Human immunodeficiency virus infection and chemotherapy treatment in the Kingdom of Bahrain

Human immunodeficiency virus (HIV) is a lentivirus which that may progress to immunodeficiency syndrome (AIDS) and predispose for opportunistic infections and malignancies. According to recent reports,  1.5 million people died of AIDS in 2013 worldwide which is a 35% decrease since 2005. The number of deaths has decreased in part due to antiretroviral treatment (ART) wide spread use. In Bahrain, in 2011, a multidisciplinary team was established for HIV management involving major stakeholders: public health, infectious diseases, pharmacists, nursing and virologists. A retrospective descriptive study is done about HIV positive patient in Bahrain, their current treatment regimens and other blood parameters were collected, aiming to have a general idea about their health status in a way to help in their medical care. The data was collected retrospectively from the 2014 registry about all patients who are diagnosed to have HIV. Their ART regimen, CD 4 count and viral load were gathered and entered in Excel sheet.. A total of 208 patients were diagnosed to have HIV up to 2014. However, only 108 of them have their full data. In addition, a review of the frequency of admission of these patients over a 10 year period was done too. On reviewing the medical records of the patients admitted over the last ten years from 2004 till 2014, it was found that the total admission of HIV positive patients were 107. Hepatitis C was the most common co infection among those patients with a percentage of 24%. It was found that with better ART treatment and better structure of HIV team and program, we are getting more patients to be controlled. There is a clear increase in the number of patients with improving CD4 count. Based on the results of our study, the HIV multi-disciplinary management team is an essential part for the best management of these patients

Infection among renal transplant patients in the Kingdom of Bahrain: A ten year retrospective study ( 2004-2014)

Introduction:  Kidney transplantation is the process of transplanting the organ to a patient with end stage renal disease. Complications with transplant can be encountered during or for a varying period post operatively. As graft survival and immunosuppressant regimens have improved, infection of grafts have become a leading concern. The diagnosis of infection in such patients is challenging too due to the lack of the typical infection indicators like fever as the patients are immunocompromised. The focus of our study is to study the extent of infection on the transplanted patients. The research will look into the type of microorganisms encountered, their management and outcome. Methods  & Materials: A retrospective study was carried out between the periods of 1st of January 2004 to 31st of December of the same year 2014. All renal transplant patients admitted during this period were segregated according to the reason of admission. Only those with impression of infection were enrolled.   Results: A total of 108 patients admitted between the period of 1st of January 2004 and 31st of December 2014 with impression of infection post renal transplant. Some of the patients had recurrent history during those ten years for infectious purposes. From the 108 patients, 74 of them received transplant from living donors (68.52%). The diagnosis on admission was limited to certain differentials. 35.19% patients were admitted with the impression of urinary tract infection. Pneumonia was diagnosed in 10.19%.  patients.  Majority of patient (89.96%) were on maintenance dose of steroids. That was followed by MMF, Tacrolimus and cyclosporine with a percentage of 81.48%, 46.3% and 25.93% respectively. Regarding the antibiotics, 86.11% of the admitted patient were started on single antibiotic on admission including those with recurrent admission. Conclusion: Fever is a common presenting symptom in our population of transplant recipients which reflects the possibility of infection. The majority responded to a single antibiotic use.  The limitation of our study is the small number of the transplanted patients. &nbsp

Tetanus in an unvaccinated laborer in Bahrain

Summary: Mr. M.D.S., a 27-year-old Indian male, presented with complaints of diffuse body pain and spasms, 7 days after a needle penetrated his right foot at his place of work. He was diagnosed clinically with tetanus. The patient was electively intubated to protect the airway and transferred to an intensive care unit. In addition to his tetanus, he developed multiple hospital-acquired infections. After 34 days, he was successfully extubated and extensive physiotherapy commenced. He was discharged 10 days after extubation. Keywords: Tetanus, Infection, Occupation, Vaccination, Antibiotic

The impact of COVID-19 on health care–associated infections in intensive care units in low- and middle-income countries: International Nosocomial Infection Control Consortium (INICC) findings

•Due to the COVID pandemic, health care–associated infection rates increased in resource-limited countries.•Due to the COVID pandemic, rates of central line–associated bloodstream infections increased.•Due to the COVID pandemic, rates of central ventilator–associated events increased.•Due to the COVID pandemic, mortality rates increased in intensive care units of resource-limited countries in 2020.•Due to the COVID pandemic, average length of stay increased in resource-limited countries in 2020. This study examines the impact of the COVID-19 pandemic on health care–associated infection (HAI) incidence in low- and middle-income countries (LMICs). Patients from 7 LMICs were followed up during hospital intensive care unit (ICU) stays from January 2019 to May 2020. HAI rates were calculated using the International Nosocomial Infection Control Consortium (INICC) Surveillance Online System applying the Centers for Disease Control and Prevention's National Healthcare Safety Network (CDC-NHSN) criteria. Pre–COVID-19 rates for 2019 were compared with COVID-19 era rates for 2020 for central line–associated bloodstream infections (CLABSIs), catheter-associated urinary tract infections (CAUTIs), ventilator-associated events (VAEs), mortality, and length of stay (LOS). A total of 7,775 patients were followed up for 49,506 bed days. The 2019 to 2020 rate comparisons were 2.54 and 4.73 CLABSIs per 1,000 central line days (risk ratio [RR] = 1.85, p = .0006), 9.71 and 12.58 VAEs per 1,000 mechanical ventilator days (RR = 1.29, p = .10), and 1.64 and 1.43 CAUTIs per 1,000 urinary catheter days (RR = 1.14; p = .69). Mortality rates were 15.2% and 23.2% for 2019 and 2020 (RR = 1.42; p < .0001), respectively. Mean LOS for 2019 and 2020 were 6.02 and 7.54 days (RR = 1.21, p < .0001), respectively. This study documents an increase in HAI rates in 7 LMICs during the first 5 months of the COVID-19 pandemic and highlights the need to reprioritize and return to conventional infection prevention practices