Effects of the Coronavirus disease 2019 pandemic on routine pediatric immunization coverage rates at the main University Hospital in Saudi Arabia.

OBJECTIVES: To investigate whether the coronavirus disease-2019 pandemic has had any effects on pediatric vaccination rates at the main university hospital in Saudi Arabia. METHODS: A retrospective study conducted at King Saud University Medical City, Riyadh, Saudi Arabia using electronic health records. The vaccination statuses of all children who were scheduled for vaccinations at birth and at 2, 4, 6, 9, and 12 months during March, April and May between 2017 and 2020 were included in the study with total sample of 15,870 children, and comparisons between the cohorts were performed. RESULTS: All vaccination visits during April and May 2020 were below the lower extremes except for the birth vaccinations. In March, April, and May 2020 there were respective drops in vaccination visits of 49.93%, 71.90% and 68.48% compared with the mean numbers of vaccination visits during the same months from 2017 to 2019. In comparisons of mean numbers of visits from March 2017 to May 2019 and March to May in 2020, the respective reductions in visits for birth and 2, 4, 6, 9 and 12-month vaccinations were 16.5%, 80.5%, 74.7%, 72.9%, 80.0% and 74.1%. CONCLUSIONS: The huge impact of the coronavirus disease-2019 pandemic on childhood vaccinations will require urgent vaccination recovery plans with innovative approaches and future action plans to maintain vaccination coverage during any subsequent pandemics.

Pediatric brucellosis. An update review for the new millennium.

Brucellosis remains the most common bacterial zoonotic infection in many countries worldwide. Despite being long recognized and controllable, the disease still causes substantial morbidity, affecting especially the young population. The aim of this review is to provide insight to the epidemiology, etiology, clinical features, diagnosis, and management of childhood brucellosis.

Emergence of carbapenem-resistant Enterobacteriaceae isolated from patients in a university hospital in Saudi Arabia. Epidemiology, clinical profiles and outcomes.

Carbapenemase-producing Enterobacteriaceae have been steadily spreading worldwide during the last decade. Nine patients were identified prospectively and were followed during their hospitalization course to identify the epidemiology, clinical profiles and outcomes. These patients had one or more cultures positive for a CRE isolate, contributing to a total of eleven positive cultures from various sites without including duplicates of isolates obtained from the same site. Isolates from these patients included five Klebseilla pneumoniae, three Escherichia coli, and one Enterobacter aerogenes. Five isolates were grown from blood cultures, three from wound cultures, one from urine cultures, one from respiratory cultures and one from an abscess collection. Five survived the hospital course. The other five patients died due to severe sepsis, septic shock or multi-organ failure. Of the nine isolates of CRE identified for which molecular analysis were available, four K. pneumonia were confirmed as blaNDM and one as OXA-48. For the purpose of controlling the spread of CRE in our institution, we recommend considering active surveillance cultures and screening patients transferred from other hospitals or coming from highly endemic settings at admission for these organisms.

Emergence of Vancomycin-resistant Enterococci at a Teaching Hospital, Saudi Arabia.

BACKGROUND: Vancomycin-resistant enterococci (VRE) are a major and emerging hospital-acquired pathogen associated with high mortality, particularly among the critically ill and Intensive Care Units (ICUs) patients. This study aimed to determine the prevalence and demographic and clinical characteristics of VRE among patients admitted to a university hospital in Riyadh, Saudi Arabia. METHODS: A study was conducted during the period from September 2014 to November 2015 at King Khalid University Hospital, a tertiary care hospital in Riyadh, Saudi Arabia, including in-patients with VRE infection. Data were collected using laboratory results and the medical records of admitted patients and were analyzed using SPSS version 19.0 statistical software. RESULTS: In a one-year period, 231 enterococci were isolated from blood, urine, exudates, sputum, stool, and body fluid. There were 191 (82.7%) vancomycin-sensitive enterococci (VSE) and 40 (17.3%) isolates were VRE. The Enterococcus species included E. faecalis 168 (72.7%), E. faecium, 53 (22.8%) E. gallinarum 5 (2.2%), and E. avium 5 (2.2%). VRE were more significant from blood specimens (P< 0.0001) while VSE were significantly more predominant from urine specimens (P< 0.0001). VRE were more commonly isolated from patients in ICUs and oncology unit (P = 0.0151 and P< 0.001, respectively) while VSE were more predominant in the medical and surgical areas (P = 0.0178 and P = 0.0178, respectively). CONCLUSIONS: This study highlights the high prevalence of VRE in the hospital and the association of enterococcal infections with high-risk areas and oncology units, which warrant more studies looking for better management of these infections.

