Nocardiosis at an Organ Transplant Center in Saudi Arabia: 15 years' experience.

BACKGROUND: Nocardiosis is a rare infection that affects immunocompromised patients on immunosuppressive medications used for transplantation and cancer therapy. Such therapies are becoming more widely available in the Middle East region. Yet, reports on nocardiosis are scarce. MATERIALS AND METHODS: This was a retrospective analysis of patients who were diagnosed with nocardiosis from 2004 to 2018 at a transplantation and cancer center. Nocardiosis were defined per the European Organization for Research and Treatment of Cancer criteria. RESULTS: During the study period, 35 patients with nocardiosis (male: 68.5%) were identified. The most common underlying associated condition was transplantation 11 (31.4%), followed by malignancy 7 (20%), connective tissue disease and sarcoidosis 7 (20%), chronic lung disease 5 (14%), miscellaneous conditions 4 (11%), and one patient with human immunodeficiency virus. Nocardia was disseminated in 8 patients (22.9%) and isolated in 27 (77.1%); the latter included 13 patients (37.1%) with bronchial form, 11 (31.4%) with isolated visceral form, and 3 (8.6%) with cutaneous form. Pulmonary involvement occurred in 90% of the cases with cough, fever, and dyspnea being the most common symptoms. The main strain isolate was Nocardia asteroides, and the cure rate was 90%. Mortality related to nocardiosis occurred in 3 transplant patients (8.6%). CONCLUSION: Wider use of immunosuppressive therapy warrants vigilance to nocardiosis, which can present in a myriad of clinical forms. In our series, mortality was confined to the transplantation group, probably because of the relatively heavy immunosuppression. Nonetheless, prognosis is favorable if the infection is recognized and treated early.

Extended-spectrum ß-lactamase-producing Klebsiella pneumoniae in the neonatal intensive care unit: does vancomycin play a role?

BACKGROUND: Extended-spectrum ß-lactamase (ESBL)-producing Klebsiella species cause worldwide problems in neonatal intensive care units (NICUs). This study aimed to determine possible risk factors for infection or colonization with ESBL-producing Klebsiella pneumoniae (ESBLKp) during an outbreak in the NICU. METHODS: A retrospective cohort study was conducted among neonates admitted to the NICU of a teaching hospital in Riyadh, Saudi Arabia, during an outbreak of ESBLKp from April to July 2008. The incidence density ratio was calculated to determine possible predictors of ESBLKp colonization or infection. RESULTS: During 2,265 person-days of follow-up of 118 neonates, 4 became infected, and 8 were colonized with ESBLKp. Univariate analyzes revealed that, among 14 neonates who were treated with vancomycin, 9 (64.3%) developed infection or colonization with ESBLKp, whereas, among 104 neonates who were not treated with vancomycin, 3 (2.9%) were affected, with an incidence density ratio of 4.22 (95% confidence interval: 1.47-5.15). Parenteral feeding and mechanical ventilation were found to be marginally significant risk factors. CONCLUSION: Treatment with vancomycin appears to be a risk factor for infection or colonization with ESBLKp in the NICU setting.

Prevalence of colistin and tigecycline resistance in Acinetobacter baumannii clinical isolates from 2 hospitals in Riyadh Region over a 2-year period.

OBJECTIVE: To describe the rates and patterns of colistin and tigecycline resistance among Acinetobacter baumannii (A. baumannii) isolates from clinical specimens from 2 major hospitals in Riyadh Region over a 2-year period. METHODS: This is a retrospective review of records of all clinical isolates of A. baumannii from the departments of microbiology at King Faisal Specialist Hospital and Research Center (KFSHRC) and Prince Sultan Military Medical City (PSMMC), Riyadh, Kingdom of Saudi Arabia for the period from January 2010 to December 2011. RESULTS: Records for 1307 Acinetobacter species isolates were identified. The overall tigecycline resistance rates were 9.7% and colistin 1.8%. Among Acinetobacter isolates from KFSHRC, tigecycline resistance rate increased from 10.4% in 2010 to 20.5% in 2011. Colistin resistance increased over the same period from 2.6% to 4.7%. No Acinetobacter isolates from PSMMC were reported to be colistin resistant, while tigecycline resistance rates increased from 1.3% in 2010 to 6.6% in 2011. In KFSHRC, resistance to tigecycline was reported significantly more in isolates from samples that originated in the intensive care units, whereas in PSMMC tigecycline resistance was reported exclusively from clinical areas other than intensive care. No temporal clustering of Acinetobacter isolates was apparent in either hospital over the study period. CONCLUSION: Tigecycline and colistin resistance were reported from a considerable proportion of Acinetobacter clinical isolates from the study hospitals over a 2-year period.

Rapid PFGE method for fingerprinting of Serratia marcescens isolates.

We modified the conventional PFGE procedure for Serratia marcescens to establish a rapid method. Our protocol showed modification in the bacterial lysis, washing, and restriction enzyme digestion time. This resulted in shortening the time needed by about 3 days compared to the conventional PFGE method.

A comparative study on the application of 3 molecular methods in epidemiological typing of bacterial isolates using MRSA as a prototype.

OBJECTIVE: To evaluate and compare 3 widely used molecular techniques, namely, restriction endonuclease analysis of plasmid deoxyribonucleic acid (REAP), randomly amplified polymorphic DNA (RAPD) and pulsed-field gel electrophoresis (PFGE) for their suitability and usefulness in the typing and fingerprinting of bacterial isolates. METHODS: Twenty-four epidemiologically unrelated methicillin-resistant Staphylococcus aureus (MRSA) isolates were used to evaluate the molecular typing methods (REAP, RAPD and PFGE). The study was conducted at the Research and Diagnostic Laboratories of King Faisal Specialist Hospital and Research Center from January 2002 through January 2003. RESULTS: Only 20.8% of all isolates studied were of the same genotypes by all 3 methods. Two major clusters of strains each representing 33% of the total number of isolates were identified by REAP analysis. Each of RAPD and PFGE however, identified one major cluster represented by 54% and 83% of the total number of isolates, all 3 typing methods, therefore, showed the clonal genetic relatedness among distant MRSA isolates. However inter-strain comparison of fingerprint data generated from each method revealed differences in clonal representation of the MRSA isolates. CONCLUSION: Although a variety of molecular assays are available for typing of bacterial species, there is no single standardized protocol for routine analysis. Reproducibility and interpretation of genotypic data are therefore, highly dependent on methodologies employed by the individual laboratory. Our findings illustrate the importance of using a combination of methods in typing schemes of bacterial isolates. In terms of reproducibility and typeability we found that PFGE is superior to REAP and RAPD and, therefore, more suitable for routine, standardized tracing of nosocomial bacterial isolates.