Seroconversion of COVID-19 in Frontline Healthcare Workers in a Tertiary Care Hospital in Oman.

Objectives: This research aimed to study the seroconversion among frontline staff at the highest risk of exposure to SARS-CoV-2 infections, including emergency department, critical care, and COVID-19 isolation wards in all healthcare job categories. Methods: We conducted a prospective cohort study on the incidence of seroconversion among frontline health care workers (HCWs) at the Royal Hospital, Muscat, Oman. Two sera were collected 12 weeks apart to look for seroconversion. We used proportions with 95% confidence interval (CI) for categorical data and mean/median as appropriate for continuous data. Results: Fourteen out of 328 HCWs seroconverted in this study accounting for an incidence rate of 3.6%, excluding four HCWs that were positive at baseline. The median age was 43.5 (range = 28-57). About 75.0% of HCWs were between 31-49 years old, with a seroconversion rate of 4.9% (95% CI: 2.7-8.1). Females accounted for most seroconverted HCWs (14/257) at a rate of 5.4% (95% CI: 3.1-8.8). Omanis seroconverted with a rate of 6.4% (95% CI 2.6-12.8), whereas non-Omanis seroconverted at a rate 4.3% (95% CI: 2.2-7.5). Ninety-two percent (302/328) of the staff lived in the capital area, and a minority lived outside the capital (3/26). Thirteen Muscat citizens seroconverted at a rate of 4.3% (95% CI: 2.4-7.1). Nurses comprised the majority (accounting for about 81%) followed by doctors (19%) at rates of 5.6% (95% CI: 3.2-9.2) and 4.2% (95% CI: 1.07-10.9), respectively. Staff covering COVID-19 isolation wards and intensive care unit comprised over 60% (n = 10) of those who seroconverted with a rate of 5.4% (95% CI: 2.8-9.5) followed by infectious diseases doctors and adult emergency at 19.0% (n = 3) and 12.5% (n = 1), respectively. Approximately 81.3% (n = 13) of HCWs performed aerosol-generating procedures at a seroconversion rate of 4.3% (95% CI: 2.4-7.1). About 50.0% of those who seroconverted had a positive polymerase chain reaction (PCR) before seroconversion, 25.0% had a negative PCR before second serology testing, and 25.0% were not tested with PCR. Approximately 20.0% of seroconverted staff had no reported symptoms compared to 80.0% who reported symptoms such as sore throat (70.0%), fever (50.0%), myalgia (20.0%), and a less frequency (15.0%) runny nose, loss of smell, and headache. Conclusions: Detection of infection among HCWs is important to prevent further transmission, especially asymptomatic carriers. A combined screening strategy of symptoms, serology, and PCR might help detect potential infections and asymptomatic carriage.

Demographic, clinical, and outcome characteristics of carbapenem-resistant Enterobacteriaceae over a 10-year period (2010-2020) in Oman.

Purpose: The incidence of carbapenem-resistant Enterobacteriaceae (CRE) has increased in the last two decades, causing significant morbidity and mortality. Our study investigated the factors associated with mortality from CRE bloodstream infection in a single center in Oman. Methods: Data from adult patients with CRE bacteremia, over a 10-year period, were retrospectively collected. Demographic and clinical characteristics were compared according to intensive care unit (ICU) admission status and mortality. A logistic regression model was used to evaluate factors associated with mortality. Results: 169 cases of CRE bacteremia were identified, of whom 93 (55%) required ICU admission and 96 (56.8%) died. Patients who required ICU care were more likely to require organ transplant (15% vs 4.0%; p = 0.02), be on immunosuppressants (31% vs 17%; p = 0.035), be transferred from other hospitals (40% vs 14%; p < 0.001), be colonized with CRE (73% vs 43%; p < 0.001), have vascular lines (85% vs 42%; p < 0.001), be on mechanical ventilation (91% vs 9.2%; p < 0.001), require a longer stay (37 vs 17 days; p < 0.001), and have increased mortality (80% vs 29%; p < 0.001). In the multivariate analysis, mechanical ventilation (adjusted odds ratio (aOR) 15.3; 95% confidence interval 5.39-43.2; p < 0.001) and prior use of the broad-spectrum antibiotics meropenem (p = 0.01) and piperacillin/tazobactam (p = 0.026) were associated with CRE mortality. Conclusion: CRE bacteremia carries a high mortality rate in patients requiring ICU care. Implementation of infection control measures and antimicrobial stewardship programs are essential in reducing the rates of CRE BSI.

Early Disseminated Mycobacterium Abscessus Complex Infection in an Infant with Coexisting Cystic Fibrosis and Progressive Familial Intrahepatic Cholestasis: Case report and literature review.

Mycobacterium abscessus complex (MABSC) is a rapidly growing mycobacterium and may rarely cause disseminated infections in immunocompromised patients. In patients with cystic fibrosis (CF), it peaks between the ages of 11 and 15 years. We present a five-month-old infant with coexisting CF and progressive familial intrahepatic cholestasis (PFIC) who had pulmonary and cutaneous dissemination of MABSC infection. The management of this disseminated infection in an infant with two coexisting chronic diseases was challenging and resulted in the rapid deterioration of lung function and progression of PFIC to liver cirrhosis with a fatal outcome.

