First insights into molecular basis identification of 16 s ribosomal RNA gene of Staphylococcus aureus isolated from Sudan.

OBJECTIVE: In this study, we analyzed the molecular evolution of Staphylococcus aureus isolates using 16S rRNA gene and phylogenetic analysis to detect the prevalence of S. aureus infections in Sudan. RESULTS: Molecular detection of S. aureus has shown that 20 (43.47%) of patients were positive for S. aureus. The phylogenetic tree of 16S rRNA sequences was divided into three lineages of S. aureus isolates detected from wound infections in Sudan. Nucleotides base-pair substitution was appeared at position 249. This mutation do not linked with Macrolides, Lincosamides and Streptogramines b resistant phenotype. Further studies should investigate the effect of that mutation on resistance to other antibiotics.

Increased multi-drug resistant Escherichia coli from hospitals in Khartoum state, Sudan.

BACKGROUND: Multidrug-resistant Escherichia coli (MDR E. coli) has become a major public health concern in Sudan and many countries, causing failure in treatment with consequent huge health burden. OBJECTIVES: To determine the prevalence and susceptibility of MDR E. coli isolated from patients in hospitals at Khartoum State. METHODS: Between May to August 2011, E. coli (n = 232) isolated from clinical specimens, identified, tested their antimicrobials susceptibility and screened for extend spectrum â-lactamase production as per standard methods. RESULTS: Of the 232 E. coli isolates, the majority were from urine (65.1%). MDR E. coli were present in 214 (92.2%). Of these, the resistance rates were recorded to: amoxicillin 97.7%, cefuroxime 92.5%, trimethoprim-sulfamethoxazole 88.3%, tetracycline 77.1%, nalidixic acid 72%, ceftriaxone 64%, ciprofloxacin 58.4%, ofloxacin 55.1%, amoxicillin-clavulanate 50.4%, ceftazidime, gentamicin 35% each, nitrofurantoin 22.4%, chloramphenicol, tobramicin 18.2% each and amikacin 1.9%. Overall MDR E. coli, 53.3% were resistant to > 7 antimicrobial agents and ESBL was detected in 32.7%. Isolates from males were more resistant than those from females (p < 0.05). CONCLUSIONS: Drug-resistance surveillance and epidemiological analysis of patient data is need periodically and can be informative for appropriate management of antimicrobial resistance.

Nosocomial infections and misuse of antibiotics in a provincial community hospital, Saudi Arabia.

The incidence of nosocomial infection and prevalence of antibiotic misuse were studied in a 174-bed community hospital in Saudi Arabia over a six-month period. Of 2445 patients admitted, 8.5% developed nosocomial infection, the rates were highest for nursery (35.8%), intensive care (19.8%), gynaecological (16.2%) and surgical (11.7%) patients. Urinary tract (31.3%), wound (27.1%) and blood (14.9%) infections accounted for more than 70% of the infections. Staphylococcus aureus (23%) and Pseudomonas aeruginosa (11%), caused more than 90% of the infections. The majority of the bacterial pathogens (79%) were multi-drug resistant. Over 80% of patients were administered prophylactic and/or therapeutic antibiotics, with 53% receiving multiple antibiotics; 72% of the antibiotics were judged to be misused. Both prophylaxis and treatment were mostly misguided and clinically unwarranted. Host- and hospital-associated infection risk factors were identified. The minimum government cost estimates for the nosocomial infections and misused antibiotics were US $273 180 and $565 603, respectively. The findings emphasize the need for effective measures to reduce both the high infection rates and widespread antibiotic misusage in the hospital. Such measures should include institution of an effective infection control committee and a hospital antibiotic policy.

Clinical and community strains of Klebsiella pneumoniae: multiple and increasing rates of antibiotic resistance in Abha, Saudi Arabia.

Klebsiella pneumoniae is the most commonly isolated bacterial species in a maternity hospital in Saudi Arabia. Here, 380 strains isolated in 1997 and 480 strains in 1999 were studied for their resistance antibiograms, using the standardised disc diffusion test. Of 16 antibiotics tested, four in 1997 and six in 1999 were ineffective against > 50% of the respective isolates, and resistance rates to 11 antibiotics increased over the two-year period (P = 0.05-< 0.0001). With resistance rates of < 20%, imipenem, ciprofloxacin, gentamicin and cefotaxime were more effective in 1997; only imipenem and ciprofloxacin remained as effective in 1999. In addition, 105 community strains were tested and > 50% were resistant to four antibiotics. Resistance rates to most antibiotics were lower than those of clinical strains (P = 0.0285-< 0.0001). Imipenem resistance was detected among both clinical and community isolates. Multiresistance was 64.5% in 1997 and 79.2% in 1999 (P < 0.0001), and 83.8% in community strains in 1999. Using the double-disc synergy test, extended-spectrum beta-lactamase (ESBL) was detected in 27.5% of ceftazidime-resistant clinical strains isolated in 1999. Among the clinical strains, seven (65%) and 11 (67.9%) resistance antibiograms occurred frequently in 1997 and 1999, respectively. Such frequency was not observed among community isolates. These findings confirm the alarmingly high rates of multiresistance and the emergence of ESBL-producing strains, highlighting the urgent need to restrict over-the-counter availability of antibiotics, and increase awareness in the local medical community.

