Three distinct clones of carbapenem-resistant Acinetobacter baumannii with high diversity of carbapenemases isolated from patients in two hospitals in Kuwait.

OBJECTIVES: This study was undertaken to investigate the clonal relatedness of multidrug-resistant (MDR) Acinetobacter baumannii isolates collected from patients in two teaching hospitals in Kuwait. MATERIALS AND METHODS: Clinically significant consecutive isolates of A. baumannii obtained from patients in the Mubarak (36) and Adan (58) hospitals over a period of 6 months were studied. These isolates were identified using molecular methods, and their antimicrobial susceptibility was determined by the Etest method. The mechanism of resistance to carbapenem was investigated by PCR, and pulsed-field gel electrophoresis (PFGE) was used to determine the clonal relatedness of MDR isolates. RESULTS: Of the 94 isolates investigated, 80 (85.1%) were multidrug resistant (MDR). The A. baumannii PFGE clone A and subclone A1 were the most prevalent in patients infected with MDR isolates. Fifty-five (94.8%) and 15 (41.7%) of the MDR isolates from the Adan and Mubarak hospitals, respectively, belonged to PFGE clone A; isolates in this group showed higher resistance rates to antibiotics than isolates form other groups. Of the 94 isolates, 40 (42.6%) were resistant to either imipenem or meropenem or to both (CRAB). Most CRAB isolates (29/40 or 72.5%) carried bla genes, which code for MBL (VIM-2 and IMP-1) enzymes. Two isolates harbored bla(OXA-23). CONCLUSION: Three distinct clones of CRAB were isolated, providing evidence of a high diversity of carbapenemases among our geographically related isolates.

The prevalence of Chlamydia trachomatis and Neisseria gonorrhoeae infections among men with urethritis in Kuwait.

PURPOSE: Chlamydial non-gonococcal urethritis and gonorrhoea are the most common sexually transmitted bacterial infections worldwide. Data on these infections are scanty in the Islamic world, especially Kuwait. The objective of this study was to establish the prevalence of Chlamydia trachomatis and Neisseria gonorrhoeae among men with symptomatic urethritis in Kuwait. METHODS: Men with urethral discharge seen and managed at eight governmental hospitals were recruited into the study. A pair of urethral swab and first-voided urine sample were taken from the patients and sent immediately to the laboratory where they were processed using strand displacement nucleic acid amplification kits (SDA; ProbeTec, Becton Dickinson); one pair per patient was studied. RESULTS: A total of 426 symptomatic men were studied, out of whom 155 (36.4%) were infected by either C. trachomatis or N. gonorrhoeae, or both. The overall prevalence rates of C. trachomatis and N. gonorrhoeae were 12.4% and 23.9%, respectively. There was no significant difference in chlamydial and gonococcal prevalence between Kuwaiti men and non-Kuwaitis (P>0.05). Infection rates were much lower in married men than unmarried men. Men in the age range of 21-35 years were more vulnerable to both infections. CONCLUSION: The findings show that N. gonorrhoeae and, to a lesser extent, C. trachomatis are common in men with urethritis in Kuwait. Appropriate preventive strategies that conform to Islamic rules and values should be of highest priority of the policymakers.

Emergence of tigecycline and colistin resistance in Acinetobacter species isolated from patients in Kuwait hospitals.

The development of resistance is a compelling reason for reviewing administration of antibiotics. Recently, most Acinetobacter infections are caused by multidrug-resistant (MDR) strains which have necessitated the use of tigecycline or colistin. This study was undertaken to determine the susceptibility of Acinetobacter spp. to these and other drugs. A total of 250 Acinetobacter isolates were collected from the 8 government hospitals over a period of 6 months. Susceptibility to 18 antibiotics, including tigecycline and colistin, was investigated by determining their minimum inhibitory concentrations using E test. Of the 250 isolates, 13.6% and 12% were resistant to tigecycline and colistin. A total of 25.2% and 37.2% were resistant to imipenem and meropenem, respectively. Of the 250 isolates 88.4% were MDR. This relatively high prevalence of tigecycline and colistin-resistant isolates indicates an emerging therapeutic problem which may severely compromise the treatment of MDR Acinetobacter spp. infections in Kuwait.

