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Saeedi FA, Hegazi MA, Alsaedi H, Alganmi AH, Mokhtar JA, Metwalli EM, Hamadallah H, Siam GS, Alaqla A, Alsharabi A, Alotaibi SA. Multidrug-Resistant Bacterial Infections in Pediatric Patients Hospitalized at King Abdulaziz University Hospital, Jeddah, Western Saudi Arabia. CHILDREN (BASEL, SWITZERLAND) 2024; 11:444. [PMID: 38671661 PMCID: PMC11049043 DOI: 10.3390/children11040444] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/15/2024] [Revised: 04/02/2024] [Accepted: 04/04/2024] [Indexed: 04/28/2024]
Abstract
Multidrug-resistant bacterial infections (MDRIs) constitute a major global threat due to increased patient morbidity/mortality and hospital stay/healthcare costs. A few studies from KSA, including our locality, addressed antimicrobial resistance in pediatric patients. This study was performed to recognize the incidence and clinical/microbiologic features of MDRIs in hospitalized pediatric patients. A retrospective cross-sectional study included pediatric patients < 18 years, admitted to King Abdulaziz University Hospital, between October 2021 and November 2022, with confirmed positive cultures of bacteria isolated from blood/body fluids. Patients' medical files provided the required data. MDR organisms (MDROs) were identified in 12.8% of the total cultures. The incidence of MDRIs was relatively high, as it was detected in 42% of patients and in 54.3% of positive bacterial cultures especially among critically ill patients admitted to the NICU and PICU. Pneumonia/ventilator-associated pneumonia was the main type of infection in 37.8% of patients with MDROs. Klebsiella pneumoniae was the most common significantly isolated MDRO in 39.5% of MDR cultures. Interestingly, a low weight for (no need for their as terminology weight for age is standard and well-known) was the only significant risk factor associated with MDROs (p = 0.02). Mortality was significantly higher (p = 0.001) in patients with MDROs (32.4%) than in patients without MDROs (3.9%). Patients who died including 85.7% of patients with MDROs had significantly longer durations of admission, more cultures, and utilized a larger number of antibiotics than the surviving patients (p = 0.02, p = 0.01, p = 0.04, respectively). This study provided a comprehensive update on the seriously alarming problem of MDROs, and its impacts on pediatric patients. The detected findings are crucial and are a helpful guide to decid for implementing effective strategies to mitigate MDROs.
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Affiliation(s)
- Fajr A. Saeedi
- Department of Pediatrics, Faculty of Medicine in Rabigh, King Abdulaziz University, Jeddah 80205, Saudi Arabia; (F.A.S.); (H.A.); (H.H.)
| | - Moustafa A. Hegazi
- Department of Pediatrics, Faculty of Medicine in Rabigh, King Abdulaziz University, Jeddah 80205, Saudi Arabia; (F.A.S.); (H.A.); (H.H.)
- Department of Pediatrics, Faculty of Medicine in Mansoura, Mansoura University Children’s Hospital, Mansoura 35516, Egypt
| | - Hani Alsaedi
- Department of Pediatrics, Faculty of Medicine in Rabigh, King Abdulaziz University, Jeddah 80205, Saudi Arabia; (F.A.S.); (H.A.); (H.H.)
| | - Ahmed Hussain Alganmi
- Faculty of Medicine in Rabigh, King Abdulaziz University, Jeddah 80205, Saudi Arabia; (A.H.A.); (A.A.); (A.A.); (S.A.A.)
| | - Jawahir A. Mokhtar
- Department of Clinical Microbiology and Immunology, Faculty of Medicine, King Abdulaziz University Hospital, Jeddah 80215, Saudi Arabia;
- Vaccines and Immunotherapy Unit, King Fahad Medical Research Center, King Abdulaziz University, Jeddah 80216, Saudi Arabia
| | | | - Hanaa Hamadallah
- Department of Pediatrics, Faculty of Medicine in Rabigh, King Abdulaziz University, Jeddah 80205, Saudi Arabia; (F.A.S.); (H.A.); (H.H.)
