Trafficking of methicillin-resistant staphylococci and co-colonization with vancomycin-resistant enterococci

To determine the trafficking of methicillin-resistant staphylococci between the hospital and community as well as the occurrence of co-colonization with vancomycin-resistant enterococci [VRE]. From November 2005 to April 2006, methicillin-resistant Staphylococcus aureus [MRSA] and methicillin-resistant coagulase-negative Staphylococcus [MRCoNS]-positive patients at the Salmaniya Medical Complex, Bahrain were assessed for VRE co-colonization. Characterization of vancomycin resistance genotype by PCR was carried out. Close family contacts were screened for MRSA and pulsed-field gel electrophoresis [PFGE] analysis of MRSA isolates from patient-family member pairs was conducted. One hundred and eighty-two patients [93 MRSA; 89 MRCoNS] and 356 family members were enrolled. Seven MRSA and 41 MRCoNS strains were isolated from the family members. PFGE analysis revealed the presence of variants of a single MRSA clone among patients and their relatives. A total of 112 patients [62 MRSA; 50 MRCoNS] provided stool for VRE screening. Of these 13 stool specimens [11.6%] were VRE-positive. All the VRE isolates were from MRSA-positive patients, thus positivity rate among MRSA patients was 20.9% [n/N = 13/62]. These were predominantly Enterococcus gallinarum with vanC1 genotype and one strain was Enterococcus faecium [vanB genotype]. Two E. gallinarum isolates harbored an additional vanB gene. The majority of VRE isolates were from patients in medical and surgical units [n/N = 10/13; 77%]. Male gender, prolonged hospitalization and presence of co-morbidities were significantly associated with MRSA/VRE co-colonization [p < 0.05]. MRSA/VRE co-colonization with MRSA trafficking between the hospital and community environment is a public health concern occurring in our setting

Predominance of CTX-M genotype among extended spectrum beta lactamase isolates in a tertiary hospital in Saudi Arabia

To determine the molecular characterization of extended-spectrum beta-lactamases [ESBL] isolates from a tertiary center in Saudi Arabia using multiplex polymerase chain reaction [PCR] technique and assess their antibiotic susceptibility pattern. Prospective study conducted at the Saudi Aramco Dhahran Health Center, Dhahran, Saudi Arabia between April-December 2006. Extended-spectrum beta-lactamases phenotype of isolates identified by automated methods was confirmed using E-test. Multiplex PCR for the detection of blaTEM, blaSHV and blaCTX-M was performed. Susceptibility to a panel of antibiotics was determined. One hundred isolates [Escherichia coli [E.coli] n=84; Klebsiella pneumoniae [K. pneumoniae] n=16] were studied and 71% harbored the blaCTX-M gene. For E.coli isolates 43 [51%] harbored CTX-M+TEM combination and 21 [25%] had CTX-M alone. In contrast, only one K. pneumoniae isolate [6.2%] harbored the CTX-M+TEM combination and 3 [18.8%] isolates had CTX-M only. One E.coli and 7 K. pneumoniae isolates were blaSHV positive. The blaCTX-M gene was found predominantly in urinary isolates [n=63/71; 88.7%]. The presence of blaCTX-M was significantly higher in isolates from outpatients compared to inpatient [p<0.05]. Sensitivity to imipenem was 100% and 78% to nitrofurantoin. Resistance to amoxicillin-sulbactam was significantly higher in blaCTX-M positive isolates [p<0.05]. The findings indicate a high-level of blaCTX-M positive ESBL isolates circulating in our setting with the dissemination of these in the community. The trend of multidrug resistance profile associated with carriage of blaCTX-M gene is cause for concern

Pattern of upper respiratory tract infections and physicians' antibiotic prescribing practices in Bahrain

To evaluate the pattern of antibiotic prescriptions for paediatric upper respiratory tract infections [URTI] and determine the associated predictors for such antibiotic use in the Kingdom of Bahrain. From March 2005 to March 2006, demographic data, clinical presentation, investigations and antibiotic prescription for children with URTI [n = 184] at the Bahrain Defence Force Hospital was recorded. To assess the factors which influence physician antibiotic prescription for URTI, a cross-sectional survey of doctors was carried out using a pre-tested questionnaire which was administered to paediatricians, general practitioners and emergency room physicians. Antibiotics were given to 95 of the 184 [51.6%] patients, mainly children <3 years [40/95]. Significant association was demonstrated for antibiotic prescription, age and diagnosis of tonsillitis or acute otitis media [p < 0.05]. Amoxicillin [37/95] was the most frequently prescribed antibiotic, followed by -lactam/-lactamase combination and second-generation cephalosporins. Fever, younger age, sore throat and presence of earache increased the likelihood of antibiotic prescription. Data from the cross-sectional survey of doctors revealed that lack of national guidelines, parental pressure and diagnostic uncertainty contributed to antibiotic overuse. Antibiotic overuse for the treatment of paediatric URTI remains a problem in our setting. We suggest the development of national guidelines which are integrated with structured continuing medical education courses, public awareness campaigns and the introduction of rapid streptococcal antigen tests in the outpatient clinic

Prevalence of extended-spectrum beta-lactamase-producing enterobacteriaceae in Bahrain

