Antimicrobial resistance of Streptococcus pneumoniae at a university hospital in Saudi Arabia

The resistance pattern of 105 consecutive strains of Streptococcus pneumoniae isolated from patients at King Abdulaziz University Hospital (KAUH), Jeddah, Saudi Arabia over a 2-year period (March 1998 to February 2000) was determined with the minimal inhibitory concentration (MIC) method using E-test. Overall 6.7% of the isolates were penicillin resistant (MICs > or = 2 mg/L), and 51% were intermediate (MICs 0.12-1 mg/L). The resistance rates to ampicillin, cefotaxime, ceftriaxone, imipenem, erythromycin and clarithromycin were 8.6%, 8.6%, 4.7%, 3.8%, 13%, and 21% respectively. High-level resistance was noted against cotrimoxazole and chloramphenicol, 76% and 68% respectively. Only 2.8% of S. pneumoniae were resistant to amoxycillin-clavulanate; no resistance to vancomycin was observed. Against penicillin-intermediate pneumococcal strains, vancomycin, ceftriaxone, cefotaxime and amoxycillin-clavulanate were the most active compounds. Against penicillin-resistant pneumococci, vancomycin was the most powerful agent, amoxycillin-clavulanate was half as active, whereas ceftriaxone, cefotaxime and imipenem were 4-fold less active than vancomycin. Fifty-six (53%) of the 105 pneumococcal strains were multi-drug resistant.     

Antimicrobial resistance among Gram-positive pathogens in Saudi Arabia

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.     

Antibiotic Resistance Among Gram-Negative Non-Fermentative Bacteria at a Teaching Hospital in Saudi Arabia

Abstract

The incidence and antimicrobial resistance of Gram-negative non-fermentative bacteria isolated over 1 year at King Abdulaziz University Hospital, Jeddah, Saudi Arabia were investigated. A total of 499 of these microorganisms were collected and account for 16% of all Gram-negative bacteria isolated. The most common species were Pseudomonas aeruginosa 291 (56%), Acinetobacter baumannii 170 (34%), and Stenotrophomonas maltophilia 35 (7%). 168 (34%) of these microorganisms were isolated from Intensive Care Unit (ICU), 147 (30%) from General Medicine, and 24 (25%) from Surgery wards. ICU was the main site of isolation of P. aeruginosa and S. maltophilia, while A. baumannii was more frequently isolated from medicine and surgery units. The vast majority of the isolates were resistant to many antibiotics tested. The antimicrobial resistance patterns of P. aeruginosa showed lowest resistance to imipenem (13%), amikacin (17%), and ciprofloxacin (18%). Imipenem was also the most active antimicrobial agent against A. baumannii (15%) resistance. S. maltophilia exhibited multi-drug resistance, and was susceptible only to sulfonamide (6%).     

Pattern of antibiotic resistance of Streptococcus pneumoniae in a hospital in the Eastern Province of Saudi Arabia

The objective of the study was to evaluate the pattern of antibiotic resistance of Streptococcus pneumoniae at Saudi Aramco Medical Services Organization (SAMSO) in the Eastern Province of Saudi Arabia. We identified, retrospectively, S. pneumoniae isolates from January 1999 to December 2002. Antimicrobial susceptibility and clinical data were collected and analyzed. A total of 162 isolates of S. pneumoniae were identified in the study period. Of these isolates, 94 (58%) isolates were obtained from out-patients and 68 (42%) were obtained from in-patients. Thirty-five percent of isolates were from blood, 46% from the respiratory tract, and the remainder were obtained from other sites. Of these isolates, 83 (51%) were penicillin-susceptible and the remaining 79 (48.8%) were not penicillin susceptible. High-level resistance to penicillin existed in 19.8% of the total isolates. Prevalence of resistance to erythromycin, tetracycline and trimethoprim-sulfamethoxazole was 25%, 29%, and 42% respectively. None of the isolates was resistant to vancomycin or ceftriaxone. However, 12% of the isolates showed multi-drug resistance. Streptococcus pneumoniae shows 19.8% high-level penicillin resistance and 12% multi-drug resistance. These findings call for wiser use of antibiotics.     

