Third Kuwaiti Multicenter Survey of Antibiotic Susceptibility of Anaerobic Bacteria: A Comparative Analysis of 20-Year Data.

Objective: This study aimed to evaluate antibiotic susceptibility and antimicrobial resistance trends among clinically significant anaerobes in Kuwait hospitals from 2013 to 2022, comparing these findings with data from 2002 to 2012. Methods: The study prospectively collected 2,317 anaerobic isolates from various body sites across four Kuwaiti hospitals between January 2013 and December 2022. The minimum inhibitory concentrations for 11 antianaerobic antibiotics were determined using E-test methodology. The study analyzed trends and resistance rates across two periods: 2013-2017 and 2018-2022, using statistical analysis for resistance comparison. Results: Of the 2,317 isolates, most were from wounds (42.2%), fluids (28.0%), and tissues (20.5%). Bacteroides fragilis was the most common pathogen (34.0%), followed by Prevotella bivia (13.4%). Over 90% of isolates were susceptible to imipenem, meropenem, tigecycline, and metronidazole, whereas lower susceptibility was observed for penicillin, amoxicillin-clavulanic acid, and clindamycin. Notable differences in resistance profiles since 2002 were observed, especially in amoxicillin-clavulanic acid, piperacillin, piperacillin-tazobactam, and clindamycin. Conclusion: Owing to detected resistance to all antibiotics, susceptibility testing for anaerobic isolates is recommended in severe infections to ensure effective antimicrobial therapy. Continuous surveillance is crucial for developing antibiotic policies to manage invasive anaerobic infections.

Microbiological Profiles and Inflammatory Biomarkers of Bacteremia in Children in a Teaching Hospital in Kuwait: An 8-Year Retrospective Study.

OBJECTIVES: The objectives of this study were to determine the bacterial profiles and prevalence of antibiotic resistance patterns of bacteria causing bacteremia in febrile children and to compare levels of inflammatory markers between children with and without bacteremia in Kuwait from 2015 to 2022. MATERIALS AND METHODS: Isolates from all episodes of significant bacteremia (n = 96) during the study period were recorded and evaluated. Microorganisms were identified using standard microbiological methods. Antimicrobial susceptibility testing was carried out using the VITEK2 system and Etest method. Extended-spectrum ß-lactamase (ESBL) production by Enterobacterales was detected by the double-disk diffusion method and VITEK2 system. Patient age, gender, and inflammatory markers were collected at admission and compared between patients with and without bacteremia. RESULTS: A majority of the patients were infants (37, 40%) and newborns (13, 14%). The main ports of entry were the lower respiratory tract, the genitourinary tract, and the gastrointestinal tract. Streptococcus pneumoniae was the most common pathogen (16, 16.7%) followed by Escherichia coli (12, 12.5%), Staphylococcus aureus (10, 10.4%), and Streptococcus agalactiae (9, 9.4%). High rates of resistance to ampicillin, cefuroxime, ciprofloxacin, and trimethoprim-sulfamethoxazole were observed among the Enterobacterales. The prevalence of ESBL-producing E. coli and K. pneumoniae were 45% and 29%, respectively. The prevalence of methicillin-resistant S. aureus was 30%. Patients with bacteremia had significantly higher white blood cell (WBC) counts, absolute neutrophil count (ANC), C-reactive protein (CRP), and neutrophil-lymphocyte ratio (NLR). CONCLUSION: Continuous surveillance of the prevalence and antimicrobial susceptibility patterns of blood isolates is imperative for the formulation of antibiotic policy. WBC, ANC, CRP, and NLR could be valuable indicators of bacteremia in febrile children.

Etiology and Antibiotic Susceptibility Patterns of Urinary Tract Infections in Children in a General Hospital in Kuwait: A 5-Year Retrospective Study.

