Risk factors, antifungal susceptibility, complications, and outcome of Candida auris bloodstream infection in a tertiary care center in the western region of Saudi Arabia.

BACKGROUND: Candida auris, an emerging multidrug-resistant fungus species that grows as yeast, causes bloodstream infection, and is associated with high mortality rates. In this study, we identified risk factors associated with C. auris bloodstream infection, antifungal susceptibility pattern, complications, and outcome of the infection. METHODS: This single-center cross-sectional retrospective study was conducted at King Abdulaziz Medical City, a tertiary care facility in Jeddah, Saudi Arabia, which included all patients 18 years or above who have had one or more blood cultures for C. auris between January 2021 and December 2022. We aimed to identify the risk factors associated with C. auris bloodstream infection, antifungal susceptibility patterns, complications, and outcomes at our center. RESULTS: Forty-six patients with C. auris-positive blood cultures were included. All the patients had healthcare-associated infections. The mean age was 64.67 years, and the majority of patients were male (73.9 %). The most common concomitant hospital-acquired infections were skin and soft tissue infections (37 %), followed by hospital-acquired pneumonia (34.8 %) and intra-abdominal infections (26.1 %). The mean total white blood cell count, procalcitonin, and C-reactive protein was 10.5 ± 5.99 × 109/L, 2.63 ± 4.82 µg/L, and 90.3 ± 64.1 mg/L, respectively. Hypertension (73.9 %) was the most common comorbidity, followed by diabetes mellitus (58.7 %) and renal dysfunction (54.3 %). Risk factors associated with C. auris candidemia included antibiotic use (91.3 %), especially for > 14 days (78.3 %), C. auris colonization (60.9 %), use of central venous catheters, especially when the catheter was in place for >30 days (80.4 %), ICU admission in the last 30 days before C. auris-positive blood culture (93.5 %), especially for more than two weeks (76.1 %), mechanical ventilation (89.1 %), total parenteral nutrition (13 %), previous intra-abdominal surgery (30.4 %), and immunosuppressive therapy (56.5 %). A total of 97.8 % of C. auris isolates were resistant to fluconazole and 17.4 % were resistant to amphotericin B. Endocarditis and endophthalmitis were reported in one (2.2 %) patient each. The all-cause mortality at 30 days was 47.8 %. CONCLUSION: Our study is one of the few studies available globally on C. auris bloodstream infection that investigated risk factors, antifungal susceptibility, complications, and outcomes. A thorough screening and risk assessment strategy should aid infection control, preventing it from becoming a major concern in the future.

Prevalence of Carbapenem-Resistant Enterobacteriaceae in Western Saudi Arabia and Increasing Trends in the Antimicrobial Resistance of Enterobacteriaceae.

PURPOSE:  The aim of the study is to estimate the prevalence rate of carbapenem-resistant Enterobacteriaceae (CRE) and to determine the types of carbapenemase genes present in patients admitted to King Abdulaziz Medical City (KAMC-J) and King Abdulaziz University Hospital (KAUH), both in Jeddah, Saudi Arabia. METHODS:  A total of 180 isolates were analyzed which were included on the basis of retrospective chart review of patients from KAMC-J and KAUH between 1st April 2017 to 30th March 2019. The prevalence of carbapenemase genes ( blaIMP, blaVIM, blaKPC, blaNDM-1, and blaOXA-48) was evaluated by Xpert® Carba-R (Cepheid, Sunnyvale, CA, USA). We assessed the CRE prevalence and described their susceptibility to antimicrobial agents based on antibiogram reports.  Results: Klebsiella pneumoniae showed a higher frequency of bla OXA-48 (79%) than bla NDM (11.7%) genes (p=0.007). The CRE prevalence in KAUH was 8% in 2017 and increased to 13% in 2018. In KAMC-J, the prevalence was 57% in 2018 and 61% in 2019. K. pneumoniae was found to be the most frequently isolated causative organism followed by Escherichia coli . The  bla OXA-48 (76.1%) gene was predominant among overall isolates followed by bla NDM (13.9%); both genes coexisted in 6.1% of the isolates. CONCLUSION:  During the study period, the prevalence of CRE considerably rose in the two tertiary care institutions from western Saudi Arabia. In the CRE isolates, bla OXA-48 was discovered to be the most common gene. We recommend an antimicrobial resistance surveillance system to detect the emergence of resistant genes through use of new rapid diagnostic tests and monitor antimicrobial use in order to improve clinical outcomes of CRE infections given the severity of infection associated with the CRE isolates as well as the limited treatment options available.

