Changing Patterns of SARS-CoV-2 Seroprevalence: A Snapshot among the General Population in Kuwait.

We sought to assess pre-vaccination and post-vaccination seroprevalences of anti-SARS-CoV-2 antibodies in Kuwait and to compare antibody levels between vaccine types. In phase 1 (pre-vaccination period, n = 19,363), blood samples were collected before the launch of COVID-19 vaccination in Kuwait between 1 September and 31 December 2020. Blood samples for phase 2 (post-vaccination period, n = 4973) were collected between 1 September and 30 November 2021. We tested subjects for anti-SARS-CoV-2 antibodies using the DiaSorin LIAISON® SARS-CoV-2 IgM and Trimeric S IgG tests. In the pre-vaccination period, the prevalence of SARS-CoV-2 IgM and IgG was 14.50% (95% CI: 14.01-15.00) and 24.89% (95% CI: 24.29-25.50), respectively. The trend of seropositivity increased with age and was higher for females and non-Kuwaiti participants (p < 0.0001). Interestingly, seroprevalence was significantly higher for those who had received one dose of BNT162b2 (95.21%) than those who had received one dose of ChAdOx1-nCov-19 (92.86%). In addition, those who reported receiving two doses had higher seroprevalence, 96.25%, 95.86%, and 94.93% for ChA-dOx1-nCov-19/AstraZeneca, mix-and-match, and BNT162b2 recipients, respectively. After the second dose, median spike-specific responses showed no significant difference between ChAdOx1-nCov-19 and BNT162b2. Furthermore, statistical analysis showed no significant difference between median anti-trimeric S antibody levels of vaccinated individuals according to sex, age, or nationality (p > 0.05). In contrast, a negative correlation between age and anti-trimeric S IgG titers of BNT162b2-vaccinated subjects was observed (r = -0.062, p = 0.0009). Antibody levels decreased with time after vaccination with both vaccines. Our findings indicate that seroprevalence was very low during the pre-vaccination period (25%) in the general population and was greater than 95% in the vaccinated population in Kuwait. Furthermore, ChAdOx1-nCov-19 and BNT162b2 are effective in generating a similar humoral response.

Evaluation of in vitro activity of ceftolozane/tazobactam and comparators against recent clinical bacterial isolates, and genomics of Pseudomonas aeruginosa, Klebsiella pneumoniae and Escherichia coli isolates that demonstrated resistance to ceftolozane/tazobactam: data from Kuwait and Oman.

Background: The treatment options for infections caused by MDR Gram-negative bacteria have been limited, especially for infections caused by bacteria that produce carbapenemases and/or ESBLs. Ceftolozane/tazobactam is a cephalosporin/ß-lactamase inhibitor developed to treat Gram-negative bacteria. Methods: Ceftolozane/tazobactam and 14 comparators (amikacin, aztreonam, cefepime, cefotaxime, cefoxitin, ceftazidime, ceftriaxone, ciprofloxacin, colistin, ertapenem, imipenem, levofloxacin, meropenem and piperacillin/tazobactam) were evaluated against Pseudomonas aeruginosa and Enterobacterales isolates collected from Kuwait and Oman (n = 606) during 2016-17. In addition, further analysis of resistance mechanisms to ceftolozane/tazobactam was done utilizing WGS. Non-susceptible isolates from ceftolozane/tazobactam surveillance were selected for analysis. Overall, 35 strains underwent WGS. Results: Among isolates from Kuwait, susceptibility of P. aeruginosa, Escherichia coli and Klebsiella pneumoniae to ceftolozane/tazobactam was 79.8%, 95.7% and 87.5%, respectively, and from Oman was 92.3%, 93.1% and 88.5%, respectively. No P. aeruginosa with a ceftolozane/tazobactam MIC <32 mg/L encoded ß-lactamases besides normal chromosomal enzymes (PDC variants or OXA-50-like) whereas all but one P. aeruginosa isolate with MIC >32 mg/L encoded either MBLs (60%), VEB-1 (19%) or additional OXAs (3.7%). Conclusions: Colistin followed by ceftolozane/tazobactam showed the greatest activity against P. aeruginosa. Enterobacterales showed more susceptibility to ceftolozane/tazobactam than to piperacillin/tazobactam, but meropenem and colistin showed better activity.