Evaluation of in vitro activity of ceftolozane/tazobactam and comparators against recent clinical bacterial isolates, and genomics of Pseudomonas aeruginosa, Klebsiella pneumoniae and Escherichia coli isolates that demonstrated resistance to ceftolozane/tazobactam: data from Kuwait and Oman.

Background: The treatment options for infections caused by MDR Gram-negative bacteria have been limited, especially for infections caused by bacteria that produce carbapenemases and/or ESBLs. Ceftolozane/tazobactam is a cephalosporin/ß-lactamase inhibitor developed to treat Gram-negative bacteria. Methods: Ceftolozane/tazobactam and 14 comparators (amikacin, aztreonam, cefepime, cefotaxime, cefoxitin, ceftazidime, ceftriaxone, ciprofloxacin, colistin, ertapenem, imipenem, levofloxacin, meropenem and piperacillin/tazobactam) were evaluated against Pseudomonas aeruginosa and Enterobacterales isolates collected from Kuwait and Oman (n = 606) during 2016-17. In addition, further analysis of resistance mechanisms to ceftolozane/tazobactam was done utilizing WGS. Non-susceptible isolates from ceftolozane/tazobactam surveillance were selected for analysis. Overall, 35 strains underwent WGS. Results: Among isolates from Kuwait, susceptibility of P. aeruginosa, Escherichia coli and Klebsiella pneumoniae to ceftolozane/tazobactam was 79.8%, 95.7% and 87.5%, respectively, and from Oman was 92.3%, 93.1% and 88.5%, respectively. No P. aeruginosa with a ceftolozane/tazobactam MIC <32 mg/L encoded ß-lactamases besides normal chromosomal enzymes (PDC variants or OXA-50-like) whereas all but one P. aeruginosa isolate with MIC >32 mg/L encoded either MBLs (60%), VEB-1 (19%) or additional OXAs (3.7%). Conclusions: Colistin followed by ceftolozane/tazobactam showed the greatest activity against P. aeruginosa. Enterobacterales showed more susceptibility to ceftolozane/tazobactam than to piperacillin/tazobactam, but meropenem and colistin showed better activity.

Disseminated Cryptosporidiosis in an Infant with Non-HIV Pediatric Immunodeficiency: First Case Report from Oman.

Cryptosporidium is a rare but important pathogen, especially in children with immunodeficiency. Intestinal cryptosporidiosis is well described in immunocompetent and immunocompromised children, but respiratory and disseminated cryptosporidiosis in immunodeficient children is not often reported. We describe an Omani infant with disseminated cryptosporidiosis and failing pharmacological therapy in the context of severe combined immunodeficiency. Chronic diarrhea can be an initial symptom of immunodeficiency in the pediatric population. Awareness of cryptosporidiosis is critical to early detection and management for such patients. As antiparasitic agents are often ineffective, amelioration of immunosuppression in immunodeficient children should be a priority.

Staphylococcous epidermidis, Staphylococcous schleiferi Infections: Are CoNS Cons?

Coagulase-negative Staphylococcus (CoNS) represents one of the major nosocomial pathogen in multimorbid, immunosuppressed patients, especially with device-associated infections, often presenting with a diagnostic dilemma and aggressive antibiotic resistance. We report a case of a healthy young man with no comorbidities who succumbed to an extensive abdominal infection with Staphylococcus epidermidis and Staphylococcus schleiferi after an uneventful diagnostic procedure, despite aggressive antibiotic therapy and surgical source control. Early identification, diagnosis, and aggressive management of CoNS species is warranted depending on clinical scenario and should not be viewed as mere skin contaminants or physiological colonization. HOW TO CITE THIS ARTICLE: Abraham B, Gokhale AU, Mohsin J, Prakash S. Staphylococcous epidermidis, Staphylococcous schleiferi Infections: Are CoNS Cons? Indian J Crit Care Med 2020;24(8):716-718.

A Cluster of Candida auris Blood Stream Infections in a Tertiary Care Hospital in Oman from 2016 to 2019.

(1) Background: Candida auris has been reported as emerging yeast pathogen that can cause invasive bloodstream infections in healthcare settings. It is associated with high mortality rates and resistance to multiple classes of antifungal drugs and is difficult to identify with standard laboratory methods. (2) Methods: We conducted a retrospective review of epidemiological, clinical, and microbiological records for 23 C. auris fungemia cases at the Royal Hospital, a tertiary care facility in Oman, between 2016 and 2018. Demographic data, risk factors associated with mortality, microbiology investigation and treatment regimens are described. Yeasts were identified by MALDI-TOF. (3) Results: We identified 23 patients with C. auris fungemia. All positive samples from patients were confirmed as C. auris using MALDI-TOF, and ITS-rDNA sequencing. Microsatellite genotyping showed that the Omani isolates belong to the South Asian clade I. The majority of patients had multiple underlying illnesses and other risk factors that have been associated with fungemia. All isolates were non-susceptible to fluconazole. Isolates from all patients were sensitive to echinocandins and these were used as first line therapy. (4) Conclusions: Candida auris affects adults and children with a variety of risk factors including central venous catheters and overuse of antibiotics. Infections occur in both immunocompromised and immunocompetent individuals. Mortality was high in this series, and the organism can be transmitted in healthcare settings. Programs for raising awareness in Oman hospitals are warranted. Caspofungin remains 1st line therapy as MICs are still low despite its wide use.