Tuberculosis in Saudi Arabia: prevalence and antimicrobial resistance

Abstract

Tuberculosis is a serious contagious disease caused by Mycobacterium tuberculosis and is endemic in many countries. Over the past two decades, there has been an increase in the number of multidrug-resistant TB and extensively drug-resistant TB cases around the world. As in many countries, TB is common in Saudi Arabia. The disease is particularly relevant in the Kingdom because of its population dynamics including a large number of resident expatriates mainly from TB endemic regions and the influx of millions of pilgrims to the country each year during the Hajj and Umrah seasons. This review investigates the prevalence and antimicrobial resistance among M. tuberculosis isolates from Saudi Arabia, highlighting the variations in rates in different geographical areas with particularly high rates in the main cities and regions hosting the annual pilgrimage. The review also refers to the measures needed to prevent and control TB transmission in the country.     

Beta-lactam and macrolide resistance and serotype distribution among Streptococcus pneumoniae isolates from Saudi Arabia

Three hundred thirty-six clinically significant Streptococcus pneumoniae isolates were collected from laboratories of different hospitals in Riyadh, Saudi Arabia. Most of these isolates were from pulmonary and otitis media (68.2%), and 31.8% were extrapulmonary (blood and CSF). Of the 336 isolates, 44.6% were susceptible to penicillin, and 55.4% were penicillin non-susceptible (35.7% were intermediate and 19.7% were fully resistant). The isolates showed 9.0% resistance to co-amoxiclav, 31.8% to cefuroxime and 39.4% to cefprozil. None of the isolates were resistant to ceftriaxone. Overall macrolide resistance rates were 22.6% to erythromycin, 18.5% to roxithromycin, 17.9% to azithromycin and 17.3% to clarithromycin. Most penicillin non-susceptible pneumococci were of serogroups/types 19 (21.0%), 6 (10.8%), 18 (8.6%), 23 (8.1%) and 14 (7.0%). Serogroups 9, 15, and 1 were found in 5.4%, 4.3%, and 2.2% of the isolates, respectively. Nontypeable strains constituted 6.5%. In exploring the mechanism of resistance to macrolides, 28 of 76 (36.8%) of isolates were erythromycin-resistant due to ribosomal mechanism (all were constitutive type, none were inducible), whereas 48 (63.2%) isolates were resistant due to an efflux mechanism. Good antibiotic control with periodical antibiotic surveillance and appropriate use of pneumococcal vaccine may improve current treatment of pneumococcal infections.     

Malignant neoplasms in Saudi Arabia.

In a sample of 1000 consecutive malignant neoplasms in Saudis resident in the Western Region of Saudi Arabia, malignant lymphoma was the commonest of the life-threatening malignancies. The differences between malignant lymphoma in this sample and Western series include the greater frequency of lymphoma; the tendency for reticulum cell and poorly differentiated lymphomas to present as abdominal lesions; the earlier peak of prevalence of Hodgkin's disease, and the dissimilar proportions of its subtypes. The distribution of cancers in the gastrointestinal tract in our sample is almost the reverse of that encountered in the West in that cancer of the mouth and esophagus were more common than cancer of the lower intestinal tract. Lung cancer was relatively uncommon. The smoking habit is not so prevalent in Saudi Arabia as in the West and there is a need to maintain this situation by discouraging smoking. Cancer of the breast was by far the commonest major malignancy in the female, although most Saudi women have their first child early in their reproductive life. Skin cancers proved to be the most prevalent malignancy, and of these squamous cell carcinoma was the most common. The biases that affect studies such as ours in Saudi Arabia are stressed.     

