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1.
Niger J Clin Pract ; 25(8): 1216-1220, 2022 Aug.
Article in English | MEDLINE | ID: mdl-35975366

ABSTRACT

Background: Extended-spectrum beta-lactamases (ESBL) are the most widespread of the new beta-lactamases and are a significant threat to patient care in the hospital and the community. Aim: The study assessed the prevalence, antibiotic susceptibility profile, and major ESBL encoding genes among Escherichia coli isolated from clinical specimens of patients in the National Hospital, Abuja (NHA). Materials and Methods: E. coli isolated from diverse clinical specimens obtained from clinically proven cases of infection managed at the NHA were included in the study. The antimicrobial susceptibility was performed by the Kirby-Bauer method and E-test was used to confirm the ESBL phenotype. Multiplex polymerase chain reaction (PCR) was used to detect the genes mediating ESBL production. Results: Meropenem, fosfomycin, and tigecycline demonstrated excellent activities against all isolates: of the 400 isolates, 392 (98%), 386 (96.5%), and 362 (90.5%) were susceptible, respectively. Similarly, 358 (89.5%) were susceptible to amikacin, 323 (80.3%) nitrofurantoin, 281 (70.3%) ceftazidime, and 279 (69.8%) cefotaxime. A total of 271 (67.8%), 219 (54.8%), and 208 (52.0%) were resistant to amoxicillin-clavulanate, ciprofloxacillin, and gentamicin, respectively. However, all the isolates were resistant to ampicillin. There was a significantly higher proportion of multidrug resistance among ESBL-producing isolates compared to non-ESBL-producing isolates (P = 0.0001). Of the 121 phenotypically detected ESBL isolates, 119 (98.3%) harbored genes mediating the production of Cefotaximase- Munich (CTX-M), Temoniera (TEM) or Sulfhydryl Variable (SHV) enzymes. Conclusion: The prevalence of ESBLs among E. coli was relatively high, at 30.2%. About 81% of all blood isolates were ESBL-producers. blaCTX-M is the predominant type of ESBL gene among E. coli. A high proportion of the ESBL-producing isolates expressed a combination of two or three genes together.


Subject(s)
Escherichia coli Infections , Escherichia coli , Anti-Bacterial Agents/pharmacology , Anti-Bacterial Agents/therapeutic use , Escherichia coli Infections/drug therapy , Escherichia coli Infections/epidemiology , Hospitals , Humans , beta-Lactamases/genetics
2.
IJTLD Open ; 1(2): 63-68, 2024 Feb.
Article in English | MEDLINE | ID: mdl-38966691

ABSTRACT

BACKGROUND: Existing models to increase TB case notifications from the private sector in Pakistan are financially unsustainable and have achieved modest success due to limited coverage. OBJECTIVE: To evaluate the impact of a social enterprise model (SEM) intervention on TB case detection in Karachi, Pakistan, and to assess its financial sustainability. METHODS: Purpose-built centres were established within the private sector that integrated TB screening, diagnostics and treatment and operated 12 hours per day with convenient locations to improve access. TB services were offered free of cost, and revenue generation took place through user fees from other diagnostics. Private providers with a focus on the informal sector were engaged through community workers to generate screening referrals. RESULTS: Overall 171,488 people were screened and 18,683 cases were notified, including 197 individuals with drug-resistant TB. Annual TB notifications in Karachi increased from 18,105 in 2014 to a maximum of 25,840 (40% increase). The proportion of cases in Karachi notified by the centres grew to 27% in 2020. Commercial revenue reached USD288,065 and enabled operating cost recovery of 15%. Average cost per TB case notified was USD203. CONCLUSION: The SEM intervention contributed a large proportion of notifications in Karachi and achieved modest cost recovery.


