Isolation and Characterization of Cholera Toxin Gene-Positive Vibrio cholerae Non-O1/Non-O139 Isolated from Urinary Tract Infection: A Case Report.

Background: Urinary tract infection (UTI) caused by V. cholerae is rare and less common. V. cholerae is a Gram-negative bacterium motile using single polar flagellum and, originally, is a waterborne microbe found in aquatic and estuarine environments. Toxigenic V. cholerae is well-known as a causative agent of acute and excessive watery diarrhea after ingesting food and water contaminated with this bacterium. Case Presentation: A 27-year-old male patient presented to the emergency department on 17th July 2021 with burning micturition, normal vital signs, and no fever, vomiting, or diarrhea. In 2017, the patient complained of short stature and vitamin D deficiency. He was on human growth hormone from January 2018 till October 2019. The diagnosis was V. cholerae Non-O1/non-O139 urinary tract infection (UTI). Considering a urinary tract infection, empirical treatment with Lornoxicam and Ciprofloxacin was initiated, while the result of urine culture was still pending. The patient was discharged on the same day and without any complications. Conclusion: V. cholerae non-O1/non-O139 is primarily a marine inhabitant and is associated with sporadic cases resulting in cholera-like diarrhea after consumption of contaminated seafood and exposure to seawater. Extraintestinal infection associated with this bacterium should no longer be ignored as this change in the behavior of cholera bacteria mechanism of pathogenicity might be related to some associated virulence genes.

Eleven-Year surveillance of methicillin-resistant Staphylococcus aureus infections at an Academic Health Centre.

Introduction: Methicillin-resistant Staphylococcus aureus (MRSA) is an important human pathogen associated with nosocomial and community infections. There is a continual focus on the epidemiology of this public health threat owing to the increase in its spread and rapid development of resistance. Aim: We aimed to demonstrate the time trend of antibiotic resistance by describing the epidemiology of MRSA infections at an academic health centre. Methodology: We retrospectively reviewed cases during an 11-year period (from January 2009 to December 2019) with positive cultures for MRSA from various clinical sites in King Fahad Hospital of the University, to understand their clinical and microbiological profiles. Screening and colonisation samples were excluded. Results: A total of 1338 MRSA isolates were identified, with an increasing trend from 5.2% to 14.5% during 2009-2019. Skin and soft tissue samples were the most common source (52.4%) of MRSA infections. Vancomycin activity remained stable against MRSA, and only one isolate showed resistance to linezolid (< 1%). A significant reduction in susceptibility to clindamycin (p = 0.003), trimethoprim-sulfamethoxazole (p = 0.001), and rifampin (p < 0.0001) was detected over the study period. Conclusions: MRSA infections still represent a significant burden on healthcare systems. Our data support the need for constant local and regional surveillance to devise relevant protocols to manage MRSA infections. Empirical therapy needs to consider the changing antimicrobial susceptibility trends among MRSA isolates.

Predictive Role of Targeted, Active Surveillance Cultures for Detection of Methicillin-Resistant Staphylococcus aureus.

INTRODUCTION: Methicillin-resistant Staphylococcus aureus (MRSA) colonisation is an important source of healthcare-acquired infections. Reliable screening strategies for MRSA colonisation are essential for the timely implementation of infection control measures. AIM: This study determined reliable MRSA screening sites to predict colonisation in resource-limited settings and estimated the impact of missed MRSA cases when shifting from multi- to single-site screening. METHODOLOGY: A cross-sectional study was conducted in patients with positive MRSA surveillance cultures from the routinely screened sites (nasal, axillary, groin, and throat) from January 2009 to December 2019. RESULTS: A total of 1906 screening tests were positive for MRSA cultures (n = 1345 patients). As a single site, the nasal cavity showed the highest MRSA detection, with a sensitivity of 66.8% (95% CI = 64-69) with 277.9 missed isolation days. Screening three or more anatomical sites detected 97-100% of MRSA cases, with 0-24.5 missed isolation days. Screening the axilla and groin separately or in combination showed a good clinical utility index (CUI) of >0.6 to <0.8, while an excellent CUI was obtained upon screening other site samples (>0.8). The combined nasal and throat cultures demonstrated a sensitivity of 93.2 (95% CI = 91-94) with 57.2 missed isolation days. CONCLUSION: Multi-site screening is the optimal strategy for minimising MRSA exposure within a healthcare facility. For active MRSA surveillance, a combination of nasal and throat cultures can provide a practical approach in low-resource settings compared to nasal sampling alone.

Prevalence of the SARS-CoV-2 Infection Among Post-Quarantine Healthcare Workers.

BACKGROUND: Coronavirus disease 2019 is an emerging highly communicable disease. Nosocomial transmission needs to be prevented through the implementation of stringent screening and infection control measures. OBJECTIVE: The objective of the study is to estimate the prevalence of severe acute respiratory syndrome- coronavirus 2 (SARS-CoV-2) infection among health care workers (HCWs) post quarantine period. METHODS: This is a prospective, observational study conducted at a teaching University hospital in Alkhobar, Saudi Arabia, during the period between May 1 and June 15, 2020. All (HCWs) joining work back from the quarantine areas had a real-time polymerase chain reaction (qRT-PCR) test for SARS-CoV-2. The demographic and clinical data from the staff were collected. RESULTS: Of the 301 HCWs screened, 18 (6%) had positive PCR. The age means of the positive cases was 32.9 Y ± 8.7 compared to 33.8 Y ± 7.0 in the negatively tested group (p value = 0.90). Of the 18 PCR-positive HCWs, 7 (38.9%) were male. Majority of those who tested positive were trainees (8.2%) followed by nurses (5.1%). In PCR-positive group, a clear epidemiological exposure was found in 4/18 cases (22.2%). Male gender and residency in specific districts were observed more in the positive cases (p value = 0.01 and 0.0001, respectively). In regards to symptoms, most of the positive PCR tested HCWs (n=12, 66.7%) remained asymptomatic. Most prevalent initial symptoms were gastrointestinal symptoms (diarrhea, abdominal pain) in six HCWs representing 33.3%. No significant difference was noted in co-morbidities reported by both groups. CONCLUSION: Health care workers tested post-quarantine period were found to be at risk of SARS-CoV-2 infection despite very minimal or no known risks of exposure, where most of them were asymptomatic. This potentially carries risk of nosocomial transmission inside healthcare facilities. Implanting policies for routine post-quarantine screening for HCWs is recommended.