Autolytic debridement and management of bacterial load with an occlusive hydroactive deressing impregnated with polyhexamethylene biguanide.

BACKGROUND: Debridement and control of bacterial load are key-points of wound care. The aim of this study is to evaluate the effectiveness of autolytic debridement and management of bacterial load (bioburden) of an occlusive hydro-active dressing impregnated with polyhexamethylene biguanide (PHMB). METHODS: We used an occlusive dressing of hydro-active for leg ulcers' treatment (TenderWet-plus® - Hartmann).  Inclusion criteria were: presence of a fibrinous ulcer with multiple etiopathogenesis, in absence of clinical infection, no hypersecretion and diameter within 5 cm. Swab for bacterial bioburden control were made at start of the study, after 3 and 7 days. We made also a measurement of the amount of granulation tissue and of pain with VAS scale; bacterial bioburden control inside the dressing was made too. RESULTS: 28 leg ulcers were treated (12 venous, 5 diabetic, 8 thraumatic, 3 mixed) in 25 patients. The ulcer has been completely covered with fibrin in almost all cases and the bacterial load was represented mainly by Staphylococcus aureus (80% of the cases) with a load within 10.000UFC/plate in 81,5% of the cases. Control at 3 and 7 days have shown the appearance of granulaton tissue up to 67,8% of the wound surface. Bacterial bioburden (load) remained constant in 50% of the cases, decreased in 15%, increased in 35% of the cases. CONCLUSION: TenderWet-plus® has proven to be effective and quick in autolytic debridement and at the same time be able to handle the bacterial load in most cases. It can then be used for home treatment.

High-resolution MR lymphangiography for planning lymphaticovenous anastomosis treatment: a single-centre experience.

PURPOSE: This article illustrates the feasibility of MR lymphangiography (MRL) for imaging lymphatic vessels in patients with lymphedema, its accuracy in distinguishing lymphatic vessels from veins, and its utility for planning Lymphaticovenous anastomosis (LVA) treatment. MATERIALS AND METHODS: We prospectively enrolled 30 patients (24 women, range 18-70, 17 cases of lower limb lymphedema, 6 cases of primary lymphedema). All the patients underwent MRL, using a 1.5T MR unit (Signa Twin Speed Hdxt; GE), after the subcutaneous injection of gadobenate dimeglumine (Gd-BOPTA) with a little dose of lidocaine into the interdigital webs of the dorsal foot or hand. Lymphatic vessels identified for the LVA at MRL were histologically confirmed after surgery. Enhancement of lymphatic vessels and veins at different times after injection of contrast medium and their diameters were measured. RESULTS: A total of 79 lymphatic vessels were clearly identified in 29 patients at MRL; their morphology was tortuous in 22 patients and rectilinear in 7, whereas, the adjacent veins were straight with focal bulging only at the level of venous valve; the enhancement kinetic of the two different structures were different (p < 0.05) but the mean diameter of affected lymphatic vessels was similar to the adjacent veins (p > 0.05). Thirty-four out of 38 specimens of presumed lymphatic vessels at MRL, collected during surgery, resulted positive at the immunoistochemical marker d2-40, with a significant association (Chi-square = 40.421, DF = 1, p < 0.05, contingency coefficent 0.644). One patient had an early complication 1 month after treatment. CONCLUSIONS: MRL is easy and safe to use and combines extensive information on the anatomy and functionality of lymphatic vessels and veins in a single process; therefore, it could be useful in LVA treatment planning and evaluating possible super-microsurgical treatment complications in patients with lymphedema.

Right gastroepiploic artery arising from the dorsal pancreatic artery: a very rare anatomic variation underlying interesting embryologic implications.

The exceptional case of the right gastroepiploic artery (RGE) arising from the dorsal pancreatic (DP) artery in an individual affected by hepatocellular carcinoma is presented. This anatomic variant was demonstrated with a selective angiography of the common hepatic artery that showed a distinct DP artery branching from the injected artery. The DP artery gave off regular pancreatic branches and continued as a long and winding vessel that was identified as the RGE by its general course, the anterior epiploic branches arising from it, and the injection of the distal splenic artery, possibly via the anastomosis with the left gastroepiploic artery. The anatomy of the RGE has few variations, mostly limited to its origin from the superior mesenteric artery. Arising of the gastroepiploic artery from the DP artery has never been previously reported and represents an unexpected possible anatomic variant of which general and heart surgeons should be aware. In particular, this case is of interest in surgical procedures involving resection of the head of the pancreas, gastrectomies or coronary artery bypass grafting using the RGE. The embryology underlying the development of this anatomic variation is reviewed.