Antimicrobial susceptibility of Salmonella typhi and non-typhi in a hospital in eastern Saudi Arabia

The objective of this study was to determine the antimicrobial susceptibility of Salmonella typhi and non-typhi at Saudi Aramco Medical Services Organization (SAMSO). We retrospectively identified isolates of S. typhi and non-typhi from January 1996 to December 2003. Antimicrobial sensitivity and clinical data were collected and analyzed. A total of 266 distinct isolates of S. typhi and non- typhi were available for analysis. Of the total isolates, 21.4% (n= 57) were S. typhi and 78.6% (n= 209) were Salmonella non-typhi and their most common serogroups were D (20.3%), C (19.5%) and B (15.8%). None of Salmonella spp. was resistant to ceftriaxone or ciprofloxacin. The susceptibility of S. typhi and non- typhi to trimethoprim-sulfamethoxazole (TMP-SMX) was 89% and 84% (P = 0.3) and to tetracycline was 81.3% and 56.6%, respectively (P <0.001). Ampicillin susceptibility was detected in 89% and 77% of S. typhi and non-typhi, respectively (P = 0.038). Multidrug resistance was present in 20% of S. typhi and 18.9% of Salmonella nontyphi. There was no difference in the susceptibility pattern of salmonella between Saudi and non-Saudi patients except for gentamicin susceptibility (97.3% vs. 65.9%, P < 0.001).     

The yeast species causing fungemia at a university hospital in Riyadh,Saudi Arabia,during a 10-year period

This study is a retrospective investigation to determine the species of yeasts causing fungemia in a university hospital in Saudi Arabia during the years 1991-2000. A total of 189 episodes of fungemia were encountered, of which 121 (64%) occurred during 1991-1995, whereas only 68 cases (36%) were found between 1996 and 2000. Overall, 50.3% episodes were due to Candida albicans including five episodes of C. dubliniensis, followed by C. tropicalis (27%), C. parapsilosis (7.9%), C. glabrata (7.4%), C. krusei (3.2%), C. famata (1.0%); 3.2% were due to other species, namely Blastoschizomyces capitatus, Hansenula anomala, Rhodotorula rubra, and Trichosporon beigelii. The percentage of episodes of fungemia caused by C. albicans ranged from 36.4% in 1991 to 71.4% in 2000, revealing an increase in recent years. The incidence of non-C. albicans fungemia decreased from 63 (33.3%) during the first 5 years (1991-1995) to 31 (16.4%) episodes during the second 5 years. Moreover, no fungemia due to C. glabrata and C. krusei were observed during the last 3 years. Overall, during the years of the study, a decreasing incidence of yeast fungemia was observed. Fungemia occurred more frequently in patients with leukemia (24%), prematurity (16%), postsurgery (10.6%), and lymphoma (9.5%). Patients with respiratory infections and preterm infants more often had C. albicans fungemia, whereas C. tropicalis predominated in patients with hepatic disorders and leukemia. The study reports for the first time the involvement of C. dubliniensis in yeast fungemia occurring in Saudi Arabia.     

Evaluation of aztreonam in the treatment of serious gram-negative infections in a university hospital in Saudi Arabia.

The efficacy and safety of aztreonam were evaluated in an open trial at King Khalid University Hospital, Riyadh, Saudi Arabia. A total of 45 critically-ill adult patients were enrolled in the study. All patients with documented Gram-negative infection were treated with aztreonam as monotherapy. Antibiotics active against only Gram-positive and/or anaerobic organisms were allowed. Twenty cases were clinically evaluable. Eleven had lower respiratory tract infections (pneumonia), 3 had urinary tract infections, and 6 had septicemia. Clinical signs and symptoms, cultures and other laboratory profiles were assessed prior to treatment, at 4-6 days during treatment and within 2-3 days of the end of therapy (usually 7-15 days). Nineteen out of 20 (95%) had a satisfactory clinical response. All cases with septicemia and urinary tract infections were microbiologically cured. The overall microbiological response rate was 90%. Fifty-five percent of all infections were caused by Pseudomonas aeruginosa. Two patients with Gram-negative pneumonia due to P. aeruginosa did not respond microbiologically to aztreonam therapy. No serious adverse events requiring discontinuation of aztreonam therapy were reported. No mortality occurred.     

