Clinically significant Coagulase Negative Staphylococci and their antibiotic resistance pattern in a tertiary care hospital.

OBJECTIVES: To identify various species of coagulase negative staphylococci involved in neonatal septicaemia and determine their antimicrobial resistance pattern. METHODS: The prospective descriptive study was carried out from January 2012 to October 2013, at Umm Al-Qura University, Makkah, Saudi Arabia, and comprised clinical isolates of coagulase negative staphylococci recovered from the blood of neonates at Maternity and Children Hospital, Makkah..The identification of species and antibiotic sensitivity for each isolate was done using Microscan Walk Away system. RESULTS: Of the 190 clinical isolates S. epidermidis was the most common species found 144(75.8%).The overall drug resistance among the species ranged from 1.6% to 99.5% to all the drugs tested, except to vancomycin and linezolid which were 100% sensitive.The highest drug resistance was exhibited by penicillin 189 (99.5%), ampicillin 188 (99%), oxacillin 178 (93.6%) and augmentin 177 (93%). The minimum drug resistance was shown by synercid 4 (2.2%) and daptomycin 3 (1.6%). All species were 100% resistant to penicillin and ampicillin, except S. hyicus and one isolate of S. hominis-homin which was sensitive to ampicillin. CONCLUSION: High rates of antibiotic resistance was seen among coagulase negative staphylococci to commonly-used antibiotics and majority of them were methicillin-resistant. The newer drugs tested can be used as an alternative.

Group B Streptococcus Colonization, Antibiotic Susceptibility, and Serotype Distribution among Saudi Pregnant Women.

BACKGROUND: Group B Streptococcus (GBS) comprises the normal flora of the female urogenital tract and can be transferred to neonates during delivery, causing invasive diseases. This study was performed to investigate the colonization rate, antibiotic susceptibility, and serotype of GBS among Saudi pregnant women. MATERIALS AND METHODS: In this cross-sectional study, vagino-rectal swabs from 400 pregnant women were collected over a period of one year. Identification of GBS isolates and determination of their antibiotic susceptibility were performed using the Microscan Walk Away system. The isolates were then typed using both latex agglutination and capsular gene-based multiplex polymerase chain reaction assays. RESULTS: Sixty (15.0%) subjects were colonized by GBS, with serotype Ia as the dominant type (30.0%) followed by serotype III and V (25.0%, each). Only 43 (71.7%) isolates were typed by latex agglutination, whereas the remaining isolates were not typable or were non-specifically typed as compared to the genotyping assay, which revealed the specific type of each GBS isolate. The highest resistance rates were observed for erythromycin and clindamycin (16.7%, each), which were mainly restricted to the prevalent serotypes. CONCLUSION: This study is the first to report the distribution of GBS serotypes based on molecular genotyping in Saudi Arabia. GBS colonization was evident among pregnant women, and resistance to erythromycin and clindamycin was predominant among serotypes Ia, III, and V. Molecular genotyping using capsular gene-based multiplex PCR provided reliable typing of the investigated GBS isolates in terms of sensitivity and specificity as compared to conventional serotyping using latex agglutination.

Enterobacterial infection in Saudi Arabia: First record of Klebsiella pneumoniae with triple carbapenemase genes resistance.

INTRODUCTION: Carbapenemase producing Enterobacteriaceae are emerging as important pathogens worldwide with serious effects on patients' outcome. The study aimed to investigate the emergence of carbapenemases associated with enterobacterial infection in Western region of Saudi Arabia. METHODOLOGY: Clinical isolates from suspected patients with enterobacterial infection were investigated over a one-year period from four tertiary care hospitals of Makkah, Saudi Arabia. All isolates were identified using Vitek-2 system and then screened for potential carbapenemase production using disk diffusion test. Suspected isolates with reduced susceptibility to carbapenems were further investigated for blaNDM-1, blaKPC and blaOXA-48 resistant genes. RESULTS: Out of 120 confirmed Enterobacteriaceae isolates, Klebsiella pneumoniae and Escherichia coli comprised the largest proportion (35% and 34.2%, respectively) of encountered infections. Twenty-six (21.7%) isolates showed resistance to carbapenems, the majority of which (21/26) were K. pneumoniae. Remarkably, 17 isolates carried triple resistant genes KPC/NDM-1/OXA-48 while the other 4 carried double resistant genes (KPC/OXA-48) or (NDM-1/OXA-48). The current study revealed that the mentioned triple resistance genes have the higher incidence with significant association risk among males (COR 4.5; CI: 1.9-17.3; P = 0.018), non-Saudi nationalities (COR 4.9; CI: 1.5-19.3; P = 0.003), ICU-obtained specimens (COR 3.6; CI: 1.5-8.4; P = 0.002) and blood specimens (COR 2.8; CI: 1.1-6.9; P = 0.02). CONCLUSION: Multidrug-resistant Enterobacteriaceae isolates in particular K. pneumoniae co-harboring KPC, NDM-1 and OXA-48 genes are emerging in Western region, Saudi Arabia. This is the first record of triple carbapenemase genes co-producing K. pneumoniae associated with enterobacterial infection.

