Antimicrobial resistance patterns among acinetobacter baumannii isolated from king abdulaziz hospital, Jeddah,Saudi Arabia, four-year surveillance study [2010-2013]

To carry out a retrospective study on Acinetobacter baumannii [A.baumannii] isolates and analyze its epidemiology, antimicrobial resistance patterns, and nosocomial status from various clinical isolates of patients samples admitted in a tertiary care Hospital, King Abdulaziz hospital, Jeddah, Saudi Arabia. The clinical specimens over a period of 4 years from January 2010 to December 2013 were identified and analyzed, by the conventional microbiology methods and/or an automated identification systems [Pheonix and MicroScan] and there covered A. baumannii isolates were segregated for further study to detect the prevalence and tested for antibiotic susceptibility patterns used the automated susceptibility systems, and/or the disk diffusion and E test methods A total 1176 A. baumannii strains out of 13440 isolates were collected from various specimens during study period. The overall proportion of A. baumannii isolates among all clinical isolates has increased throughout the study from 4.2% [N.134] in 2010 to 12.3%[N.443] in 2013. Most of the source of infections was obtained from the intensive care unit [27.3%], followed by male surgical ward [11.4%], female surgical ward [9.7%] male medical ward [7.7%], female medical ward [7.5%], renal unit [6.7%], neonatal intensive care [5.7%], pediatric Intensive care [4.9%] and lastly out patient, private ward, Ob-Gyne ward and cardiac unit were 4.3%, 2.7%, 2.5% and 2.3% respectively.cefoxitin was the most resistant agents with [100%], then ceftriaxone [92.3%], gentamicin [90.3%], cefepime [88.7%], levofloxacin [88.5%], piperacellin/ tazobactam [88.4%], ciprofloxacin [88.4%], meropenem [88.2%], ceftazidime [88.2%], imipenem [86.5%], amikacin [84.6%], trimethoprim/sulphamethoxazole [69.3%], while colistin and tigecycline were with no resistance. The prevalence of MDR and PDR A. baumannii was increased throughout this study from 55% and 20%, respectively in 2010 to 67% and 33% in 2013. Trend of A. baumannii infection incidence is on the increase with increase of MDR and PDR suggests that prevention of healthcare-associated transmission of A. baumannii infection is essential

Inhibitory effect of garlic extract on multi-drug resistant organisms

Multi-drug resistant bacteria have become a major global healthcare problem in the twenty-first century thus an urgent need for products that act on novel molecular targets that circumvent resistance mechanisms, garlic is one of hundreds of plants that are used in traditional medicine as treatment for bacterial infections, In this study, we tried to uncover the effect of different concentrations of local Aqueous Garlic Extract [AGE] on Multi-drug organisms including Escheichia coli [ESBL],Klebsiella pneumonia [ESBL],Pseudomona aeruginosa,Acinitobacter spp, MRSA, by disk diffusion and agar well diffusion assay. All tested organisms were inhibited by AGE up to 25% concentration and the activity was a linear function of concentration. At 100%, the maximum zone of inhibition was observed against MRSA, a Gram positive organism and the minimum was against Klebsiella pneumonia [ESBL], a Gram-negative organism. This indicates that AGE has the potential of a broad spectrum of activity against both Gram-positive and Gram-negative bacteria. In conclusion, the results of this study have provided scientific Justification for the use of local garlic extract in health products and herbal remedies against multidrug-resistant bacterial infections in Kingdom of Saudi Arabia

Imipenem consumption and metallo beta-lactamase producing pseudomonas aeruginosa resistance to it

Pseudomonas aeruginosa is a leading cause ofnosocomial infections. Carbapenems are highly effective antibiotics against multidrug-resistant Gram-negative bacteria. High intrinsic resistance to antibiotics and the ability to develop multidnig resistance pose serious therapeutic problems. Resistance to carbapenems can be mediated by several mechanisms and production of metallo-beta-lactamases [MBL] has assumed increasing importance in recent years Increased mortality rates have been documented for patients infected with MBL producing Pseudomonas aeruginosa, Therefore, early detection of MBL -producing organisms is crucial . The current study measured the susceptibility patterns of pseudomonas aeruginosa and used one of the phenotyping tests the Imipenem - EDTA disk method, for detection of MBL production strains. 394 consecutive P. aeruginosa isolates were recovered