The prevalence of congenital and perinatal cytomegalovirus infections among newborns of seropositive mothers.

INTRODUCTION: This study aimed to determine the prevalence of congenital and perinatal human cytomegalovirus (HCMV) infections among newborns in two major neonatal intensive care units (NICU) in Bahrain. METHODOLOGY: One hundred newborns comprised of 84 preterm and 16 term babies admitted to the NICUs were enrolled in the study. During the first six weeks of life, urine and saliva was obtained from the babies weekly and serial breast milk samples were obtained from the mothers. Maternal serum HCMV IgG was measured. Virus isolation and detection was done by shell vial culture and nested PCR. RESULTS: Maternal HCMV IgG-seropositivity was 100%. Eight HCMV infections were detected comprising of three congenital and five perinatal infections. Congenital HCMV infection was found in preterm (2/84; 1.9%) and term (1/16; 6.3%) babies. HCMV DNA was detected in breast milk samples obtained during the first 10 days postpartum from all mothers whose babies had congenital HCMV. Forty-nine women provided breast milk samples between four and six weeks post-partum and HCMV DNA was detected in the breast milk of 11 women. Five (45.5%) of these eleven were mothers of babies with perinatal HCMV infection. There was no significant difference in the detection of HCMV using shell vial culture versus nested PCR method. CONCLUSION: The findings indicate occurrence of congenital and perinatal HCMV transmission in this setting of high maternal seropositivity. The use of shell vial culture and PCR amplification for HCMV screening in the NICU for rapid detection of infection during the early postnatal period is recommended. 

Trafficking of methicillin-resistant staphylococci and co-colonization with vancomycin-resistant enterococci.

OBJECTIVES: To determine the trafficking of methicillin-resistant staphylococci between the hospital and community as well as the occurrence of co-colonization with vancomycin-resistant enterococci (VRE). SUBJECTS AND METHODS: From November 2005 to April 2006, methicillin-resistant Staphylococcus aureus (MRSA) and methicillin-resistant coagulase-negative Staphylococcus (MRCoNS)-positive patients at the Salmaniya Medical Complex, Bahrain were assessed for VRE co-colonization. Characterization of vancomycin resistance genotype by PCR was carried out. Close family contacts were screened for MRSA and pulsed-field gel electrophoresis (PFGE) analysis of MRSA isolates from patient-family member pairs was conducted. RESULTS: One hundred and eighty-two patients (93 MRSA; 89 MRCoNS) and 356 family members were enrolled. Seven MRSA and 41 MRCoNS strains were isolated from the family members. PFGE analysis revealed the presence of variants of a single MRSA clone among patients and their relatives. A total of 112 patients (62 MRSA; 50 MRCoNS) provided stool for VRE screening. Of these 13 stool specimens (11.6%) were VRE-positive. All the VRE isolates were from MRSA-positive patients, thus positivity rate among MRSA patients was 20.9% (n/N = 13/62). These were predominantly Enterococcus gallinarum with vanC1 genotype and one strain was Enterococcus faecium (vanB genotype). Two E. gallinarum isolates harbored an additional vanB gene. The majority of VRE isolates were from patients in medical and surgical units (n/N = 10/13; 77%). Male gender, prolonged hospitalization and presence of co-morbidities were significantly associated with MRSA/VRE co-colonization (p < 0.05). CONCLUSION: MRSA/VRE co-colonization with MRSA trafficking between the hospital and community environment is a public health concern occurring in our setting.

Predominance of CTX-M genotype among extended spectrum beta lactamase isolates in a tertiary hospital in Saudi Arabia.

