Molecular characterization of clinical and environmental carbapenem resistant Acinetobacter baumannii isolates in a hospital of the Eastern Region of Saudi Arabia.

BACKGROUND: Environmental and clinical carbapenem-resistant Acinetobacter baumannii (CRAb) isolated in a hospital of the Eastern Region of Saudi Arabia were compared to assess the potential environmental contamination by this pathogen. METHODS: Frequent-hand-touch surfaces of intensive care (ICU), medical (MW), and surgical (SW) units were randomly sampled for a month-long period, and the CRAb identified were compared to clinical isolates of the same period by PFGE and blaOXA-51-like gene sequencing. Carbapenemase and ribosomal methylase genes, ISAba1 link to blaOXA51-like or to blaOXA-23, respectively were detected by PCR. RESULTS: CRAb was identified from 35.5% of surfaces. All environmental and clinical isolates were multi- or extremely drug resistant. PFGE of all clinical (n=21) and selected environmental (n=30) isolates identified a singleton and four clusters, all of which included both clinical and environmental isolates. In the two largest clusters isolates carried blaOXA-66, ISAba1-linked blaOXA-23, and were from the ICU, MW and the male SW. Isolates of the female SW carried blaOXA-69, ISAba1-linked blaOXA-23 and blaGES-11. A pair of clinical and environmental CRAb from the Male SW harboured blaNDM-1 in addition to ISAba1-linked blaOXA-94. CONCLUSION: A worrying level of environmental contamination, often by CRAb belonging to international clones, was revealed, highlighting the importance of environmental hygiene.

Incidence and antibiotic susceptibility of MRSA infections in a Saudi Arabian Hospital: a 10-year surveillance study.

INTRODUCTION: Methicillin-resistant Staphylococcus aureus (MRSA) infections remain prevalent and are associated with significant morbidity and mortality. The aim of the present study was to investigate the epidemiology of MRSA infections and antibiotic susceptibility in Qatif, Saudi Arabia. METHODOLOGY: All patients who had positive culture for S. aureus from January 1, 2006 through December 31, 2015 were enrolled and analyzed in WHONET, a free database software developed by the World Health Organization (WHO). Patients' data were collected from electronic medical records and traditional chart reviews to determine whether MRSA acquisition was likely to have been in the community or in the healthcare facility. Susceptibility results for community-associated (CA)-MRSA were compared with isolates from healthcare setting. RESULTS: A total of 3395 patients with S. aureus infections were analyzed, with an overall annual MRSA incidence of 25 cases per 100,000 patients (27% of total S. aureus isolates). While the majority (64%) of MRSA infections occurred in healthcare setting, CA-MRSA isolation increased steadily from 23% in 2006 to 60% in 2015, exceeding rate of isolation of healthcare-associated (HA)-MRSA. Skin and soft tissue, the lung and blood stream were the most common sites of infection, with 20% to 35% of MRSA infections occurring in pediatric patients. In the inpatient setting, the majority of infections due to MRSA were in surgical wards and critical care units. Compared with CA-MRSA, HA-MRSA isolates turned out to be more frequently resistant against ciprofloxacin, clindamycin, erythromycin, tetracycline, and trimethoprim/sulfamethoxazole. CONCLUSIONS: Staphylococcus aureus continues to cause multiple site infections with a relatively stable methicillin-resistance rate, but the isolation of MRSA from the community is increasing.