The data obtained in this study support the widespread testing of all close contacts of MERS-CoV cases, regardless of the significance of the contact or presence or absence of symptoms. In addition, urgent careful review of guidance regarding the return of asymptomatic MERS-CoV-positive HCWs under investigation to active duty is needed.
Background and objectivesThe emergence of methicillin-resistant Staphylococcus aureus (MRSA) infections among previously healthy persons in community settings, without exposure to health care facilities, has been noted recently. Colonization rates of community-associated MRSA (CA-MRSA) have been reported to range from 0 to 9.2 percent. The nose and open skin areas are considered the most important sites for colonization. The aim of our study was to assess the prevalence and to describe the antibiotic susceptibility pattern of CA-MRSA among outpatient children.Patients and methodsWe prospectively screened every third consecutive child presenting to our pediatric emergency department of King Saud Medical City, a 275 bed tertiary care teaching hospital in Riyadh, Saudi Arabia, from March through July 2015.ResultsWe analyzed a total of 830 screening results (n = 478 males, 57.6%). Most of the screened patients were from Riyadh (n = 824, 99.3%). A total of 164 (19.8%) were found to be colonized with S. aureus, and of these 38 (4.6%) with MRSA. Thus, the MRSA rate amongst all S. aureus carriers was 23.2%. All MRSA were susceptible to vancomycin, (94.7%) were susceptible to linezolid, (65.8%) to clindamycin, and (89.5%) to trimethoprim/sulfamethoxazole.ConclusionThe rate of MRSA carriage among children in Riyadh province was within the range reported internationally. As the MRSA rate among S. aureus infected children was 23.2%, empirical MRSA coverage should be considered in children with suspected S. aureus infections.
BACKGROUND Clostridium difficile infection (CDI) is the most common cause of hospital-acquired infectious diarrhea. OBJECTIVE To analyze the methodological quality, content, and supporting evidence among clinical practice guidelines (CPGs) on CDI prevention. DESIGN AND SETTING We searched medical databases and gray literature for CPGs on CDI prevention published January 2004-January 2015. Three reviewers independently screened articles and rated CPG quality using the Appraisal of Guidelines for Research and Evaluation II (AGREE II) instrument, composed of 23 items, rated 1-7, within 6 domains. We reported each domain score as a percentage of its maximum possible score and standardized range. We summarized recommendations, extracted their supporting articles, and rated individually the level of evidence using the Oxford Centre for Evidence-Based Medicine Levels of Evidence. RESULTS Of 2,578 articles screened, 5 guidelines met inclusion criteria. Median AGREE II scores and interquartile ranges were: clarity of presentation, 75.9% (75.9%-79.6%); scope and purpose, 74.1% (68.5%-85.2%); editorial independence, 63.9% (47.2%-66.7%); applicability, 43.1% (19.4%-55.6%); stakeholder involvement, 40.7% (38.9%-44.4%); and rigor of development, 18.1% (17.4%-35.4%). CPGs addressed several common strategies for CDI prevention, including antibiotic stewardship, hypochlorite solutions, probiotic prophylaxis, and bundle strategies. Recommendations were often not consistent with evidence, and most were based on low-level studies. CONCLUSION CPGs did not adhere well to AGREE II reporting standards. Furthermore, there was limited transparency in moving from evidence to recommendations. CDI prevention CPGs need to better adhere to AGREE-II and be transparent in moving from evidence to recommendations, and recommendations need to be consistent with available evidence. Infect Control Hosp Epidemiol 2016;37:901-908.
The increasing use of carbapenems has contributed to a notable distribution of carbapenem-resistant Enterobacteriaceae (CRE). Recently, the incidence of CRE-associated infections is increasing significantly in NICUs, which pose a grave challenge to clinical treatment. We report 2 cases of IV ceftazidimeavibactam use to treat CRE infections in extremely premature neonates. The first case was diagnosed with bacteraemia and meningitis and the second one was diagnosed with bacteraemia only. Due to the lack of neonatal-specific information for IV ceftazidime-avibactam, the usual pediatric dose (62.5 mg/kg/dose every 8 hours) was used in these patients. Clinical cure occurred in these 2 patients. Although blood cultures became sterile after starting ceftazidime-avibactam in the second case, the patient died, presumably owing to sepsis or various causes, such as prematurity and chronic lung disease. Large and randomized studies are necessary to ensure the safety and efficacy of IV ceftazidime-avibactam for the treatment of neonates with sepsis caused by multidrug resistant organisms.
