Laboratory Diagnosis, Antimicrobial Susceptibility And Genuine Clinical Spectrum of Streptococcus anginosus Group; Our Experience At A University Hospital.

Background: Streptococcus anginosus group (SAG) may be unrecognized or misidentified in the Clinical Microbiology Laboratory resulting in under-reporting. Consequently, their role as genuine pathogens remains underestimated. Objectives: The aim of this study is to suggest a reasonable identification approach that is suitable for laboratories of limited resources, to detect any possible emerging antimicrobial resistance, and to assess the genuine clinical spectrum of infections that are caused solely by SAG. Methods: Our research included 190 bacterial isolates from 190 patients. The isolates were examined by colonies' morphology, odor, hemolytic pattern on 5% sheep Blood agar and Gram staining. Lancefield serogrouping was determined by agglutination test. Antimicrobial susceptibility testing (AST) was performed by disc diffusion method. The isolates were subjected to automated identification and AST by Vitek 2 compact instrument. The collected patients' data included age, gender, clinical condition and/or site of infection, and probable predisposing factor. Results: All isolates produced minute-sized colonies that consistently generated distinct odor. The isolates showed variable hemolytic patterns, and the majority (74.7%) were non-hemolytic. The isolates showed different Lancefield serogroups, and the commonest was group F (54.2%). A total of 188 (98.9%) isolates were identified by Vitek 2 compact instrument at ≥95% confidence. The isolates showed high rates of antimicrobial susceptibility, however the highest rate of antimicrobial resistance was detected to gentamicin (60.5%). A total of 98 (51.6%) strains were isolated from superficial non-invasive skin and soft tissue infections, 67 (35.3%) strains from deep invasive and sterile body fluids' infections, and 25 (13.1%) strains from upper respiratory tracts' infections. Conclusion: a combination of phenotypic characteristics could still represent a reasonable Laboratory identification battery. There was no significant emerging antimicrobial resistance detected. A broad genuine spectrum of clinical infections that are caused solely by SAG was reported in our institution.

Fungal keratitis due to Scopulariopsis brevicaulis and a potential promising therapeutic effect of antibacterial agents: A case report.

INTRODUCTION: Microbial keratitis is a serious potentially blinding corneal infection. Contact lens wear remains the most common predisposing factor. Fungal keratitis represent only a small fraction of the overall number of cases of contact lens-associated microbial keratitis, however they are proportionally more severe. PATIENT CONCERNS: An 18-year-old female, who occasionally used eye cosmetic soft contact lenses, presented with pain, redness, and blurring of vision in her left eye. DIAGNOSIS: The left eye showed decreased visual acuity, central corneal ulcer and abscess, and severe ciliary injection. A provisional diagnosis of infectious keratitis was considered. INTERVENTION: Corneal scrapings were aseptically collected and directly inoculated onto sterile bacterial and fungal agar plates that were immediately incubated. The patient was admitted and started on topical and systemic antibacterial agents. OUTCOMES: The infection showed signs of satisfactory clinical resolution. However, the mold Scopulariopsis brevicaulis was isolated in pure colonies 5 days after presentation. CONCLUSION: We report the first case from Jordan of fungal keratitis caused by the mold S brevicaulis. A high index of suspicion is required for fungal keratitis caused by S brevicaulis in immunocompetent patients who wear contact lenses despite its rarity. This fungal infection was successfully treated using antibacterial agents. However, larger studies are recommended to investigate the clinical effectiveness of antimicrobial agents that have both antibacterial and antifungal effects and to assess their role as empirical therapeutic modalities for infectious keratitis.

Is methicillin-resistant Staphylococcus aureus a common pathogen in ventilation-associated pneumonia?: The experience of a tertiary teaching hospital in Jordan.

ABSTRACT: Ventilator-associated pneumonia is a life threatening device related infection in intensive care units. Methicillin-resistant Staphylococcus aureus is considered a common contagious pathogen causing pneumonia and sepsis.To assess the prevalence of S aureus in comparison to other pathogens, and their antibacterial sensitivity profile in ventilator-associated pneumonia.Data regarding ventilator-associated pneumonia of adults admitted to the intensive care unit, at the Jordan University of Science and Technology Hospital, between 2012 and 2018 were extracted from the computerized system. Microorganisms and their susceptibility profiles were identified according to the Clinical and Laboratory Standards Institute.There were 547 isolates, of which 35 (6.4%) were Gram positive, 59% were methicillin resistant. Gram-negative isolates were present in 507 (92.6%) isolates, of which 82% were multidrug resistant, and 1% were Candida species.Gram-negative bacterial infections were significantly associated with ventilation usage. S aureus was not the predominant pathogen.

Implementation of the WHO Approved "Tailoring Antimicrobial Resistance Programs (TAP)" Reduces Patients' Request for Antibiotics.

