Awad Al-Omari

BRUCELLOSIS IN CHILDREN: CLINICAL OBSERVATIONS IN 115 CASES

OBJECTIVE Brucellosis is endemic in Saudi Arabia. This report summarizes the epidemiology of brucellosis in children. METHOD A retrospective review was made of medical records of all patients admitted to King Fahad National Guard Hospital with brucellosis during the period from 1984 to 1995. RESULTS Children < or =12 years constituted 115/545 (21%) of the total brucellosis admissions. The mean age was 5.8 years and 64% of the patients were males. Consumption of unpasteurized milk (often from camel) was the main source of infection. In 70% the clinical picture was dominated by arthritis, 20% of patients presented with a non-specific febrile illness without localizing signs, and 10% had a febrile illness with uncommon presentations. Brucella serology was most helpful in making an early diagnosis. Initial titers of >1:640 were found in 90% of the cases. Bacteremia was observed in 45% and of the isolates speciated, 96% were Brucella melitensis. No increase in resistance to commonly used antimicrobials was noted during the 12-year study period. A combination of rifampin plus co-trimoxazole with or without streptomycin was used in two thirds of the patients. The overall rate of relapse was 9% and one patient died from neurobrucellosis. CONCLUSION Brucellosis presents in various ways and should be included in the differential diagnosis of arthritis in endemic countries. Prevention should rely on education including on boiling raw milk.

Middle East Respiratory Syndrome

The Middle East respiratory syndrome is caused by a coronavirus that was first identified in Saudi Arabia in 2012. Periodic outbreaks continue to occur in the Middle East and elsewhere. This report provides the latest information on MERS.

Feasibility of Using Convalescent Plasma Immunotherapy for MERS-CoV Infection, Saudi Arabia.

Efficacy testing will be challenging because of the small pool of donors with sufficiently high antibody titers.

Cytomegalovirus infection in immunocompetent critically ill adults: literature review.

Cytomegalovirus (CMV) infection is increasingly recognized in critically ill immunocompetent patients. Some studies have demonstrated an association between CMV disease and increased mortality rates, prolonged intensive care unit and hospital length of stay, prolonged mechanical ventilation, and nosocomial infections. However, there is a considerable controversy whether such association represents a causal relationship between CMV disease and unfavorable outcomes or just a marker of the severity of the critical illness. Detection of CMV using polymerase chain reaction and CMV antigenemia is the standard diagnostic approach. CMV may have variety of clinical manifestations reflecting the involvement of different organ systems. Treatment of CMV in critical care is challenging due to diagnostic challenge and drug toxicity, and building predictive model for CMV disease in critical care setting would be promising to identify patients at risk and starting prophylactic therapy. Our objective was to broadly review the current literature on the prevalence and incidence, clinical manifestations, potential limitations of different diagnostic modalities, prognosis, and therapeutic options of CMV disease in critically ill patients.

Efficacy and safety of stress ulcer prophylaxis in critically ill patients: a network meta-analysis of randomized trials

PurposeStress ulcer prophylaxis (SUP) is commonly prescribed in the intensive care unit. However, data from systematic reviews and conventional meta-analyses are limited by imprecision and restricted to direct comparisons. We conducted a network meta-analysis of randomized clinical trials (RCTs) to examine the safety and efficacy of drugs available for SUP in critically ill patients.MethodsWe searched MEDLINE, EMBASE, and the Cochrane Library Central Register of Controlled Trials through April 2017 for randomized controlled trials that examined the efficacy and safety of proton pump inhibitors (PPIs), histamine-2 receptor antagonists (H2RAs), and sucralfate for SUP in critically ill patients. No date or language restrictions were applied. Data on study characteristics, methods, outcomes, and risk of bias were abstracted by two reviewers.ResultsOf 96 potentially eligible studies, we included 57 trials enrolling 7293 patients. The results showed that PPIs are probably more effective for preventing clinically important gastrointestinal bleeding (CIB) than H2RAs [odds ratio (OR) 0.38; 95% confidence interval (95% CI) 0.20, 0.73], sucralfate (OR 0.30; 95% CI 0.13, 0.69), and placebo (OR 0.24; 95% CI 0.10, 0.60) (all moderate quality evidence). There were no convincing differences among H2RA, sucralfate, and placebo. PPIs probably increase the risk of developing pneumonia compared with H2RAs (OR 1.27; 95% CI 0.96, 1.68), sucralfate (OR 1.65; 95% CI 1.20, 2.27), and placebo (OR 1.52; 95% CI 0.95, 2.42) (all moderate quality). Mortality is probably similar across interventions (moderate quality). Estimates of baseline risks of bleeding varied significantly across studies, and only one study reported on Clostridium difficile infection. Definitions of pneumonia varied considerably. Most studies on sucralfate predate pneumonia prevention strategies.ConclusionsOur results provide moderate quality evidence that PPIs are the most effective agents in preventing CIB, but they may increase the risk of pneumonia. The balance of benefits and harms leaves the routine use of SUP open to question.

