Genetic lineages of methicillin-resistant staphylococcus aureus acquired during admission to an intensive care unit of a general hospital

Objectives: The objectives of this study were to determine the frequency of methicillin-resistant Staphylococcus aureus [MRSA] colonization or infection while on admission to the intensive care unit [ICU], and examine the genetic backgrounds of the MRSA isolates to establish transmission among the patients

Subjects and Methods: This study involved screening 2,429 patients admitted to the ICU of Farwania Hospital from January 2005 to October 2007 for MRSA colonization or infection. The MRSA isolates acquired after admission were investigated using a combination of molecular typing techniques to determine their genetic backgrounds

Results: Of 2,429 patients screened, 25 [1.0%] acquired MRSA after admission to the ICU. Of the 25 MRSA, 19 [76%] isolates belonged to health care-associated [HA-MRSA] clones: ST239-III [n = 17, 68%] and ST22-IV [n = 2, 8%]. The remaining 6 MRSA isolates belonged to community-associated clones: ST80-IV [n = 3, 12%], ST97-IV [n = 2, 8%], and ST5-IV [n = 1, 4%]. The ST239-III-MRSA clone was associated with infection as well as colonization, and was isolated from patients from 2005 to 2007

Conclusions: The HA-MRSA clone ST239-III persistently colonized patients admitted to the ICU, indicating the possibility of its transmission among the patients over time

Unexplained peritonitis due to neisseria gonorrhoeae secondary to a sterile tubo-ovarian abscess

A 43-year-old woman presented to the surgical emergency department with acute abdominal pain associated with nausea, vomiting, constipation, fever and dysuria. Exploratory laparotomy was performed based on clinical diagnosis of acute appendicitis. Post-laparotomy, the diagnosis of pelvic disease [PID], left tuboovarian abscess and peritonitis due to Neisseria gonorrhoeae was made. The patient responded well to antibiotics and surgical management but was lost to follow-up

Present status of antimicrobial susceptibility of haemophilus influenzae isolates in Kuwait as determined by E - test

To study antimicrobial susceptibility pattern of clinical isolates of Haemophilus influenzae using E-test and compare the results with those of a study done in 1983. The antimicrobial susceptibility of 196 isolates of H. influenzae against nine antimicrobial agents [amoxicillin-clavulanic acid, ampicillin, cefaclor, cefotaxime, ceftriaxone, chloramphenicol, ciprofloxacin, clarithromycin, and trimethoprim-sulfamethoxazole] was performed by E-test on Haemophilus test medium. The results obtained were compared with those from an earlier study conducted here on 108 strains collected between October and December 1983. Except for cefotaxime, which consistently showed an excellent in vitro activity [MIC90 = 0.047 mg/l], other antimicrobial agents presented a decline in their effectiveness. Among the newer antibiotics tested, all the strains were found to be sensitive to ciprofloxacin [MIC range = 0.004-0.0094 mg/l] whereas clarithromycin showed high MIC of 12 mg/l for 90% of the strains. There was a marked increase in the number of beta-lactamase-producing isolates from 4.6% in 1983 to 31.6% in the present study. Amongst 62 beta-lactamase-producing strains 14.5% exhibited resistance to amoxicillin-clavulanic acid [MIC >8 mg/l]. Only 3.1% isolates were found to be of capsular type b in 1998 compared to 9.2% in 1983. No beta-lactamase-negative ampicillin-resistant [BLNAR] strain was isolated during the present study whereas only one strain [0.9%] was isolated in 1983. This study shows that despite a decrease in the number of type b and BLNAR H. influenzae isolates, there is an apparent increase in the trend to acquire resistance to several antimicrobial agents

Outcome of treatment of haemophilus influenzae meningitis in children complicated by febrile episodes

