Seroconversion of COVID-19 in Frontline Healthcare Workers in a Tertiary Care Hospital in Oman.

Objectives: This research aimed to study the seroconversion among frontline staff at the highest risk of exposure to SARS-CoV-2 infections, including emergency department, critical care, and COVID-19 isolation wards in all healthcare job categories. Methods: We conducted a prospective cohort study on the incidence of seroconversion among frontline health care workers (HCWs) at the Royal Hospital, Muscat, Oman. Two sera were collected 12 weeks apart to look for seroconversion. We used proportions with 95% confidence interval (CI) for categorical data and mean/median as appropriate for continuous data. Results: Fourteen out of 328 HCWs seroconverted in this study accounting for an incidence rate of 3.6%, excluding four HCWs that were positive at baseline. The median age was 43.5 (range = 28-57). About 75.0% of HCWs were between 31-49 years old, with a seroconversion rate of 4.9% (95% CI: 2.7-8.1). Females accounted for most seroconverted HCWs (14/257) at a rate of 5.4% (95% CI: 3.1-8.8). Omanis seroconverted with a rate of 6.4% (95% CI 2.6-12.8), whereas non-Omanis seroconverted at a rate 4.3% (95% CI: 2.2-7.5). Ninety-two percent (302/328) of the staff lived in the capital area, and a minority lived outside the capital (3/26). Thirteen Muscat citizens seroconverted at a rate of 4.3% (95% CI: 2.4-7.1). Nurses comprised the majority (accounting for about 81%) followed by doctors (19%) at rates of 5.6% (95% CI: 3.2-9.2) and 4.2% (95% CI: 1.07-10.9), respectively. Staff covering COVID-19 isolation wards and intensive care unit comprised over 60% (n = 10) of those who seroconverted with a rate of 5.4% (95% CI: 2.8-9.5) followed by infectious diseases doctors and adult emergency at 19.0% (n = 3) and 12.5% (n = 1), respectively. Approximately 81.3% (n = 13) of HCWs performed aerosol-generating procedures at a seroconversion rate of 4.3% (95% CI: 2.4-7.1). About 50.0% of those who seroconverted had a positive polymerase chain reaction (PCR) before seroconversion, 25.0% had a negative PCR before second serology testing, and 25.0% were not tested with PCR. Approximately 20.0% of seroconverted staff had no reported symptoms compared to 80.0% who reported symptoms such as sore throat (70.0%), fever (50.0%), myalgia (20.0%), and a less frequency (15.0%) runny nose, loss of smell, and headache. Conclusions: Detection of infection among HCWs is important to prevent further transmission, especially asymptomatic carriers. A combined screening strategy of symptoms, serology, and PCR might help detect potential infections and asymptomatic carriage.

Characteristics of healthcare workers infected with COVID-19: A cross-sectional observational study.

INTRODUCTION: Coronavirus disease 2019 (COVID-19) is a new emerging infectious disease, first identified in China in December 2019, caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). This study describes the characteristics of healthcare workers (HCWs) who tested positive for COVID-19 in a tertiary care hospital in Oman. METHODS: This was a cross-sectional descriptive analysis of HCWs with COVID-19. RESULTS: During the study period, 204 HCWs tested positive for COVID-19 by rRT-PCR test, with a test positivity rate of 21.2%; the percentage of infected hospital staff was 4.3%. Their mean age was 36 years. Overall, 2.2% of the male staff were infected, while 9.3% of the female staff were infected. Among the clinicians, 4.7% were infected; among the nurses, 4.1% were infected. Regarding acquisition, 61.3% of infections (n = 125) were community-acquired and 25.5% (n = 52) were hospital-acquired; no source was identified in 13.2% of cases (n = 27). There was a significant difference between hospital-acquired and community-acquired COVID-19 according to the different HCW categories (p < 0.001), sex (p = 0.041), and being at risk of COVID-19 exposure in the hospital (p < 0.001). There were no significant differences in relation to nationality (p = 0498), age (p = 0.119), or the presence of co-morbidities (p = 0.326). Seventy-eight percent (n = 160) had no chronic diseases and 44% presented with fever and an acute respiratory infection (n = 90); all made an uneventful full recovery. The peak of infection acquisition was after the Eid Al Fitr festival. CONCLUSIONS: HCWs are at an increased risk of COVID-19 in the workplace. The strengthening of infection control measures to prevent exposures from infected patients and colleagues and to reduce the spread of COVID-19 is a necessity.

First report of human infection with avian influenza A(H9N2) virus in Oman: The need for a One Health approach.

Following the detection of the first human case of avian influenza A subtype H9N2 in 1998, more than 40 cases were diagnosed worldwide. However, the spread of the virus has been more remarkable and significant in global poultry populations, causing notable economic losses despite its low pathogenicity. Many surveillance studies and activities conducted in several countries have shown the predominance of this virus subtype. We present the case of a 14-month-old female in Oman with an A(H9N2) virus infection. This is the first human case of A(H9N2) reported from Oman and the Gulf Cooperation Countries, and Oman is the second country outside of southern and eastern Asia to report a case (cases have also been detected in Egypt). The patient had bronchial asthma and presented with a high-grade temperature and symptoms of lower respiratory tract infection that necessitated admission to a high dependency unit in a tertiary care hospital. It is of urgency that a multisector One Health approach be established to combat the threat of avian influenza at the animal-human interface. In addition to enhancements of surveillance and control in poultry, there is a need to develop screening and preventive programs for high-risk occupations.

