Noura Al Sweih

Spectrum and antibiotic resistance of uropathogens isolated from hospital and community patients with urinary tract infections in two large hospitals in Kuwait.

Objectives: To determine the spectrum of microbial etiology and antibiotic resistance pattern of the uropathogens that cause urinary tract infections in 2 large teaching hospitals in Kuwait over a period of 1 year. Materials and Methods: The Vitek identification card system was used to identify the uropathogens. Susceptibility of the isolates against 18 antibiotics was performed by the microbroth dilution method using the Vitek automated system. In addition, gram-positive bacteria were tested in parallel by the disk diffusion technique. Results: The six overall most common isolates were: Escherichia coli, accounting for 47% of isolates in both hospitals, followed by Candida spp. (10.8%), Klebsiella pneumoniae (9.6%), Streptococcus agalactiae (GBS; 9.5%), Enterococcusfaecalis (4.2%) and Pseudomonas aeruginosa (4.1%). Amikacin provided the widest coverage amongst all the antibiotics tested followed by ciprofloxacin, gentamicin and piperacillin-tazobactam. For the gram-negatives, high resistance (26–63%) to the β-lactam antibiotics was noted, especially to ampicillin, amoxicillin-clavulanic acid, cephalothin and cefuroxime. Resistance to trimethoprim-sulfamethoxazole was also high. None of the enterococci was resistant to the glycopeptides, but 38–60% of the Staphylococcus haemolyticus were resistant to vancomycin or teicoplanin. Conclusion: These data show the high level of antimicrobial resistance amongst the uropathogens causing urinary tract infection in the two hospitals studied.

Wide Dissemination of GES-Type Carbapenemases in Acinetobacter baumannii Isolates in Kuwait

ABSTRACT Acinetobacter baumannii is an opportunistic pathogen that is an important source of nosocomial infections. Production of extended-spectrum β-lactamases (ESBLs) of the GES type in A. baumannii has been increasingly reported, and some of these GES-type enzymes possess some carbapenemase activity. Our aim was to analyze the resistance determinants and the clonal relationships of carbapenem-nonsusceptible A. baumannii clinical isolates recovered from hospitals in Kuwait. A total of 63 isolates were analyzed, and all were found to be positive for blaGES-type genes. One isolate harbored the blaGES-14 gene encoding an ESBL with significant carbapenemase activity, whereas the other isolates harbored the blaGES-11 ESBL gene. Thirty-three isolates coharbored the blaOXA-23 and blaGES-11 genes. Analyses of the genetic locations indicated that the blaGES-11/-14 genes were plasmid located. It is noteworthy that the blaOXA-23 and blaGES-11 genes were colocated onto a single plasmid. Nine different pulsotypes were observed among the 63 isolates. This study showed the emergence of GES-type ESBLs in A. baumannii in Kuwait, further suggesting that the Middle East region might be a reservoir for carbapenemase-producing A. baumannii.

Etiology and Antibiotic Susceptibility Patterns of Community- and Hospital-Acquired Urinary Tract Infections in a General Hospital in Kuwait

Objective: Our purpose was to determine the bacterial profile and prevalence of antibiotic resistance patterns of uropathogens, as well as evaluate the problem with extended-spectrum β-lactamase (ESBL) producing isolates, causing urinary tract infections (UTIs) in Al-Amiri Hospital, Kuwait, over a 3-year period. Materials and Methods: Isolates (56,505) from symptomatic UTI cases from January 2005 to December 2007 were identified by conventional methods and the VITEK identification card system. Antimicrobial susceptibility testing was performed by disk diffusion method for Gram-positive organisms and an automated VITEK 2 machine for Gram-negative organisms. ESBL production by the Enterobacteriaceae was detected by the double-disk diffusion method and VITEK-2 system. Results: Significant bacteriuria was detected in 15,064 (26.6%) of the 56,505 urine samples. Escherichia coli accounted for 4,876 (54.9%) from community-acquired UTI (CA-UTI) and 2,253 (36.4%) from hospital-acquired UTI (HA-UTI), followed by Streptococcus agalactiae (1,129, 12.7%) and Klebsiella pneumoniae (962, 10.8%) from CA-UTI cases. Candida spp. (973, 15.7%) and K. pneumoniae (747, 12.1%) were the second and third most prevalent isolates, respectively, in HA-UTI. High resistance rates were observed among the Enterobacteriaceae against ampicillin, cephalothin, ciprofloxacin, piperacillin and trimethoprim-sulfamethoxazole. About 855 (12%) and 291 (17%) of E. coli and K. pneumoniae, respectively, were resistant to ≧4 antibiotics. The prevalence of ESBL-producing E. coli and K. pneumoniae in CA-UTI was 12 and 17% and in HA-UTI 26 and 28%, respectively. Conclusion: A high percentage of the uropathogens causing UTI in the Al-Amiri Hospital setting was highly resistant to the first- and second-line antibiotics for the therapy of UTI. ESBL-producing bacteria are highly prevalent in our hospital.

Streptobacillus moniliformis Bacteremia in a Child: Case Report

Background: We report a case of bacteremia caused by Streptobacillus moniliformis. Case Presentation and Intervention: A 2 years and 3 months female Kuwaiti child presented with febrile convulsions, mild cough and vomiting. The patient’s history, clinical findings and radiological investigations were reviewed. There was no history of rat/animal bite, but the child had been camping in the desert prior to the illness and may have been exposed to rodent excreta. On two occasions, blood culture specimens yielded pure growth of the organism which was identified by standard diagnostic criteria. The patient was successfully treated with cefotaxime and clarithromicin. Conclusion:S. moniliformis may be a cause of bacteremia even in the absence of rat/animal bites.

Contents Vol. 19, 2010

501 Abstracts of Award-Winning Posters, 15th Annual Health Sciences Poster Conference, Faculty of Medicine, Health Sciences Centre, Kuwait University, Kuwait, April 20–22, 2010 505 Abstracts of Theses Approved for the MSc Degrees at the Faculty of Medicine, Health Sciences Centre, Kuwait University, Kuwait 514 List of Reviewers Vol. 19, 2010 516 Author Index Vol. 19, 2010 519 Subject Index Vol. 19, 2010