Antimicrobial resistance pattern in clinical Escherichia coli and Pseudomonas aeruginosa isolates obtained from a secondary-care hospital prior to and during the COVID-19 pandemic in Kuwait.

Introduction: The study objective was to compare the prevalence of antimicrobial resistance (AMR) in clinical Escherichia coli and Pseudomonas aeruginosa isolates obtained from a secondary-care hospital prior to and during the COVID-19 pandemic in Kuwait. Methods: A retrospective descriptive study was conducted based on AMR profiles of clinical Escherichia coli and Pseudomonas aeruginosa isolates. The AMR data represented isolates from five specimen types (body fluids; blood; respiratory; wound, bone, or other tissues; and urine) of patients admitted to four wards (surgical, medical, pediatric, and maternal-postnatal). Tested isolates between January 2019 and February 2020 represented the pre-COVID-19 pandemic period in Kuwait, whereas those from February 2020 until April 2021 represented the 'during COVID-19' period. Results: A total of 1,303 isolates (57.2% E. coli and 42.8% P. aeruginosa) were analyzed. For ceftazidime, ertapenem and meropenem, the prevalence of AMR in E. coli was significantly (p<0.05) lower in pre-COVID-19 wards compared to that during COVID-19, whereas for other antibiotics (i.e., cefepime, gentamicin, and trimethoprim/sulfamethoxazole), the prevalence of AMR in pre-COVID-19 was significantly higher than that during COVID-19. The prevalence of AMR to gentamicin in P. aeruginosa isolates from non-COVID-19 wards (52.8%) was significantly higher (p<0.001) than that from COVID-19 wards (35.0%) and from the pre-COVID-19 period (32.9%). The multidrug-resistance (MDR) prevalence was 37.4% for E. coli and 32.1% for P. aeruginosa isolates. The odds of MDR in E. coli isolates from the COVID-19 medical wards were significantly lower (OR=0.27, [95%CI: 0.09-0.80], p=0.018) compared to the pre-COVID-19 wards. The odds of MDR E. coli and P. aeruginosa isolates by COVID-19 status stratified by specimen type were not different (p>0.05). Conclusions: No major differences in AMR in E. coli and P. aeruginosa prevalence by specimen type and wards prior to and during the COVID-19 pandemic was observed at this hospital. The high reported MDR prevalence calls for better infection control and prevention.

Epidemiology and Microbiological Profile of Common Healthcare Associated Infections among Patients in the Intensive Care Unit of a General Hospital in Kuwait: A Retrospective Observational Study.

BACKGROUND: Patients admitted to the Intensive Care Unit (ICU) are prone to develop nosocomial infections due to Multidrug-Resistant (MDR) organisms. Inappropriate and overuse of antibiotics play an important role in the emergence of MDR organisms, which cause life-threatening infections resulting in significant morbidity and mortality. METHODS: Retrospective surveillance-based study on healthcare-associated infections. The study conducted over two consecutive years 2018 and 2019, looking at ICU related infections of a regional secondary care general hospital and the data were recorded using the methods and definitions of the Kuwait National Healthcare-associated infections Surveillance System (KNHSS). RESULTS: A total of 1408 patients, admitted to ICU for 7922 days during the 2 years period. Eighty-nine patients were included in this study, where 48 developed one Hospital-acquired Infections (HAI) in the ICU while 25 and two patients presented with two and three HAIs, respectively. The HAIs included Bloodstream Infections (BSI) - 42.3%, pneumonia - 28.8%, Urinary Tract Infections (UTI) - 15.3%, skin and soft tissue infections - 9.6% and Clostridium difficile infection - 3.4%. The overall infection rate was 13.14 per 1000 patient-days. The rates for Device-associated (DA)-HAIs were 6.27 for Central Line-associated BSI (CLABSI) per 1000 Central Line (CL)-days, 4.21 for Ventilator-associated Pneumonia (VAP) per 1000 Mechanical Ventilator (MV)-days, and 1.91 Catheter-associated UTI (CAUTI) per 1000 Urinary Catheter (UC)-days. Data showed that device use ratios for CL, MV, and UC were 0.81, 0.74, and 0.98, respectively. Acinetobacter baumannii and Klebsiella pneumoniae were the most common organisms isolated from the ICU infections with highest rates of antibiotic resistance. CONCLUSION: Among DA-HAIs CLABSI was found to be most common in our ICU, followed by VAP and CAUTI. Gram-negative organisms with A. baumannii and K. pneumoniae being the leading causative agents with high antimicrobial resistance profiles.

