Sensitive, resistant and multi-drug resistant Acinetobacter baumanii at Saudi Arabia hospital eastern region

Abstract: Since the Physicians start use of antibiotics long ago with un-notice drug resistance. However actual problem was recognized about 85 years ago. Antibiotic resistant and Multi-drug resistant bacterial strains are at rise throughout the world. It is physicians and researchers to take scientific research based appropriate action to overcome this ever-spreading problem.. This study is designed to find out sensitive [S], resistant [R] and multi-drug resistant [MDR] Acinetobacter baumanii strain along with other isolates in the resident patients of Eastern Region of Saudi Arabia. Pseudomonas aeruginosa is excluded from other gram-negative organisms isolated from different sites as it will be dealt separately. This study is based in was retrospective observations designed to collect data of different stains of Acinetobacter baumanii with reference to their Sensitivity [S], Resistance [R], Multi-Drug Resistance [MDR] along with other Gram negative isolated from different sites [from 1st January 2004 to 31st December 2011] at King Abdulaziz Hospital located Eastern Region of Kingdom of Saudi Arabia [KSA]. All necessary techniques were used to culture and perform sensitivity of these isolates. There were 4532 isolates out of which 3018 [67%] were from patients. Out of Acinetobacter baumanii infected were 906 [20%] while other 3626 [80%] isolates were miscellaneous. Numbers of patients or cases were 480 [53%] out of 906 isolates and numbers of patients or cases in other organisms were 2538 [70%] out of 3626 isolates. Acinetobacter baumanii infected patients 221 [46%] were male and 259 [54%] were female and the male and female ratio of 1:1.2. In other organisms this male female ratio was almost same. There was steady rise in number of patients and the hence the isolates from 2004 to 2011. Majority of the bacterial strains were isolated as single organism but some were isolated as double or triple or quadruple or more organisms from different sites. Sensitive, Resistant and Multi-Drug Resistant Acinetobacter baumanii have been isolated from different sites. The other Gram negative isolates included Escherichia coli, Klebsiella pneumoniae, Proteus vulgaris, Klebsiella oxytoca, Serratia marcescens and Stenotrophomonas maltophilia. A significant rise in R and MDR but there is rise in R and MDR Acinetobacter baumanii Strains has been interceded other isolates. It is important to adopt proper and sustainable policies and guideline regarding antibiotics prescription and used. We should also check our infection control practices in our hospital or healthcare settings. We should start antibiotics stewardship in our hospital in order to reducing or overcoming antibiotics Resistant [R] and Multi-Drug Resistant [MDR] strains prevalence.

Use of tigecycline [tygacil] against drug resistant organisms in eastern region

This study was designed to look for sensitivity and resistant pattern of tigecycline in different gram positive and gram negative infections which were resistant to different antibiotics and also look for various methods to prevent drug resistance against tigecycline [tygacil] group of antibiotic. Three hundred seventy five [375] isolates which includes MRSA [Methicillin Resistant Staphylococcus Aureus], VRE [Vancomycin Resistant Enterocooci], ESBL [Extended Spectrum Beta Lactamase], Stenotrophomonas maltophilia and MDR [Multi Drugs Resistant] Acinetobacter species were identified with the help of colonial characteristics, gram staining, biochemical reactions including API strips system, and special techniques used for each organism. Sensitivity was done with help of disc diffusion [Kirby Bauer] method for tigecycline [tygacil] 15 ug disc provided by company. This is a retrospective study which has showed that MRSA were 100% sensitive to tigecycline and VRE were also 100% sensitive to this antibiotic. The ESBL were 90% sensitive and Stenotrophomonas maltophilia 87% to tigecycline. The MDR Acinetbacter species were only 41% resistant which was high in 2008 as compared to overall sensitivity pattern. Male and female were almost equal in this study. Highest number of cases was reported from 70-80 years age group. The different isolates were from different locations from human body and different wards including ICU [Intensive Care Unit]. Tigecycline exhibit high in vitro activity against most of the commonly encountered gram positive and gram negative resistant organisms which were pathgens in this region. We should take care not to get antibiotic resistance to be developed against tigecycline by appropriate uses and preventive measures [hand hygiene etc.]

MRSA [methicillin resistant staphylococcus aureus] and MSSA [methicillin sensitive staphylococcus aureus] and their antibiotic activity pattern in eastern region of Saudi Arabia

Infection with MSSA and MRSA is quite common in the region as well as around the globe which results in a substantial number of morbidities and mortalities in a population. This study is designed to find out frequencies of MSSA and MRSA in the Pediatric and adult populations in the Eastern Region. We also assess prevalence of Community Associated [CA] MRSA and Hospital Associated [HA] MRSA along with antibiotic sensitivity pattern. It is a case series study. It was done at the King Abdulaziz Hospital [National Guard Health Affairs] Al-Ahsa, Kingdom of Saudi Arabia. A total of 1930 comprising of MRSA 463 and MSSA 1467 which were confirmed by CLSI [Clinical Laboratory Standard Institute] 2008. All standards of JCIA [Joint Commission for International Accreditation] and CAP [College of American Pathologist] were followed, as our laboratory is accredited by both, in MRSA identification of CA-MRSA [Community associated] and HA-MRSA [Hospital associated] were also done. Antibiotics sensitivity pattern is also recorded. Overall MRSA isolates were 24.0% whereas MSSA were 76.0%. MRSA varies from 22-26% from 2006 to 2008 and MSSA varies from 74-76% from 2006 to 2008. The overall male and female were 52.0% and 48.0% respectively with a ratio of 1.1:1.0. The total CA MRSA were 72.0% and HA MRSA were 28.0%. Both MRSA and MSSA were 18.55% Pediatrics and 81.45% were adults. MRSA is 100% sensitive to vancomycin, 98.0% to rifampin whereas MSSA is 100% sensitive to ciprofloxacin, cloxacillin, vancomycin and 99.0% to trimethoprim with sulfamethoxazole. It is evident from this study that both MRSA and MSSA are quite common in Eastern Region of Saudi Arabia. We should use antibiotics properly to avoid emergence of resistance and also implement infection control practices to overcome spread of these infections in the population

