Bacterial isolates from fatal cases of bloodstream infections at a university hospital in Central, Saudi Arabia

To describe the microbiology, underlying medical conditions and risk factors contributing to bloodstream infection [BSI] and mortality at a University Hospital in Riyadh, Kingdom of Saudi Arabia. We conducted this study at King Khalid University Hospital, Riyadh, Saudi Arabia, wherein clinical data from patients who died with BSI were collected. All isolates from these patients, from 1 January to 31 December 2004, were identified and antimicrobial susceptibilities were determined. Of the total 778 patients with BSI, 82 [10.5%] died. Among which 34 [41.5%] were elderly. Half of the patients were from the intensive care units [ICUs]. Cardiovascular diseases were the most common diagnosis in 14 [17.1%] patient, followed by malignancy 13 [15.9%], and respiratory diseases 12 [14.6%]. Eleven [13.4%] had chronic liver diseases, 6 [7.3%] with renal diseases, sepsis in 5 [6.1%], 4 [4.8%] were post- surgical cases, 3 [3.7%] cases had systemic lupus erythematosus [SLE] and 3 premature infants. The majority of BSI episodes were monobacterial, 71[86.5%]. Over 90% of the isolates were hospital acquired. Coagulase negative Staphylococci [CoNS] were the most common organisms representing 25 [30.5%] of all organisms isolated, while Gram positive as a whole represented 50 [61%]. Thirty one [38%] were Gram negative bacteria among which Pseudomonas species 6 [7.3%] and Escherichia coli [E. coli] 5 [6%] were the most common. Two [2.4%] of isolates were Candida glabrata. Mortality in our patients with BSI was attributed to old age and underlying medical conditions. The risk factors for nosocomial BSI were ICU admission, intravascular catheterization and respiratory tract infections

Bloodstream infections in pediatric patients

Blood stream infection [BSI] is the leading cause of morbidity and mortality in pediatric patients. This study aims to describe the clinical, microbiological characteristics and outcome of BSI in pediatric patients. We collected the clinical data from all pediatric patients with positive blood cultures. We identified all isolates from these patients from January 2004 to December 2004 at King Khalid University Hospital [KKUH], Riyadh, Saudi Arabia, and determined antimicrobial susceptibilities by MicroScan Walk Away 96 [Dade Behring Inc., West Sacramento, CA95691, USA]. Two hundred and twenty pediatric patients had BSI, of whom 147 [67%] were males and 71 [32.2%] were from intensive care units [ICUs]. Two hundred and ten [95.4%] had single blood culture isolate. One hundred and seventy-three [78.6%] of the isolates were Gram positive bacteria and included the following: Staphylococcus epidermidis [55.4%], Staphylococcus aureus [9.5%] of which 14% were methicillin resistant, Streptococcus pneumoniae [S. pneumoniae] [4.5%], 40% of which were resistant to penicillin and Enterococcus faecalis [4%]. Gram negative bacteria were 44 [20%] and included Escherichia coli and Klebsiella pneumoniae [K.pneumoniae] [3.6% each]. Three isolates [1.3%] were Candida glabrata. None of the Gram positive isolates were vancomycin resistant. Three K. pneumoniae and one Pseudomonas spp. isolates were multiresistant. One hundred and ninety-four [88%] of BSI isolates were hospital acquired. Fever was the most common presentation of pediatric patients [26%] with positive blood culture with no apparent focus of infection. Respiratory tract infections 26 [12%] were the next most common. We seen sepsis in [7.7%] children between 8 days and 6 months of age. Bone and joint infections, cardiac, renal, gastrointestinal diseases, malignancy and surgical cases were other associated clinical diagnoses of BSI in pediatric patients. Patients with immuno- suppressive disorders with BSI had isolates such as Salmonella spp., S. pneumoniae and Pseudomonas spp. Overall mortality was 13 [6%] [p<0.005] and those patients had underlying serious medical conditions with associated risk factors such as prolonged hospital stay, intensive care unit [ICU] admission, indwelling catheterization, mechanical ventilation and prior antimicrobial use. Bloodstream infection is an important cause of morbidity and mortality in pediatric patients. Risk factors for hospital acquired infection include: prematurity, prolonged hospitalization, ICU admission, indwelling catheterization, mechanical ventilation and prior antimicrobial therapy

Isolation of coryneform bacteria from blood cultures of patients at a University Hospital in Saudi Arabia