CONTEXTE: Les modèles existants visant à augmenter les notifications de cas de TB par le secteur privé au Pakistan ne sont pas viables financièrement et n'ont obtenu qu'un succès modeste en raison d'une couverture limitée. OBJECTIF: Évaluer l'impact d'un modèle déntreprise sociale (SEM, pour l'anglais « social entreprise model ¼) sur la détection des cas de TB à Karachi, au Pakistan, et évaluer sa viabilité financière. MÉTHODES: Des centres spécialisés ont été créés dans le secteur privé. Ils intègrent le dépistage, le diagnostic et le traitement de la TB et fonctionnent 12 heures par jour dans des lieux adaptés afin dén faciliter l'accès. Les services de lutte contre la TB étaient gratuits et les recettes provenaient des frais d'utilisation des autres diagnostics. Des prestataires privés, axés sur le secteur informel, ont été engagés par l'intermédiaire d'agents communautaires pour orienter les patients vers les services de dépistage. RÉSULTATS: Au total, 171 488 personnes ont été dépistées et 18 683 cas ont été notifiés, dont 197 personnes atteintes de TB résistante aux médicaments. Les notifications annuelles de TB à Karachi sont passées de 18 105 en 2014 à un maximum de 25 840 (augmentation de 40%). La proportion de cas à Karachi notifiés par les centres est passée à 27% en 2020. Les recettes commerciales ont atteint 288 065 USD et ont permis un recouvrement des coûts déxploitation de 15%. Le coût moyen par cas de TB notifié était de 203 USD. CONCLUSION: L'intervention SEM a contribué à une grande proportion de notifications à Karachi et a permis un modeste recouvrement des coûts.

3.
Article in English | MEDLINE | ID: mdl-38856819

ABSTRACT

OBJECTIVES: To evaluate literature from a 12-year period (2010-2021) on the antimicrobial resistance profile of Pseudomonas aeruginosa from the Arabian Gulf countries (Bahrain, Kuwait, Oman, Qatar, Saudi Arabia, and the United Arab Emirates). METHODS: An electronic literature search was conducted for articles on antimicrobial resistance in P. aeruginosa and associated phenotypes, covering the period of 1st January 2010 to 1st December 2021. RESULTS: Antimicrobial resistance in the Arabian Gulf was highest to meropenem (10.3-45.7%) and lowest to colistin (0.0-0.8%), among the agents tested. Annual data showed that ceftazidime resistance (Kuwait), piperacillin-tazobactam non-susceptibility (Qatar), and aztreonam, imipenem, and meropenem resistance (Saudi Arabia) increased by 12-17%. Multiple mechanisms of carbapenem resistance were identified and multiple clones were detected, including high-risk clones such as ST235. The most common carbapenemases detected were the VIM-type metallo-ß-lactamases. CONCLUSIONS: Among P. aeruginosa in the Arabian Gulf countries, resistance to meropenem was higher than to the other agents tested, and meropenem resistance increased in Saudi Arabia during the study period. Resistance to colistin, a classic antibiotic used to treat Pseudomonas spp. infections, remained low. The VIM-type ß-lactamase genes were dominant. We recommend local and regional antimicrobial resistance surveillance programs to detect the emergence of resistance genes and to monitor antimicrobial resistance trends in P. aeruginosa.

4.
Med Princ Pract ; 20(3): 213-9, 2011.
Article in English | MEDLINE | ID: mdl-21454989

ABSTRACT

OBJECTIVE: To investigate the extent, distribution and sequence analysis of bla(CTX-M) genes carried by Escherichia coli isolated from patients admitted to all government hospitals in Kuwait. METHODS: Extended-spectrum ß-lactamase (ESBL)-producing E. coli isolates were collected from the 8 major hospitals in Kuwait. CTX-M ESBLs were analyzed by PCR and sequenced. Clonality of the positive isolates was determined for genetic relatedness using pulsed-field gel electrophoresis (PFGE) with XbaI digestion of the genomic DNA. RESULTS: Of the 136 ESBL-positive isolates, 106 (77.9%) harbored bla(CTX-M) genes. Among these, bla(CTX-M-15) was the most frequent with a prevalence rate of 84.1%, followed by bla(CTX-M-14) (6.8%), bla(CTX-M-14b) (5.7%) and bla(TOHO-1) (3.4%). Ninety-three (87.7%) were isolated from Kuwaiti (35.9%), Egyptian (31.1%) and Indian (20.8%) nationals; the majority of isolates positive for bla(CTX-M-15) were mainly from these 3 nationalities. PFGE analysis did not demonstrate any clustering of positive isolates in any particular hospital. CONCLUSION: This study confirms an explosive emergence of CTX-M-15 ß-lactamase among E. coli isolates in Kuwait and shows that the strains were clonally heterogeneous with no evidence of inter- or intra-hospital spread. Thus Kuwait may represent an important source of CTX-M-15-positive E. coli.


