Antibiotic prescribing pattern in a Medical Intensive Care Unit in Qatar.
Hanssens Y, Ismaeil BB, Kamha AA, Elshafie SS, Adheir FS, Saleh TM, Deleu D.
Pharmacy Department, Hamad Medical Corporation, Doha State of Qatar.

OBJECTIVE: The primary objectives were to evaluate the current usage of anti-microbial agents in the Medical Intensive Care Unit (MICU) of Hamad Medical Corporation (HMC) in Doha, State of Qatar and to correlate this with: a) the infectious disease pattern, b) the isolated microorganisms and their sensitivity pattern, and, importantly, c) the patient's clinical outcome. A secondary objective was to evaluate the influence of the use of steroid therapy on the development of fungal infections. METHODS: A prospective study covering a 2-month period from February through April 2004, including all patients admitted to the MICU for a minimum of 48 hours, and receiving a systemic antibiotic. RESULTS: From the 71 eligible patients admitted, 54 (76%) were treated for presumed or proven infections and received antibiotics, corresponding with 280 (89%) of the 313 patient days. Respiratory infections accounted for 57%. A total of 159 antibiotics (134 intravenously and 25 orally) were administered to the 54 patients during their stay in the MICU, corresponding with an average of almost 3 antibiotics per patient. Ceftriaxone was prescribed in 31 patients (57%) as initial therapy. Throughout the study period, a total of 385 microbiology samples for culturing were taken, corresponding with almost one sample per patient per day. Fifty-two percent of patients had a microbiologically proven infection (MPI): 18% with community-acquired pneumonia (CAP), 18% ventilated-acquired pneumonia (VAP), and 11% with hospital-acquired pneumonia (HAP). In the group of bacterial MPI, sensitivity pattern resulted in change in empirical antibiotic therapy in 12 of 23 patients (52%). In the group of patients with non-MPI, antibiotherapy was changed in 5 of the 26 patients (19%). Yeast infections developed in 13 of 30 (43%) patients receiving steroids (with 3 out of 9 patients (33%) receiving steroids for severe sepsis, and septic shock) compared to 5 of 24 (21%) patients receiving no steroids. CONCLUSION: This study highlights the urgent need for updated empiric and treatment guidelines as well as the monitoring of the antibiotic usage.

 

Investigation of an outbreak of multidrug-resistant Acinetobacter baumannii in trauma intensive care unit.

El Shafie SS, Alishaq M, Leni Garcia M.

Department of Laboratory Medicine and Pathology, Division of Microbiology, Hamad Medical Corporation, Doha, Qatar.

Between January and June 2002, an outbreak of multidrug-resistant Acinetobacter baumannii occurred in a trauma intensive care unit (TICU) at the Hamad Medical Corporation, Qatar. The outbreak involved 21 patients whose infection/colonization was hospital acquired. All the strains were resistant to all tested antibiotics except amikacin. An A. baumannii strain with a similar antibiogram was isolated from the environment, equipment and hands of healthcare workers (HCWs). The technique of open suctioning probably resulted in aerosilization and contamination of the immediate patient environment. This allowed the hands of HCWs to be contaminated with the outbreak strain, with subsequent transmission to other patients and their environment. Lack of proper hand hygiene between patients and equipment contact facilitated this transmission. A review of hand hygiene practices, extensive environmental cleaning, a closed suctioning system, education and review of other infection-control practices, contributed to the termination of the outbreak.

 

Epidemiology of neonatal meningitis in Qatar.

El-Said MF, Bessisso MS, Janahi MA, Habob LH, El-Shafie SS.

Department of Pediatrics, Hamad Medical Corporation, Doha, Qatar.

OBJECTIVE: Neonatal meningitis is responsible for thousands of neonatal deaths annually all over the world. Our study was conducted to determine the epidemiology, management and best preventive measures for neonatal meningitis in Qatar. METHODS: A retrospective study reviewed the records of bacterial meningitis patients under the age of one month. The study was carried out at Hamad Medical Hospital, the only hospital that provides health care at Qatar and the study period was between January 1998 to December 2000. RESULTS: Thirteen patients were included. Sixty percent of patients had early onset meningitis. Causative organisms were group B Streptococcus pneumoniae, Klebsiella pneumonia, Pseudomonas species, Neisseria meningitidis, Staphylococcus epidermidis and Flavibacterium meningococcus septicum. A bacterial resistance to the usual combination of ampicillin and gentamicin were noticed (as initial treatment before culture sensitivity results), which affected negatively on some patients. Complications of cerebral palsy, mental retardation and epilepsy occurred in 3 patients (23%). None of the patients died during the study period. CONCLUSION: Emphasis is placed on the importance of correct early diagnosis and appropriate antibiotic therapy. It is suggested that the identification and appropriate treatment of any maternal bacterial infection is an important measure in preventing neonatal sepsis and meningitis.

 

Pattern of mycobacterial resistance to four anti-tuberculosis drugs in pulmonary tuberculosis patients in the state of Qatar after the implementation of DOTS and a limited expatriate screening programme.

Al-Marri MR.

Qatar Armed Forces Medical Services, Pulmonary, Sleep and Critical Care Medicine, Hamad General Hospital, Doha, Arabian Gulf.

OBJECTIVE: To determine the resistance pattern of Mycobacterium tuberculosis to four anti-tuberculosis drugs in pulmonary tuberculosis patients in the State of Qatar after the implementation of DOTS and an expatriate screening programme on arrival. METHOD: A state-wide, population-based, retrospective analysis of all cases of pulmonary tuberculosis with positive M. tuberculosis culture reported to the Division of Public Health TB Unit from January 1996 to December 1998. M. tuberculosis sensitivity testing was done by the Bactec method for isoniazid (INH), rifampicin (RMP), streptomycin (SM) and ethambutol (EMB). The results were interpreted as a daily change of the growth index of test vials (with drug) compared with controls. RESULTS: There were 406 isolates with positive M. tuberculosis culture. Sixty-one (15%) were resistant to one or more of the four anti-tuberculosis drugs, of which 58 (95%) were from newly diagnosed cases (primary) and three (5%) were from previously treated cases (acquired). Primary resistance was as follows: any resistance 15%, INH 12.4%, RMP 2%, SM 5.2%, EMB 0.8% and multidrug resistance (MDR, resistance to INH and RMP at least) was found in 0.8%. Acquired resistance was as follows: any resistance 15%, INH 15%, RMP 5%, SM 5% and MDR 5%. CONCLUSION: The prevalence of resistance to four anti-tuberculosis drugs is strikingly low due to the limited expatriate screening programme (chest radiography) and implementation of DOTS. The four-drug regimen is recommended for the initial phase of therapy until the results of sensitivity testing are known.

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