A study of group B streptococcus in pregnant women in Lebanon: prevalence, risk factors, vaginal flora and antimicrobial susceptibility.

Guidelines recommend universal screening of all pregnant women at 35-37 weeks of gestation for group B streptococcus (GBS) colonization and reserve a risk-factor-based approach for women who have no prenatal cultures. This study determines the prevalence of GBS among pregnant women in Lebanon and assesses the association between risk factors and vaginal flora in this patient population and antibiotic resistance pattern of the GBS isolates. Vaginal samples from women between 35-37 weeks of gestation were obtained and cultured on 5% sheep blood agar (BA), colistin nalidixic acid agar, Strep B Select chromogenic agar and Lim enrichment broth. Also, vaginal flora was evaluated on Gram-stained smears. Colonies on BA suggestive of GBS were identified by Gram staining, catalase test and agglutination in group B antiserum. Antimicrobial susceptibility to different antibiotics was tested on BA. Risk factors were obtained. The prevalence of vaginal GBS colonization was 18.4% (31/168). Evaluation of Gram-stained vaginal smears revealed an inverse relationship between the presence of lactobacilli and GBS colonization (p=0.029). Resistance of GBS to erythromycin and clindamycin was found to be 25.8% and 12.9%, respectively. Demographic and obstetric data did not reveal statistically significant differences in GBS colonization rates between age groups (p=0.498) or level of education (p=0.696) among these women. Prevalence of GBS remains high in this region with no identifiable risk factors for its acquisition. Furthermore, increase in resistance to erythromycin and clindamycin should prompt susceptibility testing of all GBS isolates. The resistance profile of these strains represents an emerging public health concern that needs further surveillance.

Severe acute respiratory syndrome coronavirus 2 seroprevalence survey among 10,256 workers in Kuwait.

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has emerged as a global pandemic. Seroprevalence surveillance is urgently needed to estimate and monitor the growing burden of coronavirus disease 2019 (COVID-19). The aim of this study is to estimate the seroprevalence of SARS-CoV-2 infection among worker population residing in areas under lockdown in Kuwait and investigated their risk factors associated with a positive status. From April 18 to May 10, 2020 a randomly sampled, worker-based survey was conducted in 7 governorate in Kuwait (Ahmadi, Farwaniya, Hawali, Asma, Jahra, and Mubarak Alkabeer) among 10,256 workers. SARS-CoV-2 IgG and IgM antibodies was assessed using a commercially point-of-care lateral flow immunoassay (Biozek medical COVID-19 IgG/IgM Rapid Test Cassette). We estimated an overall seroprevalence (IgG or IgM positive) of 5.9% (95% CI: 5.4-6.3). Notably, SARS-CoV-2 seropositivity was significantly higher in males (6.2%) than females (1.9%) ( p < 0.001). Furthermore, the seroprevalence was significantly different by age group, governorate, and nationality of the workers. These results highlighted that the relatively low prevalence of anti-SARS-CoV-2 antibodies in hotspot areas in a specific population. Thus, we emphasize to repeat the serosurvey in the general population to assess the magnitude of viral spread and monitor the growing burden of COVID-19 in Kuwait.

Prevalence of antimicrobial resistance in Gram-negative clinical isolates from a major secondary hospital in Kuwait: a retrospective descriptive study.

