BackgroundUrinary tract infection (UTIS) is a common infectious disease in which level of antimicrobial resistance are alarming worldwide. Therefore, this study aims to describe the prevalence and the resistance pattern of the main bacteria responsible for UTIS Escherichia coli (E. coli).MethodsRetrospective chart review for patients admitted to emergency department and diagnosed with UTIS at KAMC, in Riyadh, Saudi Arabia between January to March 2008 was performed. Antimicrobial susceptibility to ampicillin, augmentin (amoxicillin/clavulanate), cefazolin, co-trimoxazole (sulfamethoxazole/trimethoprim), ciprofloxacin, and nitrofurantoin, and cefpodoxime was determined for 101 E. coli urinary isolates.ResultsEscherichia coli was the most prevalent pathogen contributing to UTIS representing 93.55, 60.24, and 45.83% of all pathogen isolated from urine culture of pediatric, adult, and elderly, respectively. High rates of resistance to ampicillin (82.76, 58, and 63.64%) and co-trimoxazole (51.72, 42, and 59.09%), among E. coli isolated from pediatric, adult and elderly respectively. Nitrofurantoin was the most active agent, followed by ciprofloxacin, augmentin and cefazolin. 22.77% of E. coli isolates exhibited multiple drug resistance (MDR). Among 66 and 49 isolates resistant to ampicillin and co-trimoxazole, respectively, 34.84 and 42.85% were MDR. In contrast, all isolates resistant to augmentin and nitrofurantoin were MRD, while 72.7 and 82.4% of isolates resistant to ciprofloxacin and cefazolin were MDR.ConclusionsHigh resistance was observed to ampicillin and co-trimoxazole which commonly used as empirical treatments for UTIS, limiting their clinical use. This necessitates continuous surveillance for resistance pattern of uropathogens against antibiotics.

BackgroundMedication errors (MEs) are among the most common types of medical errors and one of the most common and preventable causes of iatrogenic injuries. The aims of the present study were; (i) to determine the incidence and types of medication prescribing errors (MPEs), and (ii) to identify some potential risk factors in a pediatric inpatient tertiary care setting in Saudi Arabia.FindingsA five-week retrospective cohort study identified medication errors in the general pediatric ward and pediatric intensive care unit (PICU) at King Abdulaziz Medical City (KAMC) through the physical inspection of physician medication orders and reviews of patients' files. Out of the 2,380 orders examined, the overall error rate was 56 per 100 medication orders (95% CI: 54.2%, 57.8%). Dose errors were the most prevalent (22.1%). These were followed by route errors (12.0%), errors in clarity (11.4%) and frequency errors (5.4%). Other types of errors were incompatibility (1.9%), incorrect drug selection (1.7%) and duplicate therapy (1%). The majority of orders (81.8%) had one or more abbreviations. Error rates were highest in prescriptions for electrolytes (17.17%), antibiotics (13.72%) and bronchodilators (12.97%). Medication prescription errors occurred more frequently in males (64.5%), infants (44.5%) and for medications with an intravenous route of administration (50.2%). Approximately one third of the errors occurred in the PICU (33.9%).ConclusionsThe incidence of MPEs was significantly high. Large-scale prospective studies are recommended to determine the extent and outcome of medication errors in pediatric hospitals in Saudi Arabia.

IntroductionUrinary tract infection (UTI) is a serious health problem affecting millions of people every year. Inappropriate antibiotic prescriptions put patients at risk and lead to bacterial resistance and elevated costs.AimsStudy aims were to assess the prevalence and antibiotic-treatment patterns of community acquired UTIs, prevalence and types of antibiotic-prescribing errors, and the cost of inappropriate antibiotic use.MethodsThis was a retrospective cross-sectional study conducted over a 3-month period in an emergency department in Saudi Arabia.ResultsDuring the study period, 1,449 patients were diagnosed with UTIs, including pediatric (18.6%), adult (59.2%), and elderly (22.2%) patients. The overall prevalence of UTIs was 9.9% of total visits. Broad-spectrum antibiotics were prescribed for 85% of patients. Three main antibiotics were prescribed: cephalosporin (39%), penicillin (26%), and fluoroquinolone (22%). The overall prevalence of inappropriate antibiotic prescription with at least one type of error was 46.2% (pediatrics 51%, adults 46%, elderly 47%). Errors were dose (37%), duration (11%), frequency (6%), and antibiotic selection (2.4%). Dose error was significantly greater in pediatric patients (P=0.001). Duration error was higher among adults and the elderly (P=0.014). Significantly more inappropriate cephalosporin prescriptions were seen in adults (P=0.001), while penicillin had significantly higher errors in pediatric patients. Positive urine culture was seen in 34.9% of patients, and the most common microorganism was Escherichia coli (51%). The mean cost of care for one episode of UTI was US$134.56±$31.34 (95% CI $132.94–$136.17). Treatment of UTI was more costly in women (63.9% of total cost), adults (59.2%), and those using broad-spectrum antibiotics (86.5%). There were statistically significant associations among sex, age, spectrum of antibiotic, category of antibiotic, and inappropriate cost.ConclusionThe results revealed a significant level of inappropriate use of antibiotics in the treatment of UTIs in the emergency department.

