Multidrug resistance Acinetobacter species at the intensive care unit, Aseer Central Hospital, Saudi Arabia: A one year analysis

OBJECTIVE@#To identify and to determine the antimicrobial susceptibility of Acinetobacter baumannii (A. baumannii) clinical isolates from ICU at Aseer Central Hospital.@*METHODS@#The study was conducted in the Intensive Care Unit, Aseer Central Hospital, Saudi Arabia over 13 months period (2014-2015). Acinetobacter species (n = 105) were isolated from various clinical samples. Isolates were identified using selected phenotypic criteria and confirmed using the Vitek 2 automated system. This system was used to determine the susceptibilities of 21 antimicrobial agents. Patients, isolates and drug data were analyzed using the SPSS statistical software package to determine some epidemiological and microbiological patterns.@*RESULTS@#Of the 105 stains, A. baumannii accounted for 49 (46.67%), A. baumannii complex, 19 (18.09%), A. baumannii/haemolyticus 32 (30.47), Acinetobacter haemolyticus 4 (3.81%), Acinetobater lwoffii 1 (0.95%) and unidentified Acinetobater species 2 (1.3%). Of the 105 Acinetobacter strains, 103 (98.1%) were found multidrug resistant (MDR). A. baumannii strain were 100% sensitive to colistin and 74.5% to trimethoprim + sulfamethoxazole. The remaining 19 antimicrobial agents revealed low or no sensitivities: amikacin 16.3%; ampicillin 7.7%; ceftazidime, 7.3%. Distribution of similar sensitivities was shown by other Acinetobacter species. Mean number of isolates from males and females indicates no statistical variation (P = 0.867) whereas age groups showed significant differences (P = 0.008) as it is clear from the high percentage of infected individuals more than 60 years followed by those aged 20-29 years old (19.05%). Upper respiratory tract (30.48%), lower respiratory tract (47.65%) and subcutaneous tissue (9.5%) were the main sources of Acinetobacter spp. but mean numbers of isolates from these specimens indicate no discrepancy between specimens (P = 0.731).@*CONCLUSIONS@#Acinetobacter species including A. baumannii were found MDR (98.1%) according to the current Acinetobacter spp. antimicrobial categorization. Approximately half of these strains were A. baumannii. All Acinetobacter species were 100% sensitive to colistin and to some extent to trimethoprim + sulfamethoxazole (74.5%). ICU-acquired pneumonia among patients over 60 years of age who spend prolong times at artificial ventilations made up the majority of the cases.

Multidrug resistance Acinetobacter species at the intensive care unit, Aseer Central Hospital, Saudi Arabia: A one year analysis

Objective To identify and to determine the antimicrobial susceptibility of Acinetobacter baumannii (A. baumannii) clinical isolates from ICU at Aseer Central Hospital. Methods The study was conducted in the Intensive Care Unit, Aseer Central Hospital, Saudi Arabia over 13 months period (2014-2015). Acinetobacter species (n = 105) were isolated from various clinical samples. Isolates were identified using selected phenotypic criteria and confirmed using the Vitek 2 automated system. This system was used to determine the susceptibilities of 21 antimicrobial agents. Patients, isolates and drug data were analyzed using the SPSS statistical software package to determine some epidemiological and microbiological patterns. Results Of the 105 stains, A. baumannii accounted for 49 (46.67%), A. baumannii complex, 19 (18.09%), A. baumannii/haemolyticus 32 (30.47), Acinetobacter haemolyticus 4 (3.81%), Acinetobater lwoffii 1 (0.95%) and unidentified Acinetobater species 2 (1.3%). Of the 105 Acinetobacter strains, 103 (98.1%) were found multidrug resistant (MDR). A. baumannii strain were 100% sensitive to colistin and 74.5% to trimethoprim + sulfamethoxazole. The remaining 19 antimicrobial agents revealed low or no sensitivities: amikacin 16.3%; ampicillin 7.7%; ceftazidime, 7.3%. Distribution of similar sensitivities was shown by other Acinetobacter species. Mean number of isolates from males and females indicates no statistical variation (P = 0.867) whereas age groups showed significant differences (P = 0.008) as it is clear from the high percentage of infected individuals more than 60 years followed by those aged 20-29 years old (19.05%). Upper respiratory tract (30.48%), lower respiratory tract (47.65%) and subcutaneous tissue (9.5%) were the main sources of Acinetobacter spp. but mean numbers of isolates from these specimens indicate no discrepancy between specimens (P = 0.731). Conclusions Acinetobacter species including A. baumannii were found MDR (98.1%) according to the current Acinetobacter spp. antimicrobial categorization. Approximately half of these strains were A. baumannii. All Acinetobacter species were 100% sensitive to colistin and to some extent to trimethoprim + sulfamethoxazole (74.5%). ICU-acquired pneumonia among patients over 60 years of age who spend prolong times at artificial ventilations made up the majority of the cases.