OBJECTIVE: To determine the molecular characterization of extended-spectrum beta-lactamases (ESBL) isolates from a tertiary center in Saudi Arabia using multiplex polymerase chain reaction (PCR) technique and assess their antibiotic susceptibility pattern. METHODS: Prospective study conducted at the Saudi Aramco Dhahran Health Center, Dhahran, Saudi Arabia between April-December 2006. Extended-spectrum beta-lactamases phenotype of isolates identified by automated methods was confirmed using E-test. Multiplex PCR for the detection of blaTEM, blaSHV and blaCTX-M was performed. Susceptibility to a panel of antibiotics was determined. RESULTS: One hundred isolates (Escherichia coli [E.coli] n=84; Klebsiella pneumoniae [K. pneumoniae] n=16) were studied and 71% harbored the blaCTX-M gene. For E.coli isolates 43 (51%) harbored CTX-M+TEM combination and 21 (25%) had CTX-M alone. In contrast, only one K. pneumoniae isolate (6.2%) harbored the CTX-M+TEM combination and 3 (18.8%) isolates had CTX-M only. One E.coli and 7 K. pneumoniae isolates were blaSHV positive. The blaCTX-M gene was found predominantly in urinary isolates (n=63/71; 88.7%). The presence of blaCTX-M was significantly higher in isolates from outpatients compared to inpatient (p<0.05). Sensitivity to imipenem was 100% and 78% to nitrofurantoin. Resistance to amoxicillin-sulbactam was significantly higher in blaCTX-M positive isolates (p<0.05). CONCLUSION: The findings indicate a high-level of blaCTX-M positive ESBL isolates circulating in our setting with the dissemination of these in the community. The trend of multidrug resistance profile associated with carriage of blaCTX-M gene is cause for concern.

Probiotics for the treatment of bacterial vaginosis.

BACKGROUND: The dominance of lactobacilli in healthy vaginal microbiota and its depletion in bacterial vaginosis (BV) has given rise to the concept of oral or vaginal instillation of probiotic Lactobacillus strains for the management of this condition. OBJECTIVES: To ascertain the efficacy of probiotics in the treatment of BV. SEARCH STRATEGY: We searched electronic databases irrespective of publication status or language. These included: Cochrane Central Register of Controlled Trials (CENTRAL), the HIV/AIDS and STD Cochrane Review Groups' specialized registers, the Cochrane Complementary Medicine Field's Register of Controlled Trials, MEDLINE (1966 to 2008), EMBASE (1980 to 2007), ISI science citation index (1955 to 2007), CINAHL (Cumulative Index to Nursing & Allied Health Literature (1982 to 2007).We handsearched of specialty journals, conference proceedings and publications list on the website of the International Scientific Association of Probiotics and Prebiotics (http://www.isapp.net/default.asp).For unpublished studies or ongoing trials, we contacted authors from relevant publications, nutraceutical companies and probiotic-related scientific associations. We searched electronic databases on ongoing clinical trials. SELECTION CRITERIA: Randomized controlled trials using probiotics for the treatment of women of any age diagnosed with bacterial vaginosis, regardless of diagnostic method used. The probiotic preparation could be single or "cocktail" of strains, any preparation type/dosage/route of administration. Studies comparing probiotics with placebo, probiotics used in conjunction with conventional antibiotics compared with placebo or probiotics alone compared with conventional antibiotics were eligible for inclusion. DATA COLLECTION AND ANALYSIS: We screened titles and abstracts , obtained full reports of relevant trialsand independently appraised them for eligibility. A data extraction form was used to extract data from the four included studies. For dichotomous outcomes, odds ratios (OR) and 95% confidence intervals (CI) were derived for each study using RevMan (versions 4.2 and 5). We did not perform meta-analysis due to significant differences in the probiotic preparations and trial methodologies. MAIN RESULTS: Analysis suggests beneficial outcome of microbiological cure with the oral metronidazole/probiotic regimen (OR 0.09 (95% CI 0.03 to 0.26)) and the probiotic/estriol preparation (OR 0.02, (95% CI 0.00 to 0.47)). For the probiotic/estriol preparation, the OR and 95% CI for physician-reported resolution of symptoms was OR 0.04 (95% CI 0.00 to 0.56). AUTHORS' CONCLUSIONS: The results do not provide sufficient evidence for or against recommending probiotics for the treatment of BV. The metronidazole/probiotic regimen and probiotic/estriol perparation appear promising but well-designed randomized controlled trials with standardized methodologies and larger patient size are needed.