| | - Ghassan S. Siam
- Faculty of Medicine in Rabigh, King Abdulaziz University, Jeddah 80205, Saudi Arabia; (A.H.A.); (A.A.); (A.A.); (S.A.A.)
| | - Abdullah Alaqla
- Faculty of Medicine in Rabigh, King Abdulaziz University, Jeddah 80205, Saudi Arabia; (A.H.A.); (A.A.); (A.A.); (S.A.A.)
| | - Abdullah Alsharabi
- Faculty of Medicine in Rabigh, King Abdulaziz University, Jeddah 80205, Saudi Arabia; (A.H.A.); (A.A.); (A.A.); (S.A.A.)
| | - Sultan Ahmed Alotaibi
- Faculty of Medicine in Rabigh, King Abdulaziz University, Jeddah 80205, Saudi Arabia; (A.H.A.); (A.A.); (A.A.); (S.A.A.)
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Aqel H, Sannan N, Foudah R. From Hospital to Community: Exploring Antibiotic Resistance and Genes Associated with Virulence Factor Diversity of Coagulase-Positive Staphylococci. Antibiotics (Basel) 2023; 12:1147. [PMID: 37508243 PMCID: PMC10376022 DOI: 10.3390/antibiotics12071147] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2023] [Revised: 06/25/2023] [Accepted: 06/29/2023] [Indexed: 07/30/2023] Open
Abstract
Coagulase-positive staphylococcus (CoPS), including methicillin-resistant Staphylococcus aureus (MRSA), poses a global threat. The increasing prevalence of MRSA in Saudi Arabia emphasizes the need for effective management. This study explores the prevalence of virulence-associated genes and antibiotic resistance patterns in CoPS. Nasal swabs from 200 individuals were collected, and standard protocols were used for the isolation, identification, and characterization of CoPS and coagulase-negative staphylococci (CoNS). Additionally, antimicrobial susceptibility testing and PCR were conducted. Bacterial growth was observed in 58.5% of participants, with 12% positive for CoPS and 30% positive for CoNS. Hospital personnel carriers showed a significantly higher proportion of CoNS compared with non-hospital personnel carriers. Non-hospital personnel CoPS strains displayed higher sensitivity to oxacillin than hospital personnel strains. Cefoxitin exhibited the highest sensitivity among β-lactam antibiotics. All isolates were sensitive to trimethoprim/sulfamethoxazole, rifampin, and quinupristin. Polymerase chain reaction analysis detected methicillin resistance genes in both non-hospital and hospital personnel MRSA strains. The coa and spa genes were prevalent in MRSA isolates, while the Luk-PV gene was not detected. A high prevalence of CoPS and CoNS was observed in both non-hospital and hospital personnel carriers. Occupational risk factors may contribute to the differences in the strain distribution. Varying antibiotic susceptibility patterns indicate the effectiveness of oxacillin and cefoxitin. Urgent management strategies are needed due to methicillin resistance. Further research is necessary to explore additional virulence-associated genes and develop comprehensive approaches for CoPS infection prevention and treatment in Saudi Arabia.