Nasal carriage and antibiotic resistance of Staphylococcus aureus isolates from hospital and non-hospital personnel in Abha, Saudi Arabia.

The prevalence of nasal carriage of Staphylococcus aureus, antibiograms and prevalence of methicillin-resistant S. aureus (MRSA) were studied in 1999 among healthy hospital and non-hospital personnel in Abha, Saudi Arabia. S. aureus was isolated from 26.1% of 299 adults in the community and 25.4% of 279 hospital personnel. No isolate was resistant to vancomycin. Antibiotic resistance rates, for all other antibiotics tested except cephalothin, were significantly higher for strains from hospital personnel (P values < 0.001-0.04) compared to non-hospital adults. The antibiograms were also compared with those of 140 clinical isolates. The rates of resistance of the inpatient strains to all the antibiotics tested were significantly higher than those of hospital nasal carrier strains (P < 0.001-0.05). MRSA was isolated, respectively, from 5.1% and 18.3% of non-hospital and hospital carriers; MRSA carriage rates were 1.3% and 4.7%, respectively, for non-hospital and hospital carriers, and 61% of S. aureus isolates from infected patients were MRSA. Only 8% of non-hospital but 44% of hospital carrier strains were multiply resistant (P < 0.001). Multiple resistance among inpatient strains (89%) was significantly higher than that among hospital nasal strains (44%) (P < 0.001). Such rates of multiple resistance and endemic MRSA prevalence among healthy carriers (11%) at a much higher rate than those reported in the literature should raise concern in a region with unrestricted availability of antibiotics.

Staphylococcus aureus as a paradigm of a persistent problem of bacterial multiple antibiotic resistance in Abha, Saudi Arabia.

We reviewed the microbiology laboratory records of Abha Maternity Hospital, Saudi Arabia for 1996 and 1998 to assess multiple antibiotic resistance, using Staphylococcus aureus as a paradigm. A total of 587 and 485 strains were isolated in 1996 and 1998 respectively. In 1996, over 60.0% were resistant to five of the nine antibiotics tested; in 1998, over 55.0% were resistant to six antibiotics. In both years, 71.0% were methicillin-resistant S. aureus. Over 85.0% of all strains were multiresistant. Although over 100 types of resistance patterns were detected, more than half of the strains displayed fewer than 15 types. The strains most frequently isolated were considered hospital strains, which accounted for most infections.

Staphylococcus aureus as a paradiagm of a persistent problem of bacterial multiple antibiotic resistance in Abha, Saudi Arabia

We reviewed the microbiology laboratory records of Abha Maternity Hospital, Saudi Arabia for 1996 and 1998 to assess multiple antibiotic resistance, using Staphylococcus aureus as a paradigm. A total of 587 and 485 strains were isolated in 1996 and 1998 respectively. In 1996, over 60.0% were resistant to five of the nine antibiotics tested; in 1998, over 55.0% were resistant to six antibiotics. In both years, 71.0% were methicillin-resistant S. aureus. Over 85.0% of all strains were multiresistant. Although over 100 types of resistance patterns were detected, more than half of the strains displayed fewer than 15 types. The strains most frequently isolated were considered hospital strains, which accounted for most infections

Neonatal septicemia.

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CD4+ Th2 cell response cytokine production in bacterial meningitis.

