Frequency of virulence-associated genes in Enterococccus faecalis isolated in Kuwait hospitals

The objective of this study was to investigate the carriage of 6 virulence-associated genes in Enterococcus faecalis isolates obtained from patients in 8 hospitals in Kuwait. In total, 466 E. faecalis isolates were obtained from 313 urine samples, 68 wound swabs, 36 blood samples, 25 rectal swabs, 12 high vaginal swabs and 12 miscellaneous sources. Genes for gelatinase[gelE],aggregation substance [aggA], hemolysin activation factor [cylA], enhanced expression of pheromone [eep], enterococcal surface protein [esp], and E. faecalis endocarditis antigen A [efaA] were detected in PCR assays. Of 466 isolates, 423 [90.8%] were positive for 1 and up to 5 genes. However, none of the genes was detected in all of the isolates. The prevalence of the individual genes was eep: 31.9%; esp: 31.5%; gelE: 28.5%; efaA: 27.9%; aggA: 23.4%, and cylA: 18.5%. Of the 423 positive isolates, 148 [34.9%] were positive for 2 genes and 52 [12.3%], 15 [3.5%] and 5 [0.9%] isolates were positive for 3, 4 and 5 virulence genes, respectively. The efaA and esp combination was detected in isolates from all clinical sources. The study showed a high prevalence of virulence genes in E. faecalis isolated in Kuwait hospitals. The absence of a dominant gene in all of the isolates suggests that infections by E. faecalis may require the involvement of multiple virulence factors

Streptobacillus moniliformis bacteremia in a child: case report

We report a case of bacteremia caused by Streptobacillus moniliformis. A 2 years and 3 months female Kuwaiti child presented with febrile convulsions, mild cough and vomiting. The patient's history, clinical findings and radiological investigations were reviewed. There was no history of rat/animal bite, but the child had been camping in the desert prior to the illness and may have been exposed to rodent excreta. On two occasions, blood culture specimens yielded pure growth of the organism which was identified by standard diagnostic criteria. The patient was successfully treated with cefotaxime and clarithromicin. S. moniliformis may be a cause of bacteremia even in the absence of rat/animal bites

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

Spectrum and antibiotic resistance of uropathogens isolated from hospital and community patients with urinary tract infections in two large hospitals in Kuwait

To determine the spectrum of microbial etiology and antibiotic resistance pattern of the uropatho-gens that cause urinary tract infections in 2 large teaching hospitals in Kuwait over a period of 1 year. The Vitek identification card system was used to identify the Uropathogens. Susceptibility of the isolates against 18 antibiotics was performed by the mi-crobroth dilution method using the Vitek automated system. In addition, gram-positive bacteria were tested in parallel by the disk diffusion technique. The six overall most common isolates were: Escherichia coli, accounting for 47% of isolates in both hospitals, followed by Candida spp. [10.8%], Klebsiella pneumoniae [9.6%], Streptococcus agalactiae [GBS; 9.5%], Enterococcus fae-calis [4,2%] and Pseudomonas aeruginosa [4.1%]. Ami-kacin provided the widest coverage amongst all the antibiotics tested followed by ciprofloxacin, gentamicin and piperacillin-tazobactam. For the gram-negatives, high resistance [26-63%] to the p-lactam antibiotics was noted, especially to ampicillin, amoxicillin-clavulanicacid, cephalothin and cefuroxime. Resistance to trimethoprim-sulfamethoxazole was also high. None of the enterococci was resistant to the glycopeptides, but 38-60% of the Staphylococcus haemolyticuswere resistant to vancomycin or teicoplanin. These data show the high level of antimicrobial resistance amongst the Uropathogens causing urinary tract infection in the two hospitals studied