Campylobacter enteritis in the Arabian Gulf.

Diarrhoea illnesses constitute a common cause of morbidity and mortality worldwide. In recent years, Campylobacter spp. has been recognized as the leading cause of bacterial enteritis in both developed and developing countries. The biology of Campylobacters as well as the mechanism by which they cause disease is yet to be fully explained. In addition, non-availability of fast and reliable diagnostic methodology and the growing trend of antibiotic resistance continue to pose significant challenges. The absence of national surveillance programs for campylobacteriosis, particularly in developing countries, makes it difficult to give an accurate picture of the true infection prevalence and the molecular epidemiology of isolates circulating in the populations, a situation which had hitherto existed in the Arabian Gulf region. However, in recent years, emerging data from studies in the Arabian Gulf region has not only enhanced our understanding of the epidemiology of Campylobacter both in humans and poultry in the region, but has also contributed to the overall understanding of the mechanism of Campylobacter enteritis, antibiotic resistance, and improved diagnostic approaches. In this review, we examine these emerging data from the Arabian Gulf region.

Extended spectrum beta-lactamases (ESBL) in Escherichia coli and Klebsiella pneumoniae: trends in the hospital and community settings.

BACKGROUND: To assess the prevalence of extended spectrum beta-lactamase (ESBL) producing Escherichia coli and Klebsiella strains in nosocomial and community-acquired infections. METHODOLOGY: The study was conducted at a centralized microbiology laboratory in the Eastern Province of Saudi Arabia. Laboratory records (January 2004 - December 2005) were assessed. Associated resistance to a panel of antibiotics was determined. RESULTS: A total of 6,750 Gram-negative organisms were assessed for ESBL-phenotype. ESBL was detected in 6% (409/6,750) of isolates, the majority of which were E. coli (83%). ESBL producers were significantly higher among isolates from in-patients 15.4% (143/927) versus out-patients (4.5%; 266/5,823); p < 0.05. Old age (older than 60 years) represented a significant risk for having an ESBL-producing pathogen. Urine was the major source of ESBL isolates in in-patients (46.1%) and out-patients (74.4%). The proportion of urinary E. coli isolates which were ESBL producers was significantly higher among in-patients (53/506; 10.4%) compared to out-patients (182/4,074; 4.4%); p<0.05. Old age (older than 60 years) represented a significant risk for having an ESBL-producing pathogen. Urine was the major source of ESBL isolates in in-patients (46.1%) and out-patients (74.4%). The proportion of urinary E. coli isolates which were ESBL producers was significantly higher among in-patients (53/506; 10.4%) compared to out-patients (182/4,074; 4.4%); p<0.05. Among in-patients, 60% of the ESBL associated infections were nosocomial. All were sensitive to imipenem but high levels of resistance to gentamicin, amikacin, amoxicillin-clavulanic acid and ciprofloxacin was shown. CONCLUSION: The findings document evidence of the spread of multiresistant ESBL-producers into the community. This has significant implications for patient management, and indicates the need for increased surveillance and molecular characterization of these isolates.

Guidelines for venous thromboembolism and clinical practice in Italy: a nationwide survey.

Venous thromboembolism (VTE) is a common health problem for today's society, and considering the role that it plays in surgical patients (general surgery, gynecology, and orthopedics), new advances in our understanding of the procedures and trauma characteristics are relevant and necessary. The most important and recently published guidelines concerning this problem have been taken into consideration, leading to articulate investigations and data evaluation. This project has proposed a data-survey framework available as a questionnaire in order to investigate application of the guidelines for VTE throughout the national territory. Of the total 714 Italian centers, a random sample of 214 were contacted and asked to take part in this study; of these, 146 replied (20.4% of total and 68.2% of the sample): 48 departments of general surgery, 46 departments of gynecology, and 52 departments of orthopedics. About 70% of the centers has appropriate information about surgery as a risk factor for VTE. The answers have provided evidence of an adequate knowledge of the instrumental and laboratory diagnostic pathways, useful to confirm the diagnosis of TE (80%). Data waiting compared with morbidity and mortality rates related to deep vein thrombosis and pulmonary embolism showed an increase of mortality associated with the diagnostic data timing of supply, with an exponential trend linked to the data acquisition delay. Both risk stratification and adequate application of prophylaxis together with treatment devices represent a real tool to control morbidity and mortality for VTE. Moreover, diagnostic data waiting significantly influences adequate prophylaxis. In Italy, only 40% of the centers are ready to provide diagnostic data within 12 hr.

