Surveillance of antibacterial resistance in Staphylococcus aureus isolated in Kuwaiti hospitals

To investigate the prevalence of antibiotic resistance among Staphylococcus aureus isolated in Kuwaiti hospitals. S. aureus were isolated and identified following standard microbiological methods. Antibacterial susceptibility test was performed by disk diffusion and the measurement of minimum inhibitory concentration with E-test strips. A total of 1,846 S. aureus isolates were analyzed from 13 hospitals between 1 March and 30 October 2005. They were isolated from 1,765 [95.6%] inpatients and 81 [4.4%] outpatients. Methicillin resistance was detected in 588 [32.0%] of the isolates. The methicillin-resistant S. aureus [MRSA] consisted of 461 [78%] multiresistant and 127 [22%] nonmultiresistant isolates. The non-multiresistant MRSA consisted of epidemic MRSA-15 and community-associated MRSA. The community-associated MRSA was detected in all hospitals with MRSA, indicating its establishment in Kuwaiti hospitals. The proportion of isolates resistant to gentamicin, kanamycin, erythromycin, tetracycline, ciprofloxacin, fusidic acid and trimethoprim was higher among MRSA than methicillin-susceptible S. aureus [MSSA] isolates. Twenty-four and 22% of MRSA and MSSA isolates, respectively, expressed reduced susceptibility to vancomycin [minimum inhibitory concentration = 3-4 mg/l]. The study revealed the presence of methicillin resistance in 32% of S. aureus isolated in Kuwaiti hospitals and revealed an increase in the number of MRSA and MSSA with reduced susceptibility to vancomycin

Significance of atypical pathogens among community-acquired pneumonia adult patients admitted to hospital in Kuwait

The aim of this study is to determine the microbial etiology and severity of community-acquired pneumonia [CAP] in Kuwait. The severity of consecutive adult CAP cases admitted to 3 hospitals over a 1-year period was classified according to the Pneumonia Outcome Research Team [PORT] severity index. The microbial etiology was determined using st and ard methods for bacteria and serological tests for atypical and viral pathogens. The study population was 124 of the 135 admissions; 63 female, 61 male; mean age 41.3 +/- 18 years. The severity class distribution was: class 131%, class II 37%, class III 17%, class IV 13%, and class V 2%. Etiological agents were identified from 44 patients [35%], with one pathogen in 31 [25%], two in 9 [7%], and three or more in 4 [3%]. The most common pathogens identified were: Mycoplasma pneumoniae in 14 patients [11%], Legionella pneumophila in 10 [8%], Chlamydia pneumoniae in 8 [6%], influenza B virus in 8 [6%], influenza A virus in 5 [4%], Haemophilus influenzae in 4 [3%], Streptococcus pneumoniae in 3 [2%], Staphylococcusaureus in 3 [2%], gram-negative enterobacteria in 5 [4%], Moraxella catarrhalis in 2 [2%], and viruses in 4 [3%]. The yields from laboratory tests were 48% for paired serology, 20% from adequate sputum sample, and 3% from blood culture. Our study shows that a large percentage of mild CAP cases are admitted to hospitals in Kuwait, Atypical pathogens have a significant role in the etiology of CAP. There is overtreatment of CAP with a combination treatment consisting mainly of third-generation chephalosporins and macrolides

Outcome of treatment of meningitis complicated by ventriculitis due to multidrug resistant Pseudomonas aeruginosa with ciprofloxacin in an infant

We describe an infant who developed meningitis following a left upper lobectomy for congenital lobar emphysema. Serial cultures of cerebrospinal fluid consistently yielded growth of Pseudomonas aeruginosa. Initial antimicrobial susceptibility tests indicated that the organism was susceptible to piperacillin, gentamicin, amikacin, tobramycin, imipenem, and ciprofloxacin. During therapy, the organism became resistant to almost all of the antimicrobial agents except tobramycin, imipenem, and ciprofloxacin. This necessitated several changes in antimicrobial therapy. Sterilization of cerebrospinal fluid was finally achieved when treatment with ciprofloxacin was initiated