Isolation of Lodderomyces elongisporus from the Catheter Tip of a Fungemia Patient in the Middle East.

Lodderomyces elongisporus is phenotypically closely related to Candida parapsilosis and has recently been identified as an infrequent cause of bloodstream infections in patients from Asia and Mexico. We report here the isolation of Lodderomyces elongisporus from the catheter of a suspected case of fungemia. The identity of the isolate was confirmed by phenotypic characteristics and ribosomal DNA sequencing.

Diagnosis of endocarditis caused by Mycobacterium abscessus.

We report a fatal case of native valve endocarditis due to Mycobacterium abscessus in a hemodialysis patient. The diagnosis was based on culture isolation of acid-fast bacilli from peripheral blood and a permanent catheter tip, and their identification as M abscessus by a reverse hybridization-based assay and direct DNA sequencing of the 16S-23S internal transcribed spacer region. Rapid diagnosis and combination therapy are essential to minimize mortality due to this pathogen. Although combination therapy was started with clarithromycin and tigecycline, the patient refused to take clarithromycin due to severe abdominal pain. The patient became afebrile after therapy with tigecycline alone although bacteremia persisted. He was discharged against medical advice and readmitted three months later for persistent fever. His blood cultures again yielded M abscessus and a transesophageal echocardiogram showed two mobile vegetations. The patient was noncompliant with therapy and died due to cardiac arrest and multiorgan failure. This report shows that M abscessus should also be considered in the differential diagnosis of infective endocarditis in hemodialysis patients.

Antimicrobial resistance in clinical isolates of Streptococcus pneumoniae in a tertiary hospital in Kuwait, 1997-2007: implications for empiric therapy.

OBJECTIVE: This study evaluated antibiotic resistance trends in Streptococcus pneumoniae isolated in a tertiary hospital in Kuwait and its implications for empiric therapy. MATERIALS AND METHODS: Antimicrobial susceptibility of 1353 strains of S. pneumoniae isolated from clinical specimens during 1997-2007 was performed by disc diffusion method. MIC was determined by E test. The results were compared for 1997-2001, 2002-2005 and 2006-2007. RESULTS: The prevalence of resistance for the respective periods were as follows: penicillin, 51.3%, 61.3% and 54.5%; erythromycin, 31.2%, 36.7% and 37.7%; tetracycline, 30.8%, 45.3% and 41.3%; co-trimoxazole, 49.5%, 58.5% and 62.8%; clindamycin, 20.4%, 20.6% and 24.5% and chloramphenicol, 8.1%, 8.9% and 3.7%. All were susceptible to vancomycin and rifampicin. For oxacillin-resistant isolates, penicillin resistance was rare (0.8%) with the new non-meningeal breakpoint. However, using the meningeal breakpoints, resistance increased for penicillin from 0.6%, to 28.7%, for cefotaxime from none to 16.5%, and for ceftriaxone from none to 7%. Intermediate resistance to meropenem increased from 1.7% to 22.4%. Multiple drug resistance increased from 22.4% to 37.8%. CONCLUSION: The study demonstrated that antimicrobial resistance of S. pneumoniae is increasing in Kuwait. However, the results of MIC determinations indicated that penicillin can still be used for therapy of non-meningeal infections. High prevalence of erythromycin resistance suggests that therapy of pneumonia with a macrolide alone may result in failure and should be based on results of susceptibility testing.

Antibacterial resistance and their genetic location in MRSA isolated in Kuwait hospitals, 1994-2004.

