effect of hand hygiene compliance on hospital-acquired infections in an ICU setting in a Kuwaiti teaching hospital

Hand washing is widely accepted as the cornerstone of infection control in the intensive care unit [ICU]. Nosocomial infections are frequently viewed as indicating poor compliance with hand washing guidelines. To determine the hand hygiene [HH] compliance rate among healthcare workers [HCWs] and its effect on the nosocomial infection rates in the ICU of our hospital, we conducted an interventional study. The study spanned a period of 7 months [February 2011-August 2011] and consisted of education about HH indications and techniques, workplace reminder posters, focused group sessions, and feedback on the HH compliance and infection rates. The WHO HH observation protocol was used both before and after a hospital-wide HH campaign directed at all staff members, particularly those in the ICU. Compliance was measured by direct observation of the HCWs, using observation record forms in a patient-directed manner, with no more than two patients observed simultaneously. The overall HH compliance rate was calculated by dividing the number of HH actions by the total number of HH opportunities. The nosocomial infection rates for the pre- and post-interventional periods were also compared to establish the effect of the intervention on rate of infections acquired within the unit. The overall rate of HH compliance by all the HCWs increased from 42.9% pre-intervention to 61.4% post-intervention, P < 0.001. Individually, the compliance was highest among the nurses, 49.9 vs. 82.5%, respectively [P < 0.001] and lowest among the doctors, 38.6 vs. 43.2%, respectively [P = 0.24]. The effect of the increase in the HH compliance rate on the nosocomial infection rate was remarkable. There were significant reductions in the following: the rate of overall health care-associated infections/1000 patient-days, which fell from 37.2 pre-intervention to 15.1 post-intervention [P < 0.001]; the rate of bloodstream infections, which fell from 18.6 to 3.4/1000 central-line-days [P < 0.001]; and the rate of lower respiratory tract infections, which fell from 17.6 to 5.2/1000 ventilator-days [P < 0.001]. Similarly, there were significant reductions in the isolation rates of 4 major hospital pathogens [P < 0.001 and P = 0.03]. These findings suggest that although cross-infection in the ICU is a complex process, its frequency can be affected by meticulous adherence to hand hygiene recommendations

Point-surveillance of antibiotic resistance in enterobacteriaceae isolates from patients in a Lagos teaching hospital, Nigeria

This study was carried out to determine a point prevalence of drug resistance and extended-spectrum Beta -lactamase [ESBL] among members of the family Enterobacteriaceae. Consecutive clinically significant non-repetitive isolates obtained from both hospitalized patients and outpatients' samples were studied. The isolates were identified using VITEK 2 while susceptibility testing was performed against 16 antibiotics using the E-test strips. Phenotypic production of ESBL was detected by E-test ESBL method. Positive isolates were confirmed by PCR. Of a total of 102 isolates studied, 43 [42.2%] were Escherichia coli and 32 [31.4%] Klebsiella pneumoniae. These isolates demonstrated remarkable high rates of resistance to the Beta -lactam antibiotics, except the carbapenems and piperacillin-tazobactam. Fifty-two [51%] were resistant to >/= 3 classes of drugs and 29 [28.4%] to >/= 5 drugs. Thirty-eight [37.3%] were ESBL producers. Of these, 21 [55.3%] were E. coli and 12 [31.6%] K. pneumoniae. Thus, the overall prevalence of ESBL-producing E. coli was 20.6% and K. pneumoniae 11.8%. This study showed an alarmingly high prevalence of antibiotic resistance in invasive Enterobacteriaceae isolates and a high prevalence of ESBL producers in the study center. Antibiotic stewardship and other preventive strategies are recommended to reduce the high rate of resistant bacteria in this hospital

study of the microbiology of diabetic foot infections in a teaching hospital in Kuwait

