Mutasim E. Ibrahim

Vaginal infections among pregnant women at Omdurman Maternity Hospital in Khartoum, Sudan

INTRODUCTION Microbial infections of the vagina in pregnant women are health problems that lead to serious medical complications and consequences. This study aimed to investigate and determine antimicrobial susceptibilities of the causative agents of vaginal infections in pregnant women. METHODOLOGY A cross-sectional study of pregnant women (n = 200) was conducted between August and December 2008 at Omdurman Maternity Hospital, Khartoum, Sudan. Vaginal and cervical swabs were obtained from each subject and processed for isolation and identification of pathogenic microorganisms using standard methods of wet mount preparation, direct Gram smear, Nugent scoring system, direct immunofluorescence, and cultural techniques. Antimicrobial susceptibility testing of bacterial isolates was performed using standard procedures. Statistical analysis was done using SPSS program version 12.0.1. A p value < 0.05 was considered statistically significant. RESULTS Of the 200 pregnant women enrolled, BV was detected in 49.8%, followed by Chlamydia trachomatis (31.3%) and Candida albicans (16.6%), with low frequencies of Neisseria gonorrhoeae (1.8%) and Trichomonas vaginalis (0.5%). Higher infection rates were recorded among subjects in the third trimester (71.6%) than in the second trimester of gestation (28.4%). No significant association (p = 0.7) between history of abortions and C. trachomatis infections was found. Gentamicin was the most active agent against Gram-positive and Gram-negative bacteria. Clarythromycin was the most active against Mycoplasma species. CONCLUSIONS Pregnant women with vaginal complaints revealed various positive microbiology results. Such cases may require specific medication. Routine culture of vaginal and cervical samples should be performed on all pregnant women during prenatal visits.

Prevalence of Extended-spectrum β-Lactamases-producing Escherichia coli from Hospitals in Khartoum State, Sudan

OBJECTIVE This study aimed to determine the prevalence and assess antimicrobial susceptibility of extended- spectrum β-lactamase-producing Escherichia coli isolated from clinical specimens of patients at hospitals in Khartoum State, Sudan. METHODS During April to August 2011, a total of 232 E. coli isolates were collected from various clinical specimens of patients. Isolates were identified, tested for antimicrobial susceptibility and screened for ESBL production as per standard methods. The double-disk diffusion method was used to confirm ESBL production using antimicrobial disks of ceftazidime (30 μg), cefotaxime (30 μg), with or without clavulanic acid (10 μg). A zone difference of >5 mm between disks was considered indicative of ESBL production. RESULTS Out of 232 E. coli isolates, 70 (30.2%) were found to be positive for ESBL by the applied phenotypic methods. ESBL-producing isolates yielded high resistance rates for trimethoprim-sulfamethoxazole (98.6%), tetracycline (88.6%), nalidixic acid (81.4%) and ciprofloxacin (81.4%). The highest antimicrobial activities of ESBL-producing isolates were observed for amikacin (95.7%), followed by tobramicin (74.3%) and nitrofurantoin (68.6%). Resistance to quinolones, aminoglycosides, trimethoprim-sulfamethoxazole, tetracycline, nitrofurantoin and chloramphenicol was higher in ESBL than non-ESBL isolates (p<0.05). The frequency of ESBL-producing isolates varied among hospitals (18.2% to 45.1%), although a high prevalence was recorded as 45.1% at Khartoum Teaching Hospital. Wound specimens were the most common source of ESBL-producing isolates. The proportion of ESBL-producing E. coli did not differ significantly between adults and children (31% vs. 27%). CONCLUSION The prevalence of ESBL-producing E. coli detected in this study is of great concern, which requires sound infection control measures including antimicrobial management and detection of ESBL-producing isolates.