ESBL [extended spectrum beta-lactamases] and non-ESBL isolates in urinary tract infection

To determine the prevalence of Extended Spectrum Beta-Lactamase [ESBL] among Entero-bacteriaceae isolated from urine culture in a tertiary care hospital and comparing it with Non-ESBL. The organisms identified were Escherichia coli, Klebsiella pneumoniae, Klebsiella oxytocia and Proteus mirabilis in ESBL as well as in the control group. We carried out this study at the King Abdul Aziz National Guard Hospital Al-Ahsa, Kingdom of Saudi Arabia during the period from January 2006 to August 2008. We tested a total of 1522 isolates of the family Enterobacteriaceae from urine culture for the prevalence of Extended Spectrum Beta-Lactamase [ESBL] and Non-ESBL production by the standardized disc diffusion method and confirmed by the ESBL E-test strips. All cases of Urinary Tract Infection [UTI] irrespective of age, sex, color, race, cast and creed were included in this study. Single isolates were included in this study. Four organisms for which initial screening as well as confirmatory facilities were present [Escherichia coli, Klebsiella pneumoniae, Klebsiella oxytocia and Proteus mirabilis] as well as comparable Non-ESBL. UTI with two or more organisms as isolates were excluded from this study. The patients with urinary catheters and long term care were also excluded from this study. Two hundred eighty one [18.5%] of the isolates out of 1522 were ESBL producers and 1241[81.5%] were Non-ESBL producers. The ratio between ESBL and Non-ESBL was 1:4.4. Among these ESBL, 207 [73.7%] were Escherichia coli, 67 [23.8%] were Klebsiella pneumoniae followed by 6 [2.1%] Proteus mirabilis and 1 [0.4%] Klebsiella oxytocia. In Non-ESBL producer isolates there were 886 [71.4%] Escherichia coli, 309 [24.9%] Klebsiella pneumoniae, 42 [3.4%] Proteus mirabilis and 4 [0.3%] Klebsiella oxytocia. The ESBLs were 100% sensitive to Imipenam and Meropenam. The penicillins, cephalosporin's and aztreonams were 100% resistant against ESBL. Escherichia coli, Klebsiella pneumoniae, Proteus mirabilis and Klebsiella. oxytocia that produced ESBL were present in quite a high number. Extended Spectrum Beta-Lactamase gram-negative bacilli present significant diagnostic and therapeutic challenges to the management of infections due to these organisms. Microbiology laboratories should start reporting ESBL producing Enterobacteriaceae isolates due to their importance in respect to antibiotic therapy and infection control aspects

Prevalence of hepatitis g virus [HGV] amongs blood donors in our population

Ali types of hepatitis are quiet common in our population. Hepatitis G Virus [HGV] infection is relatively new viral infection and a little work is done on it. The objective of this study is to find out prevalence HGV infection in blood donors [Professional and Volunteer blood donors]. It is a comparative study. This study was done at Abbasi Shaheed Hospital and KMDC, Karachi from 1[st] July 1995 to 30[th] June 1999. Three hundred seventy-one [371] blood donors were screened for HGV infection by Polymerase Chain Reaction [PCR] for HGV RNA. These blood donors includes 173 professionals and 198 volunteers. Three hundred seventy one [371] blood donors were screened for HGV with 05 [1.35%] positive cases. In professional donors group out 173 there were 04 [2.31%] positive for HGV where as in volunteer donor group only one [0.5%] was positive forHGV out of 198. All were male and highest positive cases for HGV were in 50-59 years age group in professional donors and 01[2.2%] in volunteer donor group. HGV infection is present in both professionals as well as volunteers donors with a ratio of 4:1. It is advisable to include HGV testing or screening mandatory for each blood bag before transfusing it to individual to minimize serious outcome of HGV infacture as people suffered from HBV, HCV and HIV

Sterile supply department of different hospitals and their sterilization testing profile

The objective of this study is to determine whether Sterile Supply Department [SSD] or Central Sterile Supply Department [CSSD] of different hospitals are performing sterilization testing profile as per international recommendation or not. Hospitals based cross sectional descriptive study. The study was conducted at different hospitals SSD or CSSD and their sterilization testing profile activities during January 1998 to June 2001. Seventy two hospitals with number of beds above 50 to less than 3000 were selected both from public and private sectors and their sterilization testing profile were recorded. 72. Number of beds above 50 and less than 3000 were included in this study. SPSS version. Number of beds less than 50 and more than 3000 were not included in this study. Total 72 hospitals were included in this study out of which 22 [30.5%] were from public sector and 50[69.5%] were from private sector. In public sector out of 22 hospitals only 01 [4.5%] was performing complete sterilization test profile at their SSD or CSSD and in private 05 [10.0%] out of 50 hospitals. There is significant difference in public and private hospitals. Sterilization testing profile P < 0.005 which is significant, yet both were not up to the mark. It seems from this study that private hospitals sterilization testing profile activity is more than twice as compare to public hospitals but we can not comprised on proper sterilization at both settings as this results in infection during procedures, government is requested to make some legislation on it