BackgroundInappropriate antibiotic (ATB) prescriptions are a threat to patients, leading to adverse drug reactions, bacterial resistance, and subsequently, elevated hospital costs. Our aim was to evaluate ATB prescriptions in an emergency department of a tertiary care facility.MethodsA cross-sectional study was conducted by reviewing charts of patients complaining of infections. Patient characteristics (age, sex, weight, allergy, infection type) and prescription characteristics (class, dose, frequency, duration) were evaluated for appropriateness based on the AHFS Drug Information and the Drug Information Handbook. Descriptive and analytic statistics were applied.ResultsSample with equal sex distribution constituted of 5,752 cases: adults (≥15 years) =61% and pediatrics (<15 years) =39%. Around 55% complained of respiratory tract infections, 25% urinary tract infections (UTIs), and 20% others. Broad-spectrum coverage ATBs were prescribed for 76% of the cases. Before the prescription, 82% of pediatrics had their weight taken, while 18% had their weight estimated. Allergy checking was done in 8% only. Prevalence of inappropriate ATB prescriptions with at least one type of error was 46.2% (pediatrics =58% and adults =39%). Errors were in ATB selection (2%), dosage (22%), frequency (4%), and duration (29%). Dosage and duration errors were significantly predominant among pediatrics (P<0.001 and P<0.0001, respectively). Selection error was higher among adults (P=0.001). Age stratification and binary logistic regression were applied. Significant predictors of inappropriate prescriptions were associated with: 1) cephalosporin prescriptions (adults: P<0.001, adjusted odds ratio [adj OR] =3.31) (pediatrics: P<0.001, adj OR =4.12) compared to penicillin; 2) UTIs (adults: P<0.001, adj OR =2.78) (pediatrics: P=0.039, adj OR =0.73) compared to respiratory tract infections; 3) obtaining weight for pediatrics before the prescription of ATB (P<0.001, adj OR =1.83) compared to those whose weight was estimated; and 4) broad-spectrum ATBs in adults (P=0.002, adj OR =0.67).ConclusionPrevalence of ATB prescription errors in this emergency department was generally high and was particularly common with cephalosporin, narrow-spectrum ATBs, and UTI infections.

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BackgroundOne of the most unfortunate events toddlers may encounter during their early years of curiosity and experimentation is substance poisoning. The aim of the study was to evaluate the poison severity score and its associated factors among toddlers with orally ingested substances at a pediatrics emergency department (ED), central Saudi Arabia.MethodsA cross-sectional, poisoning report review between 2009&2011 was conducted. Exposures were patient characteristics (sex, age, body mass index, medical history) and incident characteristics (substance type, amount, form, witnessed or not, home remedy, arrival time to ED). Outcome was Poison Severity Score (PSS) that rates signs/symptoms of 11 body aspects on scale 0–4 (none, minor, moderate, severe, fatal). Inclusion criteria: age (1–3 years), previously healthy and oral exposure route. Bivariate analysis and multi-linear regression were conducted. Significance at p < 0.05.ResultsEligible cases were 165/315(52 %). Males (58 %) and females (42 %) had normal BMI (70 %). Substances ingested were medications (60 %) and chemicals (40 %). Almost 85 % were witnessed incidents and 27 % received a home remedy (water, juices, dairy products, salt/sugar solutes, and/or manually induced vomiting). Delayed arrival (≥1 hour) was observed in 57 %. Composite mean PSS of total was (0.16 ± 0.21), and was highest at the gastrointestinal (GI) aspect (0.39 ± 0.63), metabolic balance (0.35 ± 0.60), and respiratory aspect (0.30 ± 0.61). Significantly associated factors with higher severity scores were: home remedies at the composite mean PSS (adj.p = 0.048), chemical poisoning at two aspects respiratory (adj.p = 0.047) and muscular (adj.p = 0.009) compared to medication poisoning. Unwitnessed incidents at the muscular aspect (adj.p = 0.026) compared to witnessed incidents; delayed arrival time to ED at three aspects GI (adj.p = 0.001), nervous system (adj.p = 0.014) and kidney (adj.p < 0.001).ConclusionsParents are not recommended to provide any home remedy to their orally poisoned toddlers, but rather directly visit the ED. Physicians are expected to observe more severe clinical outcomes among toddlers with chemical poisoning, unwitnessed incidents, and delayed arrival times especially at the respiratory, GI, muscular, nervous and kidney aspects.

