Virulence factors, clonality, antibiotic and disinfectant resistance of Enterobacteriaceae isolated in the Arabian Peninsula

The emergence and rapid spread of multi-drug resistant (MDR) Enterobacteriaceae is one of the most challenging problems we currently faced. However, locally, no details on the strains causing outbreaks are available. Furthermore, globally, we still do not understand what makes certain clones capable of spreading widely while others are only confined to sporadic cases. Aim: Our aim was to characterize the virulence factors, antibiotic and disinfectant susceptibilities of local clonal and sporadic Escherichia coli and Klebsiella pneumoniae strains and to analyze the data to reveal which particular feature might be responsible for the outbreak potential of clonal isolates. Methods: Escherichia coli and Klebsiella pneumoniae strains collected from countries of the Arabian Peninsula were subjected to genotyping by PCR targeting a broad spectrum of virulence and antibiotic resistance genes. This was followed by antibiotic susceptibility tests, serum resistance and biofilm formation assays and molecular typing by macro-restriction analysis and multilocus sequence typing. Results: Our study shows that among blood stream E. coli isolates, the rate of strains expressing R4 core type is currently much higher than seen before, most likely due to a few multi-resistant clones that have emerged recently. Further studies should reveal whether, beyond their more extensive antimicrobial resistance, the presence of the previously rare core types, or possibly the lower base-line immunity in the population against them, contributes to their recent epidemiological success. We also show that a majority of local K. pneumoniae clones do not possess considerably more virulence related features than sporadic isolates. Rather, they are clearly distinguishable from the latter group by their broader spectrum of resistance to non-ß-lactam antibiotics, well substantiated by the increased carriage of the respective resistance genes. Resistance to disinfectants was observed to be more common among K. pneumoniae strains non-susceptible to carbapenems than among the antibiotic sensitive isolates. We speculate that this may also increase the outbreak potential of the strains. Finally, we show that a considerable part of local carbapenem resistant K. pneumoniae strains are still susceptible to fosfomycin, although the rate of resistance to fosfomycin, particularly among blood stream isolates, is already alarming. Conclusions: Together, data reveals that it is particularly the increased resistance rather than any specific virulence-related feature that makes strains spread as clones. A well-organized surveillance system based on molecular typing is needed in the country to follow the characteristics of the spread of multidrug resistance organisms in the region

Who is More Likely to Complete the Appointments, and What Factors Determine the Appointment Wait Time?

Background: Digital health significantly affects healthcare delivery. Moreover, empirical studies on the utilization of telehealth in Dubai are limited. Accordingly, this study examines the utilization of telehealth services in Dubai Health Authority (DHA) facilities and the factors associated with telehealth appointment completion and turnaround time. Methods: This cross-sectional study examines patients who used telehealth services in DHA from 2020 through 2021 using 241,822 records. A binary logistic regression model was constructed to investigate the association between appointment turnaround time as a dependent variable and patient and visit characteristics as independent variables. Results: Of the total scheduled telehealth visits, more than three-quarter (78.55%) were completed. Older patients, non-Emiratis, patients who had their visits in 2020, patients who had video visits, and those who sought family medicine as a specialty had a shorter turn-around time to receive their appointment. Conclusions: This study identifies several characteristics associated with the turn-around time. Moreover, technological improvements focusing on specialties that can readily be addressed through telehealth and further research in this domain will improve service provision and support building an evidence base