Biomedical subjects
Publications and source records attributed to Jaffar A Al-Tawfiq.
Granulicatella elegans is a fastidious organism that is rarely implicated as a cause of infective endocarditis. Here, we describe a patient with mitral valve prolapse who developed G. elegans endocarditis. The organism was isolated from blood cultures and the patient had mitral valvuloplasty and repair, and completed a course of 6 weeks of intravenous antibiotics with no sequela.
During 1999-2003 in a Saudi Arabian Hospital, methicillin-resistant Staphylococcus aureus constituted 6% of all S. aureus isolates; the proportion had increased from 2% in 1999, to 9.7% in 2002, to 8% in 2003. Of all MRSA isolates, 62% represented community-acquired infection, 20.4% represented healthcare-associated infection, and 17.6% represented nosocomial infection. The proportion of community-acquired isolates increased from 41.7% in 1999 to 66.6% in 2002, and the proportion representing nosocomial infection decreased from 33% in 1999 to 19% in 2003. Isolates representing nosocomial infection showed higher rates of resistance to ciprofloxacin (76.6%), clindamycin (76.6%), erythromycin (68%) and trimethoprim-sulfamethoxazole (68%) than did isolates in the other categories (P<.001).
OBJECTIVES: The objective of this study was to evaluate the Candida species and the change over time in the organisms causing candidemia at Saudi Aramco Medical Services Organization in Saudi Arabia. We also describe the risk factors associated with mortality. METHODS: This was a retrospective study of candidemia over nine years (1996-2004). RESULTS: A total of 98 distinct episodes of candidemia were identified over the study period. The annual incidence of candidemia ranged between 0.2 and 0.76 cases/1000 hospital discharges with an incidence per 10 000 patient-days per year of 0.45 to 1.6. The most frequent Candida species were Candida albicans (53%), Candida tropicalis (19%), Candida parapsilosis (16%), and Candida glabrata (7%). In relation to predisposing factors, 83% of candidemia occurred in patients with central venous catheters and 96% had received broad-spectrum antibiotics. Other predisposing factors included complicated abdominal surgeries (22%), total parenteral nutrition (52%), neutropenia (9%), acute renal failure (24%), malignancy (26%) and burns (15%). However, prior fluconazole use was low (8%). The overall crude mortality rate was 43% for all candidemia. Logistic regression analysis identified two independent determinants of death, C. albicans (OR 5.91, 95% CI 1.50, 23.24, p=0.01) and acute renal failure (OR 5.15, 95% CI 1.18, 22.55, p=0.03). CONCLUSION: The study showed that the rate of candidemia was low in our hospital and that C. albicans was the major species followed by C. tropicalis and C. parapsilosis. Future studies are needed to evaluate the antifungal susceptibility pattern in our hospital.
OBJECTIVE: To study the pattern of antibiotic resistance among Escherichia coli and the trend in resistance during a 6-year period in a Saudi Arabian hospital. DESIGN: Retrospective in vitro surveillance study of the antibiotic susceptibility pattern among E. coli isolates recovered from outpatients and from inpatients. SETTING: A general hospital in Saudi Arabia. PATIENTS: All patients with a culture positive for E. coli during a 6-year study period. RESULTS: A statistically significant increase in antibiotic resistance was observed among outpatient and inpatient isolates of E. coli. Inpatient isolates were more likely to be resistant to antimicrobial agents. Among isolates from outpatients, 50% were resistant to ampicillin, 33% were resistant to trimethoprim-sulfamethoxazole (TMP-SMZ), and 14% were resistant to ciprofloxacin. Among isolates from inpatients, 63% were resistant to ampicillin, 44% were resistant to TMP-SMZ, and 33% were resistant to ciprofloxacin. There was a low rate of resistance to imipenem (0.3% of isolates), amikacin (2%), and nitrofurantoin (2.4%-6.5%). Resistance to ceftazidime was detected in 9% of outpatient isolates and 17% of inpatient isolates. Multidrug resistance was defined as resistance to 2 or more classes of antibiotics. Multidrug resistance was detected in 2.0%-28.1% of outpatient isolates and 7.4%-39.6% of inpatient isolates, depending on the combination of antimicrobials tested. More isolates were resistant to ampicillin plus TMP-SMZ than to any other combination of antimicrobials. CONCLUSION: The prevalence of antibiotic resistance among outpatient and inpatient E. coli isolates increased during the study period. The rates of antibiotic resistance were statistically significantly higher among inpatient isolates, compared with outpatient isolates. These findings call for wiser use of antibiotics and continued surveillance of antibiotic resistance.
