prevalence of chlamydia trachomatis infection among Saudi women attending the infertility clinic in central Saudi Arabia

To determine the prevalence of Chlamydia trachomatis [C. trachomatis] infection among Saudi women, its clinical presentation, and its association to infertility. This study was conducted between October 2012 and July 2013 at King Khalid University Hospital and King Abdulaziz University Hospital, Riyadh, Kingdom of Saudi Arabia. Female patients aged between 19 and 46 years old with infertility problems seen at both hospitals were recruited to join the study. A separate group of female patients without infertility problems was also recruited from both hospitals to serve as controls for the study. Endocervical swabs were collected from both groups of patients, and samples were analyzed using real time polymerase chain reaction. There was a statistically significantly greater prevalence of C. trachomatis infection in infertile women [n=8, 8.0%] compared with the fertile group of women [n=1, 1.0%]. The C. trachomatis infection was significantly correlated to infertility. A significant association between infertility and increased prevalence of C. trachomatis infection is shown in this study, thus, we suggest that screening for Chlamydial infection to be part of the routine investigation for infertility

Rate of blood culture contamination in a teaching hospital: a single center study

Objectives: Contamination of blood samples can lead to serious problems in patient management. The administration of unnecessary antibiotics, wastage of hospital resources, and risks to patient life are some of the known hazards. This study aimed to calculate the rate of blood culture contamination and associated factors at King Khalid University Hospital [KKUH], Riyadh, KSA

Methods: This is a retrospective cross-sectional study. The total study population was calculated based on a review of all of the request sheets for blood cultures submitted to the microbiology laboratory from 1st of January to 31st of December, 2012, at KKUH, Riyadh, KSA

Results: The rate of blood culture contamination [false positive] was 1.9%, while 8.71% of the blood culture samples had true infections [true positive]. Coagulase negative staphylococcus [CoNS] was the most predominant isolate [87%]. The rate of blood culture contamination was significantly higher during the summer season of June [1.38%], July [3.97%] and August [3.72%] compared to other months of the year [p value < 0.05]. The surgical units in this study had the highest rate of blood culture contamination [3.92%], followed by intensive care [2.61%] and medical units [2.48%]

Conclusion: The rate of blood culture contamination at KKUH is within the acceptable international range. The highest rates of blood culture contamination occurred during the summer season and in the surgical units

Changing epidemiology of tuberculosis detected by an 8-year retrospective laboratory study in a tertiary teaching hospital in central Saudi Arabia

To study the laboratory diagnosis of tuberculosis [TB], and relate the findings to its epidemiology in Central Saudi Arabia. This retrospective study was carried out at the Department of Pathology/Microbiology, King Khalid University Hospital, Riyadh, Kingdom of Saudi Arabia between January 2003 and December 2010. Data were retrieved from the hospital information system on laboratory findings. After adjustment, 9,405 specimens were studied. The specimens were stained by Ziehl-Neelsen [ZN], auramine-rhodamine, and cultured in Bactec alert 960, and Lowenstein-Jensen media. Mycobacterium tuberculosis [M. tuberculosis] complex and non-tuberculous mycobacteria were differentiated by ProbTec system and p-nitrobenzoate medium. The BACTEC MGIT 960 SIRE kit was used for susceptibility testing. A total of 568 [6%] specimens grew M. tuberculosis complex, and 87% were from Saudis with an incidence rate of 55.6/100,000 of TB. Time to positive growth in the Bactec liquid medium was directly related to the acid fast bacilli smear load. Most of the positive patients were from the 18-35 years age group. The percentage of multidrug resistance was 0.7%. Most patients [87%] were Saudis showing an incident rate of 55.6/100,000. An increase of TB cases was noticed in the 18-35 age group. Resistance to isoniazid was 10.6%, 1% to Rifampicin, 2-8% to Ethambutol, and streptomycin was 6%

Panton-Valentine leukocidin Staphylococcus aureus osteomyelitis of the femur in a Saudi child

Staphylococcus aureus producing Panton-Valentine leukocidin [PVL] is well recognized to cause severe skin and soft tissue infections. Recently, it has been increasingly recognized as causing life-threatening musculoskeletal infection. We reported previously 3 children who had osteomyelitis caused by methicillin resistant Staphylococcus aureus. We report and discuss a case of Methicillin sensitive Staphylococcus aureus encoding the PVL genes isolated from a child with acute osteomyelitis from Saudi Arabia

Antibiotic resistance among clinical isolates of stenotrophomonas maltophilia at a teaching hospital in Riyadh, Saudi Arabia

Stenotrophomonas maltophilia has emerged as a significant pathogen in compromised patients, causing infections which are difficult to treat. This study was carried out to comprehend the recent trend of antimicrobial resistance among clinical isolates of S. maltophilia and suggest management guidance for patients in general and in our region in particular. A total of 222 clinical isolates were tested between Jan 2003 to Jun 2009 at King Khalid University Hospital, College of Medicine, King Saud University, Riyadh Saudi Arabia. The organisms were identified as per standard guidelines. Final identification and minimum inhibitory concentration [MIC] was determined by using Microscan[registered]. S. maltophilia showed absolute resistance to Imipenem. In vitro, least resistance was observed against Cotrimoxazole [9.45%] followed by Ceftazidime [57.21%], Piperacillin/Tazobactam [60.82%], Ciprofloxacin [77.03%], Aztreonam [86.03%]. Gentamicin showed overall highest resistance [87.39%]. The crude mortality rate was 47%.Cotrimoxazole is still the most effective agent against S. maltophilia but, keeping in view the increasing resistance to first and second line drugs, there is an urgent need for an effective surveillance system. To discourage development of resistance and devise an effective empirical therapy, large scale study should be considered.

