Ten-year review of invasive Candida infections in a tertiary care center in Saudi Arabia

To review the epidemiology of invasive Candida infections in a single center in Saudi Arabia over a subsequent 10-year period. This retrospective study was carried out in a single center in Saudi Arabia over a 10-year period. Records of all patients with invasive Candida infections [ICI] over the period from January 2003 to December 2012 were reviewed. Mann-Whitney U test was used for comparison of Candida albicans [C. albicans] versus non-albicans Candida species, and fluconazole resistance versus fluconazole susceptible in relation to crude mortality at 30 days and 90 days. Eight hundred positive sterile site cultures, associated with 652 ICI were identified. Median age was 52 years and 53% of patients were males. Candida albicans were the most common species [38.7%], followed by Candida tropicalis [18.9%], and Candida glabrata [C. glabrata] [16.3%]. The proportion of ICI caused by C. albicans remained stable over time [p=0.07], but C. glabrata increased significantly [p<0.001]. The median rate of ICI per 1,000 hospital discharges per year was 1.65, with a significant trend towards higher rates over time [p=0.01]. Most isolates were susceptible to fluconazole, voriconazole, and amphotericin B. Only 66.7% of Candida krusei were susceptible to caspofungin. Overall 30-day crude mortality was 40.6%. There was no significant difference in crude mortality in association with C. albicans compared with non-albicans species, nor in association with fluconazole resistance. The rate of ICI increased significantly in the proportion of ICI caused by C. glabrata. Most isolates remain susceptible to caspofungin, voriconazole, and amphotericin B. The crude mortality remains high

GeneXpert MTB/RIF Testing in the Management of Patients with Active Tuberculosis; A Real Life Experience from Saudi Arabia

BACKGROUND: GeneXpert MTB/RIF is a real-time PCR assay with established diagnostic performance in pulmonary and extra-pulmonary forms of tuberculosis. The aim of this study was to assess the contribution of GeneXpert MTB/RIF assay to the management of patients with any form of active tuberculosis in a single large tertiary center in Saudi Arabia, with a special focus on the impact on time to start of antituberculous therapy compared with Ziehl-Neelsen (ZN) smears and mycobacterial cultures. MATERIALS AND METHODS: Clinical, radiological and laboratory records for all patients who were commenced on antituberculous therapy between March 2011 and February 2013 were retrospectively reviewed. RESULTS: A total of 140 patients were included, 38.6% of which had pulmonary tuberculosis. GeneXpert MTB/RIF was requested for only 39.2% of patients and was the only reason for starting antituberculous therapy for only 12.1%. The median time to a positive GeneXpert MTB/RIF result was 0 days (IQR 3) compared with 0 day (IQR 1) for smear microscopy (P > 0.999) and 22 days (IQR 21) for mycobacterial cultures (P < 0.001). No patients discontinued antituberculous therapy because of a negative GeneXpert MTB/RIF result. CONCLUSIONS: In a setting wherein physicians are highly experienced in the diagnosis and treatment of tuberculosis, GeneXpert MTB/RIF was remarkably under-utilized and had only a limited impact on decisions related to starting or stopping antituberculous therapy. Cost-effectiveness and clinical utility of routine testing of all smear-negative clinical samples submitted for tuberculosis investigations by GeneXpert MTB/RIF warrant further study.