Prospective multicentre study in intensive care units in five cities from the Kingdom of Saudi Arabia: Impact of the International Nosocomial Infection Control Consortium (INICC) multidimensional approach on rates of central line-associated bloodstream infection.

OBJECTIVE: To analyse the impact of the International Nosocomial Infection Control Consortium (INICC) Multidimensional Approach (IMA) and INICC Surveillance Online System (ISOS) on central line-associated bloodstream infection (CLABSI) rates in five intensive care units (ICUs) from October 2013 to September 2015. DESIGN: Prospective, before-after surveillance study of 3769 patients hospitalised in four adult ICUs and one paediatric ICU in five hospitals in five cities. During baseline, we performed outcome and process surveillance of CLABSI applying CDC/NHSN definitions. During intervention, we implemented IMA and ISOS, which included: (1) a bundle of infection prevention practice interventions; (2) education; (3) outcome surveillance; (4) process surveillance; (5) feedback on CLABSI rates and consequences; and (6) performance feedback of process surveillance. Bivariate and multivariate regression analyses were performed. RESULTS: During baseline, 4468 central line (CL) days and 31 CLABSIs were recorded, accounting for 6.9 CLABSIs per 1000 CL-days. During intervention, 12,027 CL-days and 37 CLABSIs were recorded, accounting for 3.1 CLABSIs per 1000 CL-days. The CLABSI rate was reduced by 56% (incidence-density rate, 0.44; 95% confidence interval, 0.28-0.72; P = 0.001). CONCLUSIONS: Implementing IMA through ISOS was associated with a significant reduction in the CLABSI rate in the ICUs of Saudi Arabia.

Human immunodeficiency virus type-1 (HIV-1) disease progression and viral activity: a seroepidemiological and molecular study.

OBJECTIVE: To determine the frequency and epidemiological characterization of human immunodeficiency virus type-1 (HIV-1) infection, HIV disease progression, immune status and viral activity. STUDY DESIGN: Descriptive study. PLACE AND DURATION OF STUDY: Department of Microbiology, University of the Punjab and Institute of Public Health, Lahore, from September 2005 to August 2008. METHODOLOGY: The study enrolled samples from general population, high risk groups and spouses of HIV+ deport workers with criteria; positive double enzyme linked immunosorbent assay (ELISA) and positive western blot. Immune status and viral activity was determined by cluster determinants (CD4+ and CD8+) cell count, ratio of CD4+/CD8+ on flow cytometer, and HIV RNA viral load on polymerase chain reaction (PCR). RESULTS: A total of 116 HIV+ untreated subjects enrolled after screening of 2260 blood samples. The seroprevalence rate in general population, high risk individuals and spouses of HIV+ deport workers was found 0%, 0.4% and 26% respectively. The CD4+ cell count was found 533/mm3 (range 12-1800/mm3) and plasma viral load 27,122 copies/ml (range 00-40,621). The CD4+/CD8+ ratios < 0.5, < 1, < 1.5 and < 2 appeared as 17.2%, 30.2%, 51.7% and 0.9% respectively. Significant correlation was observed between plasma viral load, CD4+ count and CD4+/CD8+ ratio (p = 0.001). CD4+ T-cell counts < 200 cells/mm3 was found in 23 HIV+ patients. CONCLUSION: There was a low frequency of HIV in the general population and high risks groups as compared to very high frequency in spouses of HIV+ deport workers with significant correlation of viral activity and immune status.

Antimicrobial susceptibility pattern of Staphylococcus aureus on clinical isolates and efficacy of laboratory tests to diagnose MRSA: a multi-centre study.

BACKGROUND: The global problem of increasing trend in antimicrobial resistance is particularly pressing in the developing countries, where the Methicillin-Resistant Staphylococcus aureus (MRSA) is often the severe casual agent in hospital-acquired infections. METHODS: This multi-centre surveillance prospective study was planned to define the magnitude of problem of MRSA among clinical isolates from four teaching hospitals of Lahore Pakistan; Mayo, Services, Jinnah and Shaikh Zayed Hospitals during April 2006-March 2008. Identification of organisms was done by the standard Microbiology methods. MRSA isolates identified on Kirby-Bauer disc diffusion were further evaluated by minimum inhibitory concentration on BD Phoenix system and detection of mecA gene by pulsed-field gel electrophoresis (PFGE) PCR. RESULTS: Of the total 1,102 S. aureus isolates, oxacillin resistance was found in 462 on disc diffusion and 420 on MIC while mecA gene was detected from 307 strains. The prevalence of MRSA among S. aureus isolates was 41.9%, 38.1% and 27.9% on disc diffusion, MIC, and mecA gene detection respectively. Hospital acquired-MRSA strains were multi drug resistant while community acquired-MRSA showed susceptibility to clindamycin (63%), ciprofloxacin (24.2%) and SMZ/TMP (3.9%). In diagnosing MRSA, the sensitivity and specificity rates of disc diffusion test were 100% and 83.7% while MIC 96.2% and 93.3% respectively. CONCLUSION: There is an increasing trend in emergence MRSA and the conventional method of antimicrobial susceptibility testing showed false positive tests. This is the reason of misuse of vancomycin by physicians which may further increase MRSA in Pakistan. Therefore, molecular diagnostic facilities are recommended to avoid false-susceptible results.

Misdiagnosis of an imported case of malaria caused by Plasmodium falciparum.

An unusual case of malaria presented with gastroenteritis and bloody diarrhoea in a 46-year-old male. The patient was a non-Saudi resident of Makkah, Saudi Arabia. Fever was not the presenting complaint, and the patient had not experienced any chills or sweating. He gave history of recent travel to Pakistan. Initial laboratory investigations showed anemia, thrombocytopenia, normal liver function, and negative blood film for malaria. His widal, Brucella, and dengue serology was negative. Endoscopic examination showed gastroenteritis. On the fifth day of admission, a sexual form of Plasmodium falciparum on peripheral smear was reported by chance. Malaria was misdiagnosed because of initial negative blood film which may have been due to false microscopy or a long period between exposures and positive blood film. We concluded that a repeat blood film for malaria at 12- to 24-hour intervals for 48 to 72 hours is cost effective when a patient has recently travelled to an endemic area.