Subject(s)
Cross Infection/microbiology , Escherichia coli Infections/microbiology , Escherichia coli/enzymology , Escherichia coli/genetics , beta-Lactamases/genetics , Adult , Aged , Escherichia coli/isolation & purification , Escherichia coli Proteins/genetics , Escherichia coli Proteins/isolation & purification , Female , Genotype , Humans , Kuwait , Male , Middle Aged , Polymerase Chain Reaction , Sequence Analysis , Young Adult , beta-Lactamases/isolation & purification
5.
Anaerobe ; 16(1): 1-5, 2010 Feb.
Article in English | MEDLINE | ID: mdl-19406247

ABSTRACT

The susceptibility trends for all anaerobes processed by the Anaerobe Reference Laboratory against various antibiotics were determined by using data for 2557 isolates referred by all government hospitals in Kuwait from 2002 to 2007. MIC were determined for the following anti-anaerobic antibiotics: amoxicillin-clavulanic acid, clindamycin, imipenem, meropenem, metronidazole, penicillin, piperacillin, piperacillin-tazobactam and vancomycin (for Gram-positive anaerobes only), using E-test method. The commonest isolates were Bacteroides fragilis (36.8%), followed by Peptostreptococcus spp. (21.9%), Bacteroides ovatus (15.5%) and Prevotella bivia (12.1%). In addition, Prevotella oralis and other Bacteroides spp. represented 8.5% and 8.1% of total number of isolates, respectively. Resistance rate varied among the antimicrobial agents and the species tested. The beta-lactams, with the exception of penicillin, were the most active drugs. Piperacillin-tazobactam was the only antimicrobial agent to which all the isolates were uniformly susceptible. Imipenem and metronidazole were highly active with resistance rate of only <5% recorded against most isolates. However, 42.8, 55.8 and 9.3% of Clostridium difficile isolates were resistant to imipenem, clindamycin and meropenem, respectively. It is noteworthy that from 2002 to 2007, there was a gradual increase in resistance rates to clindamycin, amoxicillin-clavulanic acid and piperacillin among B. fragilis. Periodic surveillance of antibiotic resistance among the anaerobic bacteria is recommended as a guide to empiric antibiotic use and formulation of guideline for appropriate choice of antimicrobial therapy in anaerobic infections.


Subject(s)
Anti-Bacterial Agents/pharmacology , Bacteria, Anaerobic/drug effects , Bacteria, Anaerobic/isolation & purification , Bacterial Infections/microbiology , Drug Resistance, Bacterial , Hospitals , Humans , Kuwait , Microbial Sensitivity Tests
6.
Anaerobe ; 16(6): 560-5, 2010 Dec.
Article in English | MEDLINE | ID: mdl-20887795

ABSTRACT

We conducted a prospective study to evaluate the prevalence and epidemiology of CDI in Kuwait government hospitals over a 3-year period, January 2003 to December 2005, to determine the ribotypes responsible for CDI and to estimate the prevalence of ribotype 027. We also conducted a case-control study to identify the risk factors in our patient population. A total of 697 stool samples from patients with suspected CDI were obtained and sent to Anaerobe Reference Laboratory, Faculty of Medicine, Kuwait University for Clostridium difficile toxin detection, culture and PCR ribotyping. During the period, 73 (10.5%) out of 697 patients met the case definition of CDI. Of these, 56 (76.7%) were hospital-acquired and 17 (23.3%) were from outpatient clinics. Thus, the prevalence of hospital-acquired CDI amongst patients with diarrhoea was 8% over the study period; the prevalence in 2003, 2004 and 2005 was 9.7%, 7.8% and 7.2%, respectively. Our data showed that 42.9% of the CDI patients were above 60 years, of which >79% were aged 71 years and above. Patients with CDI were more likely than the controls to have been exposed to immunosuppressive drugs and feeding via nasogastric tube. The most common ribotypes isolated during this study were 002, 001, 126 and 140 and they represent 55.1% of all isolates. PCR ribotype 027 was not isolated.


Subject(s)
Clostridioides difficile/classification , Clostridioides difficile/isolation & purification , Clostridium Infections/epidemiology , Cross Infection/epidemiology , Case-Control Studies , Clostridioides difficile/genetics , Clostridium Infections/microbiology , Cross Infection/microbiology , Feces/microbiology , Hospitals , Humans , Kuwait/epidemiology , Molecular Epidemiology , Polymerase Chain Reaction , Prevalence , Ribotyping , Risk Factors
7.
Med Princ Pract ; 19(3): 235-9, 2010.
Article in English | MEDLINE | ID: mdl-20357511