Low recovery rate of helicobacter pylori from positive CLO test patients suffering from dyspepsia

Helicobacter pylori are a well-known cause of gastrointestinal diseases particularly amongst patients suffering from dyspepsia. To evaluate the recovery rate of Helicobacter pylori from suspected peptic ulcer patients with dyspepsia symptom. Gastroenterology Unit, Aseer Central Hospital, Saudi Arabia. A Prospective Study. Gastroscopy and gastric biopsy were performed on 53 patients with dyspepsia from January 2012 to January 2013; all were subjected urease CLO test and culture. The CLO-positive biopsies were cultured using brain-heart infusion agar with added blood [7%], and Skirrow's supplement was used for isolating Helicobacter pylori. Inoculated plates were incubated at 37°C for 7-10 days in a microaerophilic incubation environment and examined for suspected Helicobacter pylori colonies. Helicobacter pylori cultures were confirmed by the positive urease, oxidase and rapid antigen test. Cultures of non-Helicobacter pylori bacteria were identified using few phenotypic tests then confirmed by VITEK 2 automated system. Seventeen [32.08%] Helicobacter pylori were isolated [in pure form or in mixed cultures] using Brain-Heart Infusion agar with blood and Skirrow's supplement. Nineteen [35.85%] samples revealed no growth, 5 [9.43%%] revealed the growth of Acinetobacter spp, 4 [7.55%] revealed Brucella melitensis, 2 [3.77%] revealed Pasteurella spp. and 1 [1.89%] revealed Pseudomonas aeruginosa. The recovery rate of Helicobacter pylori from CLO positive biopsies was low, 17 [32.08%], but growth of other gram negative bacilli was documented

Is there is an association between the presence of Staphylococcus species and occurrence of vernal keratoconjunctivitis?

Purpose: The aim of this study was to identify the association of normal bacterial flora with vernal keratoconjunctivitis [VKC] occurrence in VKC and non-VKC groups

Methods: Conjunctival specimens were collected from 18 VKC patients and 22 healthy controls, cultured and identified following standard methods. The association between the presence of bacteria and occurrence of VKC was analyzed using Chi square statistic

Results: Comparable bacterial growth was observed in VKC [77.8%] as well as control group [77.2%] [p = 0.970]. Analysis of individual bacterial revealed that Staphylococcus aureus was detected more frequently in VKC [27.78% vs. 4.55% in control, p = 0.041] and Staphylococcus epidermidis was found much more commonly in the control eyes [45.45% in control vs. 5.56% in VKC, p = 0.005]

Conclusions: An aggravating role of S. aureus colonization in the occurrence of VKC, and a possible role of S. epidermidis against the occurrence of VKC were concluded

Candida and other yeasts of clinical importance in Aseer region, southern Saudi Arabia. Presentation of isolates from the routine laboratory setting

