Mycobacterium tuberculosis complex: Detection and patterns of resistance to the first line anti-TB drugs at the King Abdulaziz University Hospital, Saudi Arabia

Tuberculosis (TB) remains a major cause of morbidity and mortality worldwide. Continued surveillance of drug susceptibility help determining treatment regimen by anti-tuberculous drugs. Gene Xpert PCR sensitivity was compared to the liquid culture media by Versa TREK for detecting Mycobacterium tuberculosis complex(MTBC). Rates, patterns and types of anti-tuberculosis drug- resistance atKing Abdulaziz University Hospital (KAUH), Jeddah, KSA were determined from January 2013 to June 2014.A total of 101 tuberculous patients were included, 43 Saudi tuberculous patients and 58 non-Saudi tuberculous patients. All resistances detected were primary resistances. PCR Sensitivities for detection of MTBC were 29.4%, 80%, 87.5%, 77.8% and 100% in AFB-negative samples and AFB +1,+2,+3 and +4 positive samples respectively. MTBC percentage detected by PCR was 88.1% in AFB-positive samples and 29.9% in AFB-negative ones. Versa Trek detection time was 15.01±7.32 days in AFB-positive samples and 26.63±6.7 days in AFB-negative ones. MTBC pyrazinamide resistance was (13.86%), followed by streptomycin (7.9%), rifampicin (3.96%) and isoniazid (3.96%). Mono-resistance percentages to pyrazinamide, rifampicin and isoniazid were 11.88%, 1.98% and 0.99% respectively. MDR-TB were 1.98% and anti-TB resistance percentage was 24.75%. There was no significant difference between Saudi and non-Saudi tuberculous patients regarding anti- tuberculous drugs resistance.Â

Antifungal susceptibility, risk factors and treatment outcomes of patients with candidemia at a university hospital in Saudi Arabia

Background: Candidemia is a major cause of morbidity and mortality in hospitalized patients. The spectrum of candidemia has been changed especially among critically ill patients due to emergence of non-albicans Candida (NAC) species. The increasing use of azole agents is suggested to be responsible for this epidemiological shift. NAC species are of special concern because of their high drug-resistance and increasing prevalence.The aim of this study was to detect antifungal-susceptibility patterns, treatment outcomes and associated risk factors in patients with candidemia who were admitted to King Abdulaziz University Hospital (KAUH), Jeddah, Kingdom of Saudi Arabia (KSA) .Methods: This work represents a cross sectional study done in the Clinical and Microbiology Laboratory at KAUH, during the periodfrom March 2012 till February 2014 on a total of 141 patients with candidemia. They were 31(22%) Saudi and 110(87%) non-Saudi patients with age ranged from 1 day - 102 years. Blood cultures were collected for suspected cases of candidemia, followed by subculture on SDA. Identifiation was done by VITEK MS (MALDI-TOF MS), and confimation of Candida isolates and antifungal-susceptibility testing were performed by using VITEK ®2 system.Results: C.albicans isolates accounted for 39.7%, followed by C. tropicalis (21.3%), C. galabrata (18.4%) and C. parapsiliosis (14.9%). Additionally, C. dublinsis, C. krusei and C. famata were representing 2.1%, 2.1% and 1.4%, respectively. All Candida isolates were 100% susceptible to amphotericin B. The best susceptibility to flconazole was detected among each C. dubliensis and C. famata (100%). All C. krusei isolates were resistant to flconazole, while they were susceptible  to other antifungal agents. All isolates were susceptible to flcytosine,except C. albicans and C. dubliensis which were susceptible 92.9%and 66.7%, respectively. All isolates were susceptible to itraconazol,except C. albicans and C. tropicalis which were susceptible 94.6% and 96.7%, respectively. The percentage of deceased patients with candidemia was signifiantly higher than the survivors among age group >64 years, particularly those who were mechanically ventilated and those understeroid therapy. The percentage of deceased patients was signifiantly higher than survivors among those admitted to adult ICUs (73.78%vs 26.23%) .Conclusion: This study shows an epidemiological shift to higher NAC species isolation rates, with 100% susceptibility to amphotericin B in all isolates either C. albicans or NAC species, and 100% susceptibility to flconazole among C. dubliensis and C. famata. Patients aged > 64 years, admission to adult ICUs, mechanical ventilation and steroid therapy were signifiant risk factors for increased mortality due to candidemia

A new focus of autochthonous transmission of Cordylobia anthropophaga in Saudi Arabia