INTRODUCTION: Building an antimicrobial resistance (AMR) surveillance system in a country requires analysis of available data on AMR in clinical isolates. This study's objective was to determine the AMR prevalence of Gram-negative bacterial (GNB) isolates cultured from clinical specimens at a major general hospital in Kuwait. METHODS: A retrospective descriptive study was conducted on AMR profiles of GNB clinical isolates (n=5290) between January and December 2018. Data were extracted from the laboratory information system in the hospital. The GNB organisms (i.e., Escherichia coli, Klebsiella pneumoniae, Pseudomonas aeruginosa, and Acinetobacter baumannii) were isolated from five main locations at the hospital (i.e., intensive care units [ICUs], surgical wards, medical wards, pediatric wards, and outpatient polyclinics). RESULTS: Overall, high AMR prevalence (>50%) against ampicillin, cefuroxime, cefotaxime, ceftazidime, ciprofloxacin, and trimethoprim/sulfamethoxazole, were observed across the GNB organisms. However, low resistance prevalence (<10%) were observed against amikacin, ertapenem, meropenem, and piperacillin/tazobactam. In general, AMR prevalence in E. coli isolates from ICU, medical and surgical wards was significantly (p<0.05) higher compared to other locations, whereas, AMR prevalence in P. aeruginosa isolates from pediatric ward was higher (p<0.05) compared to other locations. The overall multidrug resistance (MDR) prevalence was 38.7% (95% CI: 37.4-40.0). The highest MDR prevalence was among E. coli isolates from respiratory specimens (48%); wounds, bones, or other tissues (47.7%); and body fluids (47.1%). Similarly, MDR prevalence in K. pneumoniae, P. aeruginosa, and A. baumannii isolated from respiratory specimens was significantly (p<0.05) higher compared to other specimen types. The most frequent MDR phenotypes in the four GNB organisms and across the different specimen types included three antimicrobial drug classes: penicillins, cephalosporins, and fluroquinolones. CONCLUSIONS: Our findings demonstrate high AMR prevalence among common Gram-negative bacteria at this major hospital. Monitoring data on antimicrobial susceptibility of common bacterial organisms is critical for assessing trends in AMR at hospitals and for informing policy decisions.

Molecular Epidemiology of Candida Auris Outbreak in a Major Secondary-Care Hospital in Kuwait.

The emerging, often multidrug-resistant Candida auris is increasingly being associated with outbreaks in healthcare facilities. Here we describe the molecular epidemiology of a C. auris outbreak during 18 months, which started in 2018 in the high dependency unit (HDU) of a secondary-care hospital in Kuwait. Demographic and clinical data for candidemia and colonized patients were prospectively recorded. Clinical and environmental isolates were subjected to phenotypic and molecular identification; antifungal susceptibility testing by broth microdilution method; PCR-sequencing of ERG11 and FKS1 for resistance mechanisms to triazoles and echinocandins, respectively; and molecular fingerprinting by short tandem repeat (STR) analyses. Seventy-one (17 candidemic and 54 colonized) patients including 26 with candiduria and seven environmental samples yielded C. auris. All isolates were identified as C. auris by Vitek2, MALDI-TOF MS, PCR amplification and/or PCR-sequencing of rDNA. Twelve candidemia and 26 colonized patients were admitted or exposed to HDU. Following outbreak recognition, an intensive screening program was instituted for new patients. Despite treatment of all candidemia and 36 colonized patients, 9 of 17 candidemia and 27 of 54 colonized patients died with an overall crude mortality rate of ~50%. Nearly all isolates were resistant to fluconazole and contained the Y132F mutation in ERG11 except one patient's isolates, which were also distinct by STR typing. Only urine isolates from two patients developed echinocandin resistance with concomitant FKS1 mutations. The transmission of C. auris in this outbreak was linked to infected/colonized patients and the hospital environment. However, despite continuous surveillance and enforcement of infection control measures, sporadic new cases continued to occur, challenging the containment efforts.

