study of the microbiology of diabetic foot infections in a teaching hospital in Kuwait

The purpose of this study was to determine the microbiological profile of diabetic foot infections [DFIs] and assess the antibiotic susceptibility of the causative agents. Data were obtained from a retrospective analysis of DPI samples collected from June 2007 to July 2008. Specimens were cultured using optimal aerobic and anaerobic microbiological techniques, and antibiotic susceptibility testing was performed according to the methods recommended by the Clinical and Laboratory Standards Institute [CLSI]. Extended-spectrum beta-lactamase [ESBL] production was measured using the double disk synergy test and the ESBL Etest. A total of 440 patients were diagnosed with DFIs during this period, and a total of 777 pathogens were isolated from these patients with an average of 1.8 pathogens per lesion. We isolated more Gram-negative pathogens [51.2%] than Gram-positive pathogens [32.3%] or anaerobes [15.3%]. Polymicrobial infection was identified in 75% of the patients. The predominant organisms isolated were members of the Enterobateriaceae family [28.5%], Pseudomonas aeruginosa [17.4%], Staphylococcus aureus [11.8%], methicillin-resistant S. aureus [7.7%], anaerobic Gram-negative organisms [10.8%], and Enterococcus spp. [7%]. Vancomycin was the most effective treatment for Gram-positive bacteria, and imipenem, piperacillin-tazobactam and amikacin were the most effective treatments for the Gram-negative bacteria. In conclusion, DFI is common among diabetic patients in Kuwait, and most of the cases evaluated in this study displayed polymicrobial etiology. The majority of isolates were multi-drug resistant. The data gathered in this study will be beneficial for future determinations of empirical therapy policies for the management of DFIs. 2011 King Saud Bin Abdulaziz University for Health Sciences. Published by Elsevier Ltd. All rights reserved

study of the microbiology of breast abscess in a teaching hospital in Kuwait

To determine the microbiological profile of breast abscess and assess the antibiotic susceptibility of the causative agents. Data obtained from cases of breast abscess over a period of 3.5 years, June 2006 to December 2009, were retrospectively analyzed. Specimens were cultured using optimal aerobic and anaerobic microbiological techniques. The antibiotic susceptibility test was carried out using the methods recommended by the Clinical and Laboratory Standards Institute. One specimen per patient was analyzed. Of the 114 patients, 107 [93.8%] non-lactating and 7 [6.1%] lactating women were diagnosed with breast abscess during this period. Of the 114 specimens, 83 [73%] yielded bacterial growth. Of these, 115 pathogens were isolated with an average of 1.4 pathogens per abscess. Eighteen [22%] of the 83 specimens yielded mixed bacterial growth. There were more Gram-positive pathogens [60, 52%] than anaerobes [32, 28%] and Gram-negative pathogens [22, 19%]. The predominant organisms were methicillin-susceptible Staphylococcus aureus [37, 32%], methicillin-resistant S. aureus [MRSA; 11, 10%], Bacteroides spp. [16, 14%], anaerobic streptococci [14, 12%] and Pseudomonas aeruginosa [9, 8%]. Of the 48 S. aureus, MRSA accounted for 11 [23%]. All MRSA isolates were susceptible to trimethoprim-sulfamethoxazole and vancomycin. Conclusion:S. aureus was the most common pathogenic organism isolated in breast abscesses at Al Amiri Hospital, Kuwait, of which 23% were MRSA. Nearly a third of the cases were caused by anaerobes, particularly B. fragilis. The data present a basis for the formation of empirical antimicrobial therapeutic policy in the management of breast abscess

Etiology and antibiotic susceptibility patterns of community- and hospital-acquired urinary tract infections in a general hospital in Kuwait

Our purpose was to determine the bacterial profile and prevalence of antibiotic resistance patterns of uropathogens, as well as evaluate the problem with extended-spectrum beta -lactamase [ESBL] producing isolates, causing urinary tract infections [UTIs] in Al-Amiri Hospital, Kuwait, over a 3-year period. Isolates [56,505] from symptomatic UTI cases from January 2005 to December 2007 were identified by conventional methods and the VITEK identification card system. Antimicrobial susceptibility testing was performed by disk diffusion method for Gram-positive organisms and an automated VITEK 2 machine for Gram-negative organisms. ESBL production by the Enterobacteriaceae was detected by the double-disk diffusion method and VITEK-2 system. Significant bacteriuria was detected in 15,064 [26.6%] of the 56,505 urine samples. Escherichia coli accounted for 4,876 [54.9%] from community-acquired UTI [CA-UTI] and 2,253 [36.4%] from hospital-acquired UTI [HA-UTI], followed by Streptococcus agalactiae [1,129, 12.7%] and Klebsiella pneumoniae [962, 10.8%] from CA-UTI cases. Candida spp. [973, 15.7%] and K. pneumoniae [747, 12.1%] were the second and third most prevalent isolates, respectively, in HA-UTI. High resistance rates were observed among the Enterobacteriaceae against ampicillin, cephalothin, ciprofloxacin, piperacillin and trimethoprim-sulfamethoxazole. About 855 [12%] and 291 [17%] of E. coli and K. pneumoniae, respectively, were resistant to ?4 antibiotics. The prevalence of ESBL-producing E. coli and K. pneumoniae in CA-UTI was 12 and 17% and in HA-UTI 26 and 28%, respectively. A high percentage of the uropathogens causing UTI in the Al-Amiri Hospital setting was highly resistant to the first- and second-line antibiotics for the therapy of UTI. ESBL-producing bacteria are highly prevalent in our hospital

Diagnosis of endocarditis caused by Mycobacterium abscessus

We report a fatal case of native valve endocarditis due to Mycobacterium abscessus in a hemodialysis patient. The diagnosis was based on culture isolation of acid-fast bacilli from peripheral blood and a permanent catheter tip, and their identification as M abscessus by a reverse hybridization-based assay and direct DNA sequencing of the 16S-23S internal transcribed spacer region. Rapid diagnosis and combination therapy are essential to minimize mortality due to this pathogen. Although combination therapy was started with clarithromycin and tigecycline, the patient refused to take clarithromycin due to severe abdominal pain. The patient became afebrile after therapy with tigecycline alone although bacteremia persisted. He was discharged against medical advice and readmitted three months later for persistent fever. His blood cultures again yielded M abscessus and a transesophageal echocardiogram showed two mobile vegetations. The patient was noncompliant with therapy and died due to cardiac arrest and multiorgan failure. This report shows that M abscessus should also be considered in the differential diagnosis of infective endocarditis in hemodialysis patients