The misuse of antibiotics is a worldwide public health concern. Behavioral Intervention programs that aim to reduce patients' own request for antibiotics during their visit to primary care clinics is an attractive strategy to combat this problem. We tested the effectiveness of a behavioral modification method known as the Tailoring Antimicrobial resistance Programs (TAP) in reducing the request for antibiotics by patients visiting primary care clinics for mild upper respiratory tract infections (URTIs). A stratified cluster randomized design with two groups pre-post, comparing intervention with the control, was conducted in six health centers. TAP was implemented for eight weeks. Request for antibiotics was assessed before (period 1) and after introducing TAP (period 2). The percentage of patients or their escorts who requested antibiotics in period 1 was 59.7% in the control group and 60.2% in the intervention group. The percentage of patients who requested antibiotics did not significantly change between period 1 and 2 in the control group, who continued to receive the standard of care. The above percentage significantly decreased in the intervention group from 60.2% to 38.5% (p < 0.05). We conclude that behavioral change programs including TAP are a viable alternative strategy to address antibiotic misuse in Jordan.

Detection and molecular characterisation of rotavirus and norovirus infections in Jordanian children with acute gastroenteritis.

Rotavirus and norovirus are globally important causes of paediatric gastroenteritis, but no studies of viral genotypes have been reported from Jordan. We undertook a molecular epidemiological study in children hospitalised with acute gastroenteritis in Jordan between January 2006 and December 2007. Among 368 children, rotavirus and norovirus infections were detected in 49.5% and 11.4% of children, respectively. Rotavirus genotypes P[8],G1 (56%), P[4],G2 (14%) and P[8],G9 (13%) were most commonly identified, consistent with results of global rotavirus surveillance studies. Norovirus GII.3 was the most commonly detected genotype, followed by GII.4, contrasting with most studies in which GII.4 has predominated.

Molecular epidemiology and disease severity of respiratory syncytial virus in relation to other potential pathogens in children hospitalized with acute respiratory infection in Jordan.

Human respiratory syncytial virus (HRSV) is the major viral cause of acute lower respiratory tract infections in children. Few data about the molecular epidemiology of respiratory syncytial virus in developing countries, such as Jordan, are available. The frequency and severity of infections caused by HRSV were assessed in hospitalized Jordanian children <5 years of age compared with other potential etiological agents. Overall a potential pathogen was detected in 78% (254/326) of the children. HRSV was detected in 43% (140/326) of the nasopharyngeal aspirates. HRSV was found more frequently during the winter (January/February), being less frequent or negligible by spring (March/April). Analysis of 135 HRSV-positive strains using restriction fragment length polymorphism showed that 94 (70%) belonged to subgroup A, and 41 (30%) to subgroup B. There were also two cases of mixed genotypic infection. Only four of the six previously described N genotypes were detected with NP4 predominating. There were no associations between subgroup or N-genogroup and disease severity. HRSV was significantly associated with more severe acute respiratory infection and the median age of children with HRSV was lower than for those without. Next in order of frequency were adenovirus (116/312: 37%), human bocavirus (57/312: 18%), rhinovirus (36/325: 11%), Chlamydia spp. (14/312: 4.5%), human metapneumovirus (8/326: 2.5%), human coronavirus NL63 (4/325: 1.2%), and influenza A virus (2/323: 0.6%). Influenza B; parainfluenza viruses 1-4, human coronavirus HKU1 and Mycoplasma pneumoniae were not detected.

Human bocavirus infection among children, Jordan.

Human bocavirus was detected in 57 (18.3%) of 312 children with acute respiratory infection (ARI) who required hospitalization in Jordan. It was also detected in 30 (21.7%) of 138 children with severe ARI, in 27 (15.5%) of 174 with mild or moderate disease, and in 41 (72%) of 57 with other pathogens.

Evaluation of direct light microscopy for rapid detection of microorganisms in blood cultures.

OBJECTIVE: The aim of this study was to evaluate the use of direct light microscopy (x 40 objective) of unstained uncentrifuged blood-broth mixtures for rapid detection of microorganisms in blood cultures. METHODS: Two thousand two hundred and ninety-four blood cultures were investigated in this study. Blood cultures were processed in the Clinical Microbiology Laboratory, Queen Alia General Hospital, Amman, Jordan from January to December 2001. We compared the results of direct light microscopy and subcultures in 3 stages: macroscopically positive blood culture bottles, macroscopically negative blood culture bottles after 9-17 hours, and macroscopically negative blood culture bottles after 7 days of incubation. RESULTS: The total positive blood cultures was 434 (18.9%). Three hundred and fifty three (81.3%) were positive by macroscopic examination and direct light microscopy and grew viable organisms, 34 were macroscopically negative blood cultures that grew viable organisms after 9-17 hours of incubation in which 32 (94.1%) were positive by direct light microscopy and 47 macroscopically negative blood cultures that grew viable organisms after 7 days of incubation in which 45 (95.7%) were positive by direct light microscopy. CONCLUSION: The direct light microscopy methodology proved to be simple, rapid, cost effective, accurate and sensitive technique for the early detection of bacteremia.