Changes in epidemiological pattern of Meningococcal disease in Saudi Arabia. Does it constitute a new challenge for prevention and control?

Al-Mazrou YY, Al-Jeffri MH, Abdalla MN, Elgizouli SA, Mishskas AA.

Department of Preventive Medicine, Ministry of Health, Riyadh, Kingdom of Saudi Arabia.
OBJECTIVE: Meningococcal meningitis epidemics, which occurred in the Kingdom of Saudi Arabia (KSA) coincided with Hajj and Umra seasons; the 2 major pilgrims to Muslims. In many countries, the disease showed major changes of its epidemiological determinants, in particular to age and prevailing serogroup. This study was conducted to determine the epidemiological trend of meningococcal meningitis disease in KSA. METHODS: All confirmed meningococcal meningitis cases reported in KSA during the period from January 1999 to December 2002 were studied retrospectively. Confirmation of cases was based on isolation of the causative organism from cerebrospinal fluid (CSF) or blood culture or detection of antigen in the CSF. Personal, clinical and laboratory results were analyzed using Epi info version 6 software. Categorical data were tested using chi2 test. RESULTS: A total of 729 cases were reported, 304 cases (42%) were among people coming from abroad for Hajj or Umra and 425 (58%) were among local population. Nearly half of the later (48%) were reported at the 2 holy areas of Makkah and Madinah, KSA. Thirty-nine percent of cases were children aged <2 years and 58% were <5 years of age. Proportion of cases affected with serogroup W135 increased over time (up to 95%) and significantly affected children aged <5 years (p<0.001). CONCLUSION: Continuous monitoring of epidemiological determinants is essential to guide vaccination policy.

Bacteremia and septicemia in diabetic patients in Western Saudi Arabia.

Qari FA.

Medical Department, King Abdul-Aziz University Hospital, Jeddah, Kingdom of Saudi Arabia.

OBJECTIVE: The present study aims to define the pattern of bacteremia with clinical sepsis in diabetic patients at King Abdul-Aziz University Hospital (KAUH), Jeddah, Kingdom of Saudi Arabia (KSA), in relation to the type of infection, microbial pattern, source, complication, outcome, and the risk factors associated with high mortality. METHODS: Retrospective study of adult diabetic patients with bacteremia and septicemia admitted to KAUH during a 2 years period between January 2000 through to December 2002 was carried out. RESULTS: A total of 4850 blood culture were submitted to the Microbiology Laboratory of KAUH over a 2 years period. Two hundred and ninety (6%) cases had positive blood cultures, 70 were diabetic patients with an incidence rate of 24% with p-value of 0.043 which is statically significant. Urinary tract infection was the most common source of bacteremia in our study group with Escherichia coli as the most frequent organism in 62%. Mortality rate was 44%. Old age was an important risk factors for high mortality with p-value 0.011, which is statically significant. Other risk factors included comorbidity associated with diabetes, septic shock, mechanical ventilation and disseminated intravascular coagulation. CONCLUSION: Increase age was one of the important risk factors for high mortality rate in our study group. Good empiric antibiotics coverage should be instituted early in high risk groups.

Prevalence of extended-spectrum beta-lactamases in Enterobacteriaceae, Pseudomonas and Stenotrophomonas as determined by the VITEK 2 and E test systems in a Kuwait teaching hospital.

Jamal W, Rotimi VO, Khodakhast F, Saleem R, Pazhoor A, Al Hashim G.

Division of Microbiology, Mubarak Al-Kabeer Hospital, Kuwait.

OBJECTIVE: To determine the prevalence of extended-spectrum beta-lactamase (ESBL)-producing members of the Enterobacteriaceae using VITEK 2 and E test systems. MATERIALS AND METHODS: A total of 3,592 consecutive gram-negative isolates (single isolate per patient) of the family of Enterobacteriaceae and Pseudomonas adjudged to be clinically relevant to the patient's infection were studied for ESBL production over a period of 1 year at Mubarak Al-Kabeer Hospital, Kuwait. Two methods were used: the automated VITEK 2 system and E test ESBL, a manually manipulated plastic strip containing various gradients of beta-lactam antibiotics. These tests and interpretative criteria for the results were performed according to the manufacturer's instructions. RESULTS: Of the 3,592 bacterial isolates, 264 (7.5%) and 185 (5.2%) were positive for ESBL production by the VITEK 2 and E test, respectively. All the ESBL-producing Pseudomonas aeruginosa identified by VITEK 2 gave indeterminate results by E test. Prevalent ESBL producers, identified by the VITEK 2 versus E test, respectively, were: Citrobacter spp. (15 vs. 3.2%), K. pneumoniae (12.2 vs. 11.4%), Enterobacter spp. (12 vs. 3%), E. coli (6.5 vs. 5.6%), P. aeruginosa (6.5 vs. 0%) and Morganella spp. (2 vs. 1%). The most common infection associated with ESBL-producing pathogens was urinary tract infection (68.2%), followed by wound infection (14.4%) and bloodstream infection (6.1%). CONCLUSION: The result of this study showed a relatively high prevalence of clinically significant ESBL producers among the Enterobacteriaceae and Pseudomonas spp. at our teaching hospital. The VITEK 2 identified a higher prevalence of ESBL strains than the E test.

Molecular characterization of nitroimidazole resistance in metronidazole-resistant Bacteroides species isolated from hospital patients in Kuwait.

Jamal WY, Rotimi VO, Brazier JS, Johny M, Wetieh WM, Duerden BI.
Department of Microbiology, Faculty of Medicine, Kuwait University/Mubarak Al-Kabeer Hospital, Jabriya, Kuwait.

OBJECTIVES: The aim of this study was to screen for infections caused by metronidazole (MTZ)-resistant Bacteroides spp., and to characterize the genes that encode the MTZ resistance. MATERIALS AND METHODS: A total of 7 MTZ-resistant Bacteroides spp. were isolated from 5 patients with MTZ-resistant infections. These organisms were investigated for carriage of genes that encode MTZ resistance. The presence of these genes was investigated by PCR and the PCR products were subjected to PCR-RFLP analysis. RESULTS: The strains were MTZ-resistant with minimum inhibitory concentrations of > 32 microg/ml. The presence of nim genes was indicated by PCR in all 7 strains. PCR-RFLP analysis of the nim gene products demonstrated two of the five reported resistance genes, nimA-nimE. These two resistance genes were nimE in 5 of the 7 isolates and nimA in 2 strains. CONCLUSION: MTZ-resistant Bacteroides spp. have been isolated from patients in Kuwait. Nim genes, specifically nimE and nimA, mediate the drug resistance in these isolates. The methods used in detecting these genes are rapid, accurate and relatively inexpensive and could be adopted easily to help in monitoring emergence of MTZ resistance determinants in Kuwait.