Pertussis and pertussis like illness: Pediatric experience in Oman

Objectives: Aresurgence of pertussis or whooping cough has been observed worldwide despite broad vaccination coverage. Pertussis like illness [PLI] refers to a clinical syndrome compatible with pertussis infection but lacking laboratory confirmation or an epidemiological link to a confirmed case. Our study aimed to estimate the contribution of Bordetella pertussis infection and identifying predictors of its diagnosis in a cohort of children with PLI

Methods: Demographic and clinical information were retrospectively collected from the medical records of children < 13 years old and hospitalized for PLI in two pediatric units in Oman from 1 January 2012 to 31 December 2013. The laboratory data of all cases were reviewed and confirmed cases of pertussis were identified, analyzed, and compared with non-confirmed cases

Results: A total of 131 patients were enrolled in this study. The majority [95.4% [125/131]] were infants. Only 54.1% [71/131] of admitted children with PLI were tested for pertussis. The incidence of pertussis infection among the tested group was 16.9% [12/71] with a 95% confidence interval 8.2?25.6. Severe illness occurred in 56.4% [74/131] of patients, and six were confirmed to have pertussis. Pediatric intensive care unit admission was required for one confirmed case of pertussis and eight cases from the PLI group [three were negative for pertussis, and five were not tested]. Receiver operator characteristic curve analysis revealed that a white blood cell count >/= 23.5 × 10[9]/L had 96.6% specificity and lymphocytes >/= 17 × 10[9]/L had 98.3% specificity

Conclusions: Taking into consideration that the number tested for pertussis was limited, the incidence of pertussis was 16.9% [12 out of 71 patients]. Lymphocytosis can be used as a reliable predictor for the diagnosis of pertussis especially in the absence of specific confirmatory tests or until their results are available

Understanding the influenza A H1N1 2009 pandemic

A new strain of Influenza A virus, with quadruple segment translocation in its RNA, caused an outbreak of human infection in April 2009 in USA and Mexico. It was classified as Influenza A H1N1 2009. The genetic material originates from three different species: human, avian and swine. By June 2009, the World Health Organization [WHO] had classified this strain as a pandemic virus, making it the first pandemic in 40 years. Influenza A H1N1 2009 is transmitted by respiratory droplets; the transmissibility of this strain is higher than other influenza strains which made infection control difficult. The majority of cases of H1N1 2009 were mild and self limiting, but some people developed complications and others died. Most laboratory tests are insensitive except the polymerase chain reaction [PCR] which is expensive and labour intensive. The Influenza A H1N1 2009 virus is sensitive to neuraminidase inhibitors [oseltamivir and zanamivir], but some isolates resistant to oseltamivir have been reported. A vaccine against the new pandemic strain was available by mid-September 2009 with very good immunogenicity and safety profile. Surveillance is very important at all stages of any pandemic to detect and monitor the trend of viral infections and to prevent the occurrence of future pandemics. The aim of this review is to understand pandemic influenza viruses, and what strategies can be used for surveillance, mitigation and control

Extended-spectrum beta-lactamase [ESBL] in Omani Children: Study of prevalence, risk factors and clinical outcomes at Sultan Qaboos University Hospital, Sultanate of Oman

Antimicrobial resistance is a growing problem worldwide, which imposes difficulties in the selection of appropriate empirical antimicrobial therapy. This study evaluated extended-spectrum ?-lactamase [ESBL] isolates in 2005 in The Department of Child Health at Sultan Qaboos University Hospital [SQUH], Oman. During the 12 month period from January 2005 to December 2005, ESBL isolates from paediatrics inpatients were identified and analysed. Risk factors for the patients who grew ESBLs were analysed. 13.3% of E. coli and 16.6% of Klebsiella pneumoniae isolated were ESBL producers. Most of the ESBLs were from urine [46.2%] and blood [42.6%]. The main risk factors for ESBL in these children were previous exposure to antimicrobials [100%], prolonged hospital stay, severe illness [92.3%] and female gender [84.6%]. Sensitivity of 100% was observed to carbapenems whereas 92% of the isolates were susceptible to amikacin. The oximino-cephalosporins were 100% resistant. Klebsiella pneumoniae were 100% resistant to piperacillin-tazobactam and nitrofurantoin. E. coli was 100% resistant to trimethoprim-sulfamethoxazole and ciprofloxacin. No resistance was recorded for the following combinations: amikacin plus piperacillin-tazobactam, amikacin plus nitrofurantoin and gentamicin plus nitrofurantoin. ESBL-producing organisms are becoming a major problem in Omani children. Exposure to antimicrobials and long admissions are modifiable risk factors that should be targeted for better control. Carbapenems are the most sensitive and reliable treatment options for infections caused by ESBLs. Amikacin plus piperacillin-tazobactam or nitrofurantoin are good alternatives

