Molecular detection of plasmid-derived AmpC ß-lactamase among clinical strains of Enterobacteriaceae in Bahrain.

BACKGROUND: Enterobacteriaceae with AmpC ß-lactamase are multidrug-resistant organisms and represent a significant challenge to patient care. This study aims to determine the prevalence of plasmid-derived AmpC ß-lactamase among extended spectrum ß-lactamases (ESBL)-producing Enterobacteriaceae strains in Bahrain. METHODS: It was a cross-sectional study. A total of 185 ESBL-producing Enterobacteriaceae isolates were recovered from clinically significant specimens from January 2018 to December 2019. The samples underwent initial screen for cefoxitin resistance by disc diffusion test and subsequent phenotypic confirmation of AmpC production with phenyl boronic acid assays as well as genotypic analysis by multiplex polymerase chain reactions for AmpC subtypes. Drug-resistant features of these clinical isolates were also examined. RESULTS: Twenty-nine ESBL-producing Enterobacteriaceae isolates were cefoxitin resistant. Phenotypic and genotypic analyses confirmed that 8 and 12 cefoxitin-resistant isolates are AmpC positive, respectively. These AmpC producers are multidrug resistant, and Escherichia coli is the dominant strain among them. CONCLUSIONS: Plasmid-mediated spread of AmpC is present in clinically relevant Enterobacteriaceae species in Bahrain. Rational antimicrobial therapy against these multidrug-resistant organisms and continued surveillance of antimicrobial resistance mechanisms among the clinical isolates are recommended for optimal patient care.

Prevalence of opportunistic infections in HIV-positive patients in Bahrain: a four-year review (2009-2013).

INTRODUCTION: This study aimed to examine the prevalence of opportunistic infections in HIV-infected patients in Bahrain and its relation to absolute CD4 count, CD4%, and CD4/CD8 ratio. METHODOLOGY: This retrospective cohort study used laboratory records (January 2009 - May 2013) from a major hospital in Bahrain. Opportunistic infections (OIs); absolute CD4 counts, CD4%, and CD4/CD8 ratio were recorded. RESULTS: CD4% and absolute CD4 count in HIV patients with associated infections (157 ± 295) was significantly lower than in those without associated infections (471 ± 285) (p < 0.001). There was no significant difference in CD4/CD8 ratio between the two groups. Infection with Staphylococcus aureus was the commonest infection, present in 9.8% of total HIV-infected patients and 28.7% of members of the AIDS patient group with OIs, followed by yeast infections (9.2% and 27.2%, respectively). Mycobacterium tuberculosis was present in 3.6% of total HIV-infected patients and 10.6% of the group with OIs, while mycobacteria other than tuberculosis (MOTT) was present in 2.5% and 7.5%, respectively. Pneumocystis jirovecii pneumonia (PCP) was observed in 5.1% and 15.1%, respectively. Herpes simplex II (HSV-II) was observed in 3% and 9%, respectively, while Cytomegalovirus antigenemia was only present in 2% and 6%, respectively. Streptococcus pneumoniae, Streptococcus milleri, Stenotrophomonas maltophilia, and Citrobacter species were bacterial infections observed least frequently. CONCLUSIONS: Studying the pattern of OIs in HIV-infected patients in Bahrain is of paramount importance due to the scarcity of data in the Arab world. This will help to improve physicians' awareness to improve care of HIV-infected patients.

Antimicrobial-resistant bacteria in a general intensive care unit in Saudi Arabia.

OBJECTIVE: To assess the prevalence of multi-drug resistant (MDR) bacteria causing infections in patients at the intensive care units (ICUs) of Riyadh Military Hospital (RMH), as well as their antimicrobial resistance patterns for one year. METHODS: A retrospective, cohort investigation was performed. Laboratory records from January to December 2009 were studied for the prevalence of MDR Gram-negative and Gram-positive bacteria and their antimicrobial resistance in ICU patients from RMH, Riyadh, Kingdom of Saudi Arabia. RESULTS: A total of 1210 isolates were collected from various specimens such as: respiratory (469), blood (400), wound/tissue (235), urinary (56), nasal swabs (35), and cerebro-spinal fluid (15). Regardless of the specimen, there was a high rate of nosocomial MDR organisms isolated from patients enrolled in the General ICU (GICU) in Riyadh. Acinetobacter baumannii (A. baumannii) comprised 40.9%, Klebsiella pneumonia (K. pneumonia) - 19.4%, while Pseudomonas aeruginosa (P. aeruginosa) formed 16.3% of these isolates. CONCLUSION: The P. aeruginosa, A. baumannii, K. pneumoniae, Escherichia coli, Staphylococcus aureus (methycillin sensitive and methycillin resistant), and Staphylococccus coagulase negative are the most common isolates recovered from clinical specimens in the GICU of RMH. Respiratory tract specimens represented nearly 39% of all the specimens collected in the ICU. The most common MDR organisms isolated in this unit were A. baumannii, and K. pneumoniae.