ABSTRACT

OBJECTIVE: To report a relatively rare presentation of methicillin-resistant Staphylococcus aureus (MRSA) meningitis in a previously healthy boy in Kuwait. CLINICAL PRESENTATION AND INTERVENTION: A 14-year-old boy presented with a 2 weeks' history of headache and fever with increasing severity. He developed photophobia and double vision 2 days prior to his hospital visit and received ceftriaxone for 6 days prior to admission to the hospital. There was no history of head trauma or neurosurgical operation. Lumbar puncture revealed a slightly turbid cerebrospinal fluid with pleocytosis and greatly reduced glucose, elevated protein level and on culture grew MRSA. Staphylococcal chromosome cassette mec (SCCmec) typing revealed that it belonged to SCCmec type III and sequence type 238 (ST238-SCCmec-III). Polymerase chain reaction screening for the presence of Panton-Valentine leukocidin (PVL) genes yielded a negative result; all these findings were consistent with hospital-acquired MRSA. He was treated with intravenous linezolid and rifampicin for 2 weeks, made good response and was discharged home fully recovered and well. CONCLUSION: Hospital MRSA should be considered in the differential diagnosis of the causative agents of community-onset meningitis in healthy patients even without predisposing factor.


Subject(s)
Acetamides/therapeutic use , Anti-Bacterial Agents/therapeutic use , Community-Acquired Infections/diagnosis , Meningitis, Bacterial/diagnosis , Methicillin-Resistant Staphylococcus aureus , Oxazolidinones/therapeutic use , Rifampin/therapeutic use , Adolescent , Community-Acquired Infections/drug therapy , Community-Acquired Infections/microbiology , Humans , Linezolid , Male , Meningitis, Bacterial/drug therapy , Meningitis, Bacterial/microbiology
8.
Access Microbiol ; 2(12): acmi000177, 2020.
Article in English | MEDLINE | ID: mdl-33490872

ABSTRACT

INTRODUCTION: Periodontal diseases are a group of chronic infections that destroy tissues surrounding and supporting the teeth. Data on the anaerobes associated with periodontal infections in Kuwait is lacking. AIM: To investigate the target anaerobes associated with chronic periodontitis (CP) in patients admitted to Dental Clinics in Kuwait University Health Sciences Center, Kuwait. METHODOLOGY: Patients with CP (severe and moderate) were recruited into this study during a period of 15 months. Samples were collected directly from inside the gingival pockets and subjected to semi-quantitative PCR assays. RESULTS: A total of 30 patients, stratified into moderate and severe CP and 31 healthy individuals, used as controls, were studied. Nine (30 %) of the 30 patients were in the 50-59-year age group. The detection rate of Aggregatibacter actinomycetemcomitans between the patients (9 : 30 %) versus the controls (5 : 16.1 %) was non-significant (P >0.05). Fusobacterium spp., were detected in all patients versus 29 (93.1 %) controls, (P >0.05). However, four target anaerobes were significantly associated with CP patients; Porphyromonas gingivalis was detected in ten (33.3 %) patients versus two (6.4 %) controls (P <0.0001); Tannerella forsythia 25 (83.3 %) versus 16 (51.6 %) controls (P <0.0001); Parvimonas micra 27 (90 %) versus 16 (51.6 %) controls (P <0.0001) and Treponema denticola, 18 (60 %) versus nine (29 %) controls (P <0.0001), respectively. Prevotella spp. were detected in 27 (90 %) patients and 30 (96.7 %) controls (P>0.5). There was no significant difference in the burden of Prevotella spp. between patients and controls determined by semi-quantitative PCR assays. CONCLUSION: Some (4/7) of the target anaerobes were significantly associated with CP in our study. P. gingivalis was the most strongly associated anaerobe with CP, although not the keystone bacteria, while Prevotella spp. was similar to the healthy controls.

9.
Annu Int Conf IEEE Eng Med Biol Soc ; 2019: 4942-4945, 2019 Jul.
Article in English | MEDLINE | ID: mdl-31946969

ABSTRACT

Sensory abnormalities are widespread in Autism Spectrum Disorder (ASD). However, their definition is still quite subjective and vague. Here we propose a novel approach for characterization of Autonomic Nervous System responses to sensory stimulation based on electrocardiogram (ECG) assessment. In particular, we develop a preliminary study where autonomic responses of both autistic (ASD = 5) and neurotypical (NT = 5) participants have been evaluated in terms of changes in responsiveness to repeated stimuli. Autonomic control has been estimated via high-frequency heart rate variability (HF-HRV) and low-frequency HRV (LF-HRV). Results show significant differences among groups for the HRV measures (p value = 0.0158), supported by expected changes of HF (p value = 0.0079) and LF (p value = 0.0079) trends over stimulations. We thus conclude that an overall decrease in autonomic arousal can give important insights for devising new habituation metrics in NT and ASD individuals.


