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Banawas SS, Alobaidi AS, Dawoud TM, AlDehaimi A, Alsubaie FM, Abdel-Hadi A, Manikandan P. Prevalence of Multidrug-Resistant Bacteria in Healthcare-Associated Bloodstream Infections at Hospitals in Riyadh, Saudi Arabia. Pathogens 2023; 12:1075. [PMID: 37764883 PMCID: PMC10536600 DOI: 10.3390/pathogens12091075] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2023] [Revised: 08/22/2023] [Accepted: 08/22/2023] [Indexed: 09/29/2023] Open
Abstract
Bloodstream infection (BSI) prevalence in hospitalized patients has increased owing to the spread of antibiotic-resistant pathogens; moreover, antimicrobial resistance in bacteria is a global problem. Here, BSIs are investigated in several patients at a hospital in Saudi Arabia, and the resistance of bacterial isolates to widely used drugs is determined. Throughout 2020, bacteria isolated from patients were identified and subjected to antibiotic susceptibility testing. In total, 1125 bacterial isolates were obtained from 1039 patients; among them, gram-positive bacteria were significantly more abundant than gram-negative bacteria. The most prevalent bacteria were Staphylococcus epidermidis and Klebsiella pneumoniae. Notably, gram-negative bacteria were mainly isolated from adult patients, and 20.63% of the gram-positive isolates were from pediatric patients, which was significantly higher than the corresponding percentages in elders and adults. The gram-positive isolates were mainly resistant to cephalothin, oxacillin, amoxicillin-clavulanate, and erythromycin and susceptible to penicillin, gentamicin, ciprofloxacin, and vancomycin. Additionally, the gram-negative isolates were mainly resistant to ampicillin, cephalothin, and amoxicillin-clavulanate and susceptible to amikacin, ertapenem, aztreonam, colistin, and trimethoprim-sulfamethoxazole. Consequently, the high prevalence of infective multidrug-resistant bacteria may account as a significant health issue; it is considered a hazard in Riyadh hospitals and must be prevented at all costs.
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Affiliation(s)
- Saeed S. Banawas
- Department of Medical Laboratories, College of Applied Medical Science, Majmaah University, Al-Majmaah 11952, Saudi Arabia; (F.M.A.); (A.A.-H.); (P.M.)
- Health and Basic Sciences Research Center, Majmaah University, Al-Majmaah 11952, Saudi Arabia
- Department of Biomedical Sciences, Oregon State University, Corvallis, OR 97331, USA
| | - Ahmed S. Alobaidi
- Department of Botany and Microbiology, College of Science, King Saud University, P.O. Box 4255, Riyadh 11451, Saudi Arabia; (A.S.A.); (T.M.D.)
| | - Turki M. Dawoud
- Department of Botany and Microbiology, College of Science, King Saud University, P.O. Box 4255, Riyadh 11451, Saudi Arabia; (A.S.A.); (T.M.D.)
| | - Abdullah AlDehaimi
- MBS-Infection Control, King Fahad Medical City, Riyadh 12211, Saudi Arabia;
| | - Faisal M. Alsubaie
- Department of Medical Laboratories, College of Applied Medical Science, Majmaah University, Al-Majmaah 11952, Saudi Arabia; (F.M.A.); (A.A.-H.); (P.M.)
| | - Ahmed Abdel-Hadi
- Department of Medical Laboratories, College of Applied Medical Science, Majmaah University, Al-Majmaah 11952, Saudi Arabia; (F.M.A.); (A.A.-H.); (P.M.)
| | - Palanisamy Manikandan
- Department of Medical Laboratories, College of Applied Medical Science, Majmaah University, Al-Majmaah 11952, Saudi Arabia; (F.M.A.); (A.A.-H.); (P.M.)