Plasmid-Mediated Colistin Resistance Gene mcr-1 in an Escherichia coli ST10 Bloodstream Isolate in the Sultanate of Oman.

AIMS: To identify plasmid-mediated colistin resistance in clinical Enterobacteriaceae isolates in Oman, where this resistance mechanism has not been encountered yet. MATERIALS/METHODS: Twenty-two colistin-resistant Enterobacteriaceae clinical isolates collected between July 2014 and June 2016 in a tertiary care hospital in Muscat were screened by PCR for the mcr-1 and mcr-2 genes. The strain identified as mcr-1 positive was genotyped and its antibiotic susceptibility was established. The mcr-1 containing plasmid was mobilized into Escherichia coli K-12 and its sequence was determined. RESULTS: A single E. coli isolate (OM97) carrying mcr-1 gene was identified, while no strains carrying the mcr-2 gene was found. E. coli OM97 was isolated in June 2016 from blood culture of a male patient with multiple comorbidities. It belonged to ST10. Beyond colistin, it was resistant to amoxicillin-clavulanic acid, piperacillin-tazobactam, amikacin, ciprofloxacin, tetracycline, and cotrimoxazole. The mcr-1 gene was located on a conjugative IncI2-type plasmid of 63722 bp size, which did not harbor any further resistance genes. The genetic surrounding of the mcr-1 gene lacked the ISApl1 element. CONCLUSIONS: Although colistin resistance caused by the mcr-1 gene is not common in our collection of clinical isolates, the occurrence of the plasmid-mediated colistin resistance in an E. coli ST10 strain is of concern as this clonal group was already shown to spread ESBL genes and quinolone resistance worldwide. It is especially worrisome that as the mcr-1 gene occurred in a non-ESBL, carbapenem-susceptible E. coli strain, current susceptibility testing algorithms may not detect its presence.

Persistent anemia in a kidney transplant recipient with parvovirus B19 infection.

Anemia after kidney transplant is not uncommon. This paper reports a case of unexplained anemia in a kidney transplant recipient that persisted for more than two months, and that did not respond to recombinant human erythropoietin treatment but was successfully treated after diagnosing Parvovirus B19 (ParvoV B19) infection. A middle-aged male underwent living-unrelated kidney transplantation from Pakistan in April 2015. He was on triple immuno-suppression therapy consisting of prednisolone, tacrolimus, and mycophenolate mofetil. He presented with anemia which persisted for more than two months that did not improve with Darbepoetin alpha and required blood transfusions. A bone marrow biopsy demonstrated pure erythroid hypoplasia and occasional giant pronormoblasts characteristic of a ParvoV B19 infection. The serum was highly positive for ParvoV B19 DNA polymerase chain reaction. The anemia resolved completely three weeks after the administration of intravenous immunoglobulin. ParvoV B19 infection should be considered in the differential diagnosis of kidney transplant recipients who present with anemia associated with a low reticulocyte count.

The first cases of Candida auris candidaemia in Oman.

Candida auris has been recognised as a problematic healthcare-associated emerging yeast which is often misidentified as Candida haemulonii by commercial systems. Correct early identification of C. auris is important for appropriate antifungal treatment and implementing effective infection control measures. Here we report emergence of the first C. auris cases in Oman, initially misidentified as C. haemulonii.

Imported Talaromycosis in Oman in Advanced HIV: A Diagnostic Challenge Outside the Endemic Areas.

A 37-year-old male living in Oman was seen by his physician with complaints of cough, body aches with bilateral lower limb weakness and on and off fever. He was diagnosed with HIV infection and culture from blood and bone marrow grew Talaromyces marneffei. He had travelled to Malaysia on several occasions. Treatment with liposomal amphotericin B resulted in complete cure. This case is reported for its rarity and unusual presentation to alert clinicians and microbiologists to consider T. marneffei as an etiology in high risk individuals. Our case is the first recorded diagnosis of T. marneffei in Oman.

Atypical Presentations of Respiratory Syncytial Virus Infection: Case Series.

The respiratory syncytial virus (RSV) usually causes a lower respiratory tract infection in affected patients. RSV has also been infrequently linked to extrapulmonary diseases in children. We report four children who had unusually severe clinical manifestations of RSV infections requiring critical care admission. These patients presented to the Royal Hospital, Muscat, Oman, in December 2013 with acute necrotising encephalopathy (ANE), acute fulminant hepatic failure with encephalopathy, pneumatoceles and croup. A unique presentation of ANE has not previously been reported in association with an RSV infection. All patients had a positive outcome and recovered fully with supportive management.