Subject(s)
Arousal , Autism Spectrum Disorder/physiopathology , Autonomic Nervous System , Heart Rate , Electrocardiography , Humans
10.
J Chemother ; 17(6): 607-13, 2005 Dec.
Article in English | MEDLINE | ID: mdl-16433190

ABSTRACT

Multidrug-resistant Gram-positive bacteria are an increasingly pressing problem in the clinic. Consequently, linezolid, a recently introduced oxazolidinone with Gram-positive activity, was tested in comparison with 10 other antibiotics against 8103 clinically significant Gram-positive cocci by Etest, disk diffusion and Vitek methods. Linezolid demonstrated excellent activities against all isolates. Vancomycin and teicoplanin demonstrated equally excellent activity against almost all isolates. The methicillin-resistant Staphylococcus aureus (MRSA) strains were all susceptible to the glycopeptides and linezolid, but resistant to erythromycin (96%), fusidic acid (91.5%), gentamicin (84%) and clindamycin (73%). Forty one and 39% of the Streptococcus pneumoniae isolates were resistant to penicillin (MIC >0.5 microg/ml) and erythromycin (MIC >1 microg/ml), respectively. S. agalactiae susceptibility was 9% and 10% resistant to clindamycin and erythromycin, respectively. In conclusion, all the Gram-positive isolates tested were susceptible to linezolid. With its oral bioavailability profiles, it obviously holds great promise. Our data should be a useful addition to the literature from the Middle East.


Subject(s)
Acetamides/pharmacology , Anti-Bacterial Agents/pharmacology , Gram-Positive Bacteria/drug effects , Oxazolidinones/pharmacology , Colony Count, Microbial , Drug Resistance, Multiple, Bacterial , Gram-Positive Bacteria/isolation & purification , Hospitals, Teaching , Humans , Kuwait , Linezolid , Microbial Sensitivity Tests , Prospective Studies
12.
Chem Commun (Camb) ; 51(45): 9366-9, 2015 Jun 07.
Article in English | MEDLINE | ID: mdl-25959229

ABSTRACT

The intrinsic nonlinear photoluminescence (PL) property of chemically functionalized multi-walled nanotubes MWNTs (f-MWNTs) is reported in this study. f-MWNTs are imaged in fixed lung epithelial cancer cells (A549) and Kupffer cells in vitro, and in subcutaneously implanted solid tumors in vivo, for the first time, using multiphoton PL and fluorescence lifetime imaging (FLIM). Multiphoton imaging in the near-infrared excitation region (∼750-950 nm), employed in this study in a label-free manner, provides sensitivity and resolution optimal to track f-MWNTs within intra-cellular compartments and facilitates tumour imaging and sentinel lymph node tracking in vivo. Wider applications include employing this technique in live imaging of f-MWNTs in biological milieu to facilitate image-guided drug delivery.


Subject(s)
Diagnostic Imaging , Drug Delivery Systems , Nanotubes, Carbon/chemistry , Animals , Cell Line, Tumor , Colonic Neoplasms/diagnosis , Humans , Luminescence , Mice
13.
J Hosp Infect ; 43(1): 49-56, 1999 Sep.
Article in English | MEDLINE | ID: mdl-10462639

ABSTRACT

An analysis of hospital-acquired bacteraemia among ICU patients was carried out over a two-year period in order to determine the incidence, associated mortality rate and susceptibility pattern of causative pathogens. There was a high incidence of bacteraemia, occurring in 127 (18.4%) of 692 patients. Mortality attributable to nosocomial bacteraemia was 52% of the total 79 deaths from all causes. The highest mortality rate (58.5%) occurred in patients with fungal infections, whilst death from Gram-negative bacteraemia was only 17%. Over 98% of patients had underlying disease. Nearly half (46.8%) of 267 organisms isolated were Gram-positive. In comparison, Gram-negative bacteria accounted for 36.6% and the rest (17.6%) were fungi (mainly Candida albicans). The majority of the bactereamic episodes were monomicrobial (90.2%). Coagulase-negative staphylococci (CNS) were the commonest pathogens isolated, representing 32.6% of all organisms. Inducible beta-lactamase producing organism (Enterobacter spp. 9.7%, Serratia marcescens 6.7%, Klebsiella pneumoniae 6% and Pseudomonas aeruginosa 6%) formed the bulk of Gram-negative bacteria. In contrast, Escherichia coli (7.5%) and K. pneumoniae (4%) were the commonest Gram-negative bacteria from hospital-acquired bacteraemia in the general hospital population. The majority (80%) of CNS were resistant to methicillin (MRSE) but susceptible to vancomycin; they were relatively resistant to erythromycin, clindamycin and beta-lactams antibiotics. Whilst Gram-negative organisms were relatively susceptible to imipenem (85%), ciprofloxacin (88%) and amikacin (87%), they had unacceptably low levels of susceptibility to cefuroxime (59.3%), cefotaxime (71%), ceftazidime (60.9%), and piperacillin (51.1%). This study shows that hospital-acquired bacteraemia in ICU patients carries a poor prognosis. Information regarding the infective agents and their susceptibility in the ICU setting is valuable for the selection of empirical therapy before culture and susceptibility results are known.