Antimicrobial resistance patterns of Pseudomonas aeruginosa in tertiary care hospitals of Makkah and Jeddah.

BACKGROUND: The clinical significance of Pseudomonas aeruginosa has greatly increased due to its ability to rapidly develop resistance to major groups of antibiotics. OBJECTIVES: Our objective was to determine the pattern of antimicrobial resistance of P aeruginosa. DESIGN: Prospective, descriptive study. SETTING: Four tertiary care hospitals in Makkah and Jeddah. METHODS: Clinical isolates of P aeruginosa were processed following standard microbiological procedures. A Microscan Walk Away system was used for the identification and antibiotic susceptibility of P aeruginosa isolates. MAIN OUTCOME MEASURES: Percentage of resistance of P aeruginosa to antibiotics. RESULTS: The overall drug resistance among 121 strains of P aeruginosa was low to moderate to commonly used anti-pseudomonal drugs (4.9% to 30.6%). Significantly less resistance was exhibited by piperacillin tazobactam (4.9%; P < .05) and meropenem showed significantly high resistance (30.6%; P < .05) as compared to other antibiotics, followed by ticarcillin (22.3%) and imipenem (19%), irrespective of the site of infection. The antibiotics with < 10% resistance were cefepime (8.3%), amikacin (7.4%) and piperacillin-tazobactam, which showed lowest resistance (4.9%). Although, data varied between hospitals, meropenem and ticarcillin had the highest drug resistance in all hospitals. Multidrug resistance was 10.7%. CONCLUSION: Low-to-moderate rates of drug resistance among P aeruginosa isolates were observed. Meropenem resistance was high irrespective of the site of infection. This pattern of resistance indicates probable overuse of broad-spectrum antibiotics like carbapenems. Overuse needs to be addressed by each institution, and consideration given to regulating use of broad-spectrum antibiotics. LIMITATIONS: Results cannot be generalized as the study did not include all tertiary hospitals in these cities.

Maternal colonization of group B streptococcus: prevalence, associated factors and antimicrobial resistance.

BACKGROUND AND OBJECTIVES: Group B streptococcus (GBS, Streptococcus agalactiae) can be transferred during delivery to neonates from mothers who are colonized with GBS in the genital tract. GBS can cause sepsis and meningitis in newborns. This study was conducted to determine GBS colonization rates among pregnant women and the antibiotic sensitivity patterns. DESIGN AND SETTING: Prospective descriptive study at the Maternity and Children Hospital, Makkah. PATIENTS AND METHODS: Vaginal swabs from 1328 pregnant women (>=35 weeks of gestation) attending antenatal clinic were cultured in Todd-Hewitt broth supplemented with gentamicin and nalidixic acid. After 36 hours of incubation, subculture was made onto sheep blood agar and incubated in 5% carbon dioxide for 18 to 24 hours. A Microscan Walk Away system was used for the identification and antibiotic susceptibility of GBS isolates. Each isolate was also tested for group B by using latex slide agglutination test. Information such as maternal age, gestational age and parity was collected using a predesigned questionnaire. RESULTS: The study population ranged between ages 17-47 years. The GBS colonization in all age groups was found to be 13.4%. A higher colonization rate was seen in pregnant women > 40 years of age (27.4%). Women with gestational age > 42 weeks were colonized (25%) more frequently that women with a gestational age from 41-42 weeks (20.2%). An increased rate of colonization was found in women who delivered > 5 times and no colonization in women who delivered once. All GBS isolates were 100% sensitive to penicillin G, ampicillin and vancomycin. Erythromycin and clindamycin showed resistance-15.7% and 5.1%, respectively. CONCLUSION: The high prevalence of GBS colonization in pregnant women demands for screening in women attending an antenatal clinic so that intrapartum antimicrobial prophylaxis can be offered to all women who are colonized with GBS, thus preventing its transfer to the newborn.