BackgroundAntibiotic prescriptions at emergency departments (ED) could be a primary contributing factor to the overuse of antimicrobial agents and subsequently antimicrobial resistance. The aim of this study was to describe the pattern of antibiotic prescriptions at an emergency department of a tertiary care hospital in Saudi Arabia.MethodsA cross-sectional study, based on a review of antibiotic prescriptions was conducted. All cases who visited the emergency department over a three-month period with a complaint of infection were analyzed in terms of patient characteristics (age, sex, infection type, and number of visits) and prescription characteristics (antibiotic category, spectrum, course and costs). The World Health Organization and International Network of Rational Use of Drugs prescribing indicators were presented. Descriptive and analytic statistics were applied.ResultsA total of 36,069 ED visits were recorded during the study period, of which 45,770 drug prescriptions were prescribed, including 6,354 antibiotics. The average number of drugs per encounter was 1.26, while the percentage of encounters with a prescribed antibiotic was 17.6%. Among antibiotic prescriptions, the percentage of encounters with injection antibiotics was 15.2%. Almost 77% of antibiotics were prescribed by their generic names, and the percentage of antibiotics prescribed from the essential list was 100%.ConclusionThe average number of drugs per encounter in general and antibiotics per encounter in specific at this setting was lower than the standard value. However, the percentage of antibiotics prescribed by its generic name was less than optimal.

Purpose: Community-acquired urinary tract infection (CA-UTI) is a common and costly condition in females. Currently, there are no data on CA-UTI and quality of life (QoL) in Saudi Arabia. The aim of this study was to evaluate the impact of UTI and related sociodemographic characteristics on health-related quality of life (HRQoL) of Saudi females using the EuroQol 5-Dimension, 3-Level (EQ-5D-3L) instrument before and after treatment. Patients and Methods: This was a cross-sectional questionnaire study conducted in the emergency department (ED) of a tertiary hospital over a three-month period. Results: A total of 339 out of 524 females with a mean age of 36.2 years (SD: 9.57 years; range 19-59 years) completed both the baseline and follow-up questionnaires of the EQ-5D-3L for a response rate of 64.7%. The baseline utility index for the worst health state "33333" was −0.495 representing 1.18% of the patients, and the full health state "11111" was 1 corresponding to 30.68% of the patients. The utility index after treatment for the moderate health state "22222" was 0.524 corresponding to 0.88% of the total patients, and the full health state "11111" was 1 corresponding to 80.24% of the patients. The mean EuroQol Visual Analogue Scale (EQ-VAS) was 73 ± 26 before treatment and 87.46 ± 18.55 after treatment. The frequency of patients reporting problems in the EQ-5D dimensions of mobility, self-care, usual activities, pain/ discomfort and anxiety/depression decreased following treatment (27.43% vs 0.88%, 4.42% vs 0.88%, 25.96% vs 6.78%, 61.95% vs 13.27%, 39.52% vs 15.63%, respectively; all P < 0.001). There were statistically significant associations between HRQoL and socio-demographic characteristics, chronic diseases, and herbal supplements. Conclusion: Community-acquired tract infections (CA-UTIs) have a significant negative impact on the HRQoL of Saudi females with a varying effect depending on the sociodemographic characteristics and chronic diseases.