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Affiliation(s)
- Hazem Aqel
- Basic Medical Sciences Department, College of Medicine, Al-Balqa' Applied University, Salt 19117, Jordan
- King Abdullah International Medical Research Centre, King Abdulaziz Medical City, Jeddah 22384, Saudi Arabia
| | - Naif Sannan
- King Abdullah International Medical Research Centre, King Abdulaziz Medical City, Jeddah 22384, Saudi Arabia
- Clinical Laboratory Sciences Department, College of Applied Medical Sciences, King Saud Bin Abdulaziz University for Health Sciences, Jeddah 21423, Saudi Arabia
| | - Ramy Foudah
- Clinical Laboratory Sciences Department, College of Applied Medical Sciences, King Saud Bin Abdulaziz University for Health Sciences, Riyadh 14611, Saudi Arabia
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Ali MA, Rajab AM, Al-Khani AM, Ayash SQ, Basha AC, Abdelgadir A, Rajab TM, Enabi S, Saquib N. Methicillin-resistant Staphylococcus aureus development in intensive care patients. A case-control study. Saudi Med J 2020; 41:1181-1186. [PMID: 33130837 PMCID: PMC7804236 DOI: 10.15537/smj.2020.11.25465] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Objectives: To determine the factors associated with the development of methicillin-resistant Staphylococcus aureus (MRSA), hospital stay and mortality, and early versus late MRSA infection. Methods: Cases (n=44) were intensive care unit (ICU) patients admitted to King Fahd Specialist Hospital, Al-Qassim, Saudi Arabia between 2015 and 2019 who developed MRSA during their hospital stay. Controls (n=48) were patients from the same place and period who did not develop MRSA. Data were abstracted from hospital records. Results: Admission with sepsis (case: 46% vs. control: 2%, p<0.001) and having at least one comorbid condition (case: 95% vs. control: 46%, p<0.001) were significantly associated with the development of MRSA. Age (mean ± SD: case: 65±18, control: 64±18, p=0.7) and gender (% male, case: 52%, control: 56%, p=0.70) were not associated with the development of MRSA. Approximately 73% of all MRSA cases developed within the first 2 weeks of admission. Among the early cases, 44% died during their ICU stay; the corresponding percentage among the late cases was 42% (p=0.69). There was no difference between early and late MRSA cases in terms of non-sepsis admissions (50% vs. 67%, p=0.32) or comorbid status (at least one: 97% vs. 92%, p=0.17). Conclusion: Sepsis and comorbid conditions were significant risk factors for MRSA development among hospital patients.
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Affiliation(s)
- Mohamed A Ali
- College of Medicine, Sulaiman Al Rajhi University, Al-Qassim, Kingdom of Saudi Arabia. E-mail.
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Mazi W, Alshammari F, Yu J, Alam MJ, Saeed M, Alshaghdali K, Saeed A. A descriptive analysis of PVL-positive multidrug-resistant Staphylococcus aureus in hospital-associated infections in Saudi Arabia. Bioinformation 2020; 16:586-593. [PMID: 33214746 PMCID: PMC7649023 DOI: 10.6026/97320630016586] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2020] [Accepted: 06/21/2020] [Indexed: 11/24/2022] Open
Abstract
Methicillin resistant Staphylococcus aureus infections impose a huge risk to public health in healthcare and community settings worldwide. Therefore, it is of interest to document data on the anti-biogramas and genotypes of isolates from Saudi Arabia. We assessed the antimicrobial susceptibility, determined spa (protein A gene) and analyzed multilocus MLST genotypes, and detected PVL gene in these isolates. We collected 28 clinical MRSA isolates, cultured and determined the minimum inhibitory concentrations of 17 antimicrobial agents using Vitek2 system (BioMerieux, USA) from 3 hospitals in Saudi Arabia during the year 2012. Polymorphic region of the spa and seven housekeeping genes were amplified and sequenced. BioNumerics v.5.1 (Applied Maths) was used for spa typing and MLST. Samples were screened for the presence of PVL and mecA genes using polymerase chain reaction (PCR). Analysis shows that all isolates were susceptible to chloramphenicol, rifampicin, nitrofurantoin, teicoplanin, daptomycin and vancomycin. The T4573/ST22 strains are found to be prevalent in the Saudi Arabia (N=6, 21%). We further noted that three isolates (t363/ST240 strain) were resistant to eight antimicrobial agents. Most of t4573/ST22 strains were PVL positive, resistant to ciprofloxacin and linked to HA-MRSA infections. We document data for the presence of emerging multi drug resistant S. aureus strains carrying the PVL gene circulating within hospitals. This highlights the urgent need for continuous active surveillance and implementation of prevention measures.