Subject(s)
Anti-Bacterial Agents/pharmacology , Bacteremia/epidemiology , Bacteria/drug effects , Cross Infection/epidemiology , Fungemia/epidemiology , Adolescent , Adult , Aged , Aged, 80 and over , Bacteremia/microbiology , Bacteria/isolation & purification , Candida/isolation & purification , Child , Child, Preschool , Cross Infection/microbiology , Female , Fungemia/microbiology , Humans , Incidence , Infant , Intensive Care Units , Kuwait/epidemiology , Male , Microbial Sensitivity Tests , Middle Aged , Prevalence
14.
J Infect Chemother ; 5(4): 217-219, 1999 Dec.
Article in English | MEDLINE | ID: mdl-11810521

ABSTRACT

To determine the bacterial etiology of lower respiratory tract infections in Kuwait, we performed quantitative culture of sputum and measured the susceptibilities of the isolated bacteria against different antibiotics. A total of 140 sputum samples were collected for a period of 14 months for the study. Single and multiple pathogens as a cause of infection were isolated from 55 and 15 samples, respectively. A total of 53.8% of Streptococcus pneumoniae were penicillin-resistant and 52% and 57% of Hemophilus influenzae and Moraxella catarrhalis were beta-lactamase positive, respectively. We concluded that the major pathogens of respiratory tract infections in Kuwait were H. influenzae, M. catarrhalis, S. pneumoniae, and Pseudomonas aeruginosa, and there was an increased resistance among the isolated bacteria against commonly used antibiotics.

15.
J Chemother ; 10(4): 285-90, 1998 Aug.
Article in English | MEDLINE | ID: mdl-9720466

ABSTRACT

During the 5-year period 1990-1993 and 1996, 202 Shigella spp. were isolated from stool specimens of symptomatic patients of all age groups seen in our hospital. Over these periods the trend of the incidence of shigellosis showed that 18% of the total strains were isolated during the invasion year (1990) followed by an upsurge (24%) during the Gulf War period (1991) and a steady decline in the post-war period, 17% in 1992 and 14% in 1993. There was another wave of increased isolation rate (27%) during a period of relative calm in the country (1996) studied for comparison. The predominant Shigella species was S. flexneri which accounted for 46% of the 202 isolates, followed by S. sonnei (42%), S. dysenteriae (7%) and S. boydii (5%). Fifty-four percent of the 202 Shigella isolates were resistant to ampicillin, 56% to trimethoprim/sulfamethoxazole, 35% to chloramphenicol, 13% and 9% to cephalothin and amoxicillin/clavulanic acid respectively. All the isolates were fully susceptible to ciprofloxacin, the aminoglycosides and the second- and third-generation cephalosporins. Eighty-seven (43%) of the 202 isolates were resistant to two or more antibiotics. Of the 87 multiply resistant Shigella spp., 58 (67%) were S. flexneri while 19 (22%) were S. sonnei. Shigella resistance to the first-line antibiotics is a major problem that frequently limits the therapeutic options with orally available active antibiotic therapy.


Subject(s)
Anti-Bacterial Agents/pharmacology , Dysentery, Bacillary/drug therapy , Shigella/drug effects , Anti-Bacterial Agents/therapeutic use , Drug Resistance, Microbial , Dysentery, Bacillary/epidemiology , Dysentery, Bacillary/microbiology , Hospitals, Teaching , Humans , Kuwait/epidemiology , Prevalence , Shigella/isolation & purification , Shigella/pathogenicity
16.
J Chemother ; 15(2): 113-7, 2003 Apr.
Article in English | MEDLINE | ID: mdl-12797385

