Hand hygiene knowledge, attitude, and practice before, during and post COVID-19: a cross-sectional study among university students in the United Arab Emirates.

Aims: Hand hygiene (HH) is an essential practice to evade the transmission of germs and minimize community-acquired infections. This study assesses the knowledge, attitude and practice (KAP) of HH and other health and safety measures before, during, and after the COVID-19 pandemic. in university students in the United Arab Emirates (UAE). Methods: A cross-sectional questionnaire study was conducted between December 2022 and March 2023, targeting university students from all disciplines and study levels. A 44-item questionnaire was used which included student demographics, knowledge, attitude, and practice of HH, as well as the anticipated risk of COVID-19 morbidity and mortality. Participants consented before commencing the questionnaire, and the collected data were analysed using the student's t-test and ANOVA test, as required. Results: A total of 378 responses were received nationwide, with a valid response rate of 98%. The HH knowledge revealed an average score of 62%, which was significantly higher in students with moderate family income. Additionally, the average attitude score was 74.7%, as measured on the Likert scale, and the score lacked any correlation with the other variables. HH practice showed an average score of 86.8%, which was correlated with the students' gender and field of study. Conclusions: This study showed a moderate level of knowledge, a good attitude, and good practice around HH and other safety measures among the UAE's university students. Socioeconomic status, gender, and field of study influenced the study outcomes. This study highlights the need for effective awareness campaigns to reinforce students' health and safety, especially for male and non-health science students, in order to protect against communicable diseases.

Medical school origins of award-winning physicians; analysis of a complete national dataset.

BACKGROUND: Educators and medical students share the same objective of achieving success in medical practice. Both groups consider doctors' successes to include optimum patient care outcomes and positive career progressions. Accordingly, identifying common educational features of such high-achieving doctors facilitates the generation of excellence amongst future medical trainees. In this study we use data from the British clinical merit award schemes as outcome measures in order to identify medical school origins of doctors who have achieved national or international prominence. METHODS: Britain has Clinical Excellence Awards/Distinction Awards schemes that financially reward all National Health Service doctors in England, Scotland and Wales who are classified as high achievers. We used these outcome measures in a quantitative observational analysis of the 2019-20 dataset of all 901 national award-winning doctors. Where appropriate, Pearson's Chi-Square test was applied. RESULTS: The top five medical schools (London university medical schools, Glasgow, Edinburgh, Oxford and Cambridge) were responsible for 51.2% of the physician merit award-winners in the 2019-20 round, despite the dataset representing 85 medical schools. 91.4% of the physician merit award-winners were from European medical schools. The lowest national award-winners (tier 3) originated from 61 medical schools representing six continents. International medical graduates comprised 11.4% of all award-winners. CONCLUSIONS: The majority of physicians who were national merit award-winners originated from only five, apparently overrepresented, UK university medical schools. In contrast, there was a greater diversity in medical school origin among the lower grade national merit awards; the largest number of international medical graduates were in these tier 3 awards (13.3%). As well as ranking educationally successful university medical schools, this study assists UK and international students, by providing a roadmap for rational decision making when selecting physician and non-physician medical education pathways that are more likely to fulfil their career ambitions.

COVID-19 and Mucormycosis Coinfection: How Challenging It Is.

Recently, cases of rhinoorbital mucormycosis in people diagnosed with COVID-19 have been reported from India particularly. Diabetes mellitus though happens to be an independent risk factor both for severe COVID-19 and mucormycosis, administration of steroids is attributed as a precipitating factor for acquiring the comorbid condition. This opportunistic fungal infection is highly angioinvasive in nature because of which, clinical outcome of infection is invariably poor, especially with rhinocerebral or rhinoorbitocerebral variety of mucormycosis. However, effective management depends upon timely and accurate diagnosis and parenteral administration of amphotericin B. At the same time, judicious use of steroids is a key factor. In addition, glycemic control in those who are severely diabetic is strongly advocated. Exenteration of an eyeball may be indicated if cavernous sinus and intracranial spread are anticipated. Therefore, in order to facilitate faster healing and better penetration of antifungal drugs, surgical debridement of the paranasal sinus cavities and removal of dead tissue from the sinuses are recommended.

Urinary tract infection by a rare pathogen Cedecea neteri in a pregnant female with Polyhydramnios: rare case report from UAE.

