Extended spectrum Beta-lactamase producing Escherichia coli and Klebsiella pneumoniae bacteremia. Risk factors and outcome in the Eastern Region of Saudi Arabia

To study the risk factors for bacteremia caused by Escherichia coli [E.coli] or Klebsiella pneumoniae [K.pneumoniae] producing extended-spectrum beta-lactamase [ESBL] and their outcome. A case-control study was conducted in King Abdul-Aziz National Guard Hospital, Al-Ahsa, Kingdom of Saudi Arabia from January 2006 through December 2007. All adult patients for whom culture results were positive for E. coli or K. pneumoniae were eligible. Twenty-nine patients with ESBL producing bacteremia [cases] were compared with 80 patients with non-ESBL producing bacteremia controls. Hospital mortality was the primary end point. Univariable and multivariable logistic regression were performed to analyze risk factors for ESBL bacteremia and its 30-day mortality. A total of 109 patients with bacteremia were enrolled that included 29 cases and 80 controls. Forty-nine percent of the patients were male. The mean age was 60.2 +/- 21.1 years. Nosocomial infection was the only independent risk factor for bacteremia due to ESBL-producing pathogens [odds ratio [OR] 3.40, 95% confidence interval [CI] 1.14-8.44, p=0.02]. Overall 30-day mortality was 22%, and was similar in both groups. The nosocomial infection [OR 3.20, 95% CI 1.48-6.94, p=0.01], presentation with septic shock [OR 48.88, 95% CI 6.01-397.32, p=0.004], and intensive care unit care [OR 7.40, 95% CI 1.94 -28.34, p=0.001] were the independent risk factors for 30-day mortality. The ESBL rate is high in our study among the bacteremic patients. Nosocomial infection is identified both as a risk factor for ESBL bacteremia and mortality

Anorectal abscesses: bacterial isolation and antimicrobial resistance

A total of 68 cases of pus or pus swabs were received at the laboratory of Abbasi Shaheed Hospital, Karachi from anorectal absecesses. They were collcted from 1993 to 1996. All samples were subjected to culture of which 53 [77.94%] showed growth. The organisms isolated from positive sample were Escherichia coli 22 [41.51%], Staphyloccus aureus 19 [35.85%], Staphyloccus epidermidis 4 [7.55%], Proteus vulgaris 3 [5.66%], Pseudomonas aeruginosa 3 [5.66%] and Streptococcus pyogenes 2 [3.77%]. Different antibiotic sensitivity and resistance patterns were found for different organisms. There was increased antimicrobial resistance observed in the present study. Proper identification, isolation and sensitivity pattern of organism is essential for successful treatment besides adequate dosage of antibiotics for appropriate duration of time By using this methodology we will decrease the chances of drug resistance in our population

AIDS-diagnosis and management

HIV infection is universal with an ever increasing number of HIV infected people. However the pattern of infection varies depending on the region involved. In Pakistan, 960 HIV positive cases were detected, of which 52 were AIDS cases. HIV is transmitted more commonly in individuals who are involved in risk activities or who belong to the high risk group. The disease has varied presentations and needs a high degree of suspicion from the health care providers. Two different types are identified; HIV [widest distribution] and HIV-2 [mostly in West Africa]. Most of HIV-1 individuals have antibodies detectable in all assasy, excepting those who have been recently exposed. No patient with suggestive symptoms or signs should be dismissed on the basis of a single negative test results and no patient should be informed definitely about a positive finding without confirmed positive results. ELISA, PCR and virus culturing are methods for diagnosis the disease

Toxoplasm IgM antibodies and reproductive losses in women of child bearing age

A survey of reproductive losses in women of child bearing age was carried out in hospitals of Karachi to find out the prevalence of and association with toxoplasmosis. The study included a total of 1330 women, comprising a pregnancy wastage group [with or without history handling] and women with normal reproductive performance. All cases were tested for IgM class of antitoxoplasma antibodies by Enzyme Immune Assay [AIE] technique. A total of 269 [20.23%] was sero-positive out of 1330 women screened. In the group with pregnancy wastage only these were 121 [22.41%] sero-positive cases out of 540, whereas in the group with pregnancy wastage and history of animal handling 118 [30.41%] women were positive out of 388 cases. There were 30 [7.46%] positive cases amongst the 402 women with normal reproductive performance. The highest number of IgM sero-positive cases was seen in the 16-25 age group. A high percentage of Toxoplasma cases in this survey indicates the need for launching a national programme for the treatment and prevention of toxoplasmosis

IgM and IgG antibodies specific to rubella in child bearing women

Three hundred fifty five pregnant women were tested for IgM and IgG type of antibodies by Enzyme Immuno Assay [EIA]. Sero- positivity for IgM and IgG antibodies were 13% and 29% respectively. Of 212 pregnant women with abortion, 39 [18%] and 80 [38%] were sero-positive and of 143 pregnant women with normal reproductive performance, 7 [5%] and 23 [16%] were positive for IgM and IgG respectively. Premarital screening and vaccination of Sero-negative girls is recommended to reduce morbidity and mortality related to rubella virus