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Gad A, Khalil A, Halil M, Chandra P, Soliman A, Rahman E’mar A, Ibrahim M, Al Khzzam F, AlHendawi T, Hamed M, Bayoumi MAA, Petkar H. Preterm infants with positive conjunctival swab culture: risk factors and association with late-onset sepsis-a retrospective cohort study. Front Pediatr 2023; 11:1259558. [PMID: 38046677 PMCID: PMC10690616 DOI: 10.3389/fped.2023.1259558] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2023] [Accepted: 10/24/2023] [Indexed: 12/05/2023] Open
Abstract
Introduction Purulent conjunctival discharge in hospitalized preterm infants may indicate conjunctivitis and warrant treatment. The purpose of this study was to examine the relationship between positive conjunctival swab (CS) culture and late-onset sepsis (LOS) in preterm infants. Methods A retrospective cohort study was conducted to determine the relationship between positive CS culture growth results (CSP) obtained in preterm infants ≤34 weeks' gestation and the development of LOS within 120 h of obtaining CS compared with those who had negative CS culture results (CSN). Electronic medical records were reviewed from January 2015 until December 2019 for preterm infants presenting with purulent conjunctival discharge and underwent CS culture testing due to suspected conjunctivitis. Results Of the 234 CS cultures obtained during the study period, 145 (61.9%) were CSP compared to 89 (38.1%) CSN cultures. Gram-negative organisms accounted for 70% of all CSP cultures, with the remaining 30% being Gram-positive. Patients with CSP were smaller, younger, had lower 1-minute APGAR scores, and required respiratory support more frequently than those with CSN. Infants with CSP received antibiotics for longer periods, both topically and systemically. Infants who developed LOS were more likely to require invasive ventilation (adjusted odds ratio, 33.5; 95% CI, 2.52-446.5, p = 0.008). The incidence of LOS between the two groups was similar, with 6.2% observed in the CSP group compared to 3.4% in the CSN group (p = 0.543). Similarly, the rates of bacteremia were similar in both groups. Of the CSP patients who were presented with bacteremia, four out of seven (57%) exhibited bacteremia caused by the same organism found in their CS cultures. Similarly, within the entire cohort, respiratory cultures were performed on nine intubated patients within two weeks of obtaining CS cultures. Of these, in the CSP group, five out of six (83%) showed an organism identical to that found in the CS cultures. Conclusion The study found a significant proportion of positive CS cultures in preterm infants, with distinct patient characteristics and treatment compared to negative cultures. While the incidence of LOS was not significantly different between the two groups, some CSP patients demonstrated bacteremia with the same CS organism, suggesting a possible connection between conjunctival or respiratory colonization and bacteremia.
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Affiliation(s)
- Ashraf Gad
- Neonatal Intensive Care Unit, Women’s Wellness and Research Center, Hamad Medical Corporation, Doha, Qatar
- Pediatric Department, Weill Cornell Medicine, Doha, Qatar
| | - Amr Khalil
- Division of Neonatology, London Health Science, Western University, London, ON, Canada
| | - Muhammed Halil
- Neonatal Intensive Care Unit, Women’s Wellness and Research Center, Hamad Medical Corporation, Doha, Qatar
| | - Prem Chandra
- Medical Research Center, Hamad Medical Corporation, Doha, Qatar
| | - Aly Soliman
- Deparment of Pediatrics, SUNY Upstate Medical University, Syracuse, NY, United States
| | - Abdel Rahman E’mar
- Department of Pediatrics, Cleveland Clinic Children’s, Cleveland, OH, United States
| | - Marwa Ibrahim
- Department of Pediatrics, Hamad Medical Corporation, Doha, Qatar
| | - Fadi Al Khzzam
- Neonatal Intensive Care Unit, Women’s Wellness and Research Center, Hamad Medical Corporation, Doha, Qatar
- Pediatric Department, Weill Cornell Medicine, Doha, Qatar
| | - Talal AlHendawi
- Department of Pediatrics, Hamad Medical Corporation, Doha, Qatar
| | - Manal Hamed
- Microbiology Division, Department of Laboratory Medicine and Pathology, Hamad Medical Corporation, Doha, Qatar