Antimicrobial Resistance of Streptococcus pneumoniae at a University Hospital in Saudi Arabia

Abstract

The resistance pattern of 105 consecutive strains of Streptococcus pneumoniae isolated from patients at King Abdulaziz University Hospital (KAUH), Jeddah, Saudi Arabia over a 2-year period (March 1998 to February 2000) was determined with the minimal inhibitory concentration (MIC) method using E-test. Overall 6.7% of the isolates were penicillin resistant (MICs >2 mg/L), and 51% were intermediate (MICs 0.12 - 1 mg/L). The resistance rates to ampicillin, cefotaxime, ceftriaxone, imipenem, erythromycin and clarithromycin were 8.6%, 8.6%, 4.7%, 3.8%, 13%, and 21% respectively. High-level resistance was noted against cotrimoxazole and chloramphenicol, 76% and 68% respectively. Only 2.8% of S. pneumoniae were resistant to amoxycillin-clavu-lanate; no resistance to vancomycin was observed. Against penicillin-intermediate pneumococcal strains, vancomycin, ceftriaxone, cefotaxime and amoxycillin-clavulanate were the most active compounds. Against penicillin-resistant pneu-mococci, vancomycin was the most powerful agent, amoxycillin-clavulanate was half as active, whereas ceftriaxone, cefotaxime and imipenem were 4-fold less active than vancomycin. Fifty-six (53%) of the 105 pneumococcal strains were multi-drug resistant.     

Systematic review of the prevalence of Mycobacterium tuberculosis resistance in Saudi Arabia

Aim:

To quantitatively estimate the prevalence of resistance of Mycobacterium tuberculosis (TB) to first line agents in Saudi Arabia.

Methods:The overall prevalence of M. tuberculosis resistance was calculated using meta-analysis.

Results:We included 22 studies from Saudi Arabia that were published from 1979 to 2013.A high degree of heterogeneity among studies was observed. Based on random effect methodology, the prevalence (and 95% CI) of the resistance rates were: INH 10.13 (8.13–12.11), rifampicin 5.41 (4.21–6.61), ethambutol 1.29 (1.83–2.37) and streptomycin 6.5 (4.9–8.1), and multi-drug resistant was 6.7 (5.1–8.3).

Conclusion:The prevalence of resistance to anti-tuberculous agents was highest for INH followed by streptomycin and rifampicin. Multi-drug resistant tuberculosis remains at 6.7%. The data support the recommendations to use four anti-tuberculous agents as empiric therapy.     

Antibiotic resistance and mechanisms implicated in clinical enterococci in a Tunisian hospital

Susceptibility testing for 15 antibiotics was performed in a series of 191 clinical enterococci recovered in a Tunisian Hospital during 2000-2003. Species detected were the following ones (number of isolates): E. faecalis (139), E. faecium (41), E. casseliflavus (5), E. gallinarum (3), E. avium (2) and E. hirae (1). The percentages of antibiotic resistance detected were as follows (E. faecalis/ E. faecium/ other species) : penicillin (0/ 73/ 9%), tetracycline (78/ 44/ 54%), chloramphenicol (52/ 29/ 27%), erythromycin (66/ 100/ 82%), spiramycin (84/ 83/ 64%), pristinamycin (100/ 0/ 73%), trimethoprim-sulfamethoxazole (88/ 78/ 91%), rifampicin (72/ 41/ 0%), vancomycin (0/ 0/ 36%), teicoplanin (0/ 0/ 0%), high-level-resistance for gentamicin (24/ 29/ 45%), streptomycin (34/ 56/ 55%) and kanamycin (41/ 68/ 55%). Increased vancomycin minimum inhibitory concentrations (MICs) were only detected in E. casseliflavus and E. gallinarum isolates (MIC range 8-24 microg/ml). The erm(B), catA, tet(M), aac(6')-aph(2'), aph(3')-IIIa, and ant(6)-Ia genes were detected in 91%, 32%, 86%, 98%, 100%, and 72% of the E. faecium and E. faecalis isolates resistant to erythromycin, chloramphenicol, tetracycline and high-level-resistant to gentamicin, kanamycin and streptomycin, respectively. A total of 20 unrelated pulsed-field-gel-electrophoresis patterns were found in the series of 46 high-level gentamicin-resistant E. faecalis and E. faecium isolates of this study.     