Objectives: To analyze the clinical characteristics and in-hospital outcomes among coronavirus disease 2019 (COVID-19) positive medical staff compared with those of public. Methods: A total of 108 COVID-19-positive medical staff patients were included in the study from March 23, 2020 to June 15, 2020. Patients were analyzed for demographic data, clinical presentations, and in-hospital outcomes and compared against 661 COVID-19-infected patients of non-medical personnel. Results: Mean age of medical staff patients was 44.05±13.9 years, most of whom were women (63.9%). The infected medical staff members consisted of 63 nurses (58.3%), 37 physicians (34.3%), 5 technicians (4.6%), and 3 pharmacists (2.8%). Smoking (60.2%) was the most frequent, followed by diabetes mellitus (37%). Of 108 COVID-19 infected medical staff, 18 (16.6%) were isolated in the intensive care unit (ICU), of which 14 (77.8%) were male, 16 (88.9%) were smokers, and 16 (88.9%) presented with pneumonia. Fatality ratio among medical staff patients was 4.6%. Male gender with odds ratios (OR) of 7.771 and 95% confidence intervals (CI) of 0.837-72.195 and a history of chronic kidney disease of (OR=10.778, 95% CI: 1.503-77.287) were predictors of death among the medical staff group. Conclusion: The incidence of COVID-19 infection among medical staff is quite high, but the occurrence of extreme illness and death is significantly low compared with the general community. Training should be implemented for all hospital staff on infection prevention techniques. Reliable and quick access for testing medical personnel is essential to maintain health, safety, and availability of health care workers during this pandemic.
Interleukin (IL)-12 is composed of p35 and p40 subunits; in this case, IL-12p40 deficiency is a rare genetic etiology of Mendelian susceptibility to mycobacterial disease. Salmonellosis has been reported in almost half of these patients and mostly present in recurrent extraintestinal form. In this report, we described an 18-month-old boy with absence of IL-12p40 production suffering from chronic disseminated nontyphoidal salmonellosis. To the best of our knowledge, this is the first-reported case.
ObjectiveTo assess whether there is any association between prolonged duration of the first course of empirical antibiotic treatment for suspected neonatal sepsis and other factors including comorbidities, interventions, and adverse outcomes.BackgroundNeonatal sepsis is one of the main reasons of mortality among premature infants in Neonatal Intensive Care Unit (NICU). Therefore, commencing antibiotics treatment on admission plays a crucial role in reducing the complications of neonatal sepsis, however the arbitrary use of antibiotics holds many serious complications. In our study we investigated the complications of prolonged use of antibiotics in treating suspected early onset of sepsis.Study designThis is a retrospective cohort study of infants of gestational age 32 weeks or less and with birth weight of 1500 g or less along with suspected neonatal sepsis admitted to our neonatal intensive care unit from July 2015 to June 2017. The study outcome measures were the association between the antibiotic treatment duration and maternal factors, gender, adverse outcomes, developmental factors, comorbid conditions, early-onset sepsis, and late-onset sepsis.ResultsOf 295 premature infants, late-onset sepsis was associated with the duration of early empiric antibiotic use (n = 54/295), where 50 (92.6%) infants with LOS received the antibiotic treatment for more than 5 days (P < .001). Approximately 91.2% of those receiving the prolonged treatment had a positive blood culture result. Necrotizing enterocolitis was more prevalent in those with long duration of antibiotic treatment (95.1%). Among patients with the comorbid conditions patent ductus arteriosus (n = 123/295), intraventricular hemorrhage (n = 73/295), and periventricular leukomalacia (n = 25/295), 100 (81.3%), 60 (82.2%), and 21 (84%) of them, respectively, received prolonged treatment.ConclusionProlonged administration of empiric antibiotics to infants with very low birth weight along with sterile cultures is associated with the adverse outcomes late-onset sepsis and necrotizing enterocolitis. However, no association with other adverse outcomes, namely, candidiasis or maternal factors, was found.
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