Profile and antibiotic-resistance pattern of bacteria isolated from endotracheal secretions of mechanically ventilated patients at a tertiary care hospital.

BACKGROUND: Critically ill patients on mechanical-ventilation are always at a higher risk of acquiring ventilator-associated respiratory infections. The current study was intended to determine the antibiotic-resistance pattern of bacteria recovered from the endotracheal (ET) specimens of ventilated patients. MATERIALS AND METHODS: This was a single-centered, retrospective study carried out in a 400-bed tertiary care hospital in Oman. The data of profile and antibiotic resistance pattern of bacterial isolates recovered from ET aspirates of ventilated patients during the period from January 2017 to August 2019 were retrieved from hospital database. The data were analyzed using the Statistical Package for the Social Sciences (SPSS) software version 22 (IBM, Armonk, New York, USA). Descriptive statistics were applied to find the frequencies and percentages. Charts and tables were constructed. RESULTS: In total, 201 bacterial isolates recovered from ET secretions of 154 ventilated patients were studied. The rate of isolation was predominant among males (65.6%) and in elderly people (50%). Gram-negative bacilli (GNB) were predominantly (88.6%) isolated. Acinetobacter baumannii (31.3%) was the most common isolate and 86% of them were multidrug-resistant strains. Klebsiella pneumoniae (23.9%) and Pseudomonas aeruginosa (22.9%) were the other common GNB, whereas Staphylococcus aureus was the most frequently isolated Gram-positive bacteria. Gentamicin showed good in vitro activity against S. aureus and all the GNB except A. baumannii reflecting good choice for empirical therapy. CONCLUSION: Gram-negative bacteria were the predominant isolates in ET secretions of ventilated patients. There was an alarmingly high rate of antimicrobial resistance among GNB. A rational use of antibiotics, regular monitoring of antibiotic resistance and use of right combination of drugs, in addition to refining of existing infection control practices are critical to control the emergence of drug-resistant strains.

Stenotrophomonas maltophilia: An emerging opportunistic nosocomial pathogen in a tertiary care hospital in Al Batinah North Governorate, Oman.

OBJECTIVES: Stenotrophomonas maltophilia, a Gram-negative non-fermentative bacillus, has emerged as an important nosocomial pathogen in recent years. It is intrinsically resistant to many antibiotics and has the ability to acquire antibiotic resistance by multiple mechanisms. Treating Stenotrophomonas infections, therefore, is a serious challenge for physicians. This study aimed to investigate the antibiotic susceptibility patterns and risk factors contributing to S. maltophilia infections. METHODS: A retrospective cross-sectional study was conducted at Sohar Hospital in Sohar, Oman. The demographic, clinical and microbiological data of individuals from whom S. maltophilia was isolated between September 2016 and August 2019 were reviewed. Descriptive statistics were presented as frequencies and percentages. RESULTS: A total of 41 S. maltophilia isolates from clinical specimens of 41 patients were studied. Infection occurred predominantly in males (73%) and the majority of patients (88%) were either ≤5 years old or >60 years old. All inpatients had at least one comorbidity while 50% had more than one. All inpatients were exposed to various medical interventions such as intensive care (44%), mechanical ventilation (41%), haemodialysis (25%), Foley's catheterisation (13%) and central venous lines (6%). Most patients (81%) were in hospital longer than two weeks. The susceptibility rates of S. maltophilia to minocycline (97%), trimethoprim-sulfamethoxazole (93%) and levofloxacin (92%) were high; the rate was lowest for ceftazidime (50%). CONCLUSION: S. maltophilia was found to be an important nosocomial opportunistic pathogen. Prolonged hospital stay and exposure to various medical interventions were key factors contributing to the development of infection. Minocycline and ceftazidime were found to be the most and least susceptible drugs, respectively.

Ongoing Challenges with Healthcare-Associated Candida auris Outbreaks in Oman.

Candida auris has emerged in the past decade as a multi-drug resistant public health threat causing health care outbreaks. Here we report epidemiological, clinical, and microbiological investigations of a C. auris outbreak in a regional Omani hospital between April 2018 and April 2019. The outbreak started in the intensive care areas (intensive care unit (ICU), coronary care unit (CCU), and high dependency unit) but cases were subsequently diagnosed in other medical and surgical units. In addition to the patients' clinical and screening samples, environmental swabs from high touch areas and from the hands of 35 staff were collected. All the positive samples from patients and environmental screening were confirmed using MALDI-TOF, and additional ITS-rDNA sequencing was done for ten clinical and two environmental isolates. There were 32 patients positive for C. auris of which 14 (43.8%) had urinary tract infection, 11 (34.4%) had candidemia, and 7 (21.8%) had asymptomatic skin colonization. The median age was 64 years (14-88) with 17 (53.1%) male and 15 (46.9%) female patients. Prior to diagnosis, 21 (65.6%) had been admitted to the intensive care unit, and 11 (34.4%) had been nursed in medical or surgical wards. The crude mortality rate in our patient's cohort was 53.1. Two swabs collected from a ventilator in two different beds in the ICU were positive for C. auris. None of the health care worker samples were positive. Molecular typing showed that clinical and environmental isolates were genetically similar and all belonged to the South Asian C. auris clade I. Most isolates had non-susceptible fluconazole (100%) and amphotericin B (33%) minimal inhibitory concentrations (MICs), but had low echinocandin and voriconazole MICs. Despite multimodal infection prevention and control measures, new cases continued to appear, challenging all the containment efforts.

Epstein Barr Virus in Patients with Nephropathy Associated with Systemic Lupus Erythematous, Pilot Study in Egyptian Patients.

Systemic lupus erythematosus (SLE) is an autoimmune disease affecting young age adults especially females. Infection with Epstein Barr virus (EBV) represents a common pathogen associated with SLE activity. This study investigates the occurrence of EBV in SLE patients with renal complications by serological markers and molecular detection of EBV genome in renal biopsies and examine the association of EBV with the pathological grades in renal diseases. The study included nineteen patients with systemic lupus nephropathy and thirteen patients with non-lupus nephropathy. Renal biopsies were subjected to detection of EBV by PCR. Serum autoantibodies (anti- dsDNA, anti-Sm and anti-RNP) and EBV-IgM and IgG antibodies were detected by ELISA. The commonest autoantibody was anti- dsDNA (73.7%) followed by anti-Sm (57.8%) and anti-RNP (31.6%). The EBV-PCR revealed that 31.6% of patients with lupus nephropathy showed positive LMP1 gene expression in renal biopsies On the other hand, serological markers for EBV showed no significant difference between both groups; IgM for EBV was positive in 26.3% of patients with lupus nephropathy and 7.7% in non-lupus nephropathy, while IgG was positive in 26.3% and 15.4 % respectively. Positive LMPI-PCR was demonstrated in all (3/3) patients with severe degree of nephropathy as compared to 23.1% of patients with moderate degree of nephropathy. A significant association was found between EBV-PCR and anti-Sm, (P=0.01), anti- dsDNA (P=0.001), and IgG for EBV and anti- dsDNA (P=0.03). In conclusion, Molecular detection of EBV DNA in renal biopsies can be applied for laboratory diagnosis in SLE nephropathy. The severity of nephropathy associated with SLE seems to be aggravated by the presence of EBV. Further extended studies are required to elucidate this association.