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Affiliation(s)
- Waleed Mazi
- Infection Prevention and Control Department, King Abdul Aziz Specialist Hospital-Taif, Saudi Arabia
- Karolinska Institute, Department of Laboratory Medicine, Division of Clinical Microbiology, Karolinska University Hospital, Huddinge, SE-141 86 Stockholm, Sweden
| | - Fawaz Alshammari
- Department of Clinical Laboratory Sciences College of Applied Medical Sciences, University of Hail-Hail-Kingdom of Saudi Arabia
| | - Jun Yu
- Strathclyde Institute of Pharmacy and Biomedical Science, University of Strathclyde, Glasgow, United Kingdom
| | - Md Jahoor Alam
- Department of Biology, College of Science, University of Hail, Hail-Kingdom of Saudi Arabia
| | - Mohd Saeed
- Department of Biology, College of Science, University of Hail, Hail-Kingdom of Saudi Arabia
| | - Khalid Alshaghdali
- Department of Clinical Laboratory Sciences College of Applied Medical Sciences, University of Hail-Hail-Kingdom of Saudi Arabia
| | - Amir Saeed
- Department of Clinical Laboratory Sciences College of Applied Medical Sciences, University of Hail-Hail-Kingdom of Saudi Arabia
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Moghnieh R, Alothman AF, Althaqafi AO, Matar MJ, Alenazi TH, Farahat F, Corman SL, Solem CT, Raghubir N, Macahilig C, Stephens JM. Epidemiology and outcome of invasive fungal infections and methicillin-resistant Staphylococcus aureus (MRSA) pneumonia and complicated skin and soft tissue infections (cSSTI) in Lebanon and Saudi Arabia. J Infect Public Health 2017; 10:849-854. [PMID: 28487208 DOI: 10.1016/j.jiph.2017.01.013] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2015] [Revised: 12/28/2016] [Accepted: 01/28/2017] [Indexed: 10/19/2022] Open
Abstract
The objectives of this retrospective medical chart review study were to document the inpatient incidence, treatment, and clinical outcomes associated with invasive fungal infections (IFI) due to Candida and Aspergillus species, Methicillin-resistant Staphylococcus aureus (MRSA) pneumonia and MRSA complicated skin and soft tissue infections (cSSTI) in the Middle East. This study evaluated 2011-2012 data from 5 hospitals in Saudi Arabia and Lebanon with a combined total of 207,498 discharges. Hospital medical chart data were abstracted for a random sample of patients with each infection type (102 patients - IFI, 93 patients - MRSA pneumonia, and 87 patients-MRSA cSSTI). Descriptive analysis found that incidence of IFI (per 1000 hospital discharges) was higher than MRSA cSSTI and MRSA pneumonia (IFI: 1.95 and 2.57; MRSA cSSTI: 2.01 and 0.48; and MRSA pneumonia 0.59 and 0.55 for Saudi Arabia and Lebanon, respectively). Median time from hospital admission to diagnosis and from admission to initiation of active therapy were 6 and 7 days, respectively, in IFI patients; median time from admission to diagnosis was 2days for both MRSA pneumonia and cSSTI, with a median of 4 and 2days from admission to MRSA-active antibiotic start, respectively. The mean hospital LOS was 32.4days for IFI, 32.4days for MRSA pneumonia and 26.3days for MRSA cSSTI. Inpatient mortality was higher for IFI (42%) and MRSA pneumonia (30%) than for MRSA cSSTI (8%). At discharge, 33% of patients with IFI and 27% and 9% of patients with MRSA pneumonia and cSSTI, respectively, were considered to have failed therapy. In conclusion, there is a significant burden of these serious infections in the Middle East, as well as opportunity for hospitals to improve the delivery of patient care for difficult-to-treat infections by promoting expedited diagnosis and initiation of appropriate antimicrobial therapy.