OBJECTIVES: The objective of this study was to describe the pattern and trends of antibiotic resistance of Pseudomonas aeruginosa over a six-year period in a Saudi Arabian hospital. METHODS: This was a retrospective study of the antibiotic resistance of outpatient and inpatient isolates of P. aeruginosa. Only one isolate per patient per year was included in the study. RESULTS: During the study period a total of 2679 isolates of P. aeruginosa were available for analysis. Outpatient isolates constituted 48% of the total number, and of these 23.4% were obtained from wound cultures. For the inpatient isolates, 33.6% and 30% were obtained from the respiratory tract and wounds, respectively. There was no significant increase in the resistance rates of outpatient isolates to the tested antibiotics over time. On the other hand, inpatient isolates showed a statistically significant increase in resistance rates to piperacillin, ceftazidime, imipenem, and ciprofloxacin (p<0.001). Over the study period, the resistance rates of outpatient and inpatient isolates to piperacillin, ceftazidime, imipenem, and ciprofloxacin were 4.6% and 11.5%, 2.4% and 10%, 2.6% and 5.8%, and 3% and 6%, respectively. Gentamicin demonstrated the highest resistance among all tested aminoglycosides for outpatient isolates (6%) and inpatient isolates (6.7%). Resistance to more than two classes of antibiotics was present in 1-2% of inpatient isolates and in 0% of outpatient isolates. CONCLUSION: Antibiotic resistance continues to be a problem especially in inpatient isolates and is likely to be related to increased antibiotic use. Thus, continued monitoring of antibiotic resistance is of great importance to ensure the proper use of antibiotics and to detect any increasing trends in resistance.
Methicillin-resistant Staphylococcus aureus (MRSA) is increasingly being recognized as a cause of community-acquired infection. Its transmission in neonatal intensive care units (NICUs) has reportedly been linked to a few cases of community-acquired MRSA (CA-MRSA) infection. Here, I describe a case of CA-MRSA transmission from a father to his child in a NICU. Recognition that CA-MRSA may be transmitted in a hospital setting raises important issues for MRSA infection control and treatment options.
OBJECTIVE: To describe the epidemiology, clinical features and outcome of hepatitis A virus (HAV) infection in children in Kuwait. SUBJECTS AND METHOD: The medical records of 350 patients (age 0-16 years) admitted to the Infectious Diseases Hospital, Kuwait, between January 2000 and December 2002, with hepatitis A infection were reviewed. RESULTS: The mean age was 8.6 +/- 3.8 years and 47% of patients were between 7 and 12 years old. Kuwaiti children comprised 44% of admitted patients. The largest proportion of children with hepatitis A (34%) were from the northern part of the country. HAV infection was prevalent throughout the year with a peak during the months of August to October. Of the Kuwaiti children, 31% reported a history of contact with jaundiced patients, while 52% of the non-Kuwaiti children had a history of recent travel prior to their illness. Patients had symptoms for a mean of 6 +/- 3.6 days prior to presentation. The mean length of hospitalization was 5.8 +/- 2.9 days. The rate of complications of HAV infection was 6% and only one child required admission to the intensive care unit for fulminant hepatitis. None of the patients had permanent sequelae. CONCLUSIONS: HAV infection is a significant cause of morbidity for children in Kuwait. The disease is mostly prevalent in preschool and school age children. Despite the excellent outcome of all patients, a considerable number of patients tend to have a complicated course and prolonged hospitalization. In view of these data, hepatitis A vaccine should be considered as a part of routine childhood immunization in Kuwait.