To isolate, identify, and determine the prevalence of Candida and other yeasts of clinical importance in Aseer region, Saudi Arabia. This is a cross-sectional study involving retrospective analysis of 6100 samples submitted to the Microbiology Laboratory, Aseer Central Hospital, Abha, Saudi Arabia between 2011 and 2012, and prospective isolation and identification of 84 isolates recovered from various clinical specimens presented to the Microbiology Laboratory between 2012 and 2013 using the classic morphological schemes and the Vitek 2 automated system. The results of the retrospective analysis [2011-2012] indicated that of the 6100 various clinical specimens submitted to the routine microbiology analysis, 143 [2.35%] revealed the presence of Candida spp. The distribution of the 143 Candida spp. according to specimens was as follows: urine 72%, sputum 10.5%, endotracheal tube 7%, blood 4.2%, catheter tip 2.1%, throat swab 2.1%, eye swab 0.7%, wound exudates 0.7%, and cerebrospinal fluid 0.7%. The results of the prospective study [2012-2013], which involved the identification of yeast recovered from 84 specimens indicated that Candida albicans 28.6% was the predominant species, followed by Candida parapsilosis 21.4%, Candida tropicalis 14.3%, and Candida lusitaniae 9.5%. Along with the commonly encountered Candida albicans, Candida parapsilosis, Candida tropicalis, and Candida lusitaniae were detected with significant rates. Many other Candida species and some other pathogenic yeasts have been detected for the first time in the region. Urinary tract samples were the main source of Candida species

Distribution of class I integrons and their effect on the prevalence of multi-drug resistant Escherichia coli clinical isolates from Sudan

To analyze integrons gene cassettes Class I among Escherichia coli [E. coli] isolates from Sudan and to determine their effect on the prevalence of resistance to antimicrobials. This cross-sectional study was conducted at 6 hospitals in Khartoum State, Sudan between April and August 2011. Escherichia coli [n=133] isolated from clinical specimens of patients were included. Isolates were identified and tested for antimicrobial susceptibility following standard procedures. Multi-drug resistance [MDR] patterns was defined as non-susceptibility to >/= 3 antimicrobials. Class I integrons was detected by polymerase chain reaction, and gene cassettes were characterized via sequencing analysis. Of the 133 E. coli isolates, 40.6% [n=54] harbored Class I integrons. All the 54 integron carriage, E. coli was found to be MDR strains. Integron carriage isolates confer higher levels of resistance than any other isolates [p<0.05] such as amoxicillin-clavulanic acid [66.7% versus 36.7%], ceftazidime [46.3% versus 17.7%], chloramphenicol [29.6% versus 7.6%], ciprofloxacin [70.4% versus 43%], tetracycline [88.9% versus 57%] and trimethoprim-sulfamethoxazole [98.1% versus 69.6%]. Sequencing of gene cassettes harbored mostly dihydrofolate reductase [dfrA], which encodes resistance to trimethoprim and aminoglycoside adenyltransferase [aadA] that encodes resistance to streptomycin. The most frequent combination types were dfrA17 and aadA5 genes. Class I integrons were quite common and its carriage contributed significantly to the emergence of MDR among E. coli. Nevertheless, factors leading to the wide spread of integrons are still to be determined

Prevalence of extended-spectrum beta -lactamases-producing Escherichia coli from hospitals in Khartoum state, Sudan