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Affiliation(s)
- Rima Moghnieh
- Makassed General Hospital, Department of Internal Medicine, Beirut, Lebanon
| | - Adel F Alothman
- King Abdullah International Medical Research Center/King Saud bin Abdulaziz University for Health Sciences, Department of Medicine, King Abdulaziz Medical City, Riyadh-NGHA, Saudi Arabia
| | - Abdulhakeem O Althaqafi
- King Saud bin AbdulAziz University for Health Sciences, King Abdullah Medical Research Center, Infection Prevention and Control Department, King Abdulaziz Medical City, Jeddah, Saudi Arabia
| | - Madonna J Matar
- Centre Hospitalier Universitaire -Notre Dame de Secours Hospital, Department of Infectious Diseases, Jbeil, Lebanon
| | - Thamer H Alenazi
- King Abdullah International Medical Research Center/King Saud bin Abdulaziz University for Health Sciences, Department of Medicine, King Abdulaziz Medical City, Riyadh-NGHA, Saudi Arabia
| | - Fayassal Farahat
- King Saud bin AbdulAziz University for Health Sciences, King Abdullah Medical Research Center, Infection Prevention and Control Department, King Abdulaziz Medical City, Jeddah, Saudi Arabia
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A Randomized Controlled Comparison of the Internal Jugular Vein and the Subclavian Vein as Access Sites for Central Venous Catheterization in Pediatric Cardiac Surgery. Pediatr Crit Care Med 2016; 17:e413-9. [PMID: 27472252 DOI: 10.1097/pcc.0000000000000878] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
OBJECTIVES To compare internal jugular vein and subclavian vein access for central venous catheterization in terms of success rate and complications. DESIGN A 1:1 randomized controlled trial. SETTING Baskent University Medical Center. PATIENTS Pediatric patients scheduled for cardiac surgery. INTERVENTIONS Two hundred and eighty children undergoing central venous catheterization were randomly allocated to the internal jugular vein or subclavian vein group during a period of 18 months. MEASUREMENTS AND MAIN RESULTS The primary outcome was the first-attempt success rate of central venous catheterization through either approach. The secondary outcomes were the rates of infectious and mechanical complications. The central venous catheterization success rate at the first attempt was not significantly different between the subclavian vein (69%) and internal jugular vein (64%) groups (p = 0.448). However, the overall success rate was significantly higher through the subclavian vein (91%) than the internal jugular vein (82%) (p = 0.037). The overall frequency of mechanical complications was not significantly different between the internal jugular vein (25%) and subclavian vein (31%) (p = 0.456). However, the rate of arterial puncture was significantly higher with internal jugular vein (8% vs 2%; p = 0.03) and that of catheter malposition was significantly higher with subclavian vein (17% vs 1%; p < 0.001). The rates per 1,000 catheter days for both positive catheter-tip cultures (26.1% vs 3.6%; p < 0.001) and central-line bloodstream infection (6.9 vs 0; p < 0.001) were significantly higher with internal jugular vein. There were no significant differences between the groups in the length of ICU and hospital stays or in-hospital mortality rates (p > 0.05 for all). CONCLUSIONS Central venous catheterization through the internal jugular vein and subclavian vein was not significantly different in terms of success at the first attempt. Although the types of mechanical complications were different, the overall rate was similar between internal jugular vein and subclavian vein access. The risk of infectious complications was significantly higher with internal jugular vein access.
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Al-Tawfiq JA, Stephens G, Memish ZA. Inappropriate antimicrobial use and potential solutions: a Middle Eastern perspective. Expert Rev Anti Infect Ther 2014; 8:765-74. [DOI: 10.1586/eri.10.56] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Shibl A, Senok A, Memish Z. Infectious diseases in the Arabian Peninsula and Egypt. Clin Microbiol Infect 2013; 18:1068-80. [PMID: 23066725 DOI: 10.1111/1469-0691.12010] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Infectious diseases are important causes of morbidity and mortality globally. Epidemiologically, differences in the patterns of infectious diseases and antimicrobial resistance exist across diverse geographical regions. In this review on infectious diseases in the Arabian Peninsula and Egypt, the epidemiology of tuberculosis, malaria and human immunodeficiency virus (HIV) infections will be addressed. The challenges of the hepatitis C epidemic in Egypt and the epidemiology of this infection across the region will be reviewed. In recent years, we have seen dengue endemicity become established, with major outbreaks in parts of the region. Emerging data also indicate that, across the region, there is an increasing burden of antibiotic resistance, with endemicity in healthcare settings and dissemination into the community. New challenges include the emergence of the Alkhurma haemorrhagic fever virus in Saudi Arabia. The annual Hajj pilgrimage in Saudi Arabia serves as a model for the control of infectious disease in mass gatherings. As most of these countries constantly experience a uniquely dynamic population influx in the form of expatriate workers, tourists, or pilgrims, concerted regional and international collaboration to address these public health concerns in a region that lies at the crossroads for the global spread of infectious pathogens is imperative.
