Scedosporium apiospermum brain abscess: an emerging challenge

Invasive fungal infection of the brain in immunocompromised patients is frequently fatal. New opportunistic fungal infections with resistance to many antifungal agents are identified. Scedosporium species [Pseudallescheria boydii] is one of them. Fortunately, the infection is not common and only occasional cases are encountered. A case of Scedosporium brain abscess was treated in a relatively preserved, immunocompromised elderly lady who did not respond to antifungal treatment with voriconazole. This is the first case of Scedosporium brain abscess to be reported in the Gulf. An emerging medical challenge is highlighted and the literature reviewed

Impact of educationl interventions on the quality of blood culture specimens

Blood cultures [BC] are among the most important specimens for detection of etiologic agents in severe infections. At Salmaniya Medical Complex [SMC], the number of BCs increased from 10580 in 2002 to 13123 for 2004. The specimens likely to be contaminated averages 4.5 percent of the total BC processed with consumption of human and financial resources. We assessed the impact of an educational intervention aimed at decreasing false positivity to internationally accepted levels [<3 percent]. During October-November 2004, BC received at the Microbiology Laboratory at SMC were examined for appropriateness. During the ensuing two investigational months [December 2004- January 2005] an educational intervention was carried out which included phone calls, personal visits in the Wards, practical and theoretical sessions with the health care workers, distribution of Guidelines and attachment of online messages to reports. In the post-intervention period [February -March 2005], the appropriateness parameters were reassessed. Fifty-nine percent of BC received was inappropriate with no significant changes before and after the educational intervention. Although we were able to decrease the number of volume-appropriate bottles likely contaminated and reduce the number of cultures likely contaminated, the figures were still above the international benchmark value. We observed an increase in the number of bottles containing less than the minimal requirement of 3ml of blood. Education per se is not effective in reducing contamination and costs. To succeed the best approach will be to rely on dedicated phlebotomists team which can be a cost effective solution saving between USD720,00 and 1.3 million annually

Neonatal sepsis 1991-2001: prevalent bacterial agents and antimicrobial susceptibilities in Bahrain

To investigate the organisms causing neonatal sepsis and their modifications over an extended period, to assess their changing sensitivities to antibiotics and to verify whether the policy for screening pregnant women for group B streptococci [GBS] carriage is desirable in our settings. Medical records of all infants with positive blood culture from the Neonatal Intensive Care Unit at Salmaniya Medical Complex between 1991 and 2001 and Bahrain Defense Force Hospital between 1999 and 2001 were reviewed. Of the 7,978 neonates in both hospitals 335 [4.19%] had culture-proven bacteremia. Gram-positive bacteria were isolated at constant rate over the 11-year period. The main agents isolated were coagulase-negative Staphylococcus [CoNS] in 138 cases [41%], Staphylococcus aureus in 28 newborns [8%] and GBS in 26 patients [7.8%, 0.2/1,000 live births]. All of them were sensitive to penicillin G, erythromycin and clindamycin. Gram-negative bacteria were declining but Escherichia coli was isolated in 35 cases [10%]. Of special concern is the increasing percentage [5.7%] of Candida isolation. No clear trend toward increasing resistance was observed, although a major difference among the two institutions was evident. Klebsiella and Enterobacter spp. showed resistance to many of the antibiotics tested, thereby posing difficult therapeutic choices. Good quality specimens are essential to evaluate the role of CoNS. The increasing threat of fungal infection must be carefully tackled. Specifically tailored policies for GBS prevention must be defined according to the local epidemiology