| | - Mohammad A. A. Bayoumi
- Neonatal Intensive Care Unit, Women’s Wellness and Research Center, Hamad Medical Corporation, Doha, Qatar
| | - Hawabibee Petkar
- Microbiology Division, Department of Laboratory Medicine and Pathology, Hamad Medical Corporation, Doha, Qatar
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Alhazmi AH, Alameer KM, Abuageelah BM, Alharbi RH, Mobarki M, Musawi S, Haddad M, Matabi A, Dhayhi N. Epidemiology and Antimicrobial Resistance Patterns of Urinary Tract Infections: A Cross-Sectional Study from Southwestern Saudi Arabia. MEDICINA (KAUNAS, LITHUANIA) 2023; 59:1411. [PMID: 37629701 PMCID: PMC10456825 DOI: 10.3390/medicina59081411] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/01/2023] [Revised: 07/28/2023] [Accepted: 08/01/2023] [Indexed: 08/27/2023]
Abstract
Background: Urinary tract infections (UTIs) are a prevalent form of urinary tract diseases affecting individuals of all ages and genders. In the Kingdom of Saudi Arabia (KSA), UTIs are a significant burden on the healthcare system, comprising 10% of all infections and ranking as the second leading cause of emergency department admissions. Despite this, limited research has been conducted in Saudi Arabia, particularly in Jazan Province, located in the southwestern region. Methods: This retrospective, cross-sectional study encompassed individuals with positive urine cultures who sought care at a tertiary hospital in Jazan between January 2022 and March 2023. A standardized data collection form was utilized to retrieve relevant information from microbiology lab test results and patients' electronic medical records. Variables such as sex, urine sample collection date, bacterial isolates, antibiotic sensitivity, and resistance were collected using the data collection form. Data were analyzed using SPSS software, version 23.0 (IBM Corp., Armonk, NY, USA). Results: A total of 1082 urinary bacterial samples were isolated and identified. Females accounted for more bacterial infections (62.66%) than males (37.34%). Gram-negative bacteria represented 94% of all isolated strains. The most prevalent pathogens associated with UTIs were Escherichia coli (47.97%), Klebsiella pneumoniae (24.58%), and Pseudomonas aeruginosa (11.55%). Antimicrobial resistance patterns indicated the presence of extended-spectrum beta-lactamase (ESBL) (30.13%), carbapenemase-resistant Enterobacter (CRE) (1.94%), methicillin-resistant Staphylococcus aureus (MRSA) (0.74%), and vancomycin-resistant Enterococci (VRE) (0.18%). UTI incidence demonstrated a higher prevalence in September (13%) compared to other months in 2022. Escherichia coli, Klebsiella pneumoniae, and Pseudomonas aeruginosa were the predominant Gram-negative multidrug-resistant organisms (MDRO), accounting for 34.42%, 13.95%, and 1.63% of the population. Conclusions: The prevalence of UTIs caused by antibiotic-resistant microbes is notable in Jazan. Consistent with findings from other regions, Escherichia coli remains the most common causative pathogen of UTIs, displaying a seasonal pattern that warrants attention. Approximately 35% of reported cases involve MDRO, with ESBLs accounting for 30%. These results should raise concerns among healthcare officials, highlighting the necessity for further investigations into factors contributing to the circulation of MDRO in Jazan.
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Affiliation(s)
| | | | - Bandar M. Abuageelah
- Department of Medicine and Surgery, Batterjee Medical College, Aseer 62451, Saudi Arabia
| | - Rena H. Alharbi
- Faculty of Medicine, Jazan University, Jazan 45142, Saudi Arabia
| | - Mousa Mobarki
- Faculty of Medicine, Jazan University, Jazan 45142, Saudi Arabia
| | - Shaqraa Musawi
- Faculty of Medical Applied Science, Jazan University, Jazan 45142, Saudi Arabia
| | - Moayad Haddad
- King Fahad Central Hospital, Ministry of Health, Jazan 45142, Saudi Arabia; (M.H.)
| | - Abdullatif Matabi
- King Fahad Central Hospital, Ministry of Health, Jazan 45142, Saudi Arabia; (M.H.)
| | - Nabil Dhayhi
- King Fahad Central Hospital, Ministry of Health, Jazan 45142, Saudi Arabia; (M.H.)
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