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Affiliation(s)
- A Shibl
- Department of Pathology and Pharmacology, College of Medicine, Alfaisal University, Riyadh, Saudi Arabia.
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Yezli S, Shibl AM, Livermore DM, Memish ZA. Antimicrobial resistance among Gram-positive pathogens in Saudi Arabia. J Chemother 2012; 24:125-36. [PMID: 22759756 DOI: 10.1179/1973947812y.0000000010] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Several species of Gram-positive cocci are major nosocomial or community pathogens associated with morbidity and mortality. Here, we review the antimicrobial resistance among these pathogens in Saudi Arabia. In the last decades, antimicrobial resistance has increased among Staphylococcus aureus in the Kingdom with a growing prevalence of both nosocomial and community methicillin-resistant S. aureus (MRSA) isolates. As yet, no vancomycin-resistant MRSA have been reported, although isolates with reduced susceptibility to the drug have been noted. Currently, the prevalence of vancomycin-resistant entrococci (VRE) is low; however, VRE has been described in the Kingdom as well as Enterococcus faecalis and E. faecium isolates with high-level resistance to penicillin, sulfamethoxazole, macrolides, tetracycline, and aminoglycosides. In recent decades, the prevalence and rate of penicillin resistance and non-susceptibility among Streptococcus pneumoniae isolates have increased in Saudi Arabia. The organism remains, however, susceptible to other beta-lactams and to quinolones. On the other hand, resistance to co-trimoxazole and tetracyclines is high and resistance to macrolides is on the increase.
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A multilevel model of methicillin-resistant Staphylococcus aureus acquisition within the hierarchy of an Australian tertiary hospital. Am J Infect Control 2012; 40:787-93. [PMID: 22336109 DOI: 10.1016/j.ajic.2011.10.014] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2011] [Revised: 10/14/2011] [Accepted: 10/17/2011] [Indexed: 11/24/2022]
Abstract
Hospitals without universal single room accommodations typically contain multibed cubicles within wards. In this study, we examined whether the variation in a patient's risk for acquiring methicillin-resistant Staphylococcus aureus (MRSA) in a major tertiary hospital was greatest at the bed, cubicle, or ward level, and quantified the risk of MRSA acquisition associated with exposure to MRSA-colonized/infected patients within the same bed, cubicle, and ward at differently distributed lag times. Nested tri-level hierarchical logistic regression models with random effects were used for non-multiresistant MRSA (nmMRSA) and multiresistant MRSA (mMRSA). The models were internally validated. Receiver operating characteristic curves were used to compare the models' predictive capability The odds of new nmMRSA acquisition were 6.06-fold (95% credible intervals [CrI], 3.93- to 9.34-fold) greater in bed-weeks when a nmMRSA-colonized/infected patient was in the same cubicle 2 weeks earlier. The odds of mMRSA acquisition were 5.12-fold (95% CrI, 4.02- to 6.51-fold) greater in bed-weeks when a colonized/infected patient was in the same ward 2 weeks earlier. The between-cluster variance was highest at the ward level. Patients were at greater risk if there was a colonized/infected patient in the same cubicle or ward 2 weeks earlier. Our findings indicate that focusing on the relevant cubicles and wards during this high-risk period can help target infection control resources more efficiently.
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Hamid ME, Mustafa FY, Alwaily A, Abdelrahman S, Al Azragi T. Prevalence of Bacterial Pathogens in Aseer Region, Kingdom of Saudi Arabia: Emphasis on Antimicrobial Susceptibility of Staphylococcus aureus. Oman Med J 2012; 26:368-70. [PMID: 22216389 DOI: 10.5001/omj.2011.91] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2011] [Accepted: 06/26/2011] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVES This short study aims to determine the prevalence of various bacterial pathogens causing infections in the Aseer regions, and to also assess the distribution of Staphylococcus aureus in relation to different body sites as well as their in vitro antimicrobial susceptibility profile. METHODS Clinical specimens (n=9831) from various infections diagnosed at Aseer Central Hospital (ACH) and Abha General Hospital (AGH), were analyzed bacteriologically. Confirmed S. aureus isolates (n=210) were tested against 44 antibacterial agents as per standard methods. RESULTS Bacterial pathogens were recovered from 24.9% of the samples. The results revealed that Escherichia coli, Klebsiella pneumoniae, Enterococcus spp. and S. aureus to be the main etiological agents, while purulent exudates of wounds and abscesses were the main source of S. aureus. Out of the 210 S. aureus isolates; 77 (38.5%) were recovered from purulent exudates of wounds and abscesses of the examined patients and 53 (26.5%) were from high vaginal discharges, while other body sites exhibited different rates of S. aureus. On the other hand, 45% of the 210 S. aureus isolates were found to be multidrug resistant S. aureus (MRSA). CONCLUSION The results from this study revealed that Escherichia coli and staphylococci were the main etiological agents, while purulent exudates of wounds and abscesses were the main source of S. aureus. Also, a higher rate of MRSA was detected.
