Prevalence of antimicrobial resistance in uropathogens among patients visiting primary health centers: implications for empiric therapy

Background: Urinary tract infection [UTI] is one of the most frequent bacterial infections in the community; in the Kingdom of Bahrain, the currently recommended empirical antimicrobial regimen is based on international guidelines but not supported by local data

Objective: To evaluate the local antibiotics profile of most common urinary pathogens among patients visiting primary health centers

Design: A Retrospective Analytical Study

Setting: Primary Health Center, Salmaniya Medical Complex

Method: All outpatients seeking care in health centers for which the attending physician clinically suspected UTI and asked for the provision of urine culture from June 2016 to June 2017 were included. Mid-stream clean catch urine specimens were obtained from patients suspected clinically to be having UTI based on symptoms. Mid-stream urine specimens were plated on Cystine-Lactose-Electrolyte-Deficient [CLED] agar plate using calibrated loops for the quantitative method to provide isolated colonies for identification and susceptibility testing

Result: Total of 1,357 urine samples with significant bacterial growth were obtained; 1,230 [90.6%] were females and 943 [69.5%] were in the age group of 19-64 years. The four most common uropathogens that contributed to 90% of the cases were as follows: 829 [61.1%] Escherichia coli, 222 [16.4%] Klebsiella pneumonia, 123 [9.1%] Streptococcus agalactiae and 62 [4.6%] Enterococcus species. Eight hundred twenty-nine [61.1%] specimens were E. coli; 731 [53.9%] demonstrated low sensitivity levels to cephalothin, and 777 [57.3%] to cotrimoxazole, 887 [65.38%] moderate sensitivity to amoxicillin-clavulanate, and 1,035 [76.3%] to norfloxacin, but 1,284 [94.6%] retained very high sensitivity to nitrofurantoin

Conclusion: Based on this study, we recommend nitrofurantoin as the first choice of empiric antibiotics therapy for uncomplicated UTI in outpatient setting; despite the good sensitivity profile of fluoroquinolones, we recommend using it only as an alternative or second line. Other suggested therapy which might be proposed for use as possible alternative option is fosfomycin, but after confirming its local sensitivity profile

Could vitamin B12 deficiency mimic erythroleukemia?

Erythroleukemia is a rare form of acute myeloblastic leukemia [AML] as described by the World Health Organization [WHO]; the condition represents less than 5% of all AML cases. It is a great challenge to establish the diagnosis. One of the principal differential diagnosis is megaloblastic anemia due to vitamin B12 deficiency. A fourteen-year-old Bahraini female was initially diagnosed with vitamin B12 deficiency based on the clinical history, blood count, smear findings and vitamin B12 level. The lack of response to supplementation with vitamin B12 injections raised suspicion of bone marrow disease. A subsequent bone marrow biopsy confirmed the diagnosis of erythroleukemia. After establishing the diagnosis with bone marrow biopsy, the patient was referred to the oncology center to receive chemotherapeutic treatment