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Kazzaz YM, Alharbi M, Nöel KC, Quach C, Willson DF, Gilfoyle E, McNally JD, O'Donnell S, Papenburg J, Lacroix J, Fontela PS. Evaluation of antibiotic treatment decisions in pediatric intensive care units in Saudi Arabia: A national survey. J Infect Public Health 2021; 14:1254-1262. [PMID: 34479076 DOI: 10.1016/j.jiph.2021.08.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Revised: 05/25/2021] [Accepted: 08/15/2021] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVE To describe variables used by Saudi pediatric intensivists to make antibiotic-related decisions for children with suspected severe bacterial infections. METHODS We conducted a cross-sectional survey, which was developed using a multi-step methodological approach. The survey included 4 clinical scenarios of the most relevant bacterial infections in pediatric critical care (pneumonia, sepsis, meningitis and intra-abdominal infection). The potential determinants of antibiotic treatment duration addressed in all scenarios included clinical variables (patient characteristics, disease severity), laboratory infection markers, radiologic findings, and pathogens. RESULTS The response rate was 65% (55/85). Eight variables (immunodeficiency, 3 months of age, 2 or more organ dysfunctions, Pediatric Risk of Mortality III score >10, leukocytosis, elevated C-reactive protein [CRP], elevated erythrocyte sedimentation rate [ESR], and elevated procalcitonin [PCT]) were associated with prolonging antibiotic treatment duration for all 4 clinical scenarios, with a median increase ranging from 3.0 days (95% confidence interval [CI] 0.5, 3.5, leukocytosis) to 8.8 days (95% CI 5.5, 10.5, immunodeficiency). There were no variables that were consistently associated with shortening antibiotic duration across all scenarios. Lastly, the proportion of physicians who would continue antibiotics for ≥5 days despite a positive viral polymerase chain reaction test result was 67% for pneumonia, 85% for sepsis, 63% for meningitis, and 95% for intra-abdominal infections. CONCLUSION Antibiotic-related decisions for critically ill patients are complex and depend on several factors. Saudi pediatric intensivists will use prolonged courses of antibiotics for younger patients, patients with severe clinical picture, and patients with persistently elevated laboratory markers and hospital acquired infections, even when current literature and guidelines do not suggest such practices. Antimicrobial stewardship programs should include interventions to address these misconceptions to ensure the rational use of antibiotics in pediatric intensive care units.
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Affiliation(s)
- Yasser M Kazzaz
- Department of Pediatrics, Ministry of the National Guard - Health Affairs, Riyadh, Saudi Arabia; King Abdullah International Medical Research Center, Riyadh, Saudi Arabia; King Saud Bin Abdulaziz University-Health Sciences, Riyadh, Saudi Arabia.
| | - Musaed Alharbi
- Department of Pediatrics, Ministry of the National Guard - Health Affairs, Riyadh, Saudi Arabia; King Abdullah International Medical Research Center, Riyadh, Saudi Arabia; King Saud Bin Abdulaziz University-Health Sciences, Riyadh, Saudi Arabia
| | - Kim C Nöel
- Department of Epidemiology, Biostatistics, and Occupational Health, McGill University, Montreal, Canada
| | - Caroline Quach
- Department of Microbiology, Infectious Diseases and Immunology, Université de Montréal, Montreal, Canada
| | - Douglas F Willson
- Department of Pediatrics, Virginia Commonwealth University, Richmond, USA
| | - Elaine Gilfoyle
- Division of Pediatric Critical Care, Department of Pediatrics, University of Toronto, Toronto, Canada
| | - James D McNally
- Department of Pediatrics, University of Ottawa, Ottawa, Canada
| | - Shauna O'Donnell
- Research Institute of the McGill University Health Centre, Montreal, Canada
| | - Jesse Papenburg
- Department of Epidemiology, Biostatistics, and Occupational Health, McGill University, Montreal, Canada; Division of Pediatric Infectious Diseases, Department of Pediatrics, McGill University, Montreal, Canada; Division of Microbiology, Department of Clinical Laboratory Medicine, McGill University Health Centre, Montreal, Canada
| | - Jacques Lacroix
- Department of Pediatrics, Université de Montréal, Montreal, Canada
| | - Patricia S Fontela
- Department of Epidemiology, Biostatistics, and Occupational Health, McGill University, Montreal, Canada; Division of Pediatric Critical Care, Department of Pediatrics, McGill University, Montreal, Canada
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The proportion, species distribution and dynamic trends of bloodstream infection cases in a tertiary hospital in China, 2010-2019. Infection 2021; 50:121-130. [PMID: 34184182 PMCID: PMC8803777 DOI: 10.1007/s15010-021-01649-y] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2021] [Accepted: 06/22/2021] [Indexed: 11/17/2022]
Abstract
Background Recent epidemiological studies on bloodstream infection (BSI) that include the proportion, species distribution and dynamic changes are scarce in China. This study was performed to understand these epidemiological data of BSI over the past 10 years in China. Methods Using a prospective nosocomial infection surveillance system, this study was retrospectively performed in one of the largest hospitals in China. The time trend was tested using the Cochran–Armitage trend test in R Programming Language. Results From 2010 to 2019, there were totally 9381 episodes of BSI cases out of 1,437,927 adult-hospitalized patients in the hospital, the total proportion of BSI cases was 6.50‰ (6.50 episodes per 1000 adult-hospitalized patients) and the proportion had significantly decreased (8.24–6.07‰, time trend P < 0.001). Among the 9381 episodes of BSI, 93.1% were bacteremia and others were fungemia (6.9%). As the most common species, the composition ratios of coagulase-negative staphylococcus (25.6–32.5%), Escherichia coli (9.8–13.6%) and Klebsiella pneumoniae (5.3–10.4%) had been dynamically increased (all time trends P < 0.05) and the proportion of Pseudomonas aeruginosa had decreased (4.0–2.4%, time trend P = 0.032). However, Staphylococcus aureus (3.3–3.1%) and Acinetobacter baumannii (4.4–4.2%) had not changed significantly (P > 0.05). These common species were consistent with China Antimicrobial Surveillance Network reported in 2018 (2018 CHINET report), but their composition ratios were different. In addition, among bacteremia, the proportion of multidrug-resistant bacteria gradually increased from 52.9 to 68.4% (time trend P < 0.001). Conclusion The proportion and species distribution of BSI were dynamically changing along certain trends. These trends deserved more attention from clinicians and researchers. Supplementary Information The online version contains supplementary material available at 10.1007/s15010-021-01649-y.