This study aimed to determine the prevalence and assess antimicrobial susceptibility of extended- spectrum beta -lactamase-producing Escherichia coli isolated from clinical specimens of patients at hospitals in Khartoum State, Sudan. During April to August 2011, a total of 232 E. coli isolates were collected from various clinical specimens of patients. Isolates were identified, tested for antimicrobial susceptibility and screened for ESBL production as per standard methods. The double-disk diffusion method was used to confirm ESBL production using antimicrobial disks of ceftazidime [30 micro g], cefotaxime [30 micro g], with or without clavulanic acid [10 micro g]. A zone difference of >5 mm between disks was considered indicative of ESBL production. Out of 232 E. coli isolates, 70 [30.2%] were found to be positive for ESBL by the applied phenotypic methods. ESBL-producing isolates yielded high resistance rates for trimethoprim-sulfamethoxazole [98.6%], tetracycline [88.6%], nalidixic acid [81.4%] and ciprofloxacin [81.4%]. The highest antimicrobial activities of ESBL-producing isolates were observed for amikacin [95.7%], followed by tobramicin [74.3%] and nitrofurantoin [68.6%]. Resistance to quinolones, aminoglycosides, trimethoprim-sulfamethoxazole, tetracycline, nitrofurantoin and chloramphenicol was higher in ESBL than non-ESBL isolates [p<0.05]. The frequency of ESBL-producing isolates varied among hospitals [18.2% to 45.1%], although a high prevalence was recorded as 45.1% at Khartoum Teaching Hospital. Wound specimens were the most common source of ESBL-producing isolates. The proportion of ESBL-producing E. coli did not differ significantly between adults and children [31% vs. 27%]. The prevalence of ESBL-producing E. coli detected in this study is of great concern, which requires sound infection control measures including antimicrobial management and detection of ESBL-producing isolates

Isolation of a rare nocardia wallacei from an HIV-positive patient with pulmonary infection in southern Saudi Arabia

This study aimed to clarify the taxonomic position of an actinomycete isolated from an HIV-positive male patient with pulmonary complications in Asir, southern region of Saudi Arabia. The strain was found to have phenotypic properties typical of nocardiae and 16S rRNA gene analysis clustered the isolate with Nocardia wallacei [accession KC677696] in the phylogenetic branch of the amikacin resistance Nocardia transvalensis complex. We consider that nocardiosis is usually missed or misdiagnosed clinically and recognition of these bacteria based on phenotypic tests is strenuous, but definitive identification is attainable by molecular methods

Detection of multidrug-resistant tuberculosis using PCR compared to the conventional proportional method

To evaluate the PCR technique for the rapid defection of Multidrug-Resistant [MDR] Mycobacterium tuberculosis compared to the conventional proportional drug sensitivity testing. Cross sectional laboratory based study. Alshaab Teaching Hospital, Abu-Angah Hospital and the National Health Laboratory, Sudan. One hundred thirty tuberculosis suspected individuals of both sexes and of different ages were included in the study. Sputum samples were cultured on Lowenstein-Jensen [LJ] medium. Resistant strains were tested for the presence of mutations conferring resistance using molecular techniques to amplify 315 base pair [bp] rifampicin [RIF] and 146 bp isoniazid [INH], as markers for MDR among Mycobacterium tuberculosis. One hundred nineteen [91.5%] showed Mycobacterium tuberculosis-like colonies, 65 of which were randomly subjected to PCR and examined for the presence of IS6110 insertion sequences. Fifty-six [86.2%] were confirmed members of the Mycobacterium tuberculosis. The result of antibiotics susceptibility testing revealed that 32/56 [57.1%] of the strains were resistant to RIF, 36/56 [64.3%] to INH and 30/56 [53.6%] were resistant to both drugs [MDR]. The conventional method showed 21/56 [37.5%] were resistant to RIF, 32/56 [57.1%] to INH and 16/56 [28.6%] were resistant to both drugs [MDR]. Not all resistant strains detected by conventional were detected by PCR method; 14 [25%] were missed for RIF, 9 [16.1%] for INH and 4 [7.1%] for both. This represents a significant lack of sensitivity of the PCR technique, which could be due to the presence of other types of mutations that needs other primers and PCR protocol

Prevalence of bacterial pathogens in aseer region, kingdom of Saudi Arabia: emphasis on antimicrobial susceptibility of staphylococcus aureus