Campylobacter jejuni induces diverse kinetics and profiles of cytokine genes in INT-407 cells.

OBJECTIVE: To examine the kinetic ability of embryonic human epithelial INT-407 cells to express messenger ribonucleic acid mRNA for various cytokines and chemokines in response to Campylobacter jejuni C. jejuni stimulation. METHODS: In an experimental single-blind study, cultured embryonic human epithelial INT-407 cells were treated with different concentrations of viable C. jejuni, its sonicated, and filtered supernatant. A modified non-radioactive in situ hybridization using probe cocktails was used to measure mRNA levels for the pro-inflammatory cytokines interleukin IL-1beta, IL-6, interferon-gamma IFN-gamma, tumour necrosis factor TNF-alpha, transforming growth factor TGF-beta1, and IL-8, and the anti-inflammatory cytokines, IL-4 and IL-10. The study was carried out from September 2005 to March 2007 at the Department of Microbiology, Immunology, and Infectious Diseases, College of Medicine, Arabian Gulf University, Bahrain. RESULTS: Viable C. jejuni, sonicated bacteria and filtered supernatant induced high mRNA expression for the pro-inflammatory cytokines IL-1beta, IL-6, IFN-gamma, TNF-alpha, TGF-beta1, and IL-8, which peaked at the 12 hours post stimulation. Anti-inflammatory cytokines IL-4 and IL-10 mRNA expression were induced maximally at 3 hours post stimulation mainly by sonicated bacteria and filtrated supernatant, however, not with living bacteria. Untreated embryonic human epithelial INT-407 cells expressed low amount of mRNA for the various cytokines and chemokines at all time points. For each cytokine, 4 samples were used per time hour. CONCLUSION: This study demonstrated that embryonic human epithelial INT-407 cells in response to viable C. jejuni or its cytotoxins can alter cytokine and chemokine mRNA expression patterns and kinetics suggesting a potential role for theses mediators in the immunopathogenesis of the infection caused by this pathogen, which might be relevant for future immunotherapeutic interventions during severe bacterial infections.

Trends in antibiotic sensitivity pattern and molecular detection of tet(O)-mediated tetracycline resistance in campylobacter jejuni isolates from human and poultry sources.

This study was conducted to determine the trends in Campylobacter antibiotic resistance occurring in our setting and to assess the differences in the isolates using patterns of plasmid profiles. One hundred Campylobacter jejuni strains of human and poultry origin isolated in 2002-2003 (phase A) and 2005-2006 (phase B) in the Kingdom of Bahrain were evaluated. Susceptibility to erythromycin, ciprofloxacin and tetracycline was determined, and plasmid extraction and polymerase chain reaction detection of the tet(O) gene was carried out. A single erythromycin-resistant isolate was identified, in sharp contrast to the high ciprofloxacin resistance which also showed an increment in phase B. Tetracycline resistance was higher in chicken (80.9%) compared to human (41.3%) isolates (P<0.01). Most isolates harbored two plasmids (23 kb and 35 kb) with significant correlation between tetracycline resistance and plasmid carriage in chicken isolates. The findings show continued effectiveness of erythromycin for campylobacteriosis but an increasing trend of high ciprofloxacin and tetracycline resistance. Tetracycline resistance is most likely due to the transfer of plasmids carrying the tet(O) gene between isolates.

Management of acute diarrhoea in primary care in Bahrain: self-reported practices of doctors.