Mycoplasma pneumoniae-associated mucositis syndrome: A rare and clinically challenging disease in a Saudi child.

Mycoplasma pneumoniae-associated mucositis (MPAM) is an extra-pulmonary manifestation of M. pneumoniae infection and may present as isolated mucosal lesions (e.g., ocular, oral, and urogenital) or as a combination of mucosal and minimal cutaneous lesions. MPAM is a rare entity that lies on the spectrum of erythema multiform (EM) major and Stevens-Johnson syndrome (SJS). We present a 12-year-old boy who presented with classical clinical manifestations of MPAM and strongly positive M. pneumoniae PCR results. The patient was treated with antimicrobial therapy and had an uneventful recovery. Physicians should be aware of this rare entity and manage patients accordingly.

Prevalence and risk factors of Gram-negative bacilli causing blood stream infection in patients with malignancy.

OBJECTIVES: To evaluate the epidemiology, risk factors, and antibiotic resistance of Gram negative bacteria (GNB) in patients with hematologic or solid organ malignancies.   METHODS: This is a retrospective study of 61 episodes of GNB bacteremia occurring in 56 patients with malignancy admitted to the Oncology Units in King Khalid University Hospital, Riyadh. Kingdom of Saudi Arabia during the period from January 2013 to October 2015. Data were retrieved from the computerized database of the microbiology laboratory and the patient's medical records.   RESULTS:  Hematological malignancies accounted for 30 (54%) and solid tumors accounted for 26 (46%). The most common hematological malignancies were leukemia 23 (77%), followed by lymphoma 6 (20%). Among solid tumors, colorectal cancer 9 (34.6) and breast cancer 6 (23%) were the most common. The most predominant pathogen was Escherichia coli (E. coli) (29.5%) followed by Acinetobacter baumannii (A. baumannii) (18%). The extended-spectrum beta-lactamases producers rate of E. coli and Klebsiella pneumonia was (34.6%). Imipenem resistance among Pseudomonas aeruginosa/ A. baumannii was high (52.4%). The multi-resistant organisms rate was (43.5%). Risk factors associated with the bacteremia were ICU admission (32.1%), post-surgery (23.2%), and placement of central line (21.4%). The overall 30-day mortality rate of the studied population was high (32.1%).  CONCLUSION: In light of the high resistant rate among the GNB isolated from malignancy patients from our institution, careful selection of antimicrobial treatment based on antimicrobial susceptibility testing is recommended.

Viral agents causing acute lower respiratory tract infections in hospitalized children at a tertiary care center in Saudi Arabia.

OBJECTIVE: To determine the load and importance of respiratory viruses in hospitalized Saudi children with acute lower respiratory tract infections (ALRIs). METHODS: A retrospective study was performed at the Departments of Pediatrics, Pathology/Microbiology, King Khalid University Hospital, Kingdom of Saudi Arabia from January 2005 to December 2010. Nasopharyngeal aspirates were collected from 643 children with ALRI. Viruses were detected by direct immunofluorescence, respiratory syncytial virus (RSV), adenovirus (ADV), type 1 to 3 parainfluenza viruses (PIV), and type A and B influenza virus (flu). RESULTS: Of the 643 children with ALRI, viruses were detected in 309 (48.1%) specimens. The viruses that were identified included RSV (n=295, 95.5%), PIV (n=8, 1.2%), ADV (n=2, 0.3%), flu A (n=2, 0.3%), and flu B (n=2, 0.3%). The RSV was predominated in 231 (75%) children less than one year of age. Only younger age and male gender were associated with severe illness. The peak frequency of the viruses detected was in the winter. Of the 309 virus positive samples, bronchiolitis was detected in 81.2% (n=251), and pneumonia in 14.2% (n=44) (p<0.0001). CONCLUSION: Viruses are an important cause of ALRIs in Saudi children constituting approximately 48.1% of the total cases. The RSV is the most common pathogen (95.5%) causing ALRIs. Most of the children were younger than one year of age, and were more likely to present with bronchiolitis than pneumonia.