Emergence of resistance to amphotericin B and triazoles in Candida glabrata vaginal isolates in a case of recurrent vaginitis.

Emergence of resistance to triazoles and amphotericin B in Candida glabrata vaginal isolates is documented by Etest. During the 18-month follow-up of a case of vaginitis, 14 consecutive isolates of C. glabrata were examined. The isolates exhibited development of in vitro resistance beginning with itraconazole (>32 microg/ml), followed by fluconazole (>256 microg/ml), amphotericin B (>32 microg/ml), and voriconazole (>32 microg/ml). The DNA sequence analyses and finger printing of the isolates strongly suggest that our patient remained colonized with a single strain. The report underscores the propensity of C. glabrata to acquire resistance during antifungal therapy and the importance of susceptibility testing in the management of infections caused by this species.

The prevalence and antibiotic susceptibility pattern of gram-negative bacterial isolates in two ICUs in Saudi Arabia and Kuwait.

In surveys of the prevalence and antibiotic susceptibility pattern of consecutive Gram-negative bacterial isolates in two intensive care units (ICUs) in Saudi Arabia (Jeddah) and Kuwait, 106 and 101 isolates, respectively, were analyzed. The most common bacterial isolates in Jeddah versus Kuwait ICUs were Pseudomonas aeruginosa (26%, 26%), Escherichia coli (23%, 3%), Klebsiella pneumoniae (20%, 17%), inducible Enterobacteraecae group (17%, 14%), and Acinetobacter spp. (9%, 33%). Overall, about 99% of all isolates were susceptible to ciprofloxacin in both centers, whereas 87 and 96% were susceptible to imipenem, 69 and 64% to ceftazidime, 59 and 52% to cefotaxime, and 25 and 67% to piperacillin, respectively, in Jeddah and Kuwait. Prior antibiotic usage was more common among patients in Jeddah than in Kuwait. Dominant features of the study in Jeddah were the E. coli and Klebsiella spp. demonstrating multiresistance to monobactams, cephems, and all three aminoglycosides, and evidence of two classes of resistance to beta-lactam antibiotics which were not seen among the Kuwaiti isolates. The Kuwaiti Pseudomonas spp. were more sensitive to imipenem than the Jeddah Pseudomonas spp. (100% versus 68%). The higher number of resistant bacteria seen in Jeddah than Kuwaiti may be a reflection of the higher antibiotic consumption, in particular higher usage of broad spectrum cephalosporins in Jeddah ICU.

Identification of enteroinvasive Escherichia coli and Shigella strains in pediatric patients by an IpaC-specific enzyme-linked immunosorbent assay.

A new method, a monoclonal antibody-based enzyme-linked immunosorbent assay (ELISA) recognizing a secreted, invasion plasmid-coded protein antigen (IpaC), was used to identify enteroinvasive Escherichia coli and Shigella strains among colonies from 859 cultures of fecal samples from children in Kuwait. A total of 33.8% of the samples were diarrheal. By the immunoassay, enteroinvasive E. coli strains were identified from two diarrheal samples but from none of the samples from children without diarrhea. These strains were fully virulent and belonged to serogroup O28ac. In addition, 26 Shigella strains were also recognized by the ELISA, while only 23 were isolated by routine biotyping and serotyping. For two diarrheal patients, Shigella was identified by culture only. The study showed that the IpaC-specific immunoassay is a simple and useful tool for identifying enteroinvasive strains. Furthermore, by reporting the first enteroinvasive E. coli isolates from Kuwait, the study indicates the presence of this group of pathogens as a potential source of diarrhea in the region.

Liver abscess and disseminated intravascular coagulation in tuberculosis.

We report the case of a 55-year-old man with chronic renal failure, and a history of prolonged fever and jaundice. Radiological studies revealed a multiloculated irregular liver abscess. Mycobacterium tuberculosis was isolated from the abscess on smear and culture of aspirated pus. Haematological studies revealed the presence of disseminated intravascular coagulation. A detailed search failed to identify any reason for this other than the tuberculous infection. The treatment of tuberculous liver abscess and pathogenesis of disseminated intravascular coagulation in tuberculosis are discussed.