The great majority of the isolateswas obtained from the wounds [33.5%], sputum [27.9%], urine [7.6%], trachea! aspirate [7.1%], blood [6.1%] and other sources including eye swab, ear swab [17.8%].Most of the sources of infection were obtained from the intensive care unit [2 4.1%] followed by male surgical [10.4%], female surgical [8.9%], male medical [7.6%], female medical [7.4%], and lastly vip ward [0.5%]. High resistance rates were observed for all antibiotic studies

Imp-1 metallo beta-lactamase producing pseudomonas aeruginosa and resistance to antibiotics

The frequency of multi-drug resistance Pseudomonas aeruginosa infections are increasingly recognized worldwide. P. aeruginosa isolates resistant to all antimicrobial agents have been detected in many areas. Since IMP1 producers tend to demonstrate a wide range of resistance to various broad-spectrum beta-lactam including oxyimino cephalosporin, cephamycine and carbapenemes, early recognifion of IMP-1 producers is very important for rigorous infection control. The present study was designed to detect the incidence of P. aeruginosa infection, characterize the antimicrobial resistance profiles and screen for the IMP-1 producers strains. From 1[st]of July 2007 to 30 June 2008, A total of 4031 isolates were obtained of these 837 [20.76%] were identified as Pseudomonas, the great majority of them was P. aeruginosa [n=816; 97.5%] and the most of which was isolated from the wounds [n=256; 30.6%] , sputum [n= 242; 28.9%] , urine [n=64; 7.6%], Tracheal aspirate [n=55; 6.65] and lastly ear swab [n=3; 0.35%]. Intensive care unit accounts the most source of infection [n= 171; 20.4%] then burns unit [n=111; 13.3%] and lastly obstetric department [n=8; 0.9%]. High resistance rates were observed for all antibiotics studied. imipenem appeared to be the most active agent against the majority of isolates [ S=78%], then levofloxacin [S=75%], followed by piperacillin / tazobactam [S= 71%], amikacin [S= 67%], tobramycin [S=65%], ciprofloxacin [S= 63%], cefepime [S=60%], gentamycin [S= 59%], pipracillin and ceftazidime [S= 57% for each], while ceftriaxone and cefotaxime were the least active agents with a sensitivity [35%] only. IMP-1 Metallo-beta-lactamas were detected in 148 [41% of the 360 CAZ- resistant isolates] out of 816 P. aeruginosa iso1ates. After the results of this study we concluded that the rates of P. aeruginosa infection were high with increasing in IMP-1 Metallo-beta-lactamase producers strains. Infection control procedures for multi drug resistance need to be re-viewed urgently. There is also a pressing need for new, and hopefully novel, compounds active against pan-resistant Gram-negative bacteria a growing problem that needs to be addressed by both governments and industries

Resistance patterns of myocobacterium tuberculosis complex to antituberculosis drugs, in Jeddah region

This study reviews the resistance patterns of Mycobacterium tuberculosis complex [MTBC] isolates obtained from 578 patients [369 Saudi and 209 non-Saudi] in the period between the first of January 2001 and the end of December, 2006. Four hundred thirty nine of the isolates were from respiratory sources while the remaining [139] were from non-respiratory sites. The isolates were tested for their susceptibility to isoniazid [INH], rifampin [RIF], ethambutol [EMB], streptomycin [SM] and pyrazinamide [PZA] using the BACTEC MGIT 960 system [Becton Dickinson Medical Systems, Sparks, MD]. The turnaround time for antimicrobial susceptibility testing [to SM, INH, RIF and EMB] ranged from 4.0 to 13.0 days with an average of 8.3 +/- 2.1 days. The turnaround time for susceptibility testing to PZA ranged from 4.04 to 14.25 days with an average of 7.2 +/- 2.2 days. The percentages of resistance to anti-tuberculosis drugs in Saudi and non-Saudi patients respectively were: 25.5% and 35.9% for INH; 13.6% and 21.1% for RIF, 18.4% and 23.4% for SM, 19.5% and 15.3% for EMB, 19.2% and 9.7% for PZA and 10.6% versus 16.7% for multidrug resistant [MDR] TB [resistant at least to INH and RIF]. Resistance to INH and RIF was significantly higher in non-Saudi patients [p < 0.05]. The percentages of resistance to anti-tuberculosis drugs in respiratory samples from Saudi and non-Saudi patients respectively were: 25.5% and 37.6% for INH; 15.0% and 24.2% for RIF, 21.5% and 25.5% for SM, 20.1% and 15.8% for EMB, 16.7% and 10.0% for PZA and 12.4% versus 19.4% for MDRTB. Regarding non-respiratory samples, the percentages of resistance to anti-tuberculosis drugs from Saudi and non-Saudi patients respectively were: 25.3% and 29.5% for INH; 9.5% and 9.1% for RIF, 9.5% and 15.9% for SM, 17.9% and 13.6% for EMB, 25.0% and 8.3% for PZA and 5.3% versus 6.8% for MDR-TB. The overall percentages of resistance to anti-tuberculosis drugs in respiratory and non-respiratory samples respectively were: 30.1% and 26.6% for INH; 18.5% and 9.4% for RIF, 23.0% and 11.5% for SM, 18.5% and 16.5% for EMB, 13.5% and 19.4% for PZA and 15.0% versus 5.8% for MDR-TB. Differences were statistically significant only in cases of RIF, SM and MDR-TB. In general, resistance was higher in respiratory samples obtained from non-Saudi patients. These variations may be mainly due to the differences in the prevalence of MTBC variants between Saudi and non- Saudi patients