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Monecke S, Skakni L, Hasan R, Ruppelt A, Ghazal SS, Hakawi A, Slickers P, Ehricht R. Characterisation of MRSA strains isolated from patients in a hospital in Riyadh, Kingdom of Saudi Arabia. BMC Microbiol 2012; 12:146. [PMID: 22823982 PMCID: PMC3464608 DOI: 10.1186/1471-2180-12-146] [Citation(s) in RCA: 81] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2011] [Accepted: 07/02/2012] [Indexed: 11/26/2022] Open
Abstract
Background Methicillin-resistant Staphylococcus aureus (MRSA) is spreading worldwide and poses a serious public health problem, being present in hospital settings and communities. However, from the Middle East and the Arabian Peninsula few molecular typing data on MRSA strains are currently available. In order to obtain data on the population structure of MRSA in Riyadh, Saudi Arabia, 107 clinical and environmental MRSA isolates were genotyped using a microarray-based assay. Results Five major MRSA strains from four clonal complexes were identified CC8/ST239-III (20.75%), PVL-positive as well as -negative CC22-IV (18.87% and 9.43%, respectively), PVL-positive CC30-IV (12.26%) and PVL-positive CC80-IV (17.92%). Minor strains, which accounted for less than 3% each, included CC1-IV/SCCfus, PVL-positive CC1/ST772-V, PVL-positive as well as- negative CC5-IV, CC5-IV/SCCfus, CC5-V, CC6-IV, CC45-IV, PVL-negative CC80-IV, PVL-positive CC88-IV, CC97-V and a CC9/ST834-MRSA strain. Conclusions Typing of MRSA strains from Riyadh revealed a high diversity of clonal complexes. The prevalence of the genes encoding the Panton-Valentine leukocidin was surprisingly high (54.21%), and a significant rate of resistance markers was detected also in strains considered as community-associated.
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Affiliation(s)
- Stefan Monecke
- Institute for Medical Microbiology and Hygiene, Technical University of Dresden, Dresden, Germany.
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Antimicrobial resistance in pathogens causing nosocomial bloodstream infections in university hospitals in Egypt. Am J Infect Control 2011; 39:e61-5. [PMID: 21835504 DOI: 10.1016/j.ajic.2011.04.009] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2010] [Revised: 04/12/2011] [Accepted: 04/12/2011] [Indexed: 11/23/2022]
Abstract
BACKGROUND Nosocomial bloodstream infections (BSIs) and antimicrobial resistance (AMR) are worldwide health care problems causing substantial patient morbidity and mortality. This study was conducted to identify bacterial pathogens isolated from nosocomial BSIs and determine their AMR patterns. METHODS An active surveillance program for BSIs was conducted in intensive care units in 3 large university hospitals in Egypt between September 1, 2006, and June 30, 2007. Infection prevention and control teams and link nurses in collaboration with intensive care physicians were looking actively to identify patients who acquired BSIs based on Centers for Disease Control and Prevention standard case definitions. Blood cultures were obtained from patients with suspected BSIs and processed to isolate bacteria and test their antimicrobial resistance. RESULTS During the 10-month active surveillance period, a total of 600 pathogens were isolated from blood cultures of 1,575 patients (38%). Of these 600 isolates, 386 (66%) were gram-negative, 178 (30%) were gram-positive, and 24 (4%) were budding yeasts. The gram-negative organisms included 162 (27%) Klebsiella pneumoniae and 23 (3.8%) Escherichia coli. Extended-spectrum β-lactamase enzymes were detected in 79% of the K pneumoniae isolates and 39% of the E coli isolates. Methicillin-resistant Staphylococcus aureus accounted for 60% of S aureus infections. CONCLUSIONS High rates of β-lactamase resistance and methicillin-resistant S aureus were found in the 3 Egyptian university hospitals studied. This study highlights the need for strengthening infection prevention and control programs, monitoring AMR at each facility, and developing policies for antibiotic use.