Evaluating the antibacterial activity of ceftaroline against clinical isolates of methicillin-susceptible and- resistant Staphylococcus aureus in Kuwait hospitals.

Ceftaroline fosamil has been approved by the US Food and Drug Administration for the treatment of skin and soft tissue infections, including those caused by methicillin-resistant Staphylococcus aureus and community-acquired bacterial pneumonia. We evaluated the in-vitro activity of not-in-use ceftaroline against clinical isolates of methicillin- resistant (MRSA) and methicillin-susceptible (MSSA) S. aureus isolates. A total of 453 single-patient S. aureus isolates were tested for susceptibility to ceftaroline. The minimum inhibitory concentration (MIC) was determined using the MIC Evaluator. Disk diffusion test was performed using 30 µg ceftaroline disk according to the Clinical Laboratory Standards Institute criteria. In total, 410 (90.5%) of the 453 strains were susceptible to ceftaroline at MIC of 1 mg/L while 9.8% isolates had MIC of 2-3 mg/L. Among the MSSA, 92.5% of the isolates were susceptible with MIC: 1 mg/L while 36 (7.9%) strains expressed intermediate resistance (MIC range of 2-3 mg/L). None of the strains was resistant (MIC: 4 mg/L). Ceftaroline showed good in-vitro activity against MSSA and MRSA which can serve as an effective alternative to vancomycin in treating infections caused by MRSA.

Phenotypic and Genotypic Characterization of Extended-Spectrum Beta-Lactamases Produced by Escherichia coli Colonizing Pregnant Women.

Introduction: Infections caused by extended spectrum beta lactamase (ESBL) producing bacteria continue to be a challenge for choosing the appropriate therapy since they may exhibit coresistance to many other classes of antibiotics. The aim of the study was to screen pregnant women for ESBL producing bacteria in Beirut, Lebanon, to examine their phenotypic and genotypic characterization and to study the association between ESBL colonization with adverse neonatal outcomes. Method: In this cross-sectional study, vaginal samples from 308 pregnant women at 35-37 weeks of gestation were studied during a one-year period. The samples were plated on MacConkey agar and selective MacConkey agar supplemented with ceftazidime. Phenotypic confirmation of ESBL production was performed by double-disc synergy test and all isolates were screened by PCR for the resistance genes blaSHV, blaTEM, and blaCTX-M. Clonal relatedness of Escherichia coli isolates was investigated by pulsed-field gel electrophoresis. Results: In total, 59 women out of 308 (19.1%) were colonized by ESBL producing gram negative bacteria. Two babies born to mothers colonized with ESBL were diagnosed with sepsis. The susceptibility rates of isolates to other antibiotics were 39% to co-trimoxazole, 49.2% to ciprofloxacin, 91.5% to gentamicin, 18.6% to aztreonam and 35.6% to cefepime. Most of isolates were highly sensitive to meropenem and imipenem, with a susceptibility of 93.2%. PCR was performed on all E. coli isolates to detect the most common ESBL producing genes; blaCTX-M was the predominant gene (90.7%), followed by blaTEM (88.4%) and finally blaSHV (44.2%). PFGE analysis of 34 E. coli isolates revealed 22 distinct clusters showing more than 85% similarity. Conclusion: In conclusion, this study showed that Lebanon has a high prevalence of ESBL carriage in pregnant women. Further studies that include a continuous screening of pregnant women and follow up of their newborn clinical status should be conducted to foresee the risk of transmission.

Prevalence and antifungal susceptibility of Candida albicans causing vaginal discharge among pregnant women in Lebanon.

