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.

Primary posterior mediastinum hydatid cyst

Primary posterior mediastinal hydatid cyst is a serious health problem for the Mediterranean countries. We diagnosed a case of a 46-year-old female with a primary posterior mediastinum hydatid cyst on CT and MRI. It was provisionally identified as either a hydatid cyst or bronchogenic cyst or neuroenteric cyst. CT guided aspiration with 18 gauge needle confirmed as hydatid sand. This is very rare in this population but it should be kept in mind when one is looking at any cyst in the posterior mediastinum.

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.]

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