1. 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 to
NATURE

2. 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 antimicrobialresistant bacteria that may potentially be pathogenic
to humans.
Sit back and enjoy the show

3. Housefly
Don’t be taken by the photos

4. The Common Species of Cockroaches
You’ve been warned!

5. German Cockroach
Adult female with ootheca
I’ve told you!

6. 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?

7. Spread of potentially pathogenic
bacteria by houseflies and German
cockroaches
Here we go!

8. I am not with them!

9. Disgusting!

10. The Housefly and German
Cockroach in Libya
Here we go again!

11. Bacteria Isolated from Hospital, City Streets and Abattoir
Houseflies in Misurata
No (%) positive
Organism
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)
#2 isolates were MRSA
Misrata is still nice city!

12. Antimicrobial Resistance of Gram-Negative Bacilli Isolated from
Hospital, City Streets and Abattoir houseflies in Misurata.
No. (%) resistant
Hospital
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!

13. Antimicrobial Resistance of Pseudomonas Isolated from Hospital, City
Streets and Abattoir houseflies in Misurata
No. (%) resistant
Hospital
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

14. Bacteria Isolated from Hospital and Household
Cockroaches in Tripoli
No (%) positive
Organism
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!

15. Antimicrobial Resistance of Gram-Negative Bacilli Isolated from Hospital
and
Household Cockroaches in Tripoli
Antibiotic
Hospital
No (%) resistant from:
Community
Total
(n=193)
(n=246)
(n=439)
-----------------------------------------------------------------------------------------------------------------------
Ampicillin
Amoxicillin-clavulanic acid
Ceftazidime
Cephalothin
Chloramphenicol
Gentamicin
Nalidixic acid
Nitrofurantoin
Norfloxacin
Tetracycline
Trimethoprimsulphamethoxazole
141 (73)
85 (44)
28 (11)
144 (75) *
51 (26)*
16 (8)*
36 (19)*
89 (46)*
0 (0)
59 (31)
48 (25)*
208 (85)*
88 (36)
53 (22)
145 (59)
39 (16)
0 (0)
19 (8)
53 (22)
1 (0.4)
62 (25)
16 (7)
349 (80)
173 (39)
81 (19)
289 (66)
90 (21)
16 (4)
55 (13)
142 (32)
1 (0.2)
121 (28)
64 (15)
We are in trouble!

16. Resistance of Pseudomonas Isolated from Hospital and Household
Cockroaches in Tripoli to Antibiotics
No. (%) resistant
Antibiotic
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)
Trimethoprim34 (100)
9 (100)
43 (100)
sulphamethoxazole
Too much trouble

17. 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!

18. 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

19. HELP! Get me out of here#*$

20. Where is my motorbike?
He is cool, isn’t he?