BACKGROUND: Vaginal candidiasis is frequent in pregnant women and is associated with sepsis and adverse neonatal outcomes. This study determined the prevalence of candida species in symptomatic pregnant women and evaluated the antifungal susceptibility profile of the isolated Candida strains. It also aimed to explore whether Candida species predicts gestational complications and adverse neonatal outcomes. METHODS: A total of 258 pregnant women with vaginal discharge at 35 to 37 week of gestation participated in this study. Vaginal swabs from these patients were collected at various obstetrics and gynecology clinics in Lebanon for a period of 14 months. Candida isolates were identified at species level and antifungal susceptibility of Candida albicans to fluconazole (FCZ), amphotericin B (AMB), itraconazole (ICZ) and voriconazole (VCZ) was determined by the agar-based E-test method. RESULTS: Among 258 women tested, 100 (39%) were positive for Candida species. C. albicans, C. glabrata and C. krusei were isolated from 42, 41 and 17% of the women, respectively. C. albicans was significantly associated only with gestational diabetes while C. krusei or C. glabrata had significant positive associations with other gestational complications. The antifungal susceptibility tests of C. albicans isolates revealed 97.5, 90, 87.5 and 97.5% susceptibility to AMB, FCZ, ICZ and VCZ, respectively. CONCLUSION: The current study revealed high incidence of both C. albicans and non-C. albicans Candida strains causing vulvovaginitis among pregnant women in Beirut, Lebanon. Candida screening as antenatal follow up is advised to minimize the risk of adverse neonatal outcome or gestational complications.

The emerging pathogen Candida auris: A focus on the Middle-Eastern countries.

Recent emergence of Candida auris as a multidrug resistant fungal pathogen, associated with difficult-to-control nosocomial transmission and high mortality, raises serious concerns for public health. Since it was first reported from Japan in 2009, C. auris infections have been diagnosed in several countries from all over the world. However, there is a paucity of reported cases from the Middle East. Literature search resulted in finding only six countries (Kuwait, Israel, Oman, KSA, UAE and Iran) reporting C. auris infections in the past three years. All patients were adults with several underlying comorbidities. Majority of the cases presented with bloodstream infection with crude mortality rate of 60%. All isolates were misidentified as C. haemulonii by commercial systems requiring specialized methods for identification. In vitro antifungal susceptibility testing showed 100% strains to be resistant to fluconazole (MIC 32 ≥ 256 mg/L) while variable resistance against other antifungal agents.

In Vitro Activity of Newer and Conventional Antimicrobial Agents, Including Fosfomycin and Colistin, against Selected Gram-Negative Bacilli in Kuwait.

Limited data are available on susceptibilities of these organisms to some of the recently made accessible antimicrobial agents. The in vitro activities of newer antibiotics, such as, ceftolozane/tazobactam (C/T) and ceftazidime/avibactam (CZA) along with some "older" antibiotics, for example fosfomycin (FOS) and colistin (CL) were determined against selected strains (resistant to ≥ 3 antimicrobial agents) of Escherichia coli, Klebsiella pneumoniae, and Pseudomonas aeruginosa. Minimum inhibitory concentrations (MIC) were determined by Clinical and Laboratory Standards Institute microbroth dilution. 133 isolates: 46 E. coli, 39 K. pneumoniae, and 48 P. aeruginosa were tested. Results showed that E. coli isolates with MIC50/90, 0.5/1 µ g / mL for CL; 4/32 µ g / mL for FOS; 0.25/32 µ g / mL for C/T; 0.25/8 µ g / mL for CZA, exhibited susceptibility rates of 95.7%, 97.8%, 76.1%, and 89.1%, respectively. On the other hand, K. pneumoniae strains with MIC50/90, 0.5/1 µ g / mL for CL; 256/512 µ g / mL for FOS; 2/128 µ g / mL for C/T; 0.5/128 µ g / mL for CZA showed susceptibility rates of 92.3%, 7.7%, 51.3%, and 64.1%, respectively. P. aeruginosa isolates with MIC50/90, 1/1 µ g / mL for CL; 128/128 µ g / mL for C/T; 32/64 µ g / mL for CZA presented susceptibility rates of 97.9%, 33.3%, and 39.6%, respectively. Higher MICs were demonstrated against most of the antibiotics. However, CL retained efficacy at low MICs against most of the isolates tested.

Draft Genome Sequences of Six Multidrug-Resistant Clinical Strains of Acinetobacter baumannii, Isolated at Two Major Hospitals in Kuwait.

