The Clinical Efficacy of Adding Ceftazidime/Avibactam to Standard Therapy in Treating Infections Caused by Carbapenem-Resistant Klebsiella pneumonia with blaOXA-48-like Genes.

Ceftazidime/avibactam (CAZ-AVI) is FDA-approved for managing infections caused by resistant gram-negative bacilli, particularly infections via carbapenem-resistant Enterobacterales pathogens. The clinical data are still limited, particularly those in Saudi Arabia. The present study is a retrospective cohort study that was carried out at the Armed Forces Hospital in the southern region of Saudi Arabia to compare the clinical and microbiological outcomes for CAZ-AVI-treated patients as monotherapy and as an add-on to standard therapy for carbapenem-resistant Klebsiella pneumonia (CRKP) OXA-48 infections to those treated with standard drugs. The study included CRKP OXA-48-like infected patients who were administered antibiotics for more than seven days from 1 August 2018 to May 2023. Patients' baseline characteristics and demography were extracted from the clinical records, and their clinical/microbiology efficiencies were assessed as per the corresponding definitions. Univariate and multivariate logistic regressions were conducted to identify the potential independent variable for CAZ-AVI efficiency. A total of 114 patient files were included for the evaluation. Among these patients, 64 used CAZ-AVI combined with standard therapy and were included in the intervention group, and 50 of them used standard therapy and were included in the comparative group. Following analysis, CAZ-AVI's clinical success was 42.2% (p = 0.028), while the intervention versus comparative groups showed decreased 30-day all-cause mortality (50.0% versus 70.0%; p = 0.036) and infection recurrence (7.8% versus 24.0%; p = 0.019), as well as substantially increased rates of microbial eradication (68.8% versus 42.0%; p = 0.007). CAZ-AVI add-on therapy rather than monotherapy showed statistically significant favored clinical and microbial outcomes over the standard therapy. Furthermore, sex (female %), ICU admission, and fever were negatively associated with patients' 30-day all-cause mortality, serving as independent negative factors. Only fever, CRP bio levels, inotropes, and ICU admissions were significant predictors influencing the CAZ-AVI's clinical efficiency. The duration of CAZ-AVI therapy positively influenced CAZ-AVI's microbial eradication, while both WBC counts and fever experiences were negative predictors. This study shows the effective usage of CAZ-AVI against CRKP OXA-48-like infections. The influencing independent variables depicted here should recommend that clinicians individualize the CAZ-AVI dose based on co-existing risk factors to achieve optimal survival and efficacy. Prospective multicenter and randomized control studies are recommended, with individualized CAZ-AVI precision administration implemented based on patients' characteristics.

Epidemiology of group A rotavirus infection after the introduction of monovalent vaccine in the National Immunization Program of Saudi Arabia.

This study aimed to investigate the prevalence of group A rotavirus (RVA) gastroenteritis and the distribution of the RVA genotypes as well as to determine a possible change in the age of occurrence of the RVA infection in the first 2 years after Rotarix® vaccine introduction in Saudi Arabia. This descriptive study included 850 hospitalized children <5 years of age with acute gastroenteritis (AG) between October 2013 and September 2015. Overall, 78 (9.2%) children were positive for RVA during the study period with a positivity rate ranging from 11.3% in the first year of the study to 6.8% in the second year. G1 (47.4%) was the predominant G type, followed by G2 (28.2%) and G9 (10.3%). The most common P type was P[8] (69.2%) followed by P[4] (25.6%). The decrease in the prevalence of G1P[8] from 51% to 37.1% was associated with an increase in the prevalence of G2P[4] from 21.6% to 33.3% during the 2-year study period. This study demonstrated a significant decrease in the prevalence of RVA-AG cases in the first 2-year period after vaccine introduction, especially in the age group between 1 and 12 months, and a reduction in the circulation of G1P[6]. The parallel rise and spread of G2P[4] in post-vaccination period might pose an impact to long-term vaccine efficacy. Continued surveillance studies in different Saudi regions are crucial to document the effectiveness of Rotarix® vaccine and evaluate the potential emergence of rare/novel RVA genotypes. J. Med. Virol. 89:429-434, 2017. © 2016 Wiley Periodicals, Inc.

Retrospective review of invasive pediatric pneumococcal diseases in a military hospital in the southern region of Saudi Arabia.

BACKGROUND AND OBJECTIVES: Invasive pneumococcal disease (IPD) is associated with high case-fatality rates and serious chronic sequelae. The objective of this study was to assess the magnitude of invasive pneumococcal infections in a pediatric population without universal vaccination during childhood in a single hospital. DESIGN AND SETTING: Retrospective review of all pediatric cases of invasive pneumococcal infection during a 7-year period. PATIENTS AND METHODS: We reviewed the microbiological and clinical records of cases of IPD in children <13 years of age admitted to the Armed Forces Hospital, Southern Region, Saudi Arabia. RESULTS: We identified 41 patients with IPD; 27 (66%) were <2 years of age. Four (50%) of those with pneumoccal meningitis were <2 years of age. The case fatality was 3 of 41 (7.3%) due to meningitis and 2 of 41 (5%) due to sepsis, with a case fatality of 5 (12%) due to meningitis and sepsis. Nine patients developed sequelae; of those with meningitis, 5 (73%) developed sequelae. Only 15 (41%) patients had predisposing medical conditions. The overall intermediate and high levels of pneumococcal resistance to penicillin and ceftriaxone were found to be 48.5%, 2.4% and 2.4%, 0%, respectively. None of the pneumococcal isolates were serotyped, and none of the patients had been vaccinated against pneumococcal infections in our hospital. CONCLUSIONS: Despite the presence of a targeted immunization program, a considerable number of cases of invasive pneumococcal infections were reported among our pediatric population over a period of 7 years. Prospective studies in serotypes and antibiotic resistance from the southern region are needed to provide baseline information for the formulation and evaluation of a national prevention and control program.