AbstractBackgroundCordylobia anthropophaga, is responsible for nodular cutaneous myiasis in sub-Saharan Africa. The fly has long been limited to tropical Africa except for Asir Province, Saudi Arabia. Al Baha Province; north of Asir has an ecological pattern close to that dominant in subtropical Africa. The Southern parts of Saudi Arabia, including Al Baha, are considered part of the Afro-tropical zoogeographical belt where C. anthropophaga is dominant. A case, with cutaneous nodular lesions, was presented to us, where comprehensive investigations were done to establish the diagnosis and to relate it to the known epidemiological background.Materials and methodsA thorough history taking, comprehensive clinical examination and an intensive parasitological examination on a viable larva recovered from the cutaneous lesions, were performed. Taxonomic identification of the larva was done based on various criteria including shape, size, cuticle spine pattern and the posterior spiracles of the recovered larva.ResultsWe report a case of cutaneous myiasis, caused by Cordylobia anthropophaga, indigenously acquired in Al-Baha. The recovered larva was identified as the third instar of C. anthropophaga. With no history of travel to Africa or to Asir, along with a comprehensive epidemiological assessment, an autochthonous pattern of transmission was confirmed.ConclusionWe present a new focus of autochthonous transmission of C. anthropophaga in Saudi Arabia suggesting a need for an epidemiological reassessment. We also propose considering Cordylobia myiasis as a differential diagnosis in furuncular skin lesions, even in individuals with no history of traveling to Africa

Bacterial contamination of cell phones of medical students at King Abdulaziz University, Jeddah, Saudi Arabia

AbstractCell phones are commonly used in healthcare settings for rapid communication within hospitals. Concerns have been increased about the use of these devices in hospitals, as they can be used everywhere, even in toilets. Therefore, they can be vehicles for transmitting pathogens to patients. This study aimed to examine the presence of pathogenic bacteria on the surfaces of cell phones that are used frequently by preclinical medical students. This cross-sectional study identified both pathogenic and nonpathogenic bacteria on cell phones of 105 medical students at King Abdulaziz University, Jeddah, Saudi Arabia, using standard microbiological methods. Out of 105 cell phones screened, 101 (96.2%) were contaminated with bacteria. Coagulase-negative staphylococci were the most abundant isolates (68%). Seventeen (16.2%) cell phones were found to harbor Staphylococcus aureus. Gram-positive bacilli were isolated from 20 (19%) samples. Viridans streptococci and Pantoea species were also isolated but at lower levels. Our findings indicate that cell phones can act as reservoirs of both pathogenic and nonpathogenic organisms. Therefore, full guidelines about restricting the use of cell phones in clinical environments, hand hygiene, and frequent decontamination of mobile devices are recommended at an early stage in medical schools, to limit the risk of cross-contamination and healthcare-associated infections caused by cell phones

Anti-Tuberculous Activity of Treponemycin Produced by a Streptomyces Strain MS-6-6 Isolated from Saudi Arabia

A Streptomyces strain MS-6-6 with promising anti-tuberculous activity was isolated from soil samples in Saudi Arabia. The nucleotide sequence of its 16S rRNA gene (1426 bp) evidenced a 100% similarity to Streptomyces mutabilis. Through an anti-tuberculous activity-guided approach, a polyketide macrolide was isolated and identified as treponemycin (TP). The structure of the isolated compound was determined by comprehensive analyses of its 1D and 2D NMR as well as HRESI-MS. In addition to the promising anti-tuberculous activity (MIC = 13.3 µg/mL), TP showed broad spectrum of activity against the Gram positive, Gram negative strains, and Candida albicans. Improvement of TP productivity (150%) was achieved through modification in liquid starch nitrate medium by replacing KNO3 with corn steep liquor and yeast extract or tryptone, and removing CaCO3 and K2HPO4. The follow up of TP percentage as well as its metabolites profile for each media was assessed by LC/DAD/MS

Culturomics and Amplicon-based Metagenomic Approaches for the Study of Fungal Population in Human Gut Microbiota

This work is dedicated to the memory of Marcel Sy (PhD student died on 15 September 2016); Marcel Sy has made a substantial contribution to this work, especially in fungal culturomics.International audienceHerein, the mycobiota was characterized in fecal samples from sick patients and healthy subjects, collected from different geographical locations and using both culturomics and amplicon-based metagenomics approaches. Using the culturomics approach, a total of 17,800 fungal colonies were isolated from 14 fecal samples, and resulted in the isolation of 41 fungal species, of which 10 species had not been previously reported in the human gut. Deep sequencing of fungal-directed ITS1 and ITS2 amplicons led to the detection of a total of 142 OTUs and 173 OTUs from the ITS1 and ITS2 regions, respectively. Ascomycota composed the largest fraction of the total OTUs analyzed (78.9% and 68.2% of the OTUs from the ITS1 and ITS2 regions, respectively), followed by Basidiomycota (16.9% and 30.1% of the OTUs from the ITS1 and ITS2 regions, respectively). Interestingly, the results demonstrate that the ITS1/ITS2 amplicon sequencing provides different information about gut fungal communities compared to culturomics, though both approaches complete each other in assessing fungal diversity in fecal samples. We also report higher fungal diversity and abundance in patients compared to healthy subjects. In conclusion, combining both culturomic and amplicon-based metagenomic approaches may be a novel strategy towards analyzing fungal compositions in the human gut