OBJECTIVE: The study describes the epidemiology of malaria in the Eastern Province of Saudi Arabia and the species of Plasmodium causing the disease and the associated factors. METHODS: This is a retrospective study of the epidemiology of malaria at Saudi Aramco Medical Services Organization in Dhahran, Eastern Province of Saudi Arabia. The study included all patients with malaria from January 1994 to June 2005. We retrieved the cases from the archive epidemiology records on all notifiable diseases. The medical records of patients were reviewed and the following information was collected: age, gender, nationality, year and month of acquisition, travel history and the species causing malaria. RESULTS: Over the study period from January 1994 to June 2005, there were 56 cases of imported malaria seen at Saudi Aramco Medical Services Organization. There were 28 males and 28 females with a mean age of 28.2 +/- 19.7 (range, 1-80) years. Saudis constituted 25% of the patients and the remaining (75%) were non-Saudi. Most of the cases (78.7%) were acquired outside Saudi Arabia and 21.3% were acquired in the Kingdom but outside the Eastern Province. The most frequent species were Plasmodium vivax (P. vivax) (54.4%), Plasmodium falciparum (P. falciparum) (43%) and Plasmodium malariae (1.8%). Of the cases acquired within other parts of Saudi Arabia, 71.4% were secondary to P. falciparum. Acquisition of malaria in India P. falciparum constituted 71.4% and in Pakistan 91%. For Sudanese patients, P. falciparum constituted 47% and P. vivax was 53%. Most of the non-Saudi cases were seen in the month of September (19%) whereas 57% of the Saudi cases were seen in February and April. CONCLUSION: There were no active cases of malaria transmission within the Eastern province of Saudi Arabia; however, the continued presence of imported malaria into this region may pose a significant health problem especially in the presence of the malaria vector. Thus, effective treatment and vigilance for cases of malaria is needed.
BACKGROUND: This study describes the resistance pattern of Streptococcus pneumoniae isolates obtained from pediatric patients in a Saudi Arabian hospital. MATERIAL/METHODS: This is a retrospective analysis of the antibiotic resistance of S. pneumoniae isolates (n=141) obtained from children in a Saudi Arabian hospital 1999-2004. Clinical data and antibiotic sensitivity were retrieved from microbiology data and analyzed. RESULTS: Of the total isolates of S. pneumoniae, 57.6% were susceptible to penicillin, 28.8% intermediately susceptible, and 13.7% were resistant organisms. Over the study period, high-level penicillin resistance of S. pneumoniae was 0% in 1999, 23% in 2001, and 3.4% in 2004. Intermediate penicillin resistance was 21% in 1999, 41% in 2001, and 27.6% in 2004. The resistance rates to other antibiotics were as follows: erythromycin 33.4%, tetracycline 30%, trimethoprim-sulfamethoxazole 40%, and clindamycin 21.6%. Children less than 2 years of age showed a higher rate of intermediately penicillin-susceptible isolates (41.9% versus 22.7%, P=0.0.02). They also had higher rates of resistance to tetracycline (42.4% versus 25%, P=0.03), trimethoprim-sulfamethoxazole (54% versus 33.8%, P=0.02), and clindamycin (33% versus 17%, P-0.04). All tested isolates were susceptibility to ceftriaxone and vancomycin. CONCLUSIONS: The overall high-level penicillin resistance of S. pneumonaie from 1999-2004 was 13.7%. The percentage of intermediately penicillin-susceptible organisms was higher in the age group under 2 years of age (41.9%) than in patients 2 years of age or older (22.7%).