Thromboprophylaxis using combined intermittent pneumatic compression and pharmacologic prophylaxis versus pharmacologic prophylaxis alone in critically ill patients: study protocol for a randomized controlled trial

Author details Intensive Care Department, King Saud Bin Abdulaziz University for Health Sciences, King Abdullah International Medical Research Center, ICU 1425, PO Box 22490, Riyadh 11426, Kingdom of Saudi Arabia. Emergency Medicine and Intensive Care Department, King Saud Bin Abdulaziz University for Health Sciences, King Abdullah International Medical Research Center, Riyadh, Kingdom of Saudi Arabia. Alfaisal University, Riyadh, Kingdom of Saudi Arabia. Interdepartmental Division of Critical Care Medicine, Li Ka Shing Knowledge Institute, St Michael’s Hospital, Toronto, ON, Canada. Department of Pulmonary and Critical Care Medicine, King Fahad Medical City, Riyadh, Saudi Arabia. King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Kingdom of Saudi Arabia. Department of Critical Care Medicine, King Khalid University, Assir Central Hospital, Abha, Kingdom of Saudi Arabia. Medical/Surgical ICU, University of Toronto, Mount Sinai Hospital, Toronto, ON, Canada. Intensive Care Department, King Abdulaziz Hospital, Al Ahsa, Kingdom of Saudi Arabia. Department of Intensive Care Services, Prince Sultan Military Medical City, Riyadh, Kingdom of Saudi Arabia. International Extended Care Centers, Jeddah, Saudi Arabia. Intensive Care Royal North Shore Hospital of Sydney and Sydney Adventist Hospital, The George Institute for Global Health, Sydney Medical School, University of Sydney, Sydney, NSW, Australia. Intensive Care Department, King Abdulaziz Medical City, Riyadh, Kingdom of Saudi Arabia. King Abdullah International Medical Research Center, Riyadh, Kingdom of Saudi Arabia. Received: 17 August 2016 Accepted: 17 August 2016

Critical care service in Saudi Arabia

[No Abstract Available] Saudi Med J 2015; Vol. 36 (6): 759-761 doi: 10.15537/smj.2015.6.11204

Treatment of ventilator-associated pneumonia and ventilator-associated tracheobronchitis in the intensive care unit. A national survey of clinicians and pharmacists in Saudi Arabia

Objectives: To assess current practices of different healthcare providers for treating extensively drug-resistant (XDR) Acinetobacter baumannii (AB) infections in tertiary-care centers in Saudi Arabia. Methods: This cross-sectional study was performed in tertiary-care centers of Saudi Arabia between March and June 2014. A questionnaire consisting of 3 parts (respondent characteristics; case scenarios on ventilator-associated pneumonia [VAP] and tracheobronchitis [VAT], and antibiotic choices in each scenario) was developed and sent electronically to participants in 34 centers across Saudi Arabia. Results: One-hundred and eighty-three respondents completed the survey. Most of the respondents (54.6%) preferred to use colistin-based combination therapy to treat VAP caused by XDR AB, and 62.8% chose to continue treatment for 2 weeks. Most of the participants (80%) chose to treat VAT caused by XDR AB with intravenous antibiotics. A significant percentage of intensive care unit (ICU) fellows (41.3%) and clinical pharmacists (35%) opted for 2 million units (mu) of colistin every 8 hours without a loading dose, whereas 60% of infectious disease consultants, 45.8% of ICU consultants, and 44.4% of infectious disease fellows preferred a 9 mu loading dose followed by 9 mu daily in divided doses. The responses for the scenarios were different among healthcare providers (p<0.0001). Conclusion: Most of the respondents in our survey preferred to use colistin-based combination therapy and intravenous antibiotics to treat VAP and VAT caused by XDR AB. However, colistin dose and duration varied among the healthcare providers.

MERS coronavirus outbreak: Implications for emerging viral infections

Abstract In September 2012, a novel coronavirus was isolated from a patient who died in Saudi Arabia after presenting with acute respiratory distress and acute kidney injury. Analysis revealed the disease to be due to a novel virus which was named Middle East Respiratory Coronavirus (MERS-CoV). There have been several MERS-CoV hospital outbreaks in KSA, continuing to the present day, and the disease has a mortality rate in excess of 35%. Since 2012, the World Health Organization has been informed of 2220 laboratory-confirmed cases resulting in at least 790 deaths. Cases have since arisen in 27 countries, including an outbreak in the Republic of Korea in 2015 in which 36 people died, but more than 80% of cases have occurred in Saudi Arabia.. Human-to-human transmission of MERS-CoV, particularly in healthcare settings, initially caused a ‘media panic’, however human-to-human transmission appears to require close contact and thus far the virus has not achieved epidemic potential. Zoonotic transmission is of significant importance and evidence is growing implicating the dromedary camel as the major animal host in spread of disease to humans. MERS-CoV is now included on the WHO list of priority blueprint diseases for which there which is an urgent need for accelerated research and development as they have the potential to cause a public health emergency while there is an absence of efficacious drugs and/or vaccines. In this review we highlight epidemiological, clinical, and infection control aspects of MERS-CoV as informed by the Saudi experience. Attention is given to recommended treatments and progress towards vaccine development.