title: Carriage of multidrug-resistant organisms in a tertiary university hospital in Albania-a point prevalence survey.
abstract: BACKGROUND
  Antimicrobial resistance has been recognised as a serious global Public Health problem. Prevalence of Multiple-Drug-Resistant (MDR) organism carriage in Albania is largely unknown since no national surveillance system is in place and few publications are accessible in the literature.
  
  
  METHODS
  A 1-day point-prevalence-survey (PPS) screening for nasal methicillin-resistant Staphylococcus aureus (MRSA) and rectal MDR Gram-negative carriage was carried out at the high-dependency wards in the country's only tertiary care hospital, in Tirana.
  
  
  RESULTS
  A total of 106 nasal and 104 rectal swabs were collected. 14.2 % of patients (95 % Confidence Interval [95 CI]: 8.1-22.3 %) were MRSA nasal carriers. Resistance to aminoglycosides and fluoroquinolones was common in these isolates (≥80 %) but no resistance was identified against glycopeptides, nitrofurantoin and the relatively newer agents, tigecycline and linezolid. Fifty Enterobacteriaceae isolates were cultivated from 33 of 104 screened patients (31.7 % [95 CI: 22.9-41.6 % 95 CI]). The prevalence of Extended Spectrum Beta-Lactamase (ESBL) production in Enterobacteriaceae was 41.3 % (95 CI: 31.8-51.4 %). The two more commonly isolated Enterobacteriaceae were E. coli ([n = 28], 24 ESBL positive; 1 AmpC positive and 3 without an identified mechanism of resistance) and Klebsiella pneumoniae ([n = 13], all ESBL positive; 1 also AmpC and metallo-β-lactamase (MBL) positive). Susceptibility to carbapenems (≥98 %), fosfomycin (90 %) and amikacin (70 + 20 % intermediate) was high but a high level of resistance to all other agents tested was noted. Non-fermenting Gram-negative bacilli were less commonly isolated {22 isolates: Acinetobacter baumannii (9); Pseudomonas aeruginosa (8) and Stenotrophomonas maltophilia (5)}.
  
  
  CONCLUSIONS
  Although a significant rate of MRSA carriage was identified, the main resistance challenge in Albania appears to be linked with Gram-negative organisms, particularly ESBL in Enterobacteriaceae.
authors: Infection Control Unit, Mater Dei Hospital, Birkirkara Bypass, Msida, 2080 MSD Malta.
authors: Falzon A
authors: FA
authors: Parascandalo
authors: Infection Control Unit, Mater Dei Hospital, Birkirkara Bypass, Msida, 2080 MSD Malta.
authors: P
authors: P
authors: Zarb
authors: Infection Control Unit, Mater Dei Hospital, Birkirkara Bypass, Msida, 2080 MSD Malta.
authors: E
authors: E
authors: Tartari
authors: University Hospital Centre, 'Mother Teresa', Tirana, Albania.
authors: D
authors: D
authors: Lacej
authors: University Hospital Centre, 'Mother Teresa', Tirana, Albania.
authors: S
authors: S
authors: Bitincka
authors: University Hospital Centre, 'Mother Teresa', Tirana, Albania.
authors: O
authors: O
authors: Manastirliu
authors: University Hospital Centre, 'Mother Teresa', Tirana, Albania.
authors: D
authors: D
authors: Nika
authors: Infection Control Unit, Mater Dei Hospital, Birkirkara Bypass, Msida, 2080 MSD Malta.
authors: M A
authors: MA
authors: Borg
keywords: Antimicrobial-resistance; ESBL; Enterobacteriaceae; Infection-prevention; Meticillin resistant staphylococcus aureus (MRSA)