To determine the occurrence of extended-spectrum beta-lactamase [ESBL]-producing Enterobacteriaceae in Bahrain. Retrospective analysis of records [January 2005-December 2006] at the Microbiology Laboratory of the Salmaniya Medical Complex, Bahrain which is the major national diagnostic laboratory. Out of a total of 11,886 member of family of Enterobacteriaceae isolated, 2695 [22.6%] were ESBL producers. Majority of ESBL isolates were from inpatients [n = 2363; 87.7%]. Escherichia coli [52.2%] and Klebsiella pneumoniae [24.3%] were predominant and distributed comparatively in the hospital wards while Proteus spp. [17.6%] was predominant in medical wards. Urine was the major source [52.2%] with low occurrence in blood cultures. No carbapenem resistant isolates was identified but resistance to three classes of antibiotics was exhibited by >25% of the isolated ESBL strains. Nitrofurantoin resistance was identified in 38.2% of urinary isolates. This is the first report from Bahrain and it indicates that the prevalence of ESBL-producing isolates is high. Carbapenems were the most active drug against the ESBL-producing isolates. We recommend strict infection control to prevent trafficking into the community

Internet and computer use by medical students in traditional and problem based learning systems

To validate the hypothesis that to achieve selfdirected learning targets, medical students in Problem- Based Learning [PBL] curriculum would have higher levels of computer literacy and make greater use of the Internet compared to their counterparts in a traditional curriculum A questionnaire based study Arabian Gulf University [AGU], Manama, Bahrain and the Medical School, University of Udine, Italy, during the academic year 2003-2004 Years 2-4 medical students of AGU [PBL curriculum] and Year-3 medical students of MSU [traditional curriculum] Comparison of computer ownership and literacy, and Internet usage among students in PBL and traditional curricula There was a high degree of computer literacy and ownership in both settings. The number of PBL students using word processing software was significantly higher [AGU 70.9% vs. MSU 34.7%; p < 0.05]. The commonest Internet use was e-mail to chat with friends [> 90% in both institutions]. Majority of the students obtained up to 40% of learning information online [MSU 93.9% vs. AGU 74.2%; p < 0.01]. There was a significant increase from year 2 - 4 in the number of AGU undergraduates getting 40-60% of learning information online [p < 0.01]. Access to original scientific literature as evidenced by websites visited and usage of Adobe Acrobat Readerr was lower among PBL students [MSU 51% vs. AGU 23.2%; p < 0.05]. For appropriate utilization of IT as an enriching PBL tool, more careful planning, integration and adequate guidance of the students with emphasis on content is needed

Human cytomegalovirus infections in pregnancy and the newborn: epidemiology, laboratory diagnosis and Medico legal aspects

Human Cytomegalovirus [HCMV] has established itself as the most significant cause of congenital infection in the developed world, leading to mental and developmental retardation. HCMV infection in expectant mothers is a major concern with the greatest risk being almost exclusively associated with women who experience the primary infection during pregnancy. Infants infected in utero may develop symptomatic or asymptomatic congenital infections with symptoms varying from modest hepato-splenomegaly to fatal illness. Majority of symptomatic neonates will develop neurological sequelae. A critical appraisal of the published data related to HCMV infection in pregnancy and the newborn in the Gulf Cooperation Council countries is presented in this review. It is apparent that validation of more recent and sensitive laboratory diagnostic tests, both serological and molecular, is needed in the region. Current data shows that a combination of IgG, IgM and IgG avidity test as first diagnostic screening is a cost effective approach for discriminating between primary and latent/reactivated infections. For high risk pregnancies, further testing incorporating viral culture and molecular techniques on various specimens including amniotic fluid is recommended. Viral load and viral typing can provide additional information about the risk of in utero transmission and symptomatic infection in the newborn. We therefore, propose a diagnostic algorithm to optimize utilization of available laboratory resources in making a diagnosis of HCMV infection during the progressive stages of pregnancy

Human papillomavirus infection among women attending health facilities in the Kingdom of Bahrain

To investigate the occurrence of human papillomavirus [HPV] infection and the associated risk factors in Bahrain's female population. This study was carried out between March to December 2004, which includes cervical scrapings for Pap smear and HPV-DNA testing using polymerase chain reaction[PCR] and restriction fragment length polymorphism [RFLP] analysis, obtained from 100 women attending the Gynecology Clinic at Salmaniya Medical Center and Sheikh Sabah Health Center in the Kingdom of Bahrain. We distributed questionnaires that include the sociodemographic data as well as information on risk factors such as smoking, parity, and the contraceptive used. Eleven women [11%] with normal cytology were HPV-positive. The RFLP analysis detected HPV-types 16, 18, 45, 62 and 53. Positive women were significantly older [43.3 +/- 10.1 years] than negatives [36.5 +/- 9.9 years; P=0.04], however, there was no difference in age of first sexual contact [positive: 18.1 +/- 5.7 years versus negative: 20.6 +/- 4.4 years]. Polygamy, smoking and hormonal contraception was not identified as risk factors, but positive women showed higher parity. In this study on HPV infection in Bahrain, the 11% positivity with high risk HPV types, in the presence of normal cytology suggests that in addition to the cervical cancer screening program, offer of HPV testing deserves consideration