The purpose of this study was to determine the microbiological profile of diabetic foot infections [DFIs] and assess the antibiotic susceptibility of the causative agents. Data were obtained from a retrospective analysis of DPI samples collected from June 2007 to July 2008. Specimens were cultured using optimal aerobic and anaerobic microbiological techniques, and antibiotic susceptibility testing was performed according to the methods recommended by the Clinical and Laboratory Standards Institute [CLSI]. Extended-spectrum beta-lactamase [ESBL] production was measured using the double disk synergy test and the ESBL Etest. A total of 440 patients were diagnosed with DFIs during this period, and a total of 777 pathogens were isolated from these patients with an average of 1.8 pathogens per lesion. We isolated more Gram-negative pathogens [51.2%] than Gram-positive pathogens [32.3%] or anaerobes [15.3%]. Polymicrobial infection was identified in 75% of the patients. The predominant organisms isolated were members of the Enterobateriaceae family [28.5%], Pseudomonas aeruginosa [17.4%], Staphylococcus aureus [11.8%], methicillin-resistant S. aureus [7.7%], anaerobic Gram-negative organisms [10.8%], and Enterococcus spp. [7%]. Vancomycin was the most effective treatment for Gram-positive bacteria, and imipenem, piperacillin-tazobactam and amikacin were the most effective treatments for the Gram-negative bacteria. In conclusion, DFI is common among diabetic patients in Kuwait, and most of the cases evaluated in this study displayed polymicrobial etiology. The majority of isolates were multi-drug resistant. The data gathered in this study will be beneficial for future determinations of empirical therapy policies for the management of DFIs. 2011 King Saud Bin Abdulaziz University for Health Sciences. Published by Elsevier Ltd. All rights reserved

case of adult botulism following ingestion of contaminated Egyptian salted fish [[Faseikh]]

Food-borne botulism is a rare and serious disease caused by potent neurotoxin of the Clostridium botulinum which is a Gram-positive strictly anerobic organism. It manifests clinically as descending paralysis characterized by prominent oculo-bulbar palsies and symptoms and autonomic signs in an afebrile patient with normal sensorium. If not promptly and aggressively treated it may lead to fatality. In this communication, we report a case of food poisoning resulting in adult botulism that responded to early and effective treatment with specific antitoxin and supportive therapy. The patient made a remarkable recovery and was discharged home three weeks after admission. This case is the first to be reported for adult variant botulism in Arabian Gulf States

Prevalence of periodontal bacteria in saliva of Kuwaiti children at different age groups

Aggregatibacter [formerly Actinobacillus] actinomycetemcomitans, Tannerella forsythensis and Porphyromonas gingivalis and to a lesser extent Prevotella intermedia and Prevotella nigrescens, are Gram-negative species that are associated with destructive periodontitis. Studies from different parts of the world have shown variable detection rates of periodontal organisms. Hardly any data exist on their carriage in children living in the Middle East. This study was designed to determine the detection of these species in the oral cavity of 240 generally healthy Kuwaiti children, divided into five age groups:<6 years [n=40], 6-9 years [n=60], 10-12 years [n=40], 13-15 years [n=40] and 16-18 years [n=60]. Saliva was used as the microbiological specimen, and the samples were analyzed by molecular methods using multiplex PCR. A total of 185 [77.1%] of the 240 children were colonized by at least one of the target periodontal bacteria. In all age groups, P. nigrescens was the most prominent and detected in saliva of 15%, 32%, 63%, 50%, and 47% of the children at the five age groups, respectively. P. gingivalis was detected only occasionally. Only few pathogens were found before the permanent dentition, i.e. at the age of<6 years. The highest carriage rates were from the groups between 6 and 15 years of age. The salivary carriage of the pathogens was essentially similar in the age groups of 10-12 years and 13-15 years. In conclusion, except for P. gingivalis, the examined periodontal pathogens are relatively common findings in Kuwaiti children and colonize the oral cavity from childhood onwards

Etiology and antibiotic susceptibility patterns of community- and hospital-acquired urinary tract infections in a general hospital in Kuwait