OBJECTIVE: The aim of this study was to determine the bacterial profile and prevalence of antibiotic resistance patterns of uropathogens, as well as to evaluate the problem with extended-spectrum ß-lactamases (ESBLs)-producing isolates, causing urinary tract infections (UTIs) in children in Al-Amiri Hospital, Kuwait, over a 5-year period. MATERIALS AND METHODS: Significant isolates from symptomatic pediatric patients with UTIs from January 2017 to December 2021 were identified by conventional methods and by the VITEK 2 identification card system. Antimicrobial susceptibility testing was performed by the disk diffusion method for Gram-positive organisms and an automated VITEK 2 system for Gram-negative organisms. ESBL-producing Enterobacterales were detected by the double-disk diffusion method and VITEK 2 system. RESULTS: Significant bacteriuria was detected in 13.7% of the 9,742 urine samples. Escherichia coli accounted for 67.3% of these, followed by Klebsiella pneumoniae (8.9%), Proteus spp. (5.7%), and Enterococcus spp. (7.4%), respectively. High resistance rates were observed among the Enterobacterales against ampicillin, cephalothin, nitrofurantoin, amoxicillin/clavulanic acid, and trimethoprim-sulfamethoxazole. The prevalence of ESBL-producing E. coli and K. pneumoniae was 26% and 55%, respectively. The most sensitive among the antibiotics tested for Gram-negative organisms were meropenem, amikacin, gentamicin, and piperacillin/tazobactam, while the antibiotics tested for Gram-positive organisms were vancomycin, ampicillin, linezolid, and nitrofurantoin. CONCLUSION: E. coli remains the most common uropathogen. A high percentage of uropathogens causing UTI in children were highly resistant to the first- and second-line antibiotics for the therapy of UTI. ESBL-producing bacteria were highly prevalent in children in our hospital. Local antibiograms should be used to assist with empirical UTI treatment.

Invasive Candida auris infections in Kuwait hospitals: epidemiology, antifungal treatment and outcome.

PURPOSE: Candida auris is a recently recognized yeast pathogen, which has attracted worldwide attention due to its multidrug-resistant nature and associated high mortality rates. Its persistence in hospital environment and propensity of nosocomial transmission underscores the need of continuous monitoring to prevent outbreaks. Since the first case of C. auris candidemia in May, 2014, we have identified 17 additional invasive cases, which are described here. METHODS: Identity of 17 isolates originating from proven or possible cases of invasive C. auris infection and identified as Candida haemulonii by Vitek 2 yeast identification system was confirmed by PCR-sequencing of rDNA. Information about risk factors, treatment and outcomes were retrospectively retrieved from case files. Antifungal susceptibility testing was performed by Etest. RESULTS: Thirteen cases of candidemia and 4 cases of other invasive infections were detected in 6 hospitals across Kuwait. Major risk factors included adult patients with cancer, diabetes, gastrointestinal/liver diseases and extended (> 25 days) hospital stay. All isolates were resistant to fluconazole. Additionally, 5 and 4 isolates were also resistant to voriconazole and amphotericin B, respectively. Despite antifungal treatment, 9 of 15 patients died. Most patients (n = 12) were hospitalized in 2 hospitals that are in close proximity, whereas 5 other patients were from 3 hospitals that are situated > 10 km apart. CONCLUSIONS: Occurrence of successive cases of invasive C. auris infections with resulting mortality in nine patients suggests persistence of this multidrug-resistant yeast in major hospitals in Kuwait. Early detection by continuous surveillance and enforcement of infection control measures are recommended.

A study of the microbiology of diabetic foot infections in a teaching hospital in Kuwait.

The purpose of this study was to determine the microbiological profile of diabetic foot infections (DFIs) and assess the antibiotic susceptibility of the causative agents. Data were obtained from a retrospective analysis of DFI samples collected from June 2007 to July 2008. Specimens were cultured using optimal aerobic and anaerobic microbiological techniques, and antibiotic susceptibility testing was performed according to the methods recommended by the Clinical and Laboratory Standards Institute (CLSI). Extended-spectrum ß-lactamase (ESBL) production was measured using the double disk synergy test and the ESBL Etest. A total of 440 patients were diagnosed with DFIs during this period, and a total of 777 pathogens were isolated from these patients with an average of 1.8 pathogens per lesion. We isolated more Gram-negative pathogens (51.2%) than Gram-positive pathogens (32.3%) or anaerobes (15.3%). Polymicrobial infection was identified in 75% of the patients. The predominant organisms isolated were members of the Enterobacteriaceae family (28.5%), Pseudomonas aeruginosa (17.4%), Staphylococcus aureus (11.8%), methicillin-resistant S. aureus (7.7%), anaerobic Gram-negative organisms (10.8%), and Enterococcus spp. (7%). Vancomycin was the most effective treatment for Gram-positive bacteria, and imipenem, piperacillin-tazobactam and amikacin were the most effective treatments for the Gram-negative bacteria. In conclusion, DFI is common among diabetic patients in Kuwait, and most of the cases evaluated in this study displayed polymicrobial etiology. The majority of isolates were multi-drug resistant. The data gathered in this study will be beneficial for future determinations of empirical therapy policies for the management of DFIs.

A study of the microbiology of breast abscess in a teaching hospital in Kuwait.