ABSTRACT

PH-027 is a new 5-triazole oxazolidinone synthesized in our laboratories, which shows strong activity against gram-positive aerobic bacteria including clinical isolates. The objective of this study was to investigate the in vitro activity of this compound in comparison with linezolid and other antibiotics against gram-positive and gram-negative anaerobes. The in vitro activity of PH-027 in comparison with those of linezolid and other antimicrobial agents was evaluated against 201 clinical isolates of gram-positive and gram-negative anaerobic bacteria by agar dilution and Etest methods. PH-027 showed excellent activity, with minimum inhibitory concentrations (MIC) in the range of 0.12-4.0 microg/ml against all isolates; MIC90s being 4.0, 1.0, 2.0, 2.0 and 2.0 microg/ml against Clostridium difficile, Peptostreptococcus spp., Bacteroides fragilis, Prevotella bivia and Fusobacterium spp. respectively. In comparison, linezolid had MIC in the range of 0.5-4.0 microg/ml against all isolates, with MIC90s of 2.0, 4.0, 4.0, 4.0 and 2.0 microg/ml against the same set of bacteria respectively. PH-027 demonstrated excellent in vitro activity that is superior to linezolid against Peptostreptococcus spp., B. fragilis and P. bivia. However, against C. difficile and Fusobacterium spp, PH-027 and linezolid showed comparable in vitro activity. Against all anaerobes, metronidazole, PH-027 and, to a lesser extent, linezolid had the most potent activity. From the results of in vitro susceptibility testing, both linezolid and PH-027 show promise in the treatment of anaerobic infections.


Subject(s)
Acetamides/pharmacology , Anti-Bacterial Agents/pharmacology , Bacteria, Anaerobic/drug effects , Clostridioides difficile/drug effects , Oxazolidinones/pharmacology , Triazoles/pharmacology , Linezolid , Microbial Sensitivity Tests
17.
J Chemother ; 11(5): 349-56, 1999 Oct.
Article in English | MEDLINE | ID: mdl-10632380

ABSTRACT

Trovafloxacin is a novel investigational trifluoronaphthyridone antibiotic with broad-spectrum activity against Gram-positive and Gram-negative organisms. Its in-vitro activity and those of eight other antimicrobial agents were evaluated against 497 clinical isolates of Gram-negative anaerobic bacteria by the agar dilution method. Trovafloxacin had excellent activity, with a minimum inhibitory concentration (MIC) range of <0.03-4 microg/ml, against all species. Out of the 497 isolates tested, 496 (99.5%) were inhibited by a concentration of < or = 2.0 microg/ml of trovafloxacin; the remaining two strains were inhibited by a concentration of 4.0 microg/ml. The MIC50s and MIC90s were 0.12 microg/ml and 1.0 microg/ml, respectively. Meropenem, imipenem and piperacillin/tazobactam were also very active. Overall, at the MIC90s, trovafloxacin was as active as meropenem, slightly more active than metronidazole and imipenem, twice as active as amoxicillin-clavulanic acid, five times more active than piperacillintazobactam and 68 times more active than clindamycin. About 21% of the isolates were resistant to cefoxitin, 30% to clindamycin and 40% to piperacillin. Five species in the Bacteroides fragilis group of isolates were highly resistant to metronidazole (MIC >128 microg/ml). In general, the relatively more resistant species were the B. vulgatus, B. ovatus, B. thetaiotaomicron, and B. fragilis sensu stricto, in that order. All the isolates of the B. fragilis group and about 50% of the Prevotella spp. were beta-lactamase positive. Trovafloxacin certainly holds promise as an alternative drug for therapy of anaerobic infections.


Subject(s)
Anti-Bacterial Agents/pharmacology , Anti-Infective Agents/pharmacology , Fluoroquinolones , Gram-Negative Anaerobic Bacteria/drug effects , Naphthyridines/pharmacology , Gram-Negative Anaerobic Bacteria/isolation & purification , Humans , Microbial Sensitivity Tests
18.
J Laryngol Otol ; 116(8): 644-6, 2002 Aug.
Article in English | MEDLINE | ID: mdl-12389698

ABSTRACT

Mesenchymal chondrosarcoma is a rare, aggressive, malignant neoplasm, which arises from extraskeletal sites in 30-40 per cent of cases. It is extremely rare in children. We present a novel case of childhood mesenchymal chondsarcoma arising from the vagus nerve in the neck, resulting in paralysis of the right vocal fold. The clinicopathologic features and management of this case are described along with a brief discussion on the aetiology of vocal fold paralysis in this age group. Current literature on extraskeletal presentation of mesenchymal chondrosarcoma is reviewed.


