Antimicrobial Management of Complicated Skin and Soft Tissue Infections in an Era of Emerging Multi-Drug Resistance: Perspectives from 5 Gulf Countries

The number of complicated skin and soft tissue infections (cSSTIs) in the Arabian Gulf region has risen in recent years, particularly those caused by multi-drug resistant (MDR) pathogens. The high prevalence of diabetes, obesity, and associated cardio-metabolic comorbidities in the region renders medical and surgical management of cSSTI patients with MDR infections challenging. An experienced panel of international and regional cSSTI experts (consensus group on cSSTIs) was convened to discuss clinical considerations for MDR infections from societal, antimicrobial stewardship, and cost perspectives, to develop best practice recommendations. This article discusses antibiotic therapies suitable for treating MDR cSSTIs in patients from the Gulf region and recommends that these should be tailored according to the local bacterial ecology by country and region. The article highlights the need for a comprehensive patient treatment pathway and defined roles of each of the multidisciplinary teams involved with managing patients with MDR cSSTIs. Aligned and inclusive definitions of cSSTIs for clinical and research purposes, thorough and updated epidemiological data on cSSTIs and methicillin-resistant Staphylococcus aureus in the region, clearcut indications of novel agents and comprehensive assessment of comparative data should be factored into decision-making are necessary.

Epidemiological and clinical features of salmonella typhi infection among adult patients in qatar: a hospital-based study

Objectives: We sought to describe the epidemiological and clinical features of typhoid fever in Qatar

Methods: We conducted a retrospective study of adult patients treated for typhoid fever at Hamad General Hospital and Alkhor Hospital between 2005 and 2012

Results: The mean age of the 354 patients enrolled in the study was 28.4+/-9.3 years; 296 [83.6%] were males. There were 42, 48, 39, 44, 46, 47, 52, and 36 cases of adults with typhoid fever in 2005, 2006, 2007, 2008, 2009, 2010, 2011, and 2012, respectively. Overall, 343 [96.9%] patients had a history of travel to endemic areas. Among them, 93.0% acquired typhoid fever in the Indian subcontinent. Fever was observed in all cases, and the other predominant symptoms were abdominal pain [38.1%], diarrhea [35.6%], and headache [33.1%]. Salmonella typhi, showed high resistance to ciprofloxacin [n = 163; 46.0%], and low resistance to ceftriaxone [n = 2; 0.6%]. Four patients developed intestinal perforation, which was surgically repaired in two cases. Two patients [0.6%] died

Conclusions: Typhoid fever was frequent among immigrants to endemic areas. Travelers returning from endemic areas with suspected typhoid fever should be treated empirically with third-generation cephalosporin after obtaining appropriate cultures. Moreover, preventive measurements such as education on food and water hygiene, and effective vaccination of travelers should be practiced widely among travelers to endemic areas to reduce morbidity and mortality

Improving influenza vaccination rates of healthcare workers: a multipronged approach in Qatar

We assessed whether an influenza vaccination [IV] campaign was effective at increasing vaccination rate in healthcare workers [HCWs] in 2 hospitals in Doha, Qatar that had no mandatory IV policy. The campaign comprised promotional, educational and vaccine delivery interventions; a dedicated IV team; telephone hotline; free IV with improved access, leadership involvement; incentives; group educational sessions; and reporting/tracking activities. During the 2014/15 influenza season, IV rates according to hospital and HCW category were calculated and compared with the 2 seasons before the intervention. The combined mean rate for IV for both hospitals increased for 2014/15 [64.3%] compared with 2013/14 [37.2%] and 2012/13 [28.4%]. There was increased IV uptake among doctors and nurses at each hospital, and the IV rate for the 2 hospitals [59.1 and 69.5%] were higher than in 2013/14 [21.1% and 53.2%] and 2012/13 [17.2% and 39.6%]. The findings highlight the importance of improving IV rates among HCWs in hospitals with no mandatory vaccination policies through multicomponent interventions

Pneumococcal disease in the Arabian Gulf: recognizing the challenge and moving toward a solution

Pneumococcal disease has substantial incidence, morbidity and mortality in older adults. Decreased birth rates and longer lifespans indicate that the global population is aging, although rates of aging differ between countries[1]. In 2010, the proportion of the population aged >60 years in the general Arab Region was 7%, and this proportion is expected to rise to 19% by 2050 for the region as a whole[2]; the United Nations estimates for the individual countries of the Arabian Gulf by 2050 are 25.7%, 24.9%, 20.7%, 26.7% and 10.5% in the Kuwait, Bahrain, Qatar, United Arab Emirates [UAE] and Oman, respectively, which are comparable to the 26.9% predicted for the USA and lower than that predicted in European countries, in which the 2050 estimates are 32.7%, 34.0% and 38.1% for France, the UK and Germany, respectively [1]. Globally and in the Gulf Region, pneumococcal disease is an increasingly important public health burden in the elderly. The burden of pneumococcal disease can be reduced by effective vaccination programs, but the recommendations on pneumococcal vaccination in adults vary widely. The major barriers to vaccine implementation among healthcare professionals are an incomplete awareness of pneumococcal disease and the vaccination options in adults. The Gulf Advocate Group calls for healthcare providers in the countries of the Arabian Gulf [Kuwait, Bahrain, Qatar, United Arab Emirates and Oman] to support awareness and education programs about adult pneumococcal disease, particularly in high-risk groups such as those >65 years of age, those with type 2 diabetes mellitus, hematological malignancy, organ and bone marrow transplantation or chronic kidney or lung diseases and pilgrims undertaking the Hajj to improve pneumococcal disease surveillance and optimize and disseminate recommendations for adult vaccination. The Gulf Advocate Group recommends following the U. S. Centers for Disease Control and Prevention [CDC] guidelines for pneumococcal vaccination [3, 4]