OBJECTIVES: To determine the microbiological profile of breast abscess and assess the antibiotic susceptibility of the causative agents. MATERIALS AND METHODS: Data obtained from cases of breast abscess over a period of 3.5 years, June 2006 to December 2009, were retrospectively analyzed. Specimens were cultured using optimal aerobic and anaerobic microbiological techniques. The antibiotic susceptibility test was carried out using the methods recommended by the Clinical and Laboratory Standards Institute. One specimen per patient was analyzed. RESULTS: Of the 114 patients, 107 (93.8%) non-lactating and 7 (6.1%) lactating women were diagnosed with breast abscess during this period. Of the 114 specimens, 83 (73%) yielded bacterial growth. Of these, 115 pathogens were isolated with an average of 1.4 pathogens per abscess. Eighteen (22%) of the 83 specimens yielded mixed bacterial growth. There were more Gram-positive pathogens (60, 52%) than anaerobes (32, 28%) and Gram-negative pathogens (22, 19%). The predominant organisms were methicillin-susceptible Staphylococcus aureus (37, 32%), methicillin-resistant S. aureus (MRSA; 11, 10%), Bacteroides spp. (16, 14%), anaerobic streptococci (14, 12%) and Pseudomonas aeruginosa (9, 8%). Of the 48 S. aureus, MRSA accounted for 11 (23%). All MRSA isolates were susceptible to trimethoprim-sulfamethoxazole and vancomycin. CONCLUSION: S. aureus was the most common pathogenic organism isolated in breast abscesses at Al-Amiri Hospital, Kuwait, of which 23% were MRSA. Nearly a third of the cases were caused by anaerobes, particularly B. fragilis. The data present a basis for the formation of empirical antimicrobial therapeutic policy in the management of breast abscess.

Etiology and antibiotic susceptibility patterns of community- and hospital-acquired urinary tract infections in a general hospital in Kuwait.

OBJECTIVE: Our purpose was to determine the bacterial profile and prevalence of antibiotic resistance patterns of uropathogens, as well as evaluate the problem with extended-spectrum ß-lactamase (ESBL) producing isolates, causing urinary tract infections (UTIs) in Al-Amiri Hospital, Kuwait, over a 3-year period. MATERIALS AND METHODS: Isolates (56,505) from symptomatic UTI cases from January 2005 to December 2007 were identified by conventional methods and the VITEK identification card system. Antimicrobial susceptibility testing was performed by disk diffusion method for Gram-positive organisms and an automated VITEK 2 machine for Gram-negative organisms. ESBL production by the Enterobacteriaceae was detected by the double-disk diffusion method and VITEK-2 system. RESULTS: Significant bacteriuria was detected in 15,064 (26.6%) of the 56,505 urine samples. Escherichia coli accounted for 4,876 (54.9%) from community-acquired UTI (CA-UTI) and 2,253 (36.4%) from hospital-acquired UTI (HA-UTI), followed by Streptococcus agalactiae (1,129, 12.7%) and Klebsiella pneumoniae (962, 10.8%) from CA-UTI cases. Candida spp. (973, 15.7%) and K. pneumoniae (747, 12.1%) were the second and third most prevalent isolates, respectively, in HA-UTI. High resistance rates were observed among the Enterobacteriaceae against ampicillin, cephalothin, ciprofloxacin, piperacillin and trimethoprim-sulfamethoxazole. About 855 (12%) and 291 (17%) of E. coli and K. pneumoniae, respectively, were resistant to ≥4 antibiotics. The prevalence of ESBL-producing E. coli and K. pneumoniae in CA-UTI was 12 and 17% and in HA-UTI 26 and 28%, respectively. CONCLUSION: A high percentage of the uropathogens causing UTI in the Al-Amiri Hospital setting was highly resistant to the first- and second-line antibiotics for the therapy of UTI. ESBL-producing bacteria are highly prevalent in our hospital.

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.

Erythema nodosum and bilateral breast abscesses due to Salmonella enterica serotype Poona.

A woman presented with erythema nodosum followed by bilateral breast abscesses without a gastrointestinal manifestation, due to a rare serotype of Salmonella, namely, Salmonella enterica serotype Poona. This is the first reported case of erythema nodosum presumably associated with Salmonella infection without a gastrointestinal manifestation.

Cystitis caused by Aeromonas caviae.

Aeromonas sp. organisms rarely cause urinary tract infection. We report for the first time a case of urinary tract infection caused by A. caviae in an adult patient with a history of increased frequency of urination, dysuria, hematuria, and weight loss.