Subject(s)
Chondrosarcoma, Mesenchymal/diagnosis , Cranial Nerve Neoplasms/diagnosis , Vagus Nerve Diseases/diagnosis , Child , Chondrosarcoma, Mesenchymal/complications , Chondrosarcoma, Mesenchymal/surgery , Cranial Nerve Neoplasms/complications , Cranial Nerve Neoplasms/surgery , Female , Hoarseness/etiology , Hoarseness/surgery , Humans , Tomography, X-Ray Computed , Vagus Nerve Diseases/complications , Vagus Nerve Diseases/surgery
19.
Int J Infect Dis ; 26: 167-70, 2014 Sep.
Article in English | MEDLINE | ID: mdl-25080355

ABSTRACT

OBJECTIVES: To prospectively evaluate the performance of two matrix-assisted laser desorption/ionization time-of-flight mass spectrometry systems (MALDI-TOF MS) for the identification of clinically significant yeast isolates compared to the VITEK 2 system. METHODS: One hundred and eighty-eight consecutive yeast isolates were analyzed by Bruker Biotyper and VITEK MS. The results were compared with the conventional VITEK 2 yeast identification system. Discrepant results were resolved by direct sequencing of rDNA. RESULTS: Accurate identification by VITEK 2, VITEK MS, and Bruker Biotyper MS was 94.1% (177/188), 93.0% (175/188), and 92.6% (174/188), respectively. Three isolates were not identified by VITEK MS, while nine Candida orthopsilosis were misidentified as Candida parapsilosis, as this species is not present in its database. Eleven isolates were not identified or were wrongly identified by Bruker Biotyper and although another 14 were correctly identified, the score was unreliable at <1.7. CONCLUSION: The overall accuracy of rapid MALDI-TOF MS systems was essentially comparable to that of the conventional VITEK 2 yeast identification system. However, future expansion of the databases may further improve the outcome and accuracy of identification of yeast species.


Subject(s)
Candida/isolation & purification , Spectrometry, Mass, Matrix-Assisted Laser Desorption-Ionization/methods , Humans , Reproducibility of Results , Yeasts/isolation & purification
20.
Indian J Med Microbiol ; 29(2): 130-5, 2011.
Article in English | MEDLINE | ID: mdl-21654106

ABSTRACT

OBJECTIVE: This study reports an outbreak of Klebsiella pneumoniae infections in 14 patients during a 2-month period (August-September, 2008) in the intensive care unit (ICU) of a teaching hospital in Kuwait. MATERIALS AND METHODS: The clinical sources were blood (9), urine (3) and respiratory secretions (2) identified by the automated VITEK-2 ID System. Susceptibility testing was performed by the E-test method. Extended-spectrum ß-lactamase (ESBL) production was assessed using the ESBL E-test and confirmed by PCR. Carriage of bla genes was determined by PCR and sequence analysis. The transferability of resistance phenotypes was demonstrated by conjugation experiments and clonal relatedness was determined by PFGE. RESULTS: The isolates were susceptible to imipenem, meropenem, and tigecycline and produced ESBL. All isolates yielded an amplicon of 499 bp with universal consensus primers (MA primers). DNA sequence analysis showed that they all harboured bla CTX-M-15 and bla TEM-1 genes. The environmental isolate obtained from a suction machine was also CTX-M-15/TEM-1 producer. The resistance phenotypes were transferrable to the Escherichia coli J53 r strain. PFGE, revealed two clones, A and B, related with a Dice coefficient of >94.1%. A mortality rate of 21.4% was recorded. CONCLUSION: The outbreak was contained by robust and aggressive infection control measures. This study highlights the first outbreak of CTX-M-15-producing K. pneumoniae associated with high mortality in an adult medical ICU in Kuwait.


Subject(s)
Disease Outbreaks , Klebsiella Infections/epidemiology , Klebsiella Infections/microbiology , Klebsiella pneumoniae/enzymology , beta-Lactamases/biosynthesis , Adult , Aged , Aged, 80 and over , Bacterial Typing Techniques , Bacteriological Techniques , Blood/microbiology , Conjugation, Genetic , Electrophoresis, Gel, Pulsed-Field , Female , Gene Transfer, Horizontal , Genotype , Hospitals, Teaching , Humans , Intensive Care Units , Klebsiella pneumoniae/classification , Klebsiella pneumoniae/genetics , Klebsiella pneumoniae/isolation & purification , Kuwait/epidemiology , Male , Middle Aged , Molecular Typing , Polymerase Chain Reaction , Sequence Analysis, DNA , Sputum/microbiology , Urine/microbiology , beta-Lactamases/genetics
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