Nosocomial candidemia in a tertiary care hospital in Saudi Arabia.

Demographic information, risk factors, therapy, and outcome for all patients who had candidemia at King Fahad teaching hospital Al-khobar, between January 1995 and January 2000 were retrospectively reviewed. Thirty-two candidemic patients were identified. Candida parapsilosis was the most frequently isolated species (44%), followed by Candida tropicalis (25%), Candida albicans (19%), Candida krusei (6%), Candida glabrata (3%), and Candida guilliermondi (3%). Risk factors included recent broad-spectrum antibiotics use (100%), ICU residency (71%), central venous catheters (66%), recent surgery (56%), total parenteral nutrition (43%), and immunosuppressive therapy (31%). Fluconazole was used before the onset of candidemia in only two patients. The overall mortality rate was 44%. Eight (25%) episodes of candidemia were not diagnosed and treated before the patient's demise. In view of the high mortality rate associated with hematogenous candidiasis, and lack of sensitive and specific laboratory tests necessary for the premortem diagnosis of infection, empirical antifungal therapy is recommended for high-risk patients.

Emergence of methicillin-resistant Staphylococcus aureus as a community pathogen.

Methicillin-Resistant Staphylococcus aureus (MRSA) infection is an established nosocomial pathogen, with hospital-based outbreaks occurring worldwide. An increase in MRSA infections without risk factors has been recently documented in several reports. A prospective study was conducted over a 36-month period to determine the prevalence and risk factors for community-acquired MRSA infection at King Fahad Hospital of the University Al-Khobar, Saudi Arabia. Patients hospitalized within the previous 12 months or transfers from hospitals or nursing homes were excluded. The number of patients with community-acquired MRSA disease increased from a single patient in 1998 to fifteen patients in the year 2000 and the percentage of community-acquired MRSA/total number of MRSA increased from 5% to 33%. Fifteen (75%) of 20 patients with community-acquired MRSA infection had no discernible characteristics of MRSA infections. Skin and soft tissue infections were the predominant presentation. Most MRSA isolates (95%) were susceptible to multiple antibiotics. Our data suggest that MRSA is an emerging community pathogen. Hospital infection control strategies will have to be redefined and community approaches developed to reduce transmission.

The epidemiology of methicillin-resistant Staphylococcus aureus at a Saudi university hospital.

To determine changes in the epidemiology of methicillin-resistant Staphylococcus aureus (MRSA), a prospective study was conducted for a 30-month period in a university hospital in the eastern province of Saudi Arabia. Of 1,096 Staphylococcus aureus isolates identified, 92 (8.4%) were MRSA. Seventy-two (78%) of the 92 isolates were from nosocomial cases and 20 (22%) isolates were from community cases. Thirteen (14%) of 20 patients with community-acquired MRSA had no discernible risk factors. The community-acquired MRSA from patients without identified risk were susceptible to a greater number of antimicrobials compared with isolates obtained from patients with community-acquired MRSA with identified risk or with nosocomially acquired MRSA. No strain resistant to vancomycin was recorded in this study. The impact of these organisms could be substantial if they become more frequent or widespread.