Insulin like growth factor-1 serum level in knee osteoarthritis patients: correlation with age and severity of the disease

Somatedin which got renamed insulin like growth factor-1 [IGF-1] is primarily involved in the normal growth and development of humans and in cartilage metabolism. IGF-1 tends to decrease with advancing age. As long as OA is most prevalent in the elderly, thus a rationale for studying the relationship between IGF-1 and OA could arise. This was the aim of our study, in which, the knee joint was chosen. Seventy-eight osteoarthritis Knee patients were chosen for this study, besides forty control subjects. The patients were symptomatic and had different radiological OA changes. They were 43 males and 35 females; the mean age was [52. +/- 7.6]. All the subjects were thoroughly examined. Radiographs of the knees including A-P, lateral and sky- line views were taken and grading according to Kellgren and Lawrence grading system of OA patients was performed. IGF-1 serum level was estimated with radioimmunoassay. There was no significant difference between males and females serum IGF-1 levels. The mean serum level of IGF-1 was lower in elderly patients and controls, with no significant difference. Also no significant difference was detected between OA mean serum level of IGF-1 and controls. Although there was lowering of the mean serum IGF-1 level in advanced age and in severe radiological OA, no significant difference was detected. More studies are needed to evaluate the role of IGF-1 in the pathogenesis and treatment of osteoarthritis

Correlation of fibronectin distribution in chronic maxillary sinusitis with histopathological and bacteriological findings

In 40 patients their ages ranged from 18 - 40 years with clinically and radiologically proved chronic maxillary sinusitis [CMS], we investigated them for the significance of fibronectin [Fn] distribution in antral mucosa and its correlation with bacteriological and histopathological findings.We obtained bacterial growth in 60% of our series which was polymicrobial including anaerobes [41.66%] mixed [33.34%] and aerobes [25%]. Failure to obtain bacterial growth in 40% of cases does not indicate absence of the disease which may be confirmed by Fn distribution and histopathological findings. It was also confirmed that no rule could be given to the type of histological pattern in relation to specific pathogen. According to the type and amount of cellular infiltration the CMS was divided into 4 categories; plasmalymphocytic, eosinophilic, mixed and hypocellular.Also according to the course of the disease the CMS was classified into fibrotic sinusits which needs no treatment and evolutive sinusitis with acitve inflammatory reaction which may be managed depending upon the type of cellular infiltration and amount of mucosal damage.As for Fn distribution, it was proved to be found on surface epithelium, intracellular, basement membrane, periglandular, apical cell glandular, perivascular and stromal areas in different combinations. While it was present on surface epithelium in cases of gram - positive bacteria and to lesser extent in mixed types but it was absent in cases of gram - negative bacteria. It was proved that total amount of Fn was more in gram positive bacteria than in gram -negative bacteria and in aerobes more than cases of anaerobes. Correlation between Fn distribution in CMS in relation to histopathological and bacteriological findings may be of special values as follows: 1. Presence of interacellular Fn, and on the surface epithelium, indicates the presence of tissue damage and type of bacteria even with negative bacterial growth. 2. Metaplasia is a risky sign in CMS but with reasonable amount of Fn we may predict less risky prognosis. 3-Fn is usually present in pre-fibrotic stage and its amount may represent a good clue to prediction the healing process .4. Absence of Fn on surface epithelium, while the pathogen was gram- positive bacteria may indicate aeration defect of the antrum, and suggesting the line of treatment .Biopsy is mandatory in this study which may be a limiting factors, but it allows the recongnition, and categorization of the disease and gives valuble diagnostic and prognostic data on studing Fn distribution and histopathological pattern in CMS in relation to histological and bacteriological findings may be a suitable parameter for proposed a universal treatment proctocol

value of polymerase chain reatriction enzyme analysis [PRA] compared with that of conventional and biochemical tests for identifieation and classification ofmycobacteria into the species