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Point prevalence surveys of healthcare-associated infection in 13 hospitals in Hubei Province, China, 2007-2008. J Hosp Infect 2010; 76:150-5. [PMID: 20692727 DOI: 10.1016/j.jhin.2010.04.003] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2009] [Accepted: 04/06/2010] [Indexed: 11/20/2022]
Abstract
Successive point prevalence surveys were conducted in November 2007 and 2008 to monitor the prevalence of healthcare-associated infection (HCAI) in 13 grade III, 1st class hospitals in Hubei Province of China, using the case definition criteria established by the Ministry of Health in the People's Republic of China. In total, of 20 350 patients surveyed, 833 (4.09%) HCAIs were observed in 790 (3.88%) patients. There was no significant difference between the overall prevalence of HCAI in 2007 (4.14%) and 2008 (3.72%). Respiratory tract infection was the most common HCAI (63.15%), followed by surgical site infection (9.60%) and urinary tract infection (8.64%). Only 35.29% (294/833) of HCAI patients had positive microbiology results. Gram-negative bacteria were isolated most frequently and the most frequent organism was Pseudomonas aeruginosa, followed by Escherichia coli, Acinetobacter baumannii and Staphylococcus aureus. Antibiotic use was documented for 10,344 (50.83%) patients, and cephalosporins, penicillins, and quinolones were the most commonly used agents for treatment or prophylaxis.
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The effect of media attention on concern for and medical management of methicillin-resistant Staphylococcus aureus: a multimethod study. JOURNAL OF PUBLIC HEALTH MANAGEMENT AND PRACTICE 2009; 15:150-9. [PMID: 19202416 DOI: 10.1097/01.phh.0000346013.74522.f8] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Reports of an increase in the incidence and severity of methicillin-resistant Staphylococcus aureus (MRSA) infections provoked widespread media attention in October 2007. This study attempted to determine whether this widespread media attention led to changes in physician practices related to skin infections. DESIGN Data collection via LexisNexis, Central New York (CNY) microbiologic laboratory records, publicly available data on Internet search activity, and a survey of CNY healthcare providers allowed for examination of concurrent trends in media attention, public information-seeking behavior, and physician response. RESULTS During the period of October 15-29, 2007, a roughly 10-fold increase in the number of newspaper and television news broadcasts mentioning "MRSA" and "staph" coincided with a six-to eightfold increase in Internet search activity for the terms "MRSA" and "staph" and a 79 percent increase in provider-reported patient concern with MRSA. In addition, providers reported more frequent orders for cultures and prescription of antibiotics since then. Practices serving urban or low socioeconomic status patients tended to see less MRSA-related concern and activity, indicating a potential disparity in penetration of MRSA information into different populations. CONCLUSIONS Increased media coverage of MRSA coincided with increased public information-seeking behavior. Self-reported survey data demonstrate that this period was associated with a change in healthcare provider practice, and a concomitant twofold increase in the number of outpatient skin and soft tissue cultures reinforces this link. However, increased public attention appears not to have penetrated urban, less-affluent areas, raising questions about how quickly healthcare information penetrates different patient populations.
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Molina A, Del Campo R, Maiz L, Morosini MI, Lamas A, Baquero F, Canton R. High prevalence in cystic fibrosis patients of multiresistant hospital-acquired methicillin-resistant Staphylococcus aureus ST228-SCCmecI capable of biofilm formation. J Antimicrob Chemother 2008; 62:961-7. [DOI: 10.1093/jac/dkn302] [Citation(s) in RCA: 46] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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