Epidemiological and molecular description of nosocomial outbreak of COVID-19 Alpha (B.1.1.7) variant in Saudi Arabia.

BACKGROUND: Nosocomial outbreaks frequently occurred during the Coronavirus disease 2019 (COVID-19) pandemic; however, sharing experiences on outbreak containment is vital to reduce the related burden in different locations. OBJECTIVES: This article aims at sharing a practical experience on COVID-19 outbreak containment, including contact tracing, screening of target population, testing including molecular analysis, and preventive modalities. It also provides an epidemiological and molecular analysis of the Severe Acute Respiratory Syndrome Coronavirus 2 (SARS­CoV­2) infection outbreak in a tertiary care hospital in Saudi Arabia. METHODS: The outbreak occurred in a non-COVID medical ward at a tertiary care hospital in Jeddah, Saudi Arabia, from 22nd March and 15th April 2021. The multidisciplinary outbreak response team performed clinical and epidemiological investigations. Whole-Genome Sequencing (WGS) was implemented on selected isolates for further molecular characterization. RESULTS: A total of eight nurses (20 % of the assigned ward nurses) and six patients (16.2 % of the ward admitted patients at the time of the outbreak) tested positive for the SARS-CoV-2 virus based on PCR testing. The outbreak investigation identified strong evidence of an epidemiologic link between the affected cases. WGS revealed a set of spike mutations and deletions specific to the Alpha variant (B.1.1.7 lineage). All the nurses had mild symptoms, and the fatality among the patients was 50 % (three out of the six patients). CONCLUSIONS: The current nosocomial COVID-19 outbreak, caused by the Alpha variant, revealed multiple breaches in the adherence to the hospital infection control recommended measures. Containment strategies were successful in controlling the outbreak and limiting infection spread. Molecular analysis and genome sequencing are essential tools besides epidemiological investigation to inform appropriate actions, especially with emerging pathogens.

Long-term comparative pharmacovigilance of orally transmitted Chagas disease: first report.

BACKGROUND: Two old drugs are the only choice against Trypanosoma cruzi and little is known about their secondary effects in the acute stage of oral-transmitted Chagas disease (ChD). METHODS: A cross-sectional analytical surveillance study was conducted in a sizable cohort of patients seen during the largest acute foodborne ChD microepidemic registered so far. Individuals were treated with benznidazole (BNZ) or nifurtimox (NFX). 'Common Terminology Criteria for Adverse Events' was assessed to categorize side effects according to severity. RESULTS: Out of 176 treatments applied, 79% had one or more adverse effects, which predominated in adults (97.8%) as compared to children (75.5%). Risk of side effects with NFX was significantly higher than BNZ. Four adults and a child treated with NFX had severe side effects (pulmonary infarction, facial paralysis, neutropenia, blurred vision, bone marrow hypoplasia) warranting hospitalization, and drug suspension. Adverse effects frequently reported with NFX were abdominal pain, hyporexia, weight loss, headache, nausea and lymphocytosis, whereas skin rash, neurosensory effects, hyporexia, fatigue, pyrosis, abdominal pain and eosinophilia were observed with BNZ. CONCLUSIONS: Frequency and severity of side effects during treatment of acute oral infection by T. cruzi demand direct supervision and close follow-up, even in those asymptomatic, to prevent life-threatening situations.

Prevalence of antiretroviral drug resistance among treatment-naive and treated HIV-infected patients in Venezuela.

An in-house, low-cost method was developed to determine the genotypic resistance of immunodeficiency virus type 1 (HIV-1) isolates. All 179 Venezuelan isolates analysed belonged to subtype B. Primary drug resistance mutations were found in 11% of 63 treatment-naïve patients. The prevalence of resistance in isolates from 116 HIV-positive patients under antiretroviral treatment was 47% to protease inhibitors, 65% to nucleoside inhibitors and 38% to non-nucleoside inhibitors, respectively. Around 50% of patients in the study harboured viruses with highly reduced susceptibility to the three classical types of drugs after only five years from their initial diagnoses.