Our purpose was to determine the bacterial profile and prevalence of antibiotic resistance patterns of uropathogens, as well as evaluate the problem with extended-spectrum beta -lactamase [ESBL] producing isolates, causing urinary tract infections [UTIs] in Al-Amiri Hospital, Kuwait, over a 3-year period. Isolates [56,505] from symptomatic UTI cases from January 2005 to December 2007 were identified by conventional methods and the VITEK identification card system. Antimicrobial susceptibility testing was performed by disk diffusion method for Gram-positive organisms and an automated VITEK 2 machine for Gram-negative organisms. ESBL production by the Enterobacteriaceae was detected by the double-disk diffusion method and VITEK-2 system. Significant bacteriuria was detected in 15,064 [26.6%] of the 56,505 urine samples. Escherichia coli accounted for 4,876 [54.9%] from community-acquired UTI [CA-UTI] and 2,253 [36.4%] from hospital-acquired UTI [HA-UTI], followed by Streptococcus agalactiae [1,129, 12.7%] and Klebsiella pneumoniae [962, 10.8%] from CA-UTI cases. Candida spp. [973, 15.7%] and K. pneumoniae [747, 12.1%] were the second and third most prevalent isolates, respectively, in HA-UTI. High resistance rates were observed among the Enterobacteriaceae against ampicillin, cephalothin, ciprofloxacin, piperacillin and trimethoprim-sulfamethoxazole. About 855 [12%] and 291 [17%] of E. coli and K. pneumoniae, respectively, were resistant to ?4 antibiotics. The prevalence of ESBL-producing E. coli and K. pneumoniae in CA-UTI was 12 and 17% and in HA-UTI 26 and 28%, respectively. A high percentage of the uropathogens causing UTI in the Al-Amiri Hospital setting was highly resistant to the first- and second-line antibiotics for the therapy of UTI. ESBL-producing bacteria are highly prevalent in our hospital

Comparative efficacy of two methods of skin preparation of the perineal and genital skin of male urological patients

To compare the efficacy of two methods of skin antiseptic preparations of the genitalia and perineum in male urological patients. Prospective study. Mubarak Hospital, Kuwait. Adult male patients of two study groups numbering 114 [group-1] and 117 [group-2] admitted for cystoscopic procedures. The perineum and genitalia of patients in both groups were prepared by applying chlorhexidine-cetrimide mixture [CCM] and CCM plus povidone-iodine solution respectively. Swab specimens were obtained from the perineum and genitalia, before cleaning and disinfection [specimen A], after disinfection and draping [specimen B] and after the completion of the operative procedure [specimen C]. Specimens were cultured on appropriate media and representative colonies identified by standard methods. In groups 1 and 2, the A specimen yielded bacterial growth in 35.1 and 63% of patients, respectively. The commonest isolates in both groups were Gram-positive bacteria [89.2%] while Gram-negative bacteria accounted for only 10.8%. The B and C specimens in group-1 yielded positive bacterial culture in 7.1 and 11.4% patients respectively. In group-2, specimens B and C yielded bacterial growth in 5.1 and 2.6% patients respectively. In both groups, there was a significant reduction of patients with culture-positive B specimens after skin disinfection [p < 0.001]. The isolation rate of bacteria in specimen C in group-2 was significantlylower than group-1 patients [p < 0.001]. The addition of povidone-iodine to the CCM based regimen of perineal skin antiseptic preparation is associated with longer and more effective skin disinfection in male urological patients

Mycobacterium tuberculosis breast infection mimicking pyogenic abscesses in Kuwait