BACKGROUND: Cedecea neteri is a gram-negative, oxidase-negative bacillus, a rare pathogen. Few reports are emerging globally about its antimicrobial resistance pattern especially in immunocompromised individuals with comorbidities. CASE PRESENTATION: In this paper, we report the first case of C. neteri causing urinary tract infection in a pregnant woman at a specialty care hospital in the Northern Emirates of Ras al Khaimah, UAE. DISCUSSION AND CONCLUSION: C. neteri is a rare and unusual pathogen, unlike routine gram-negative urinary tract pathogens from the family of Enterobacteriaceae and therefore may be missed or misidentified by routine laboratories using conventional microbiology identification techniques. Hence, Cedecea infections may be under-reported. Physicians and microbiology technicians must be aware of such a rare pathogen, as most of the isolates are multi-drug-resistant and require combined antibiotic treatment with beta-lactamase inhibitors and hence pose a treatment challenge especially in immunocompromised patients with comorbidities. In recent years, it has been reported as an emerging opportunistic pathogen.

High incidence of New Delhi metallo-beta-lactamase-producing Klebsiella pneumoniae isolates in Sharjah, United Arab Emirates.

The purpose of this study was to identify carbapenem-resistant Klebsiella pneumoniae in a tertiary care hospital in Sharjah Emirate, to identify the plasmids carrying the carbapenemase genes and to reveal clonal relationships among the isolates. Two hundred and two clinically relevant isolates collected between September 2011 and October 2012 at Al-Qassimi hospital, Sharjah, were investigated for meropenem resistance. Strains with decreased susceptibility were further tested with the modified Hodge test, by EDTA and phenylboronic acid synergy and by E-test. The genes of New Delhi metallo-ß-lactamase (NDM), IMP, VIM, OXA-48, and KPC beta-lactamases were targeted by polymerase chain reaction and the genes were located on plasmids by Southern blotting. Clusters of the isolates were revealed by macrorestriction analysis. Seven percent of the isolates were originally found to be meropenem resistant, one isolate have lost its resistance during storage. All of the 13 resistant isolates were positive for the NDM-1 gene located on plasmids of 125 to >170 kb, while three isolates also carried the blaOXA-48-like genes. Clusters having repeatedly been isolated over the study period were identified. Carbapenem-resistant Klebsiella pneumoniae carrying the blaNDM-1 gene is a fast emerging problem, emphasizing the potential role of the Middle East as a secondary reservoir for these organisms.

Incidence of community-acquired methicillin-resistant Staphylococcus aureus carrying Pantone-Valentine leucocidin gene at a referral hospital in United Arab Emirates.

Community-acquired methicillin-resistant Staphylococcus aureus (CA-MRSA) is an emerging pathogen in hospitalized patients worldwide. The present study was undertaken to identify CA-MRSA in hospitalized patients in a 350-bed tertiary care hospital in Sharjah, UAE over a 2-year period from January 2011 to December 2012. CA-MRSA was defined based on identification within first 48 h of admission in the hospital. Staphylococcal cassette chromosome (SCC) mec typing of the CA-MRSA isolates was carried out by multiplex polymerase chain reaction (PCR). Detection of PVL and mecA genes was done by PCR using the GenoType(®) MRSA test system (Hain Lifescience). Patient's clinical data and antimicrobial susceptibility pattern of the CA-MRSA isolates were also evaluated. Fifty seven of the 187 MRSA isolates were identified as CA-MRSA. All the CA-MRSA strains in our study belonged to SCCmecIV type and were positive for both PVL and mecA genes. The patients with CA-MRSA infections were young (median age, 32 years) and the majority of infections involved the skin and soft tissue (36%). Antimicrobial susceptibility pattern of the CA-MRSA isolates showed a better susceptibility profile to the non-beta-lactam antimicrobials with the exception of ciprofloxacin having 28% resistance. This study evidently strengthens the recent observation of an increase in CA-MRSA emergence among hospitalized patients in the UAE.

Misidentification of Brucella melitensis as Bergeyella zoohelcum by MicroScan WalkAway®: a case report.