This nationwide study was conducted to assess the extent of adherence of primary-care physicians to the World Health Organization (WHO)-recommended guidelines on the use of oral rehydration therapy (ORT), antimicrobials, and prescribing of other drugs used in treating symptoms of acute diarrhoea in Bahrain. A questionnaire-based, cross-sectional survey was carried out in primary-care health centres. During a six-week survey period (15 August-30 September 2003), 328 (25.2%) completed questionnaires were returned from 17 of 20 health centres. In a sample of 300 patients, oral rehydration salts (ORS) solution was prescribed to 89.3% (n=268) patients; 12.3% received ORS alone, whereas 77% received ORS in combination with symptomatic drugs. Antimicrobials were prescribed to 2% of the patients. In 11.4% of the cases, rehydration fluids and other drugs were given parenterally The mean number of drugs was 2.2+0.87 per prescription. In approximately one-third of the patients, three or more drugs were used. Primary-care physicians almost always adhered to the WHO guidelines with respect to ORT and antimicrobials. However, in several instances, ORT was prescribed along with polypharmacy, including irrational use of drugs for symptomatic relief. Effective health policies are needed to reduce the unnecessary burden on the healthcare system.

Multiplex PCR for direct identification of Campylobacter spp. in human and chicken stools.

Differentiation between Campylobacter jejuni and Campylobacter coli is problematic in clinical specimens due to fastidious growth requirements and limited biochemical tests. This study describes a rapid, multiplex PCR protocol for the direct detection and differentiation of C. jejuni and C. coli in stools. An evaluation was carried out of this multiplex protocol based on the detection of cadF (genus specific), and hipO (C. jejuni) and asp (C. coli) genes, using stool from patients with Campylobacter enteritis and chicken. Protocol sensitivity was assessed and specificity determined using a panel of enteric bacteria, and evaluation of 30 diarrhoeic stool specimens culture negative for Campylobacter. Of the 114 specimens (54 human and 60 chicken) evaluated by the protocol, 70 (61.4 %) were identified as C. jejuni, 35 (30.7 %) as C. coli and 9 (7.9 %) as a mixed infection/colonization with both species. All mixed infections were identified as C. jejuni by culture. Among the stool specimens that were culture negative for Campylobacter, two (6.7 %) were C. jejuni positive by multiplex PCR. The protocol sensitivity limit was 0.015-0.016 ng C. jejuni and C. coli DNA mul(-1) in the specimen. There was no cross-reaction with the reference strains assessed. Comparison of hippurate test and multiplex PCR demonstrated 17 isolates with false-positive hippurate enzymic activity and 7 with false-negative activity. This rapid protocol (turnaround time 6 h) is highly sensitive and specific for direct evaluation of stool for these pathogens. It has significant application for routine clinical diagnostic and epidemiological purposes.

Pattern of antibiotic susceptibility in Campylobacter jejuni isolates of human and poultry origin.

Campylobacter jejuni antibiotic resistance is rising with a variable geographical pattern; but there is limited data from the Arabian Gulf region. We assessed the sensitivity of human (117) and chicken (33) C. jejuni isolates to erythromycin, ciprofloxacin, tetracycline and trimethoprim-sulfamethoxazole by agar dilution, disc diffusion and the E test. Only 2 human isolates were resistant to erythromycin. In contrast, over 80% of chicken and human isolates were resistant to ciprofloxacin. A significantly higher proportion of chicken isolates than human isolates were resistant to tetracycline, with much higher MIC(50) values (P < 0.001). The MIC(90) for trimethoprim-sulfamethoxazole by agar dilution was 40 microg/ml. Comparison of the results of the agar dilution method and E test showed 1 major disagreement and 8 minor disagreements for erythromycin, 4 major disagreements for ciprofloxacin and 23 disagreements for tetracycline (19 were major disagreements). This was the first study to describe the pattern of antibiotic resistance in Campylobacter isolates in this region; the results indicate a high degree of erythromycin sensitivity that validates the continued use of this agent as a first-line therapy for Campylobacter enteritis. These findings have wide implications because of the large, highly mobile expatriate population in this setting. In addition, the correlation between agar dilution and disc diffusion supports the use of the latter as an alternative susceptibility testing method for Campylobacter.

Clinical relevance of virulence genes in Campylobacter jejuni isolates in Bahrain.