To present 2 cases of primary breast abscesses caused by Mycobacterium tuberculosis mimicking pyogenic abscesses in healthy young females. Two young non-lactating Indonesian and Indian women, aged 27 and 29 years old, respectively, presented with breast abscesses caused by M. tuberculosis. The breasts presented as huge, swollen, hot, tender masses with a discharge at the subareolar site. Surgical drainage revealed deep abscess with copious amount of pus, samples of which were positive for acid-fast bacilli [AFB] and later confirmed as M. tuberculosis by positive cultures in Becton Dickinson BBL Migit and BACTEC 12B media. The initial therapies with clindamycin were changed to 4 anti-tuberculous drugs as soon as the smears showed the presence of AFB. The patients were discharged a week later, but both were lost to follow-up. Mammary tuberculosis should be considered in the differential diagnosis of breast lesion, especially in patients from endemic areas

Epididymo-orchitis and testicular abscess caused by salmonella enteritidis in immunocompromised patients in Kuwait

To report relatively uncommon presentations of epididymo-orchitis and testicular abscess caused by Salmonella spp. in 2 immunocompromised patients. A 56-year-old man, a known case of systemic lupus erythematosus on azathioprine and prednisolone therapy, developed urinary tract infection followed by bacteremia and epididymo-orchitis. Both urine and blood cultures yielded Salmonella enteritidis strains, which were demonstrated by pulsed-field gel electrophoresis typing method to be genotypically identical. The second patient, a 55-year-old diabetic [type II], presented with a testicular abscess from which a pure culture of S. enteritidis was obtained. Both were treated with intravenous piperacillin and amikacin followed by oral ciprofloxacin, responded well to the therapeutic regimen and were discharged home well. Their follow-ups were uneventful. This report shows that it is important to consider Salmonella infection in the differential diagnosis of inflamed and tender testis in immunocompromised patients and to include blood, urine and stool cultures in all cases

Infant botulism due to consumption of contaminated commercially prepared honey

To report the first case of infant botulism in Arabian Gulf States. A 6-week-old infant, presenting with signs of sepsis, was intubated and ventilated due to progressive weakness. Infant botulism was suspected with acute flaccid paralysis and a history of honey consumption. An electromyogram showed decreased amplitude of compound muscle action potential in all motor nerves, preserved sensory responses; the motor terminal latencies and motor conduction velocities were normal. Blood, stool and honey samples were sent for culture. Stool and honey cultures showed two identical strains of Clostridium botulinum.This case shows that the infant botulism occurred from the ingested contaminated honey. Hence vigilance should be maintained when a baby is fed honey and shows signs of progressive weakness because the disease can quickly progress to respiratory failure

prevalence of bacterial vaginosis and vaginosis-associated pathogens in pregnant women in Kuwait

To establish the prevalence of bacterial vaginosis [BV] and vaginosis-associated pathogens in pregnancy and to assess the role of Gram-stained smear in the diagnosis of By. Two sets of high vaginal and cervical swabs were collected from 165 pregnant women attending the antenatal clinic of the Maternity Hospital, Kuwait, during the 2nd and 3rd trimesters. Vaginal secretions from 30 healthy non-pregnant female volunteers were also investigated. One set was Gram-stained for morphotype and semi-quantitative scores and the other cultured on appropriate culture media for growth of Gardnerella vaginalis, Lactobacillus spp., Mycoplasma spp. and other vaginosis-associated pathogens. Of the 165 pregnant women, only 44 [27%] satisfied the clinical diagnosis of BV. Twenty one [48%] were Kuwaitis and 23 [52%] non-Kuwaitis. The majority of the 44 women with BV had grade III vaginal flora and a few had grade II flora. The Gram-stained smear from all 44 women had typical Gardnerella morphotypes characteristic of BV, and C. vagina/is was isolated from all of them. The overall prevalence rates of Mycoplasma hominis, Urea plasma urealyticum and Mobiluncus spp. were 4%, 29% and 61%, respectively. Compared with the isolation rates in non-pregnant women, Mobiluncus and M. hontinis were significantly associated with pregnancy [P < 0.001]. This study provides evidence of a high prevalence of BV [27%] and other selected vaginosis-associated genital tract pathogens among pregnant women in Kuwait and confirms that direct Gram staining of smear is adequate for the diagnosis of BV in any clinical setting with little need for confirmation by culture