Prevalence of antiretroviral drug resistance among treatment-naive and treated HIV-infected patients in Venezuela

An in-house, low-cost method was developed to determine the genotypic resistance of immunodeficiency virus type 1 (HIV-1) isolates. All 179 Venezuelan isolates analysed belonged to subtype B. Primary drug resistance mutations were found in 11 percent of 63 treatment-naïve patients. The prevalence of resistance in isolates from 116 HIV-positive patients under antiretroviral treatment was 47 percent to protease inhibitors, 65 percent to nucleoside inhibitors and 38 percent to non-nucleoside inhibitors, respectively. Around 50 percent of patients in the study harboured viruses with highly reduced susceptibility to the three classical types of drugs after only five years from their initial diagnoses.

Infección por el Virus de Inmunodeficiencia Humana evaluación del tratamiento: antirretroviral de alta eficacia / Human Immunodeficiency Virus treatment evaluation: antirretroviral of hight efficacy

Evaluar respuesta de pacientes VIH (+) al tratamiento antirretroviral de alta eficacia, relacionándose con la carga viral y el contaje de células CD4+. 2) Determinar si hay diferencias en respuesta al tratamiento utilizado esquemas con inhibidores de proteasas (IP) versus esquemas con inhibidores de transcriptasa reversa no nucleósidos (NNRTI). 3) Precisar si los factores demográficos o antecedentes de enfermedades oportunistas, intervienen en falla virológica al tratamiento. Estudio retrospectivo comparativo basado en la revisión de 222 historias pacientes con SIDA, controlados en la Fundación Daniela Chappard. Estadísticamente se evaluó por Wilcoxon Rank en relación con el de Kaplan-Meier y modelo proporcional de Cox. Un 76 por ciento de los pacientes recibieron HAART, 88,75 por ciento esquemas con IP, y 11,24 por ciento NNRTI de los pacientes con NNRTI fueron 15:7 sin tratamiento previo y 8 con tratamiento. la media de carga viral al inicio, fue 520,68 copias/ml, D.S. de 98.032, y la carga viral por tratamiento fue <500 copias/ml, con delta de carga viral 63,800 copias/ml, tiempo promedio de 11,62 meses. El promedio de CD4+ al inicio fue de 280 células x mm3, D.S. de 206.74 cél. x mm3, y post-tratamiento 320 cel. x mm3, delta de 40,90 células x mm3, en un tiempo de 10,51 meses. Delta de la carga viral utilizando IP 62,132 copias/ml, y con NNRTI 35-858,33 copias/ml, sin diferencia significativa. Delta de CD4+ en esquemas con IP fue de 38,71 cél. x mm3, y con NNRTI 81,2 cél. x mm3 sin diferencia significativa. La falla virológica 18,66 por ciento, Delta de CD4+ tuvo una razón de riesgo (RR=0,99) a falla virológica estadísticamente significativo (p=0,014). El tratamiento antirretroviral previo no influyó. HAART es efectivo para lograr supresión mantenida de viremia plasmática y elevar CD4+ independientemente del esquema antirretroviral usado, de CD4+ es factor predictor de buen pronóstico.

Tiara: hacia la reflexión y solución de sus problemas / Tiara: forword the reflection and soluction of its problems

Nuestro propósito fue demostrar que el Modelo de Investigación Acción Participante puede beneficiar a la comunidad, no sólo por los resultados obtenidos sino por el proceso mismo. Este debe involucrar a la comunidad desde la formulación del problema hasta el análisis de los resultados, discusión de las soluciones y acciones a tomar. En este proceso, el investigador no es líder sino copartícipe de la investigación. El marco metodológico consistió en el planteamiento de los principales problemas que presentaba la comunidad. Entre ellos, el más preocupante era la posibilidad del agua de consumo. Se tomaron muestras de las principales fuentes de agua. Todas las muestras resultaron contaminadas con bacterias coliformes. La comunidad analizó las implicaciones de esos resutados y decidió organizarse en la búsqueda de dos objetivos principales: educar a la población acerca de higiene del agua y los alimentos y acudir a instancias superiores gubernamentales para la resolución de sus problemas. Conclusión: una comunidad conciente de sus necesidades y organizada para la consecuencia de sus objetivos, puede lograr en el tiempo un desarrollo integral como grupo humano. De manera que el modelo de Investigación Acción Paticipante se transforma en un instrumento facilitador de dicho desarrollo