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Kazzaz YM, AlTurki H, Aleisa L, Alahmadi B, Alfattoh N, Alattas N. Evaluating antimicrobial appropriateness in a tertiary care pediatric ICU in Saudi Arabia: a retrospective cohort study. Antimicrob Resist Infect Control 2020; 9:173. [PMID: 33143749 PMCID: PMC7640689 DOI: 10.1186/s13756-020-00842-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2020] [Accepted: 10/27/2020] [Indexed: 02/07/2023] Open
Abstract
Background Inappropriate antibiotic utilization is associated with the emergence of antimicrobial resistance (AMR) and a decline in antibiotic susceptibility in many pathogenic organisms isolated in intensive care units. Antibiotic stewardship programs (ASPs) have been recommended as a strategy to reduce and delay the impact of AMR. A crucial step in ASPs is understanding antibiotic utilization practices and quantifying the problem of inappropriate antibiotic use to support a targeted solution. We aim to characterize antibiotic utilization and determine the appropriateness of antibiotic prescription in a tertiary care pediatric intensive care unit. Methods A retrospective cohort study was conducted at King Abdullah Specialized Children’s Hospital, Riyadh, Saudi Arabia, over a 6-month period. Days of therapy (DOT) and DOT per 1000 patient-days were used as measures of antibiotic consumption. The appropriateness of antibiotic use was assessed by two independent pediatric infectious disease physicians based on the Centers for Disease Control and Prevention 12-step Campaign to prevent antimicrobial resistance among hospitalized children. Results During the study period, 497 patients were admitted to the PICU, accounting for 3009 patient-days. A total of 274 antibiotic courses were administered over 2553 antibiotic days. Forty-eight percent of antibiotic courses were found to be nonadherent to at least 1 CDC step. The top reasons were inappropriate antibiotic choice (empirical or definitive) and inappropriate prophylaxis durations. Cefazolin and vancomycin contributed to the highest percentage of inappropriate DOTs. Conclusions Antibiotic consumption was high with significant inappropriate utilization. These data could inform decision-making in antimicrobial stewardship programs and strategies. The CDC steps provide a more objective tool and limit biases when assessing antibiotic appropriateness
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Affiliation(s)
- Yasser M Kazzaz
- Department of Pediatrics, Ministry of National Guards - Health Affairs, Riyadh, Kingdom of Saudi Arabia. .,College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Kingdom of Saudi Arabia. .,King Abdullah International Medical Research Center, Riyadh, Kingdom of Saudi Arabia.
| | - Haneen AlTurki
- Department of Pediatrics, Ministry of National Guards - Health Affairs, Riyadh, Kingdom of Saudi Arabia.,King Abdullah International Medical Research Center, Riyadh, Kingdom of Saudi Arabia
| | - Lama Aleisa
- Department of Pediatrics, Ministry of National Guards - Health Affairs, Riyadh, Kingdom of Saudi Arabia.,King Abdullah International Medical Research Center, Riyadh, Kingdom of Saudi Arabia
| | - Bashaer Alahmadi
- Department of Pediatrics, Ministry of National Guards - Health Affairs, Riyadh, Kingdom of Saudi Arabia.,King Abdullah International Medical Research Center, Riyadh, Kingdom of Saudi Arabia
| | - Nora Alfattoh
- Department of Pediatrics, Ministry of National Guards - Health Affairs, Riyadh, Kingdom of Saudi Arabia.,King Abdullah International Medical Research Center, Riyadh, Kingdom of Saudi Arabia
| | - Nadia Alattas
- Department of Pediatrics, Ministry of National Guards - Health Affairs, Riyadh, Kingdom of Saudi Arabia.,College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Kingdom of Saudi Arabia
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