Acinetobacter baumannii is an important opportunistic pathogen in global health care settings. Its dissemination and multidrug resistance pose an issue with treatment and outbreak control. Here, we present draft genome assemblies of six multidrug-resistant clinical strains of A. baumannii isolated from patients admitted to one of two major hospitals in Kuwait.

Genetic Lineages of Methicillin-Resistant Staphylococcus aureus Acquired during Admission to an Intensive Care Unit of a General Hospital.

OBJECTIVES: The objectives of this study were to determine the frequency of methicillin-resistant Staphylococcus aureus (MRSA) colonization or infection while on admission to the intensive care unit (ICU), and examine the genetic backgrounds of the MRSA isolates to establish transmission among the patients. SUBJECTS AND METHODS: This study involved screening 2,429 patients admitted to the ICU of Farwania Hospital from January 2005 to October 2007 for MRSA colonization or infection. The MRSA isolates acquired after admission were investigated using a combination of molecular typing techniques to determine their genetic backgrounds. RESULTS: Of 2,429 patients screened, 25 (1.0%) acquired MRSA after admission to the ICU. Of the 25 MRSA, 19 (76%) isolates belonged to health care-associated (HA-MRSA) clones: ST239-III (n = 17, 68%) and ST22-IV (n = 2, 8%). The remaining 6 MRSA isolates belonged to community-associated clones: ST80-IV (n = 3, 12%), ST97-IV (n = 2, 8%), and ST5-IV (n = 1, 4%). The ST239-III-MRSA clone was associated with infection as well as colonization, and was isolated from patients from 2005 to 2007. CONCLUSIONS: The HA-MRSA clone ST239-III persistently colonized patients admitted to the ICU, indicating the possibility of its transmission among the patients over time.

Classical Presentation of Acute Pyelonephritis in a Case of Brucellosis.

Although Brucella species is known to affect almost all organs in humans, renal involvement presenting as acute pyelonephritis remains a rare entity in brucellosis. We report the case of a female patient who presented with symptoms of fever with chills, right loin pain and dysuria in the emergency room. Blood cultures drawn at the time of admission grew Brucella spp., but no organisms were isolated from urine culture although urinalysis data was indicative of urinary tract infection. Empiric therapy with piperacillin/tazobactam plus gentamicin relieved her symptoms. However, the treatment was switched to doxycycline plus rifampicin once the blood culture result was obtained.

Evaluation of chromogenic medium and direct latex agglutination test for detection of group B streptococcus in vaginal specimens from pregnant women in Lebanon and Kuwait.

This study was undertaken to evaluate chromogenic medium and a direct latex agglutination test (DLA) for detection of Group B Streptococcus (GBS) in the vaginal specimens of pregnant women, and to ascertain the prevalence of GBS in this population in Kuwait and Lebanon. Vaginal swabs, collected from women at 35-37 weeks of gestation, were cultured on 5 % sheep blood agar (SBA), colistin nalidixic acid agar (CNA), Strept B Select chromogenic agar (SBS) as well as Lim enrichment broth in 168 cases in Lebanon while only SBA was used for 1391 samples in Kuwait. In addition, vaginal samples from 102 GBS-positive and 20 GBS-negative women near the time of delivery were collected in Kuwait for evaluation of the DLA test. During the study period, the prevalence of GBS colonization was determined to be 20.7 % (288/1391) in Kuwait while 18.4 % (31) of 168 pregnant women in Lebanon had vaginal cultures positive for GBS. By direct plating of vaginal swabs on the three media used, the isolation rates of GBS were 51.6, 64.5 and 77.4 % on SBA, CNA and SBS, respectively, which increased to 90.35, 93.1 and 96.8 %, respectively, following subculture in Lim broth after 18 h of incubation. The sensitivity of the DLA test was found to be dependent on the density of GBS colonization, resulting in 100 % sensitivity and 100 % specificity for heavy (>10(2) c.f.u. per swab) and moderately heavy (50-100 c.f.u. per swab) growth of GBS. However, for vaginal specimens yielding <50 c.f.u. per swab, the sensitivity, specificity, positive and negative predictive values of the DLA test were 100, 55.5, 63.6 and 100 %, respectively. In conclusion, a chromogenic agar, such as SBS, and a DLA test can be used for rapid detection of GBS in pregnant women. The DLA test, in particular, could prove to be a useful tool for immediate detection of GBS in women near delivery so that intrapartum antibiotic prophylaxis can be initiated.

