High level resistance to aminoglycosides in enterococci from Riyadh.

Enterococci with high level of aminoglycosides resistance are being reported from different parts of the world with increasing frequency. Treatment of infections caused by such isolates is associated with a high incidence of failure or relapse. This is attributed to the loss of the synergetic effect of aminoglycosides and cell wall active agents against isolates exhibiting this type of resistance. To determine the prevalence of enterococci with high level resistance to aminoglycosides in Riyadh, Saudi Arabia, 241 distinct clinical isolates were examined by disk diffusion method using high content aminoglycosides disks. Seventy-four isolates (30%) were resistant to one or more of the aminoglycosides tested. The most common pattern of resistance was that to streptomycin and kanamycin. Of the 241 isolates tested, 29 (12%) were resistant to high levels of gentamicin, 35 (15%) to tobramycin, 65 (27%) to kanamycin and 53 (22%) to streptomycin. The highest rate of resistance to a high level of gentamicin was found among enterococcal blood isolates (30%). Eighteen of the isolates were identified as Enterococcus faecium, 13 (72%) of these showed high level resistance to two or more of the aminoglycosides tested.

Urinary tract infection due to Rahnella aquatilis in a renal transplant patient.

Rahnella aquatilis is an unusual gram-negative rod belonging to the family Enterobacteriaceae. It inhabits fresh water and is rarely isolated from clinical specimens. We report the case of a urinary tract infection caused by this organism in a renal transplant patient.

Etiology of bacterial diarrhea in a major referral center in Saudi Arabia.

A total of 34, 856 stool specimens from 19, 437 patients with symptoms of gastroenteritis were analyzed for bacterial enteropathogens during the period of January 1, 1985, to December 31, 1989, at a major tertiary care referral hospital in Saudi Arabia. Bacterial pathogens were isolate from 1426 (7.3%) patients, with Salmonella being the most frequent (3.8%), followed by Campylobacter (2.0%), Shigella (1.1%), and Aeromonas hydrophila (0.34%). Salmonella serogroups B and C and Shigella B and D constituted the majority of isolates in these two groups. Major clinical symptoms associated with bacterial gastroenteritis included mild to moderate diarrhea, abdominal discomfort, tenesmus, vomiting, fever, and dehydration. Bloody diarrhea was more common in patients with shigellosis (32%) than in those infected with other bacteria. Stool specimens from 80% of the patients with Shigella gastroenteritis had leukocytes, compared with about 40% of the patients with Salmonella or Campylobacter.