Antimicrobial susceptibility patterns of multidrugresistant Pseudomonas aeruginosa and Acinetobacter baumannii against carbapenems, colistin, and tigecycline

To examine susceptibility of Pseudomonas aeruginosa [P. aeruginosa] and Acinetobacter baumannii [A. baumannii] against carbapenems along with colistin and tigecycline as alternative therapeutic options. A total of 117 strains of multidrug-resistant [MDR] non-fermenting Gram negative bacteria isolated from non-duplicate samples were collected consecutively. We included one sample from each patient [84 isolates of A. baumannii and 33 isolates of P. aeruginosa isolated from patients seen at King Khalid University Hospital, Riyadh, Saudi Arabia, from June to December 2010]. Isolates were identified by the MicroScan WalkAway 96 Plus system. The minimum inhibitory concentrations [MICs] were determined by E-test following the Clinical and Laboratory Standards Institute breakpoint recommendations. Most A. baumannii strains were resistant to imipenem [90.5%], meropenem [90.5%], and doripenem [77.4%]. Whereas, a higher percentage of P. aeruginosa was resistant to imipenem [90.9%], and meropenem [81.8%], only 39.4% were resistant to doripenem. Colistin had excellent activity against both A. baumannii [100%] and P. aeruginosa [93.9%], while 89.3% of A. baumannii strains were susceptible to tigecycline. Among the carbapenems, doripenem was found to be the most potent antimicrobial agent against P. aeruginosa, whereas colistin proved to be an effective alternative antimicrobial agent for treatment of A. baumannii or P. aeruginosa. Tigecycline remains the best therapeutic option for MDR A. baumannii

Comparison of E-test and disc diffusion methods for the in vitro evaluation of the antimicrobial activity of colistin in multi-drug resistant gram-negative bacilli

To study susceptibility of clinical isolates of multi-drug resistant [MDR] Gram-negative bacilli to colistin by minimum inhibitory concentration [MIC] determination using Etest, and compare this with their susceptibility measured by the disc diffusion [DD] method. A total of 224 of MDR organisms [147 Acinetobacter baumannii [A. baumannii], 49 Acinetobacter species, 24 Stenotrophomonas maltophilia [S. maltophilia], and 43 Pseudomonas aeruginosa [P. aeruginosa]] were tested between January 2007 and August 2008 at King Khalid University Hospital, Riyadh, Kingdom of Saudi Arabia. They were identified by standard microbiological methods. Susceptibility by DD and MIC by Etest were interpreted according to the Clinical and Laboratory Standards Institute breakpoints. Using the MIC method, colistin was found to be active against 100% of Acinetobacter species, 98% of A. baumannii, 84% of P. aeruginosa, and 79% of S. maltophilia. An ascending order MIC90 of colistin was 1 ug/ml for A. baumannii, 1.5 ug/ml for Acinetobacter species, 3 ug/ml for P. aeruginosa, and 16 ug/ml for S. maltophilia. Comparing DD with the Etest method, very major errors of 1.4% were found for A. baumannii and 2.3% for P. aeruginosa, with minor errors of 0.7% for A. baumannii, 8.3% for S. maltophilia, and 11.6% for P. aeruginosa. Colistin was active against most of the MDR isolates tested. The DD method showed significant errors when compared with the Etest method. We recommend using the MIC method to test the susceptibility of MDR Gram-negative bacilli organisms to colistin

imported enteric fever caused by a quinolone-resistant Salmonella typhi

Recent reports indicate that nalidixic acid susceptibility correlates well with the clinical outcome of patients with Salmonella Typhi infection treated with quinolones. We report a case of enteric fever caused by S Typhi in which the isolate was resistant to nalidixic acid, but showed in vitro susceptibility to ciprofloxacin. Following treatment with ciprofloxacin, the clinical outcome was not satisfactory and the patient had a relapse. However, after using a higher dose of ciprofloxacin, the patient was cured. We recommend that all Salmonella systemic infections resistant to nalidixic acid with in vitro but decreased susceptibility to fluoroquinolones be treated with other antibiotics like third-generation cephalosporins or azithromycin. These patients should be closely followed up and observed for further relapse

Antimicrobial activity of tigecycline against bacterial isolates from intensive care units in a teaching hospital in central Saudi Arabia

To test the activity of tigecycline against bacterial isolates including multi-drug resistant [MDR] gram negative and gram positive organisms from intensive care patients. Clinically significant gram positive and MDR gram negative isolates from specimens of patients in the intensive care units of King Khalid University Hospital [KKUH], Riyadh, Kingdom of Saudi Arabia between November 1, 2006 and December 31, 2008 were tested against tigecycline by disc diffusion [DD] method. In some isolates, the minimal inhibitory concentration was carried out by E-test method. Some of the gram negative isolates, and gram positive isolates were tested using both methods. The study was approved by the hospital ethics committee. All the 83 gram positive organisms tested by both DD and E-test were susceptible to tigecycline. Two hundred and fifty-four MDR gram negative isolates were tested for susceptibility to tigecycline. Of these 176 tested by DD, 159 [90%] were susceptible, 6 [3.4%] were resistant, and 11 [6.2%] were intermediately susceptible [data are not the same in table 3]. From the 188 isolates tested by E-test, 140 [74.4%] were susceptible, 35 [18.6%] were resistant, and 13 [6.9%] showed intermediate susceptibility. For comparison between the methods, 109 isolates of the MDR gram negative organisms were tested by both E test and DD. The difference between the 2 methods was not significant. Tigecycline was active against gram positive and most MDR gram negative isolates from patients in medical and surgical intensive cases in KKUH. There was no significant difference between the DD and E-test methods for susceptibility testing of tigecycline against these isolates