Bacteremia caused by Rhizobium radiobacter in a preterm neonate.

The authors report a case of bacteremia due to Rhizobium radiobacter in a preterm neonate. Although the baby recovered from the septic episode following therapy with appropriate antibiotics he succumbed to complications, mainly associated with prematurity. This case highlights a rare manifestation of R.radiobacter infection in a neonate in whom the source of the organism remained undiscovered.

Frequency and clinical association of Panton-Valentine leukocidin-positive Staphylococcus aureus isolates: a study from Kuwait.

OBJECTIVE: This study was undertaken to determine the frequency of Panton-Valentine leukocidin (PVL)-producing Staphylococcus aureus among strains isolated in our laboratory and to study the association of PVL-positive strains with clinical disease. MATERIALS AND METHODS: A total of 291 S. aureus isolates obtained from different clinical specimens from June 1, 2009, to March 31, 2010, at the Farwania Hospital Laboratory were investigated for antimicrobial susceptibility, carriage of genes for PVL, and SCCmec elements. Antimicrobial susceptibility testing was performed by standard methods. The presence of mecA genes for PVL SCCmec typing was determined by PCR. RESULTS: Of the 291 S. aureus isolates, 89 (30.6%) were methicillin-resistant S. aureus (MRSA), whereas 202 (69.4%) were methicillin susceptible (MSSA). Genes for PVL were detected in 13 (14.6%) and 24 (12.0%) of the MRSA and MSSA isolates, respectively. The majority of the PVL-producing MRSA and MSSA were isolated from 12 (30.7%) and 19 (21.8%) cases of skin and soft tissue infections (SSTI), respectively. Although both MSSA and MRSA strains were uniformly susceptible to rifampicin, teicoplanin, and vancomycin, multidrug resistance was observed among PVL-producing and nonproducing MRSA isolates. Both MRSA types carried SCCmec type III, IV, IVc, and V genetic elements. CONCLUSION: This study revealed the presence of genes for PVL in both MSSA and MRSA, associated mostly with SSTI and respiratory tract infections, supporting previous observations that PVL production is widespread among S. aureus strains obtained from different clinical sources.

Diagnostic performance of gastric imprint smear for determination of Helicobacter pylori infection.

BACKGROUND: Despite the availability of several methods (invasive and noninvasive) for the diagnosis of Helicobacter pylori infection, no test is considered to be the 'gold standard'. Endoscopy-based tests are regarded as the reference method in most studies. OBJECTIVE: To evaluate the diagnostic performance of imprint cytology smears of antral biopsies compared with Gram-stained smears, the rapid urease test and culture methods, separately and in combination. METHODS: Antral biopsies were obtained from consecutive patients undergoing upper gastrointestinal endoscopy at a single centre. The biopsies were examined for the presence of H pylori by Gram-stained smear, the rapid urease test, culture methods and imprint cytology smear.  RESULTS: A total of 273 biopsies were studied. All tests were positive in 36% of the patients. Of 252 biopsies tested, 73% were positive using the imprint cytology technique. Using Gram-stained smear, the rapid urease test and culture methods individually, the sensitivity and specificity of imprint cytology smears for the detection of H pylori were found to be 92.7% and 50%; 92.7% and 49%; and 92.4% and 38.5%, respectively. Combining the three microbiological methods resulted in a sensitivity of 92.1%, a specificity of 51.0% and an efficiency of 71.7% for imprint cytology smears. CONCLUSIONS: Endoscopic examination provides useful clinical information. Imprint gastric cytology can be used as a rapid test to establish the diagnosis of H pylori infection at the time endoscopy is performed, enabling the endoscopist to start treatment with immediate effect.