Prevalence of Cigarette Smoking Usage among Adolescent Students in Northern Saudi Arabia

Background Cigarette smoking is a major public health issue in the Kingdom of Saudi Arabia (KSA) in recent years, particularly among adolescents. Therefore, the aim of this study was to determine the prevalence of cigarette smoking usage among adolescent students in the north of the country. Materials and Methods This was a cross-sectional study investigated 305 adolescent students from the Northern KSA population, their ages ranging from 11 to 19 years old. Results Of the 287 respondents, 56/287(19.5%) were found to be current smokers. Of the 56 current smokers, 14/52 (27%), 29/52 (55.8%), and 9/52 (17.2%) smoked 1-3, 4-10 and 11+ cigarettes/day, respectively. For duration most had smoked for 26-36 months. Conclusions The findings of the present study indicate that cigarette smoking use is still an important risk behavior among adolescent students. The findings of this study found a significant association of cigarette smoking usage and adolescents various believes and attitude for initiation of smoking and perception toward knowledge of other factors that contribute to the burden of tobacco use.     

Extended-spectrum and metallo-beta-lactamases among ceftazidime-resistant Pseudomonas aeruginosa in Riyadh,Saudi Arabia

Abstract

We investigated the extended-spectrum (ESBLs) and metallo-beta-lactamases (MBLs) among Pseudomonas aeruginosa isolates in Saudi Arabia. Disc susceptibility testing was performed on 200 P. aeruginosa isolates collected during 2010 at the Armed Forces Hospital in Riyadh, with MIC testing and phenotypic screening for ESBLs and MBLs carried out on those found to be ceftazidime resistant. Genes for ESBLs and MBLs were sought by PCR. Thirty-nine (19·5%) P. aeruginosa isolates were ceftazidime resistant, mostly with considerable resistance to other antibiotics except colistin. Twenty-three of these 39 (59%) appeared ESBL positive and 16 (41%) had MBLs. bla_VEB, and bla_GES genes were found in 20 (86·95%), and 5 (21·74%) of 23 ESBL-positive isolates, respectively whilst bla_VIM was detected in all 16 MBL-producers. bla_OXA-10-like often accompanied bla_VEB, bla_VIM or bla_GES. Several isolates had similar antibiogram and β-lactamase profiles, and may represent outbreaks; nevertheless, the collection was not dominated by any single clone. This dominance of acquired ceftazidime-inactivating beta-lactamases, often in combination is in contrast to the situation in Europe and the USA, where most ceftazidime resistance in P. aeruginosa is attributable to AmpC and efflux.     

Antibiotic resistance patterns of Gram-negative and Gram-positive strains isolated from inpatients with nosocomial infections in a tertiary hospital in Beijing,China from 2011 to 2014

This study was to evaluate the resistance of antimicrobial agents against pathogens from inpatients with nosocomial infection collected in Beijing, China, during 2011–2014. Measurement of minimum inhibitory concentrations (MICs) was carried out using the broth microdilution method with the Clinical and Laboratory Standards Institute (CLSI) guidelines as the indicator. A total of 5442 Gram-negative and 806 Gram-positive isolates were collected in this study in 2011–2014. Two carbapenem-resistant strains appeared among Escherichia coli (E. coli), while imipenem-resistant isolates increased in proportion from 0% to 8.2% among Klebsiella pneumonia (K. pneumonia) during 4 year. Acinetobacter baumannii (A. baumannii) revealed severe antibacterial resistance to most antimicrobial agents. In contrast, a decreasing trend on resistance had been observed among Pseudomonas aeruginosa (P. aeruginosa) especially after 2012, range from 1.8% for co-trimoxazole to 13.5% for piperacillin. The resistance of Staphylococcus aureus (S. aureus) also had the lowest resistant to linezolid and vancomycin (0.1%). In summary, antimicrobial-resistant nosocomial pathogens have gradually increased from 2011 to 2014, so improved surveillance of hospital-acquired infections and effective infection-control measures may be the best way to solve the present problem.