Because of the long time required to identify and classify Mycobacteria into the species by conventional and biochemical tests, the need for simple rapid methods is urgent. Thirty-six respiratory and non respiratory specimens that gave positive smears for [AFB] were classified into the species by comparing the polymerase chain reaction and restriction enzyme analysis [PRA] with the conventional and biochemical tests. PRA is a rapid method based of evaluation of the gene encoding for the 65-KD[a] protein, where the products of PCR obtained with primers common to all Mycobacteria were analysed by using two restriction enzymes, BstEII and HaeIII, the laboratory isolates were identified and classified into the species. PRA was done directly from the positive specimens and from the cultured media. It proved to be a simple rapid method which does not involve hybridization steps or radioactive materials

Evaluation of immunocytochemistry in diagnosis of CMV plancental infection

Despite its public health imoprtance, very little is known about the pathophysiology of the transplacental transmission of CMV from the mother to the fetus and also the diagnosis of placental CMV infection is still a main problem untile now. In the present study eleven placentae from mothers with symptomatic congenitally infected infants out of 180 [6.1%] pregnant woman positive for CMV specific Ig[M] antibodies, were examined, histopathologically and immunocytochemically [Single and double staining]. By immunocytochemistry we found that infection in eight cases [73%] [one, two and five with aborted, premature, and full term babies respectively], while histopathological study discovered infection in only 4 cases [36.5%] [one, and three with premature, and full term babies respectively]. Immunocytochemistry is more valiable than routine histopathology especially in early stage of pregnancy and help to clarify the role of the placenta in congenital CMV infection

Bacteremia after nasal surgery

Bacteremia is often harmless, but not in subjects at high risk of cardiovascular lesions. The risk factor depends on the frequency of bacteremia and the involved microorganism. To determine this factor, 50 patients were managed by nasal surgery. Thirty of them with CS were operated upon by functional endoscopic sinus surgery [FESS], Caldwell-Iuc operation, and intra-nasal antrostomy according to clinical and radiological findings. The other twenty patients were operated upon by septoplasty or rhinoplasty according to each indication. Preoperative nasal swabs and peri-operative blood cultures were done according to conventional methods. The cultures of nasal swabs were positive in 90% of cases and were polymicrobial with prevalence of anaerobes. All the pre-operative blood cultures were negative, while it was positive in post-operative blood cultures in 25% of cases operated upon by Caldwell-Iuc operation, and 10% in cases operated upon by intranasal antrostomy. Postoperative blood cultures of patients operated upon by FESS or septorhinoplasty were negative. The difference [in our opinion] may be due to compromised vascular tree for each technique, and the amount of manipulation and tissue destruction. According to this study, we can postulate that bacteremia is an avoidable complication by selection of surgical techniques with minimal manipulation like FESS, and knowledge of bacteria involved in bacteremia is of value in choosing first-line antibiotic if symptoms arise

Materno-Fetal transmission of hepatitis-C virus

Materno- fetal transmisson of hepatitis [C] virus [HCV] is still controversial. To verify this hypothesis. 100 pregnant women were screened for anti - HCV using ELA second generation. Ten out of 13 anti - HCV seropsitive pregnant women and their infants were investigated for hepatitis [C] virus using polymerase chain reaction [PCR]. nine months of follow up for the infants was done using PCR ELA and transaminases estimation at birth and every 3 months onwards. HCV- RNA was found in 5 infants delivered by women who were HCV- RNA seropositive and persisted for 3-9 months of follow up either continuously or intermittently. Anti - HCV was detected in 5 infants, one of them was HCV-RNA negative by PCR Serum transaminases [ALT/AST] were raised in 3 HCV- RNA seropositive infants. The mothers of anti- HCV seropositive infants were either diabetic. bilharzial or HBsAg positive. All these findings provide good evidence of matrerno - fetal transmission of HCV and indicate that infants born to anti - HCV seropositive mothers more liable to HCV infection. particularly in presence of risk factor as diabetes mellitus, and HCV infection and suggest that perinatal infection may initiate a silent disease process of chronic carrier state