There are no data describing the genetic make-up of Campylobacter strains (an important aetiological agent of diarrhoea) circulating in the Arabian Gulf region. Here, the molecular characterization of two virulence genes in Campylobacter jejuni from Bahrain and the relationship with clinical infection are reported. Molecular screening for cytolethal distending toxin (cdtB) and invasion-associated marker (iam) genes was carried out on C. jejuni stool isolates collected from January 2002 to January 2004 in Bahrain. The molecular characterization was correlated with the patients' socio-demographic and clinical parameters. Of the 96 C. jejuni strains tested, 50 (52 %) were cdtB+/iam+, 30 (31 %) were cdtB+/iam- and 16 (17 %) were cdtB-/iam-. Sixty-nine per cent (66/96) of patients were less than 3 years old, with significantly higher detection of cdtB+/iam+ and cdtB+/iam- strains (P < 0.001 and P < 0.01, respectively) in this age group. Seventy patients (73 %) were symptomatic. In the group that were less than 3 years old, 62 and 85 % of those with cdtB+/iam+ and cdtB+/iam- strains, respectively, were symptomatic compared with 100 % for those over 3 years of age. However, the presence of cdtB-/iam- strains still resulted in clinical infection in the children under 3 years but not in the older patients. This is the first report describing the molecular characterization of virulence genes in Campylobacter isolates from this region. The findings indicate that strains of different virulence genetic make-up are circulating in the population, with children under the age of 3 years being most vulnerable. Further work on the molecular characterization, gene expression and determination of the invasive phenotypes of C. jejuni strains circulating in different regions is needed.

Human papillomavirus infection among women attending health facilities in the Kingdom of Bahrain.

OBJECTIVE: To investigate the occurrence of human papillomavirus (HPV) infection and the associated risk factors in Bahrain's female population. METHODS: This study was carried out between March to December 2004, which includes cervical scrapings for Pap smear and HPV-DNA testing using polymerase chain reaction (PCR) and restriction fragment length polymorphism (RFLP) analysis, obtained from 100 women attending the Gynecology Clinic at Salmaniya Medical Center and Sheikh Sabah Health Center in the Kingdom of Bahrain. We distributed questionnaires that include the sociodemographic data as well as information on risk factors such as smoking, parity, and the contraceptive used. RESULTS: Eleven women (11%) with normal cytology were HPV-positive. The RFLP analysis detected HPV-types 16, 18, 45, 62 and 53. Positive women were significantly older (43.3 +/- 10.1 years) than negatives (36.5 +/- 9.9 years; p=0.04), however, there was no difference in age of first sexual contact (positive: 18.1 +/- 5.7 years versus negative: 20.6 +/- 4.4 years). Polygamy, smoking and hormonal contraception was not identified as risk factors, but positive women showed higher parity. CONCLUSION: In this study on HPV infection in Bahrain, the 11% positivity with high risk HPV types, in the presence of normal cytology suggests that in addition to the cervical cancer screening program, offer of HPV testing deserves consideration.

Neonatal sepsis 1991-2001: prevalent bacterial agents and antimicrobial susceptibilities in Bahrain.

OBJECTIVES: To investigate the organisms causing neonatal sepsis and their modifications over an extended period, to assess their changing sensitivities to antibiotics and to verify whether the policy for screening pregnant women for group B streptococci (GBS) carriage is desirable in our settings. SUBJECTS AND METHODS: Medical records of all infants with positive blood culture from the Neonatal Intensive Care Unit at Salmaniya Medical Complex between 1991 and 2001 and Bahrain Defense Force Hospital between 1999 and 2001 were reviewed. RESULTS: Of the 7,978 neonates in both hospitals 335 (4.19%) had culture-proven bacteremia. Gram-positive bacteria were isolated at constant rate over the 11-year period. The main agents isolated were coagulase-negative Staphylococcus (CoNS) in 138 cases (41%), Staphylococcus aureus in 28 newborns (8%) and GBS in 26 patients (7.8%, 0.2/1,000 live births). All of them were sensitive to penicillin G, erythromycin and clindamycin. Gram-negative bacteria were declining but Escherichia coli was isolated in 35 cases (10%). Of special concern is the increasing percentage (5.7%) of Candida isolation. No clear trend toward increasing resistance was observed, although a major difference among the two institutions was evident. Klebsiella and Enterobacter spp. showed resistance to many of the antibiotics tested, thereby posing difficult therapeutic choices. CONCLUSION: Good quality specimens are essential to evaluate the role of CoNS. The increasing threat of fungal infection must be carefully tackled. Specifically tailored policies for GBS prevention must be defined according to the local epidemiology.