Comparison of Phenotypic Characteristics and Antimicrobial Resistance Patterns of Clinical Escherichia coli Collected From Two Unrelated Geographical Areas

Background: Antimicrobial resistance among pathogenic Escherichia coli is an increasing problem especially in developing countries. Aims: To compare between resistance patterns of E. coli collected from two unrelated geographical areas. Methods: A descriptive comparative study was conducted between May 2010 and August 2011. E. coli (n= 402) collected from hospitals in Khartoum state, Sudan and in Aseer region, Saudi Arabia were studied. Identification and antimicrobial susceptibility testing of isolates were performed following standard methods. Multi-drug resistance (MDR) was defined as non-susceptibility to ≥ three antimicrobials. Results: Of the 402 E. coli isolates studied, MDR patterns were significantly higher among isolates from Sudan than Saudi Arabia [92.2% (214/232) vs. 70.6% (120/170)] (p = 0.000). The resistance rates of E. coli isolates were recorded as follows (Sudan and Saudi Arabia): High to moderate resistance to amoxicillin (97.7% and 94.2%), trimethoprim-sulfamethoxazole (88.3% and 82.5%), tetracycline (77.1% and 74.2%), amoxicillin- clavulanic acid (51.4% and 70%), ceftriaxone (64% and 52.4%) and ciprofloxacin (58.4% and 40%). Low resistance was to ceftazidime (35% and 20%), gentamicin (35% and 17.5%) and nitrofurantoin (22.4% and 11.7%). Resistance to amikacin was uncommon (1.9% and 5%). Significant differences (p < 0.05) in resistance rates of isolates between both countries in term to patient’s gender and age. The most frequent MDR phenotypes among isolates were to 7(15.9%) in Khartoum state and to 3(20.8%) in Aseer region. Conclusions: Variation and emerging of antimicrobial resistance among pathogenic E. coli isolates was observed in both regions. Continuous monitoring of resistance profiles, locally and international surveillance programs are required.

Inducible clindamycin resistance and nasal carriage rates of Staphylococcus aureus among healthcare workers and community members

BACKGROUND Nasal carriage of Staphylococcus aureus is becoming an increasing problem among healthcare workers and community individuals. OBJECTIVES To determine the prevalence of methicillin-resistant S. aureus (MRSA) nasal colonization and inducible clindamycin resistance (ICR) of S. aureus among healthcare workers at Soba University Hospital and community members in Khartoum State, Sudan. METHODS Five hundred nasal swabs samples were collected during March 2009 to April 2010. Isolates were identified using conventional laboratory assays and MRSA determined by the disk diffusion method. The D-test was performed for detection of ICR isolates with Clinical Laboratory Standard Institute guidelines. RESULTS Of the 114 S. aureus isolated, 20.2% represented MRSA. The occurrence of MRSA was significantly higher among healthcare worker than community individuals [32.7% (18/55) vs. 6.9% (5/59)] (p=0.001). Overall the 114 S. aureus isolates tested for ICR by D-test, 29 (25.4%) yielded inducible resistance. Significantly higher (p=0.026) ICR was detected among MRSA (43.5%) than methicillin-susceptible S. aureus (MSSA) (20.9%). CONCLUSION MRSA nasal carriage among healthcare workers needs infection control practice in hospitals to prevent transmission of MRSA. The occurrence of ICR in S. aureus is of a great concern, D- test should be carried out routinely in our hospitals to avoid therapeutic failure.

Evaluation of microscopical and serological techniques in the diagnosis of Schistosoma mansoni infection at Sennar State, Central Sudan

Objective To determine the prevalence of Schistosoma mansoni (S. mansoni) infection among schoolchildren and to evaluate the sero-diagnostic techniques of indirect-haemagglutination (IHA) and enzyme-linked immunosorbent assay (ELISA) in comparison with Kato-Katz smear examination.