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Methicillin-resistant Staphylococcus aureus (MRSA) is being recognized increasingly as a cause of community-acquired infection. The organism usually causes skin and soft tissue infection. Here, we present a patient with community-acquired MRSA pneumonia and review the literature. The patient, a 37-year-old Saudi male with no significant medical history was admitted with fever, respiratory distress and scrotal ulceration. Scrotal swabs and blood cultures grew MRSA. Imaging studies showed necrotizing pneumonia. Physical examination and echocardiographic findings revealed no evidence of endocarditis. The patient was treated successfully with 4 weeks of intravenous vancomycin. The infection appears to have originated in the skin and subcutaneous tissues of the scrotum, and subsequently led to necrotizing pneumonia. Community-acquired MRSA pneumonia has been associated with the production of Panton-Valentine leukocidin.
OBJECTIVES: The objective of this study was to examine the prevalence and trends of drug resistance of Mycobacterium tuberculosis at the Saudi Aramco Medical Services Organization. METHODS: We retrospectively identified M tuberculosis isolates from January 1989 to December 2003. Antimicrobial susceptibility and clinical data were collected and analyzed. RESULTS: From 1989 to 2003, 276 nonrepetitive culture-positive cases were identified. There were 236 Saudis (84.6%), and the remainder were non-Saudis (15.4%). M tuberculosis isolates were obtained from pulmonary specimens (49%) and extrapulmonary sites (51%). The resistance rates of M tuberculosis to tested first-line agents were as follows: isoniazid, 12.5%; ethambutol, 7.5%; streptomycin; 6.9%; and rifampin, 1.1%. The resistance rate to isoniazid and streptomycin was 1.8%, the rate to isoniazid and rifampin was 0.7%, and the rate to isoniazid and ethambutol was 2.5%. The resistance rate to isoniazid, ethambutol, and streptomycin was 0.7% CONCLUSION: M tuberculosis resistance to isoniazid showed a decreased rate over the study period from 20 to 5.7%. The rate of multidrug-resistant M tuberculosis remained low.
OBJECTIVE: The aim of this study was to evaluate the epidemiology of cutaneous leishmaniasis in the Eastern Province of Saudi Arabia. In addition, the clinical spectrum of the disease was evaluated. METHODS: This is a retrospective study of cutaneous leishmania cases from 1956 to 2002. RESULTS: In the study period, there were 1862 patients with cutaneous leishmaniasis in the Saudi Aramco health care system. The disease is more prevalent in the Al-Hasa Oasis (Eastern Province of Saudi Arabia) and affects males and females equally. Cutaneous leishmaniasis follows a seasonal distribution in parallel with the known activity of the sandfly. The majority (76%) of cases occurred in patients < 15 years of age and the disease affected the extremities more frequently than the face. Seventy-one percent of patients presented with a single lesion and 27% presented with two lesions. Ulcerative cutaneous leishmaniasis was the predominant morphology (89%). CONCLUSION: Cutaneous leishmaniasis attained epidemic proportions in 1973 and subsequently declined and reached a plateau in the mid-1980s. Skin involvement is the major clinical picture, with no evidence of dissemination or viscerotropic syndrome.
Haemophilus ducreyi causes the sexually transmitted disease chancroid, which facilitates the transmission of HIV infection. This review focuses on recent advances in the epidemiology, diagnosis, treatment and pathogenesis of this disease.
Brucellosis is a zoonotic disease caused by Brucella sp. and may affect many parts of the body. Brucella epididymo-orchitis had been reported in up to 20% of patients with brucellosis. This is a case report of Brucella epididymo-orchitis in a Saudi male patient. He presented with a unilateral swelling of the left testicle. He had fever, arthralgia and night sweats. Ultrasound examination revealed enlarged left epididymis and testicle. Brucella serology was positive and the patient responded to treatment with doxycycline and gentamicin. Thus, brucella infection should be considered in the differential diagnosis of patients presenting with epididymo-orchitis from an endemic area.
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