacteremia were included in this study; matching was successful for 39 patients. Baseline characteristics did not differ in the two groups: male gender (46% in the resistant group vs. 41% in the control group), diabetes (33 vs. 30%), renal insufficiency (14 vs. 9%), chronic pulmonary disease (12 vs. 5%), malignancy (45 vs. 33%) and immunosuppressive therapy (35 vs. 26%). Risk factors associated with bacteremia due to a resistant pathogen on multivariable analysis were a hospital stay of 6 days or more within the month preceding the infection (odds ratio [OR] 3.92, 95%CI 1.26-12.19) and antibiotic intake within the 24 hours preceding the infection (OR 3.59, 95%CI 1.05-12.31). Although mortality rates were not significantly different (19 vs. 8%, p=0.136), patients with bacteremia due to a resistant pathogen had a significantly longer hospital stay due to the infection (OR 6.8, 95%CI 2.23-20.77) compared to patients with controls, with a mean additional length of hospitalization of 12.14 (SD 3.7) and 7 days (SD 2.9), respectively. Conclusion: Our data suggest that in patients who develop bacteremia, a prior hospital stay of 6 days or more and antibiotic intake within 24 hours increase the risk of detecting an ESBL-producing strain. Patients with ESBL bacteremia have a longer hospital stay.
    European Congress of Clinical Microbiology and Infectious Diseases, Berlin, Germany; 04/2013
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    ABSTRACT: Abstract Invasive pneumococcal disease (IPD) associated with Streptococcus pneumonia is a major public health problem worldwide for all age groups, including in Lebanon. Prevention through vaccination remains the most valuable tool to decrease the burden of disease. Pneumococcal conjugate vaccine 7 (PCV7), marketed internationally including in the Middle East and North Africa region for the prevention of IPD, was introduced in Lebanon in 2006, followed by PCV10 and PCV13 in 2010. However, none of these is currently part of the Extended Program of Immunization schedule and published data on IPD incidence, pneumococcal serotypes and vaccine coverage in the region are lacking. The Lebanese Inter-Hospital Pneumococcal Surveillance Program is a surveillance system set up to determine the burden of IPD and the prevalent serotypes responsible. The aim of this prospective 6-year study carried out in 78 hospitals throughout Lebanon was to obtain such data to help health authorities make informed decisions on the implementation of pneumococcal vaccination at the national level. A total of 257 isolates of culture-confirmed Streptococcus pneumoniae were evaluated. Considering all age groups, vaccine coverage was 41.4%, 53.9%, and 67.2% for PCV7, PCV10, and PCV13 serotypes, respectively; for patients <2, 2-5, and >60 years of age, PCV7 coverage was 50%, 51%, and 35%, respectively; PCV10 coverage was 53%, 74%, 45%, respectively; and PCV13 coverage was 63%, 80%, and 68%, respectively. Overall, 17.4% of these isolates were penicillin-G non-susceptible using the latest established breakpoints and mortality occurred in 23.5% of the patients with non-susceptible isolates. In addition, 10.9% of isolates were multi-drug-resistant. The highest mortality rates were observed in the eldest (>60 years of age) and youngest (<2 years of age) patients. The most prevalent invasive serotypes identified were those found in currently available pneumococcal conjugate vaccines, emphasizing the importance of implementing the vaccine in the routine immunization schedule at the national level. Continuation of current surveillance practices will help assess the impact of vaccine implementation on IPD epidemiology, serotype distribution and antibiotic resistance patterns.
    Vaccine 12/2012; 30(supp 6):G11. DOI:10.1016/j.vaccine.2012.07.020 · 3.77 Impact Factor
  • The Journal of allergy and clinical immunology 07/2012; 130(6). DOI:10.1016/j.jaci.2012.06.012 · 11.25 Impact Factor
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    ABSTRACT: In June 2009, the World Health Organization announced the 21st century's first influenza pandemic caused by pandemic influenza H1N1 2009 (H1N1 pdm). Our goal was to analyze antiviral drug resistance and the phylogenetic relationships among hemagglutinin (HA) and neuraminidase (NA) genes of H1N1 pdm samples in Lebanon. Nasopharyngeal swabs were collected from 197 patients with influenza-like illness from May 2009 through January 2010. Of the 50 influenza A-positive samples, 30 were analyzed for antiviral drug resistance by using in vitro susceptibility assays and cycling-probe real-time PCR. The HA and NA genes were also analyzed. The results of hemagglutination-inhibition assays confirmed that all 30 analyzed samples were H1N1 pdm. In July 2009, community transmission of H1N1 pdm was detected in Lebanon, and an outbreak occurred in October 2009. The outbreak cases were caused by a strain with 4 mutations in the NA gene (i.e., V42I, N68T, N248D, and E462K) and 2 mutations in the HA gene: 1 in the Ca1 antigenic site (i.e., S206T) and 1 in the Ca2 antigenic site (i.e., D225E). This strain was closely related to a major H1N1 pdm cluster that was isolated worldwide. All 30 samples were amantadine-resistant, and none were zanamivir-resistant. The 1 oseltamivir-resistant sample appeared to be from a community-transmitted case in an otherwise healthy 2-year-old child. Continuous monitoring of oseltamivir susceptibility among H1N1 pdm is essential to guide the effective use of this drug.
    Journal of clinical virology: the official publication of the Pan American Society for Clinical Virology 07/2011; 51(3):170-4. DOI:10.1016/j.jcv.2011.04.001 · 3.47 Impact Factor