Coryneform bacteria have been increasingly recognized as opportunistic pathogens in recent years. The aim of this study is to identify and determine the antimicrobial susceptibility of coryneform bacteria isolated from blood cultures of patients seen at King Khalid University Hospital [KKUH], Riyadh, Kingdom of Saudi Arabia and review the literature. All coryneform bacteria isolated from blood culture specimens between January 2001 and March 2003 were prospectively identified by API Coryne System [BioMerieux, France]. Clinical data were collected from each patient's medical record. Antimicrobial susceptibility to 16 antimicrobial agents were determined by minimum inhibitory concentration [MIC] using E-test [AB Biodisk, Solna, Sweden]. Out of 50 coryneform bacteria isolated, 19 different species were identified. Corynebacterium propinquum was the most common species 6/50 [12%] followed by Corynebacterium auris 5/50 [10%], Corynebacterium afermentans, Corynebacterium striatum, Dermabacter hominis, Brevibacterium, and Arthrobacter species 4/50 [8%] each. Underlying chest diseases were common among the patients 11/50 [22%], followed by different surgeries 10/50 [20%]. Of all, 12/50 [24%] patients were from different intensive care units [ICUs], 36/50 [72%] had either vascular, urinary or respiratory intubation. Three patients in ICUs died, one was an elderly patient with gastrointestinal bleeding and 2 teenagers [one had tracheoesophageal fistula and the other was post-arrest road traffic accident patient]. Vancomycin was the most active antimicrobial agent against all coryneform species. The majority had MIC <1 ug/ml. For most isolates, the MIC90s of erythromycin, clindamycin, and ciprofloxacin were above the break points. Corynebacterium striatum was the only isolate susceptible to ampicillin. This study revealed that coryneform bacteria are increasingly being recognized as a cause of serious infections in immunocompromised patients. We recommend identification and susceptibility testing of predominant isolates of coryneform bacteria from different clinical sites of seriously ill patients to select the antimicrobial agent necessary for clinical intervention

Acinetobacter blood stream infection in a teaching hospital- Riyadh, Saudi Arabia

To study the clinical conditions of patients with blood stream infection [BSI] due to Acinetobacter species, the predisposing factors, the antimicrobial susceptibilities and the outcome of infection by these organisms. Settings: The study took place at King Khalid University Hospital, Riyadh, Saudi Arabia. Forty patients with blood stream infection due to Acinetobacter species were prospectively studied. Acinetobacter isolates were identified by API 20E. Antimicrobial susceptibility to 13 antimicrobial agents was performed by a disc comparative Stoke's method. For 23 isolates, susceptibility was also tested by minimum inhibitory concentration using E test [Abbiodisk, Solna, Sweden]. The predominant Acinetobacter isolate was Acinetobacter baumannii 24 [60%] followed by Acinetobacter baumannii complex 10 [25%] and six [15%] were other Acinetobacter species. Patients with Acinetobacter baumannii blood stream infection were more frequently managed in intensive care units. Nineteen of them [47.5%] had serious underlying illnesses predisposing to Acinetobacter blood stream infections including, cardiac, renal diseases, prematurity and severe burns with six [25%] having a fatal outcome. Risk factors for Acinetobacter baumannii blood stream infection included: intravascular catheters, mechanical ventilation, prior antibiotic use and colonization at other body sites. These factors were independently associated with Acinetobacter baumannii acquisition in these patients [P = > 0.05]. The results of anti microbial susceptibility tested by disc diffusion method were comparable to those of E test. Among the 13 anti microbial agents tested, imipenem was the most active agent against Acinetobacter baumannii as well as other Acinetobacter species. We concluded that Acinetobacter baumannii is the most common Acinetobacter species causing significant blood stream infections among patients in intensive care units with serious underlying illnesses. Risk factors studied were independently associated with the disease process of these patients. Imipenem is the most active anti microbial agent against clinically significant Acinetobacter baumannii blood stream infection

Hemophilus influenzae serotype-b meningitis in an adult immunocompetent patient

We present a case of meningitis caused by Hemophilus influenzae type'b in an immunocompetent 41-year-old Saudi lady. The patient was successfully treated with Ceftriaxone for 10 days. A review of Hemophilus influenzae meningitis in adults and the impact of conjugated vaccine on the epidemiology of the disease are given

Vaginal microflora and its association with obstetric and gynecological disorders and other illness

To determine the vaginal microflora among women with recurrent vaginal discharge and its association with obstetric and gynecologic disorders and otherillnesses. Vaginal flora was determined by Gram stain of high vaginal swabs and culture. Results of this study have related the predominance of lactobacilli among the normal vaginal flora and its reduction with recurrent vaginal discharge. Reduction of lactobacilli number was associated with abortion, bacterial vaginosis, cervical pathology, urinary tract infection and intrauterine growth retardation. The depletion and non function of lactobacilli was influenced by intrauterine contraceptive device use, hormonal therapy and diabetes. Clinicians, should be alerted to the possible association of recurrent vaginal discharge with other illnesses such as urinary tract infection and diabetes and hence with reduction of lactobacilli in the vaginal microflora

Isolation of campylobacter lari from pediatric patients in King Khalid University Hospital

Four cases from whom Campylobacter lari were isolated from blood and/or stool specimens are reported. All the patients aged less than 3 years, all presented with diarrhea, which was bloody in one case. None of the patients was immunocompromised. Isolation of C.lari from the blood of such patients is not commonly encountered. The methods of isolation and identification of C.lari are presented with a brief review of the literature