case of community-onset meningitis caused by hospital methicillin-resistant staphylococcus aureus successfully treated with linezolid and rifampicin

To report a relatively rare presentation of methicillin-resistant Staphylococcus aureus [MRSA] meningitis in a previously healthy boy in Kuwait. A 14-year-old boy presented with a 2 weeks' history of headache and fever with increasing severity. He developed photophobia and double vision 2 days prior to his hospital visit and received ceftriaxone for 6 days prior to admission to the hospital. There was no history of head trauma or neurosurgical operation. Lumbar puncture revealed a slightly turbid cerebrospinal fluid with pleocytosis and greatly reduced glucose, elevated protein level and on culture grew MRSA. Staphylococcal chromosome cassette mec [SCCmec] typing revealed that it belonged to SCCmec type III and sequence type 238 [ST238-SCCmec-lll]. Polymerase chain reaction screening for the presence of Panton-Valen-tine leukocidin [PVL] genes yielded a negative result; all these findings were consistent with hospital-acquired MRSA. He was treated with intravenous linezolid and rifampicin for 2 weeks, made good response and was discharged home fully recovered and well. Hospital MRSA should be considered in the differential diagnosis of the causative agents of community-onset meningitis in healthy patients even without predisposing factor

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

Plasmid-mediated high-level ceftriaxone resistance in a Salmonella enterica serotype typhimurium isolate

We evaluated ion exchange chromatography [IEC] on the Jeol Aminotac 500 analyzer for total homocysteine [tHcy] determination and compared it with an immunoassay method using fluorescence polarization on an Abbott IMx analyzer. IEC method validation [linearity, limit of detection, precision, interference] was made according to the French Biology Society guidelines [Societe Fran‡aise de Biologie Clinique]. Moreover, during a 2-month period, 55 plasma samples from patients scheduled for routine tHCy measurement were assayed by both methods for determining correlation. The IEC method was found linear up to at least 190 micro mol/l, and the limit of detection was 1.6 micro mol/l. Precision was studied with 3 controls at 6, 15 and 30 micro mol/l. Intra-assay coefficients of variation [n = 14] were 8.3, 3.1 and 2.3%, respectively, and inter-assay coefficients of variation [n = 15] were 9.6, 5.1 and 4.9%, respectively. No interference was found with other sulfur-containing amino acids [methionine, cysteine]. An excellent agreement was found between IEC and fluorescence polarization [Deming regression; y = 0.99x - 1.23; r = 0.97; p < 0.001]. The IEC method for tHcy measurement shows adequate precision and correlates highly with the IMx assay. The IEC method is more time-consuming but less expensive in reagent cost and allows simultaneous determination of plasma methionine concentration which may help to explain the underlying mechanism responsible for hyperhomocysteinemia

Point surveillance of staphylococcus aureus carriage among medical staff in infectious diseases hospital, Kuwait

To investigate the carriage of Staphylococcus aureus among doctors and nurses in Infectious Diseases Hospital, Kuwait, following the detection of 3 cases of methicillin-resistant S. aureus [MRSA]. Materials and A total of 260 nasal and throat swabs were obtained from 19 doctors and 111 nurses and cultured for the carriage of S. aureus. Forty-three S. aureus were identified based on their growth characteristics on mannitol-salt agar, catalase and tube coagulase and DNA hydrolysis. The isolates were tested for susceptibility to antibacterial agents and typed by phage typing; plasmid analysis and pulsed-field electrophoresis were carried out to determine their relatedness. Of the 19 doctors, 4 [21%] had nasal carriage while only 1 of them had a throat carriage. Sixteen [14.4%] nurses carried S. aureus in their noses and 20 [18%] in their throats. The combined nasal carriage rate for both doctors and nurses was 15.8%, and combined throat carriage was 16.6%. None of them carried MRSA. The isolates were resistant to penicillin G [90%], tetracycline [23.3%], erythromycin [9.3%] and cadmium [100%]. Typing of the isolates showed a variety of phage types, plasmid and pulsed-field gel electrophoresis patterns. Discussion: None of the doctors or nurses carried MRSA. Typing of the methicillin-susceptible strains that they carried demonstrated that the S. aureus were different, indicating an absence of a dominant clone capable of spreading. It is important to maintain a low carriage of S. aureus among health-care workers

Susceptibility of staphylococci isolated from aberrans unit to mupirocin and other antimicrobial agents

The activity of mupirocin [Bactroban] against coagulase-positive and coagulase-negative staphylococci isolated in a burns unit was tested to ascertain its effectiveness, and to detect any resistant isolates after continuous use of mupirocin for 2.5 years. A total of 395 staphylococci, consisting of 330 Staphylococcus aureus and 65 coagulase-negative staphylococci, were tested for resistance to mupirocin and other antimicrobial agents. The results showed that 94.5% of the isolates were fully susceptible to mupirocin [MIC 1,024 mg/l]. It transferred high-level mupirocin resistance to other staphylococci in conjugation experiments, which indicated a capacity to transmit mupirocin resistance between species. The results demonstrated that mupirocin was still highly effective against staphylococci in the burns unit. However, the demonstration that the resistant S. haemolyticus isolate could transfer high-level mupirocin resistance to other staphylococci was of concern. There is a compelling need to test staphylococci from clinical materials for mupirocin resistance. Early detection of resistance can prevent the establishment and spread of the mupirocin-resistant strains in the unit