BACKGROUND: Methicillin-resistant Staphylococcus aureus (MRSA) continues to be a major cause of serious infections in hospitals and in the community worldwide. In this study, MRSA isolated from patients in Kuwait hospitals were analyzed for resistance trends and the genetic location of their resistance determinants. METHODS: Between April 1994 and December 2004, 5644 MRSA isolates obtained from different clinical samples were studied for resistance to antibacterial agents according to guidelines from the National Committee for Clinical Laboratory Standards and the British Society for Antimicrobial Chemotherapy. The genetic location of their resistance determinants was determined by curing and transfer experiments. RESULTS: They were resistant to aminoglycosides, erythromycin, tetracycline, trimethoprim, fusidic acid, ciprofloxacin, chloramphenicol, rifampicin, mupirocin, cadmium acetate, mercuric chloride, propamidine isethionate and ethidium bromide but susceptible to vancomycin, teicoplanin and linezolid. The proportion of the isolates resistant to erythromycin, ciprofloxacin and fusidic acid increased during the study period. In contrast, the proportion of isolates resistant to gentamicin, tetracycline, chloramphenicol and trimethoprim declined. High-level mupirocin resistance increased rapidly from 1996 to 1999 and then declined. They contained plasmids of 1.9, 2.8, 3.0, 4.4, 27 and 38 kilobases. Genetic studies revealed that they carried plasmid-borne resistance to high-level mupirocin resistance (38 kb), chloramphenicol (2.8-4.4 kb), erythromycin (2.8-3.0 kb) and cadmium acetate, mercuric chloride, propamidine isethionate and ethidium bromide (27 kb) and chromosomal location for methicillin, the aminoglycosides, tetracycline, fusidic acid, ciprofloxacin and trimethoprim resistance. Thus, the 27 kb plasmids had resistance phenotypes similar to plasmids reported in MRSA isolates in South East Asia. CONCLUSION: The prevalence of resistance to erythromycin, ciprofloxacin, high-level mupirocin and fusidic acid increased whereas the proportion of isolates resistant to gentamicin, tetracycline, chloramphenicol and trimethoprim declined during the study period. They contained 27-kb plasmids encoding resistance to cadmium acetate, mercuric chloride, propamidine isethionate and ethidium bromide similar to plasmids isolated in MRSA from South East Asia. Molecular typing of these isolates will clarify their relationship to MRSA from South East Asia.

Molecular characterization of nitroimidazole resistance in metronidazole-resistant bacteroides species isolated from hospital patients in Kuwait.

OBJECTIVES: The aim of this study was to screen for infections caused by metronidazole (MTZ)-resistant Bacteroides spp., and to characterize the genes that encode the MTZ resistance. MATERIALS AND METHODS: A total of 7 MTZ-resistant Bacteroides spp. were isolated from 5 patients with MTZ-resistant infections. These organisms were investigated for carriage of genes that encode MTZ resistance. The presence of these genes was investigated by PCR and the PCR products were subjected to PCR-RFLP analysis. RESULTS: The strains were MTZ-resistant with minimum inhibitory concentrations of > 32 microg/ml. The presence of nim genes was indicated by PCR in all 7 strains. PCR-RFLP analysis of the nim gene products demonstrated two of the five reported resistance genes, nimA-nimE. These two resistance genes were nimE in 5 of the 7 isolates and nimA in 2 strains. CONCLUSION: MTZ-resistant Bacteroides spp. have been isolated from patients in Kuwait. Nim genes, specifically nimE and nimA, mediate the drug resistance in these isolates. The methods used in detecting these genes are rapid, accurate and relatively inexpensive and could be adopted easily to help in monitoring emergence of MTZ resistance determinants in Kuwait.

Prevalent PCR ribotypes of clinical and environmental strains of Clostridium difficile isolated from intensive-therapy unit patients in Kuwait.

Ninety-five isolates of Clostridium difficile from symptomatic and asymptomatic patients and 18 from their environment in the intensive-therapy units (ITUs) of four teaching hospitals in Kuwait were typed by PCR amplification of rRNA intergenic spacer regions (PCR ribotyping). A total of 32 different ribotypes was detected among the clinical isolates. The predominant ribotypes from the clinical isolates were types 097 and 078, which accounted for approximately 40 % of all isolates in the ITUs in Kuwait. Ribotypes 097 (toxigenic), 078 (toxigenic) and 039 (non-toxigenic) were three distinct clones that were circulating in all four hospitals. Ribotypes 097, 078 and 076 (i.e. 50 % of isolates from symptomatic patients) were the predominant isolates associated with C. difficile-associated disease (CDAD). The environmental isolates belonged to a diverse range of ribotypes, with no particular types common to all the hospitals. Ribotype 078 was found only in the patient environment in Mubarak hospital, while ribotype 097 was restricted to Amiri hospital. The hospital environment occupied by symptomatic as well as symptom-free patients was contaminated with C. difficile. Eight new strains that did not match any in the PCR ribotype library established at the PHLS Anaerobe Reference Unit, Cardiff, UK, were assigned ribotypes 105, 125, 128, 129, 131, 134, 140 and 141. These findings show that the isolates associated with CDAD in Kuwait are different from those found in the UK and some other European countries.