Antibiotic combination as empirical therapy for extended spectrum beta-lactamase

extended spectrum beta-lactamase [ESBL] producing gram negative bacilli are becoming a growing problem worldwide with difficulties in designing a national formulary for empirical treatment of gram negative sepsis. In this study, we investigated the in vitro activity of Carbapenems, Pipracillin-Tazobactam, Ciprofloxacin alone or in combination with aminoglycosides against ESBL-producing strains isolated from clinical samples. Three hundred and one ESBL-producing Escherichia coli and K. pneumoniae strains isolated from clinical samples were investigated. Isolates were screened initially for ESBL production using an automated system. All ESBL isolates were further confirmed using the double-disk diffusion method. The overall Piperacillin-Tazobactam susceptibility was 57.9 [64.4% E. coli and 43.6% Klebsiella pneumoniae]. Only 29.6% of ESBLs [24.9% E. coli and 39.6% Klebsiella pneumoniae] were ciprofloxacin susceptible. 98.1% E. coli and 93.1% of Klebsiella pneumoniae were susceptible to Piperacillin-Tazobactam plus Amikacin combination. 73.7% E. coli and 61.4% of Klebsiella pneumoniae were susceptible to Piperacillin-Tazobactam plus Gentamicin combination. 96.7% E. coli and 91.1% of Klebsiella pneumoniae were susceptible to Ciprofloxacin plus Amikacin combination. 41.2% E. coli and 51.5% of Klebsiella pneumoniae were susceptible to Ciprofloxacin plus Gentamicin combination. ESBLs have high resistance profile against Piperacillin/Tazobactam and Ciprofloxacin. The ESBLs from Oman have similar resistantce pattern as those reported from UK and USA. This resistance decreases when these drugs are combined with Amikacin. All ESBLs are susceptible to Carbapenems. However, carbepenam overuse can lead to emergence of carbapenems resistant gram negative bacilli and ESBLs. Combination of Amikacin plus Piperacillin/Tazobactam is a feasible empirical therapy for ESBLs

Prevalence of extended-spectrum beta-lactamases-producing isolates over a 1-year period at a University Hospital in Oman

To evaluate the prevalence of extended-spectrum beta-lactamases isolates over one year period at Sultan Qaboos University Hospital. We identified the ESBL isolates during a 12-month period from July 2004 to June 2005, using a commercial system, and confirmed the result using the National Committee for Clinical Laboratory Standards-approved double-disk diffusion method. Sensitivity was recorded for a wide range of antibiotics, aminoglycosides, carbapenem, cephalosporins, quinolones, aztreonam, ampicillin, amoxicillin/clavulanate, ampicillin/sulbactam, piperacillin-tazobactam, trimethoprim/ sulfamethoxazole and nitrofurantoin. Of the total ESBL isolated, 29.6% were from medical ward, followed by outpatients clinic, 24.3%. Urine was the main source of ESBLs 70.4%, followed by 16.5% from blood. We observed a 100% sensitivity to carbapenems, whereas 93.9% of the isolates were susceptible to amikacin. Cephalosporins were 100% resistant, except for cefoxitin, which demonstrated sensitivity of 77.4%. Aztreonam, ampicillin, co-amoxyclav and ampicillin/sulbactam were 100% resistant. Of the isolates, 57.4% were sensitive to nitrofurantoin, whereas Tazocin showed 49.6% sensitivity and co-trimoxazole 13.9%. To quinolones, 74.8% of the isolates were resistant. Excess use of third generation cephalosporins led to increase rate of ESBLs, which are difficult to treat. Carbapenem are most reliable for treatment of infections caused by ESBL isolates. However, overuse of carbapenem may lead to resistance of other gram-negative organisms. Therefore, justifiable use of third-generation cephalosporins, will be an effective means of controlling and decreasing the spread of ESBL isolates