Aim: In this retrospective study, 20 cases of Haemophilus influenzae type b [Hib] meningitis were analysed to assess the outcome of treatment. Bacteriologically proven cases of meningitis due to Hib were included in this study. The clinical and relevant laboratory data were retrieved from the hospital files. Thirteen patients were treated with a combination of cefotaxime and ampicillin, 4 with cefotaxime, 2 with ceftriaxone and 1 with a combination of ampicillin and chloramphenicol. Only 9 children received concomitant dexamethasone. Nine [45%] cases experienced permanent defervescence within 4 days of admission and were discharged from the hospital after an average stay of 10.5 days. The overall rates of secondary [25%], persistent [5%] and prolonged fever [25%] were observed with an average number of days in hospital of 20.4, 20.0 and 22.8, respectively. Although there was no mortality, there is still a need for appropriate short-duration therapy which will help in bringing about a decline in febrile episodes, thereby reducing cost of management and hospital stay

Biochemical identification and assessment of virulence in fecal isolates aeromonas spp

One hundred sixteen fecal isolates of Aeromonas spp. were identified to the species level on the basis of phenotypic characteristics. The three species of Aeromonas recognized were A. hydrophila [n = 59], A. sobria [n = 18], and A. caviae [n = 39]. Of the 18 strains of A. sobria, 100% were cytotoxic for Vero cells and positive [titer >/= 1:8] in the hemolysin assay. Fifty-one percent of the A. hydrophila strains and 18% of the A. caviae were positive for both cytotoxic and hemolysin activities. A positive lysine decarboxylase phenotype had the highest positive predictive value [PPV = 81%] for producing both cytotoxin and hemolysin. It was followed by negative arabi-nose fermentation phenotype [PPV = 75%], positive Voges-Proskauer phenotype [PPV = 74%] and positive gas production from D-glucose phenotype [PPV = 69%]. A combination of positive Voges-Proskauer, positive lysine decarboxylase and negative arabinose fermentation reactions increased the PPV to 85%. We conclude that the virulence of Aeromonas spp. may reliably be based on these three biochemical reactions considered in combination

Characterization of Shigella sonnei strains from three different geographical locations

Colicin typing, biotyping, phase typing and in vitro antimicabial susceptibility testing were performed on clinical isolates of Shigella sonnei from three different geographical locations. Results of 93 strains from Kuwait, 61 strains from Saudi Arbia and 23 strains from Bangladesh were compared. Of 169 strains of S. sonnei tested, 75% belonged to colicin type 6/11. It was the most common colicin type in all three countries However, differences in antimicrobial susceptibility patterns were observed. The resistance pattern in 62% of resistant strains from Kuwait was tetracycline - trimethoprim/sulpha methoxazole - trimethoprim [TE-TMP/SMZ-TMP]. Saudi Arabian strains were of the same resistance pattern with additional resistance to ampicillin [AM] AM-TE-TMP/SMZ-TMP [34%] which was seem more often than TE-TMP/SMZ-TMP [26%]. Most of the strains [65%] from Bangladesh were sensitive to all the antimicrobial agents against which they were tested. Of the 8 strains which showed resistance, 50% were resistant to tetracycline alone. Study of carbohydrate fermentation of 12 sugars which were incubated for 21 days did not aid in discriminating different biotypes

In vitro activity of conventional and newer antimicrobial agents against brucella melitensis clinical isolates from Kuwait

The in vitro activity of 15 antimicrobial agents was tested against 21 clinical isolates of Brucella melitensis from Kuwait. The minimum inhibitory concentration for 90% of strains [MIC 90] was determined. Tetracycline and doxycycline showed similar activity [MIC 90 0.5-4]. Antagonism [> 4] was seen in only one strain for the combination of ciprofloxacin plus rifampin and trimethoprim-sulfamethoxazole plus cefotaxime. Time-kill studies showed that doxycycline or gentamicin alone decreased the viable counts below 2 log 10 after 24 h. Combinations of doxycycline plus gentamicin or ciprofloxacin plus gentamicin decreased the viable counts below 2 log 10 within 6 h