Incidence of Bloodstream Infections in a Speciality Hospital in Kuwait: 8-Year Experience

Abstract

Objectives: To determine the frequency of isolation and antibiotic-susceptibility patterns of clinically significant bacterial pathogens isolated from blood. Materials and Methods: The study was conducted over a period of 8 years (1995–2002) at Infectious Diseases Hospital (IDH), Kuwait. Demographic and clinical data were obtained from medical records. 18,535 blood cultures were analyzed. Disk diffusion method was used to perform antibiotic-susceptibility testing. Minimum inhibitory concentrations of 9 antimicrobials were determined using E-test. Double disk (potentiation) test and E-test ESBL strips were used to detect the production of extended-spectrum beta-lactamases (ESBLs). Results:Salmonella spp. and Brucella spp. were predominant blood isolates, and represented 60.6 and 30.0% of all clinically significant episodes of bloodstream infections, respectively. Among the Salmonella, Salmonella enterica serotypes typhi and paratyphi A were most frequently isolated. The percentage of multidrug resistance (MDR) among them varied from 22 to 51%. A high percentage (40%) of MDR S. enterica serotypes typhi and paratyphi A also showed reduced susceptibility to ceftriaxone and ciprofloxacin. Conclusion: During the study period, Salmonella spp. and Brucella spp. were predominant blood isolates. MDR S. enterica serotypes typhi and paratyphi A, with reduced susceptibility to ceftriaxone and ciprofloxacin, are among the most frequent causes of bloodstream infections in IDH, suggesting the need to monitor their susceptibility.

Ciprofloxacin treatment failure in a case of typhoid fever caused by Salmonella enterica serotype Paratyphi A with reduced susceptibility to ciprofloxacin

“…Since then, similar cases have been reported from other countries (Wain et al, 1997;Threlfall & Ward, 2001;Hakanen et al, 2001). Although reduced susceptibility to ceftriaxone and ciprofloxacin has been reported previously for Salmonella enterica serotype Typhi and S. Paratyphi A isolated in Kuwait (Dimitrov et al, 2005), this report describes a case of ciprofloxacin treatment failure in a patient with enteric fever who had recently returned to Kuwait from India. The isolate in this report is different from that reported previously because it is susceptible to ceftriaxone whereas the isolates reported previously expressed reduced susceptibility to ceftriaxone (Dimitrov et al, 2005).…”

“…Although reduced susceptibility to ceftriaxone and ciprofloxacin has been reported previously for Salmonella enterica serotype Typhi and S. Paratyphi A isolated in Kuwait (Dimitrov et al, 2005), this report describes a case of ciprofloxacin treatment failure in a patient with enteric fever who had recently returned to Kuwait from India. The isolate in this report is different from that reported previously because it is susceptible to ceftriaxone whereas the isolates reported previously expressed reduced susceptibility to ceftriaxone (Dimitrov et al, 2005). Treatment failures with fluoroquinolones in patients infected with S. Typhi with reduced susceptibility to ciprofloxacin have also been reported from Cameroon in Africa (Nkemngu et al, 2005) and Bangladesh in Asia (Asna et al, 2003).…”

In vitro antibiotic susceptibility testing of Brucella isolates from Egypt between 1999 and 2007 and evidence of probable rifampin resistance

“…To our knowledge, this is the first report of high rates of reduced susceptibility to rifampin among Brucella isolates from Egypt, suggesting the emergence of isolates with variable degrees of resistance to this drug (CLSI criteria for slow-growing bacteria). Only a few isolates (8-9%) with reduced susceptibility to rifampin have been described before in Turkey [16,23], Kuwait [24] and Mexico [18]. In another study conducted in Peru, only one Brucella isolate demonstrated reduced susceptibility to rifampin (1.0 μg/ml) [15].…”

Detection of mutations in thegyrA gene in fluoroquinolone resistanceSalmonella entericaserotypestyphiandparatyphiA isolated from the Infectious Diseases Hospital, Kuwait

“…Blood cultures were performed with Bactec 9120 (Becton Dickinson Diagnostic Instrument System, Sparks, Maryland, USA), a continuous-monitoring blood culture system14; details have been published previously 15. All isolates were identified by their API 20E profiles (bio Meraux, SA, France) and slide agglutination using specific Salmonella antisera (Ha, Hd, O9 and 02; Denka Seiken, Tokyo, Japan).…”