Sequence analysis of bla [CTX-M] genes carried by clinically significant Escherichia coli isolates in Kuwait hospitals

To investigate the extent, distribution and sequence analysis of bla[CTX-M] genes carried by Escherichia coli isolated from patients admitted to all government hospitals in Kuwait. Extended-spectrum beta-lactamase [ESBL]-producing E. coli isolates were collected from the 8 major hospitals in Kuwait. CTX-M ESBLs were analyzed by PCR and sequenced. Clonality of the positive isolates was determined for genetic relatedness using pulsed-field gel electrophoresis [PFGE] with XbaI digestion of the genomic DNA. Of the 136 ESBL-positive isolates, 106 [77.9%] harbored bla[CTX-M] genes. Among these, bla[CTX-M-15] was the most frequent with a prevalence rate of 84.1%, followed by bla[CTX-M-14] [6.8%], bla[CTX-M-14b] [5.7%] and bla[TOHO-1] [3.4%]. Ninety-three [87.7%] were isolated from Kuwaiti [35.9%], Egyptian [31.1%] and Indian [20.8%] nationals; the majority of isolates positive for bla[CTX-M-15] were mainly from these 3 nationalities. PFGE analysis did not demonstrate any clustering of positive isolates in any particular hospital. This study confirms an explosive emergence of CTX-M-15 beta-lactamase among E. coli isolates in Kuwait and shows that the strains were clonally heterogeneous with no evidence of inter- or intra-hospital spread. Thus Kuwait may represent an important source of CTX-M-15-positive E. coli

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

Antibacterial resistance and molecular typing of methicillin-resistant Staphylococcus aureus in a Kuwaiti general hospital

To investigate antibiotic resistance and genetic relatedness of methicillin-resistant Staphylococcus aureus [MRSA] isolated in a general hospital in Kuwait over a period from 1996 to 1998 and 2001. The isolates were characterized by antibacterial susceptibility testing, coagulase serotyping, coagulase gene polymorphism [coag-RFLP] and pulsed-field gel electrophoresis [PFGE]. The MRSA isolates were highly resistant to gentamicin, kanamycin, ciprofloxacin, tetracycline, fusidic acid and mupirocin. The prevalence of gentamicin, kanamycin, streptomycin, tetracycline and erythromycin resistance remained high [80-96%] throughout the study period, but the prevalence of resistance to ciprofloxacin, fusidic acid and mupirocin steadily increased. The already high mupirocin resistance level increased from 12.5 in 1996, to 85.7% in 2001, and the fusidic acid resistance varied between 70.8 and 85.7%. In contrast, chloramphenicol and trimethoprim resistance declined from 25 and 29% in 1996 to 4.7 and 14.2% in 2001, respectively. The majority [91.5%] of the isolates were coagulase serotype 4. Alu I restriction endonuclease analysis of amplified coagulase gene generated four coag-RFLP patterns: 92% of them were coag-RFLP type 1, while types 2,3 and 4 were 3.5,4.6 and 1.1% respectively. PFGE differentiated them into seven pulsotypes [PFGE types 1-7]. The PFGE type 1 pulsotype constituted 90.2% of the isolates. Isolates with the type A coag-RFLP also had the typel PFGE pulsotypes. The concordant results of PFGE and coag-RFLP demonstrated the presence of a persistent MRSA clone in the hospital during the study period

Antibiotic susceptibility profile of group B streptococcus [streptococcus agalactiae] at the Maternity hospital, Kuwait

This study was designed to determine the antibiotic susceptibility profile of clinical isolates of group B streptococcus [GBS, Streptococcus agalactiae] and to use the information for formulating appropriate intrapartum antibiotic policy for GBS carriage in pregnancy. Materials and A total of 1,166 clinical isolates [single isolates] of GBS obtained from vaginal/rectal samples of pregnant mothers seen at the Maternity Hospital, Kuwait were studied over a period of 43 months between May 1998 and December 2001. The isolates were identified by st and ard methods and their susceptibility to penicillin, ampicillin, cephalothin, clindamycin and erythromycin was determined by disk diffusion technique, minimal inhibitory concentration [MIC] using the Vitek automated sensitivity card system and E-test methods. All the GBS isolates were fully susceptible to penicillin, ampicillin and cephalothin. Only 0.7 and 1.7% were resistant to erythromycin and clindamycin, respectively. Disk diffusion results interpreted by the st and ard interpretative criteria recommended by the National Committee on Clinical Laboratory St and ards correlated well with Vitek results as well as the E-test for penicillin. The MIC of penicillin against all isolates ranged between 0.016 and 0.064 micro g/ml. For the 6 months of 1998 and throughout 1999, the percentages of isolates susceptible at MICs of 0.016, 0.023, 0.032, 0.047 and 0.064 micro g/mi were 6.5, 9.9, 31, 38.8 and 12%, respectively. The trend was similar in the subsequent years except that the percentage of isolates susceptible at MIC of 0.064 micro g/ml increased to 26.6% in 2000, but went down to 4.4% in 2001. The trend in susceptibility of GBS to a variety of often used antibiotics for therapy and prophylaxis remained unchanged over nearly a 4-year period. The apparent increase in the number of isolates susceptible at higher MIC values of penicillin [0.047 and 0.064 micro g/ml] in 2000 appears to be a bleb that cannot be explained by any event in the hospital for that year. Our data, based on susceptibility profiles, supports the use of penicillin or ampicillin for intrapartum chemoprophylaxis to prevent early-onset neonatal GBS infections