OBJECTIVE: To describe the misidentification of Brucella melitensis as Bergeyella zoohelcum by MicroScan WalkAway®, a commonly used bacterial identification system. CLINICAL PRESENTATION AND INTERVENTION: A 35-year-old man was admitted to the Intensive Care Unit with sepsis syndrome. Three sets of aerobic blood culture samples were positive after 48 h of incubation. The isolated organism was identified as B. zoohelcum using the MicroScan WalkAway (Siemens Healthcare Diagnostics Inc., West Sacramento, Calif., USA). However, due to the rareness of the pathogen, the isolate was reidentified as B. melitensis with Vitek® 2 system and later 16S ribosomal sequence analysis confirmed the isolate as B. melitensis having 100% match. CONCLUSION: This case showed that Brucella can be misidentified using MicroScan WalkAway. Countries where brucellosis is endemic need to be careful while using such automated identification systems in order not to miss the diagnosis of Brucella.

16S rRNA gene sequence analysis of a Brucella melitensis infection misidentified as Bergeyella zoohelcum.

Misidentification of Brucella species from clinical specimens using commercial bacterial identification systems is a recurring problem. An isolate from a bacterimic patient was identified as Bergeyella zoohelcum by MicroScan Walk-Away (Siemens Healthcare Diagnostics Inc., West Sacramento, CA, USA) and as Brucella melitensis by Vitek 2 system (bioMérieux Inc., Durham, NC, USA). Because of this identification ambiguity by the two automated bacterial identification systems we performed 16S rRNA sequencing and serotyping of the isolate and confirmed it as a Brucella spp. Combining the sequence data with the Vitek 2 system data we conclude that the infection was caused by B. melitensis.

Tuberculosis and MDR-TB in the northern emirates of United Arab Emirates: a 5-year study.

In this study, we describe the prevalence of TB and occurrence of multi-drug-resistance tuberculosis (MDR-TB) in a major referral hospital belonging to the Ministry of Health in Sharjah, United Arab Emirates (UAE). A retrospective re-view of the clinical and laboratory records of 1,810 suspected cases of TB was carried out between January 2004 and September 2008. The antimicrobial susceptibility patterns of each Mycobacterium tuberculosis isolate were analyzed. During the study period, 312 M. tuberculosis culture confirmed cases were recorded; 230 were males and 82 were females. The majority of TB cases (36%) were seen among expatriates from South and Southeast Asian countries. Fifty-one active TB cases (16%) were reported in native people (Emaratis) of the country. The peak age group was between 16 and 45 years. Among first-line antituberculosis drugs, resistance to isoniazid was the most common (21%), followed by streptomycin (14%). MDR-TB was found in 15 cases (4.8%). Although the prevalence of TB in UAE is fairly low, an increasing number of cultures confirmed TB and MDR-TB among native and expatriate patients, necessitating improved vigilance in case detection, effec-tive management and prevention of MDR and XDR-TB emergence in the country.

Prevalence and antimicrobial susceptibility pattern of extended-spectrum beta-lactamase-producing Enterobacteriaceae in the United Arab Emirates.

OBJECTIVE: To investigate the prevalence and antibiotic susceptibility pattern of extended-spectrum beta-lactamases (ESBL)-producing Enterobacteriaceae among patients in the United Arab Emirates. MATERIALS AND METHODS: A total of 130 Enterobacteriaceae comprising of Escherichia coli (n = 83), Klebsiella pneumoniae (n = 45) and Klebsiella oxytoca (n = 2) was studied. Of these 130 isolates, 64 were from urine. ESBL screening was by disc diffusion and confirmatory tests for ESBL phenotype were conducted using BD Phoenix ESBL System and cephalosporin/clavulanate combination discs. Susceptibility to a panel of antibiotics was evaluated. RESULTS: Of the 130 isolates, 53 (41%) were identified as having ESBL phenotype; of these, 32 (60%) were E. coli, 20 (36%) K. pneumoniae and 2 (4%) K. oxytoca. ESBL phenotype was seen in 100% of endotracheal tubes isolates, 20 (31%) from urine, 7 (58%) from blood and 4 (80%) from catheter tips. Amikacin susceptibility was 100%. Over 90% of ESBL isolates showed resistance to aztreonam and cephalosporins. All Klebsiella isolates were carbapenem sensitive. One ESBL isolate showed intermediate resistance to imipenem and meropenem (both MIC 8 microg/ml), cefotetan (MIC 32 microg/ml) and piperacillin/tazobactam (MIC 32 microg/ml). MIC for the carbapenems was lower in non-ESBL isolates (0.034 microg/ml) than ESBL isolates (0.071 microg/ml). Resistance to gentamicin, ciprofloxacin and piperacillin/tazobactam was higher in ESBL than non-ESBL isolates (p < 0.05). CONCLUSION: A high prevalence of ESBL-producing bacteria exists among in-patients in the United Arab Emirates. Amikacin and carbapenems remain the most effective drugs, but the presence of carbapenem-resistant ESBL-producing E. coli and occurrence of multidrug resistance are of concern. Continued surveillance and judicious antibiotic usage are recommended.

