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

Significance of atypical pathogens among community-acquired pneumonia adult patients admitted to hospital in Kuwait

The aim of this study is to determine the microbial etiology and severity of community-acquired pneumonia [CAP] in Kuwait. The severity of consecutive adult CAP cases admitted to 3 hospitals over a 1-year period was classified according to the Pneumonia Outcome Research Team [PORT] severity index. The microbial etiology was determined using st and ard methods for bacteria and serological tests for atypical and viral pathogens. The study population was 124 of the 135 admissions; 63 female, 61 male; mean age 41.3 +/- 18 years. The severity class distribution was: class 131%, class II 37%, class III 17%, class IV 13%, and class V 2%. Etiological agents were identified from 44 patients [35%], with one pathogen in 31 [25%], two in 9 [7%], and three or more in 4 [3%]. The most common pathogens identified were: Mycoplasma pneumoniae in 14 patients [11%], Legionella pneumophila in 10 [8%], Chlamydia pneumoniae in 8 [6%], influenza B virus in 8 [6%], influenza A virus in 5 [4%], Haemophilus influenzae in 4 [3%], Streptococcus pneumoniae in 3 [2%], Staphylococcusaureus in 3 [2%], gram-negative enterobacteria in 5 [4%], Moraxella catarrhalis in 2 [2%], and viruses in 4 [3%]. The yields from laboratory tests were 48% for paired serology, 20% from adequate sputum sample, and 3% from blood culture. Our study shows that a large percentage of mild CAP cases are admitted to hospitals in Kuwait, Atypical pathogens have a significant role in the etiology of CAP. There is overtreatment of CAP with a combination treatment consisting mainly of third-generation chephalosporins and macrolides

Emergence of high-level penicillin-resistant streptococcus pneumoniae and cefotaxime treatment failure in immunocompromised patients in Kuwait

The emergence of Streptococcus pneumoniae resistant to penicllin [PRP] in different parts of the world has complicated the epidemiology, antimicrobial susceptibility testing and management of serious infections caused by this organism. Experience in the past decade indicates that S. pneumoniae in Kuwait were only relatively resistant to penicillin [MIC>0.5-1.0 micro g/ml]. Recently, however, 2 cases of clinical infections with high-level PRP were encountered at the Cancer Center in Kuwait. The patients involved were a 7-year-old female neutropenic patient who had an overwhelming PRP septicemia and a 70-yearrr-old male patient with chronic lymphocytic leukemia and lower respiratory tract infection. The S. pneumoniae isolates were identified by standard bacteriology methods, and the antimicrobial susceptibility and subsequent interpretation of results were according to the recommended criteria of the National Committee for Clinical Laboratory Standards. With both strains the minimal inhibitory concentration [MIC] of penicillin was 2 micro g/ml each. The MIC of cefotaxime for the isolate from the 7-year-old child was also high [MIC 2 micro g/ml]. This is the first report of PRP with high-level beta-lactam resistance in Kuwait

Nocardia farcinica septicemia in a patient with Hodgkin's diseases and literature review

A case of Nocardia Farcinica septicemia in a Kuwait female with Hodgkin's disease is described. The diagnosis was established by the isolation of N. Farcinica from blood on two occasions. Her symptoms included fever, dry cough, cutaneous and neurological manifestations. Chest X-rays revealed progressive pneumonitis. The disease ran a very rapid course and the patient died within 4 weeks following the onset of respiratory symptoms despite treatment with cefotaxime to which the organism was later found to be resistant. The delay in the diagnosis of the case was probably due to the masking of clinical manifestations of nocardiosis by the preexistence of Hodgkin's disease and the subsequent development of herpetic eruptions. N. Fracinica appears to cause a more fulminant infection in immunosuppressed patient than do other species of the genus. The report emphasizes that all Nocardia isolates should be adequately identified and subjected to antimicrobial susceptibility testing, so as to make the therapeutic regimen more efficacious. Infections due to N. fracinica appear to be far more prear to be far more prevalent than the current literature suggests