Rates of central line-associated bloodstream infection in tertiary care hospitals in 3 Arabian gulf countries: 6-year surveillance study.

The objective of this study was to compare central line-associated bloodstream infection (CLABSI) rates in Gulf Cooperation Council (GCC) states with those of the U.S. National Healthcare Safety Network (NHSN) and International Nosocomial Infection Control Consortium (INICC) using pooled data from 6 hospitals in 3 GCC countries. The overall CLABSI rate was 3.1 per 1,000 central line days. After adjusting for differences in intensive care unit types, the risk of CLABSI in GCC hospitals was 146% higher than NHSN hospitals but 33% lower than INICC hospitals.

Ventilator-associated pneumonia rates in critical care units in 3 Arabian Gulf countries: A 6-year surveillance study.

BACKGROUND: Data estimating the rates of ventilator-associated pneumonia (VAP) in critical patients in Gulf Cooperation Council (GCC) countries are very limited. The aim of this study was to estimate VAP rates in GCC hospitals and to compare rates with published reports of the U.S. National Healthcare Safety Network (NHSN) and International Nosocomial Infection Control Consortium (INICC). METHODS: VAP rates and ventilator utilization between 2008 and 2013 were calculated from aggregate VAP surveillance data using NHSN methodology pooled from 6 hospitals in 3 GCC countries: Saudi Arabia, Oman, and Bahrain. The standardized infection ratios of VAP in GCC hospitals were compared with published reports of the NHSN and INICC. RESULTS: A total of 368 VAP events were diagnosed during a 6-year period covering 76,749 ventilator days and 134,994 patient days. The overall VAP rate was 4.8 per 1,000 ventilator days (95% confidence interval, 4.3-5.3), with an overall ventilator utilization of 0.57. The VAP rates showed a wide variability between different types of intensive care units (ICUs) and were decreasing over time. After adjusting for the differences in ICU type, the risk of VAP in GCC hospitals was 217% higher than NHSN hospitals and 69% lower than INICC hospitals. CONCLUSIONS: The risk of VAP in ICU patients in GCC countries is higher than pooled U.S. VAP rates but lower than pooled rates from developing countries participating in the INICC.

Postrenal transplant renopulmonary zygomycosis with vascular aneurysms responded to surgical treatment and salvage therapy with posaconazole after failure to respond to liposomal amphotericin.

BACKGROUND: Zygomycosis is a difficult to treat and frequently fatal infection affecting immunocompromised and (rarely) immunocompetent patients. It requires a multifaceted approach involving elimination of predisposing factors, surgical debridement, and antifungal therapy. CASE REPORT: We report the case of a postrenal transplant patient who developed disseminated zygomycosis with vascular aneurysms after receiving empirical voriconazole treatment for presumed pulmonary fungal infection in addition to immunosuppression and methylprednisolone pulses for presumed graft rejection, as renal biopsy was declined. Initially, liposomal amphotericin therapy in combination with surgical intervention failed. Addition of posaconazole as salvage therapy improved the patient outcome. He received total of 6 weeks of AmBisome and 12 weeks of posaconazole. CONCLUSIONS: Zygomycosis is a difficult to treat infection. Management includes surgical debridement and antifungal therapy, namely liposomal amphotericin. However, in cases where treatment with liposomal amphotericin along with surgical intervention fails, posaconazole can be given as a salvage therapy. Duration of antifungal treatment should be determined on an individual basis.

Characterization of OXA-181, a carbapenem-hydrolyzing class D beta-lactamase from Klebsiella pneumoniae.

Klebsiella pneumoniae KP3 was isolated from a patient transferred from India to the Sultanate of Oman. K. pneumoniae KP3 was resistant to all ß-lactams, including carbapenems, and expressed the carbapenem-hydrolyzing ß-lactamase OXA-181, which differs from OXA-48 by four amino acid substitutions. Compared to OXA-48, OXA-181 possessed a very similar hydrolytic profile. The bla(OXA-181) gene was located on a 7.6-kb ColE-type plasmid and was linked to the insertion sequence ISEcp1. The ISEcp1-mediated one-ended transposition of bla(OXA-181) was also demonstrated.

NDM-1-producing Klebsiella pneumoniae isolated in the Sultanate of Oman.

OBJECTIVES: To analyse the mechanisms responsible for multidrug resistance in two carbapenem-resistant Klebsiella pneumoniae isolates recovered from patients hospitalized in Oman. METHODS: PCR and sequencing were used to search for ß-lactamase and 16S RNA methylase genes. Multilocus sequence typing was used to determine the sequence type (ST) of each isolate. Clonal relationships were evaluated by PFGE. RESULTS: Both isolates carried the bla(NDM-1) carbapenemase gene. Isolate 601 was recovered from a patient who was transferred from India, whereas isolate 419 was from an Omani patient who had not travelled abroad. The two isolates were clonally unrelated, and belonged to ST14 (isolate 601) and ST340 (isolate 419). In addition to NDM-1, the ST14 isolate expressed ß-lactamases CTX-M-15, SHV-28, OXA-1, OXA-9 and TEM-1, and the aminoglycoside resistance methylase ArmA. The ST340 isolate expressed ß-lactamases SHV-11, OXA-1 and ArmA. In both isolates, the bla(NDM-1) gene was located on plasmids that were of similar size (170 kb), but of different incompatibility groups. CONCLUSION: This is the first description of NDM-1 producers in the Arabian peninsula and in the Middle East.