High antimicrobial resistant rates among Gram-negative pathogens in intensive care units. A retrospective study at a tertiary care hospital in Southwest Saudi Arabia

Objectives: To determine the distribution and resistance profiles of Gram-negative bacteria (GNB) in intensive care units (ICUs) at King Abdullah Hospital in Bisha, Saudi Arabia. Methods: A record based retrospective study was conducted from December 2016 to January 2018. In total, 3736 non-duplicate clinical specimens from the general intensive care unit (ICU), neonatal ICU (NICU), and coronary CU (CCU) were analyzed for pathogens. Results: Of 3736 specimens, 9.6% (358) were positive for pathogens, and GNB constituted the majority (290/358; 81%). Acinetobacter is predominant in the general ICU, whereas Klebsiella pneumoniae is common in the NICU and CCU. Overall, GNB revealed a high resistance rate for cefuroxime (75.8%) trimethoprim/sulfamethoxazole (73.4%), cefotaxime (72.9%), aztreonam (64.6%), piperacillin (62.1%), and ciprofloxacin (61.5%). Acinetobacter revealed a high resistance (93.4% to 97.5%) to all antimicrobials except colistin (4%). Klebsiella pneumoniae showed a high resistance to trimethoprim/sulfamethoxazole (71.8%), cefotaxime (71.4%) and aztreonam (65.2%). Pseudomonas aeruginosa showed good activity for aminoglycosides but increasing resistance for cephalosporins and meropenem. GNB exhibited a high rate of multi-drug-resistant (MDR) phenotypes (67.9%) with a higher level among Acinetobacter spp. (97.5%). There were no significant differences in the resistance rates of GNB from different ICUs except for imipenem (p=0.002) and ciprofloxacin (p=0.003). Conclusions: Increased antimicrobial resistance with high proportions of MDR patterns were found among GNB from ICUs. Comprehensive surveillance programs are needed to track the origins and emergence pathways of resistant pathogens.

Implementing of a problem-based learning strategy in a Saudi medical school: requisites and challenges

Due to the current changes in healthcare realities and the continuing expansion of knowledge, there is an increasing demand for cognitive and problem-solving abilities to recognize patient and society’s needs.1,2 The health needs might be accomplished by making changes in traditional learning strategies to a more student-centered approach and utilizing flexible educational strategies as well as problem-based learning (PBL).2 The educational goals of PBL allow students to integrate basic science knowledge into the solution of clinical problems and ultimately serve better the future patient.3,4 In this article, we explore our experience in implementation of a hybrid PBL curriculum at the University of Bisha, College of Medicine (UBCOM), Saudi Arabia. Initially, we will briefly summarize the existing state of medical education in Saudi medical schools, followed by a description of PBL curriculum structure and its implementation challenges faced at UBCOM.

The Effectiveness of Problem-based Learning in Acquisition of Knowledge, Soft Skills During Basic and Preclinical Sciences: Medical Students' Points of View

Background: Students’ opinions about their medical curriculum is essential process for evaluating program strength and weakness. Aim: We aimed to assess the benefits and effectiveness of PBL in acquisition of knowledge and soft skills during basic (Phase I) and preclinical (Phase II) sciences. Methods: Across-sectional study was conducted at the University of Bisha, College of Medicine, Saudi Arabia. Students at Phase I and Phase II were involved. A validated self-administered questionnaire used for data collection. Responses to the questionnaire items regarding PBL benefits, preferences and effectiveness in acquisition of knowledge and soft skills were ordinal following a four-point Likert scale format. Independent and paired t tests were used to compare between the means and SD of each two variables. A p value ≤ 0.05 considered as statistically significant. Results: Most of students (86.3%) reported a positive perception on all the items assessing the benefits of PBL approach. Students’ responses on PBL relating to the acquisition of knowledge (3.27±0.46) and soft skill (3.32±0.45) were high. There were no significant differences determined in the mean score and SD of acquisition of knowledge (p=0.768) and soft skills (p=0.297) between second and third year students. PBL was preferred in Phase II comparable to Phase I modules (3.371±0.299 vs. 3.026±0.627; p=0.001). Conclusion: Effectiveness of PBL found to be high and increasing after taking a series of modules. Although PBL methodology has impact in acquisition of knowledge and skills, intended program outcome should be determined to assess the effects of PBL.