Acute bacterial meningitis among children < 5 years of age in Oman: a retrospective study during 2000-2005.

BACKGROUND: During the last two decades, significant changes have taken place in the epidemiology of meningitis, especially due to the global availability and expanding use of Hib vaccines. The introduction of conjugate Hib vaccine in the Expanded Programme of Immunization (EPI) in Oman and recent availability of meningococcal vaccines against serogroups A and C plus the introduction of pneumococcal heptavalent conjugate vaccine are expected to influence the epidemiology of the disease in the country. We conducted this periodic review of acute bacterial meningitis in children younger than five years of age in Oman from January 2000 to December 2005 to reflect changes in the epidemiological pattern of these pathogens. METHODOLOGY: Retrospective analysis of all cases of acute bacterial meningitis in children younger than five years of age reported to the Department of Communicable Diseases Surveillance and Control, Ministry of Health, Oman. RESULTS: There were 344 cases of meningitis due to suspected bacterial etiologies reported in children younger than 5 years of age. Although Haemophilus influenzae 76 (22%) was the most common pathogen identified during the study period, the incidence of meningitis due to Haemophilus influenzae has been dramatically reduced since the introduction of conjugate Hib vaccination in Oman in October 2001. Streptococcus pneumoniae 53 (15%) and Neisseria meningitidis 37 (11%) were the next two leading agents of meningitis respectively. In one hundred seventy four (52%) cases of presumptive bacterial meningitis, the etiologic organism remains unidentified. The peak occurrence of meningitis was in young children younger than one year old. The total male to female ratio was 1.4:1 and the case fatality rate (7 deaths) was 2%. CONCLUSIONS: With the introduction of Hib vaccine in Oman in October 2001, the absolute number of cases due to Haemophilus influenzae significantly declined over the years. The incidence of meningitis due to other pathogens such as S. pneumoniae and N. meningitidis remains steady. There is significant need to improve laboratory methods of bacterial detection and identification, which will help to formulate better antibiotic policies and strengthen control measures through newly introduced vaccines in Oman.

Antimicrobial resistance among Streptococcus pneumoniae and Haemophilus influenzae isolates in the United Arab Emirates: 2004-2006.

BACKGROUND: Streptococcus pneumoniae and Haemophilus influenzae represent key aetiological agents in respiratory tract infections showing an increasing trend of antimicrobial resistance. We present the first report on the antimicrobial resistance in S. pneumoniae and H. influenzae isolated from patients in the United Arab Emirates. METHODS: One hundred S. pneumoniae and 102 H. influenzae strains were isolated from patients with community acquired respiratory tract infections during the study period (October 2004-March 2006). Susceptibility testing to a panel of antibiotics was conducted using disc diffusion and E test. Minimum inhibitory concentrations were interpreted using CLSI and Pharmacokinetic-pharmacodynamic (PK/PD) breakpoints. RESULTS: For S. pneumoniae isolates, 57% were penicillin susceptible while 98% were susceptible to amoxicillin/clavulanate with both interpretative criteria. Cefaclor was the least effective cephalosporin with only 57% and 43% of isolates showing susceptibility with CLSI and PK/PD breakpoints respectively. Thirty-six isolates were ofloxacin non-susceptible (intermediate and resistant); three resistant isolates were associated with high ciprofloxacin MICs (>8 mg/L). There was elevated macrolide resistance with associated high levels of erythromycin/clindamycin cross-resistance (n=22/30) suggesting predominant erm(B)-mediated resistance and 21% of isolates demonstrated multidrug resistance. For H. influenzae, 18% were beta-lactamase producers. Reduction in cefaclor and cefprozil susceptibility with PK/PD breakpoints (94.1% to 41.2% and 62.7% respectively) was seen and only 1% remained azithromycin and clarithomycin susceptible. For both pathogens, lowest susceptibility was with co-trimoxazole. CONCLUSION: These findings indicate a high level of penicillin resistance and continued usefulness of amoxicillin/clavulanate. Elevated macrolide and fluoroquinolone resistance and the occurrence of multidrug resistance indicate a need for continued surveillance.