This short study aims to determine the prevalence of various bacterial pathogens causing infections in the Aseer regions, and to also assess the distribution of Staphylococcus aureus in relation to different body sites as well as their in vitro antimicrobial susceptibility profile. Clinical specimens [n=9831] from various infections diagnosed at Aseer Central Hospital [ACH] and Abha General Hospital [AGH], were analyzed bacteriologically. Confirmed S. aureus isolates [n=210] were tested against 44 antibacterial agents as per standard methods. Bacterial pathogens were recovered from 24.9% of the samples. The results revealed that Escherichia coli, Klebsiella pneumoniae, Enterococcus spp. and S. aureus to be the main etiological agents, while purulent exudates of wounds and abscesses were the main source ofS. aureus. Out of the 210 S. aureus isolates; 77 [38.5%] were recovered from purulent exudates of wounds and abscesses of the examined patients and 53 [26.5%] were from high vaginal discharges, while other body sites exhibited different rates of S. aureus. On the other hand, 45% of the 210 S. aureus isolates were found to be multidrug resistant S. aureus [MRSA]. The results from this study revealed that Escherichia coli and staphylococci were the main etiological agents, while purulent exudates of wounds and abscesses were the main source of S. aureus. Also, a higher rate of MRSA was detected

Molecular detection of mycobacterium other than tuberculosis among patients with pulmonary infection

Isolation of Mycobacterium other than tuberculosis [MOTTs] among patients with pulmonary infection and evaluation of the usefulness of polymerase chain reaction [PCR] as a confirmatory test. Descriptive laboratory based study. National Health Laboratory [Stack], Elasha'ab Teaching Hospital, Abo Anga Hospital, Ebrahem Malek Hospital and Academy Charity Hospital. One hundred and seventy-one sputum samples were collected from suspected pulmonary tuberculosis patients, males and females with different ages. Informed consent was taken. Sputum samples were inoculated on LJ medium and organisms were identified according to their Ziehl-Neelsen stain, cultural characteristics and biochemical proprieties. The rapidly growing isolates were subjected to PCR. In this study, males were found to be more affected than females 125 [73.1%]. The patients between 21-50 years were the most affected with TB and NTM. On LJ medium, 40 [23.4%] of the isolates gave characteristic growth of Mycobacterium tuberculosis and were identified according to their Ziehl-Neelsen stain and cultural characteristic. Ten [5.8%] isolates were identified as rapid growers, 6 out of which were identified as MOTTs according to their indirect Ziehl-Neelsen stain, cultural characteristics and biochemical proprieties. On PCR, six of the ten rapid growers showed a band typical in size [136 bp] to target rpoB gene as indicated by the standard DNA marker. The results revealed clearly the importance of conventional methods including Z.N stain and culture techniques in the diagnosis of TB and NTM. As well as it proved the effectiveness of PCR as a sensitive, specific and rapid diagnostic and confirmatory test

Evaluation of a PCR-amplified IS6110 insertion element in the rapid diagnosis of pulmonary tuberculosis in comparison to microscopic methods in Sudan

The aim of this study was to evaluate the sensitivity and specificity of a polymerase chain reaction [PCR]-based method [IS6110 insertion site] in the diagnosis of pulmonary tuberculosis in sputum samples in comparison to smears by using culture on Loewenstein-Jensen medium as a standard. The study was conducted during the period 1999 through to 2000, at Khartoum Teaching Hospital, Sudan, on 200 sputum samples. The samples were collected from patients suspected of having pulmonary tuberculosis, were examined using a PCR amplified IS6110 insertion element in comparison to Ziehl-Neelsen stained smears in terms of sensitivity and specificity. Culture on Loewenstein-Jensen medium was used as the standard to control the 2 tests. Microscope sensitivity was found to be 65.4% and the specificity was 90.5%, whereas sensitivity of the IS6110 was 88.5% and specificity was 98.6%. The study concluded that though IS6110 sensitivity was 13.1% higher than smear method, it provided a significant improvement in specificity for the diagnosis of pulmonary tuberculosis. Improvement is still needed to increase the sensitivity of the IS6110 methods by decreasing the number of the false negative samples before its use can be at routine levels