Clinical and laboratory profiles of urinary tract infections caused by extended-spectrum beta-lactamase-producing Escherichia coli in a tertiary care center in central Saudi Arabia.

OBJECTIVE: To study the clinical and laboratory characteristics of urinary tract infections (UTIs) caused by extended-spectrum beta-lactamase (ESBL) producing Escherichia coli (E. coli). METHODS: A retrospective clinical and laboratory study was performed at the Bacteriology Unit, Department of Pathology/Microbiology, King Khalid University Hospital, Riyadh, Kingdom of Saudi Arabia from June 2009 to June 2011. A total of 339 adults and pediatric patients with UTI was included in the study. Two groups of patients (ESBL E. coli UTI and non-ESBL E. coli UTI) were studied. Symptoms and signs of illness, comorbidities, outcomes, and urine analysis results were analyzed. RESULTS: There was 339 episodes of culture-verified UTI, 113 (33.3%) cases were caused by ESBL E. coli, and 226 (66.7%) cases were caused by non-ESBL E. coli. Non-ESBL E. coli UTI was more commonly found in children, and ESBL E. coli was more predominant in female patients. Identified risk factors for acquisition of ESBL E. coli UTI included patients who had underlying renal disease and renal transplant (p=0.017), children with vesicoureteric reflux (p=0.044), surgical intervention, recurrent UTI (p<0.004), and in inpatients. Non-ESBL E. coli patients are more likely to present with UTI. The ESBL E. coli uropathogen are resistant to antibiotics, including the third generation cephalosporin, gentamicin, and ciprofloxacin, whereas the non-ESBL E. coli were more resistant to antibiotics Ampicillin and cotrimoxazole. CONCLUSION: Identifying the risk factors and the antimicrobial resistance patterns associated with ESBL producing E. coli UTI is necessary for the development of an appropriate empirical antibiotic treatment.

Panton-Valentine leukocidin Staphylococcus aureus osteomyelitis of the femur in a Saudi child.

Staphylococcus aureus producing Panton-Valentine leukocidin (PVL) is well recognized to cause severe skin and soft tissue infections. Recently, it has been increasingly recognized as causing life-threatening musculoskeletal infection. We reported previously 3 children who had osteomyelitis caused by methicillin resistant Staphylococcus aureus. We report and discuss a case of Methicillin sensitive staphylococcus aureus encoding the PVL genes isolated from a child with acute osteomyelitis from Saudi Arabia.

Severe community-acquired infection caused by methicillin-resistant Staphylococcus aureus in Saudi Arabian children.

Community acquired methicillin-resistant Staphylococcus aureus (CA-MRSA) infection has become a major pathogen causing significant infection in children in Saudi Arabia. It has emerged as a frequent cause of skin and soft tissue infections and can be associated with life-threatening complications such as necrotizing pneumonia and sepsis. Between January 2005 and March 2008, 5 (6%) previously healthy children with invasive CA-MRSA infections were identified from 80 children with community-onset MRSA infections. Three children had osteomyelitis, with one patient presenting a fulminant and extensive soft tissue and bone destruction complicated by deep vein thrombosis and pathological fracture. One child had deep-seated infection, and one infant had severe orbital cellulitis and bilateral orbital abscess complicated by subdural empyema. The median age was 4-years (range 3 months to 17 years). Only one patient had a risk factor. Two patients were initially treated with ineffective antimicrobial therapy (beta-lactam). One isolate showed inducible clindamycin resistance. The recovery was uneventful in all patients. This report should increase the awareness of clinicians regarding severe CA-MRSA infections and highlight the challenges encountered in the choice of therapy of serious infections caused by this organism.