There has been a growing body of evidence suggesting that CD4+ Th1/Th2 cell responses participate in pathologic and immunologic processes in infectious disease. Bacterial meningitis is a fatal disease of children and is associated with a spectrum of clinical syndromes. This study provides evidence of CD4+ enhanced interleukin (IL)-4 and IL-6 but decreased IL-2 and interferon-gamma (IFN-gamma) production, the induction of characteristic Th2 cell response cytokines in bacterial meningitis, which may play an important role in disease mechanism. Additionally, monocyte-induced enhanced IL-6, IL-8, and tumor necrosis factor-alpha production may be associated with distinct clinical features such as fever, seizures, and neurological sequelae. A striking finding was also the highly deficient monocyte-induced granulocyte-macrophage colony-stimulating factor production. Of particular interest, the CD(8+)-enhanced IFN-gamma production may be required for the cytolytic activity or protective response to be maintained in this disease. Taken together, these data reveal that monocytes and CD4+ (Th2) and CD8+ subsets produce distinct cytokines in bacterial meningitis, which may exert an immunoregulatory and immunopathologic effect and thus mediate some of the clinical manifestations of the disease.

The source of organisms in the post-prostatectomy bacteriuria of patients with pre-operative sterile urine.

Ninety patients undergoing prostatectomy for benign prostatic hyperplasia (BPH) with sterile urine pre-operatively were prospectively studied for post-prostatectomy bacteriuria; 26 of 90 patients (29%) developed bacteriuria (18 of 64 after transurethral resection (TUR) and 8 of 26 after open prostatectomy), of whom 15 had pre-operative indwelling urethral catheters. The correlation of bacteriuria with several factors was studied, namely the presence of a histological inflammatory reaction within the prostatic adenoma, prostatic culture, intra-operative outgoing irrigation fluid culture, intra-operative blood culture and post-operative external meatal swab culture. The only significant correlation was between bacteriuria and meatal cultures. It was concluded that post-prostatectomy bacteriuria is probably caused by post-operative ascending infection along urethral catheters. There was not enough evidence to ascribe bacteriuria to pre-existing septic foci within the adenoma. Intra-operative contamination and infection from distant foci were also unlikely causes.

Salmonella infections in Asir region, southern Saudi Arabia: Expatriated implications.

One hundred forty-two cases of salmonella infection seen in Asir region, Southern Saudi Arabia, during the period of 1989-1991 inclusive, were analyzed. Ninety-four cases were found to have enteric fever and 48 cases were found to have, Salmonella enteritidis gastroenteritis. Enteric fever is more common in non-Saudis (64%) than in the indigenous Saudi population (34%). Salmonella enteriditis gastroenteritis is more common among the Saudi population (75%) than non-Saudis (25%). The clinical presentation of both types of salmonella infection is outlined. Enteric fever is more common among expatriates who recently came from India (40.5%), Egypt (10.6%), Pakistan (6.4%), and Syria (4.3%). Salmonella typhi resistant to tetracycline, ampicillin, and chloramphenicol are more common among Indian patients (75% of resistant cases) and Syrian patients (12.5-28% of resistant cases). Resistance to cotrimoxazole is commonly encountered in Indians (50% of resistant cases) and Egyptians (33.3%). Salmonella enteriditis resistant to tetracycline, ampicillin, and chloramphenicol is more common among Saudis (66.7% of resistant cases) and Filipinos (16.7-33.3% of resistant cases). Recommendations regarding screening of expatriates for enteric fever and proper drug therapy of possible resistant cases are outlined.

A study of the knowledge, attitude and practice (KAP) of a Saudi Arabian community towards the problem of brucellosis.

The present study included 337 patients, presenting to Asir Central Hospital with fever of more than two weeks duration, or symptoms associated with brucellosis but without fever. Of the 337 subjects examined for knowledge about methods and means of transmission of brucellosis, 309 (92%) were ignorant while only 28 (8%) appeared to possess some knowledge as to the source, type of animal contact and presentation of illness. None of the 337 subjects was able to link the disease with a microbial infection. The most important common practices associated with brucellosis included raw milk consumption, close animal contact and the slaughtering and disposal of wastes. Illiteracy, ignorance and faulty behaviours emphasize the importance of health education of the community, to raise the KAP standard of the full spectrum of brucellosis in the community would be valuable in its prevention and control.

Genito-urinary complications of brucellosis.

Twelve cases of genito-urinary complications of brucellosis are presented. Ten patients had epididymo-orchitis, 1 presented with right hydronephrosis and 1 with haematuria and dysuria. The 10 cases of epididymo-orchitis were compared with 15 cases of acute non-specific epididymo-orchitis. The former were of longer duration and were not associated with lower urinary tract symptoms; almost all of these patients had ingested unpasteurised milk. Non-specific epididymo-orchitis had a more acute onset, shorter duration and was associated more frequently with pyuria, lower urinary tract symptoms, higher leucocyte counts and insignificant brucella titres. The distinction between these two types of epididymo-orchitis is essential, since the treatments are entirely different.