BACKGROUNDVancomycin-resistant enterococci (VRE) are a major and emerging hospital-acquired pathogen associated with high mortality, particularly among the critically ill and Intensive Care Units (ICUs) patients. This study aimed to determine the prevalence and demographic and clinical characteristics of VRE among patients admitted to a university hospital in Riyadh, Saudi Arabia.

METHODSA study was conducted during the period from September 2014 to November 2015 at King Khalid University Hospital, a tertiary care hospital in Riyadh, Saudi Arabia, including in-patients with VRE infection. Data were collected using laboratory results and the medical records of admitted patients and were analyzed using SPSS version 19.0 statistical software.

RESULTSIn a one-year period, 231 enterococci were isolated from blood, urine, exudates, sputum, stool, and body fluid. There were 191 (82.7%) vancomycin-sensitive enterococci (VSE) and 40 (17.3%) isolates were VRE. The Enterococcus species included E. faecalis 168 (72.7%), E. faecium, 53 (22.8%) E. gallinarum 5 (2.2%), and E. avium 5 (2.2%). VRE were more significant from blood specimens (P< 0.0001) while VSE were significantly more predominant from urine specimens (P< 0.0001). VRE were more commonly isolated from patients in ICUs and oncology unit (P = 0.0151 and P< 0.001, respectively) while VSE were more predominant in the medical and surgical areas (P = 0.0178 and P = 0.0178, respectively).

CONCLUSIONSThis study highlights the high prevalence of VRE in the hospital and the association of enterococcal infections with high-risk areas and oncology units, which warrant more studies looking for better management of these infections.

Adult ; Aged ; Anti-Bacterial Agents ; pharmacology ; Child, Preschool ; Enterococcus ; drug effects ; Female ; Hospitals, Teaching ; Humans ; Male ; Microbial Sensitivity Tests ; Middle Aged ; Saudi Arabia ; Vancomycin ; pharmacology ; Vancomycin-Resistant Enterococci ; drug effects ; isolation & purification ; pathogenicity

No abstract available.
Aged ; Anti-Bacterial Agents/pharmacology/therapeutic use ; Bacteremia/blood/*diagnosis/microbiology ; C-Reactive Protein/analysis ; Cholecystitis/blood/cerebrospinal fluid/microbiology ; Electrophoresis, Gel, Pulsed-Field ; Enterococcus faecium/drug effects/isolation & purification/metabolism ; Humans ; Male ; Microbial Sensitivity Tests ; Microscopy, Electron, Scanning ; Ochrobactrum/drug effects/isolation & purification/*metabolism ; RNA, Ribosomal, 16S/analysis/genetics/metabolism ; Sequence Analysis, DNA ; Spectrometry, Mass, Matrix-Assisted Laser Desorption-Ionization

Urinary tract infection (UTI) is one of the most common complications after radical cystectomy and orthotopic neobladder reconstruction. This study investigated the incidence and implicated pathogen of febrile UTI after ileal neobladder reconstruction and identify clinical and urodynamic parameters associated with febrile UTI. From January 2001 to May 2015, 236 patients who underwent radical cystectomy and ileal neobladder were included in this study. Fifty-five episodes of febrile UTI were identified in 46 patients (19.4%). The probability of febrile UTI was 17.6% and 19.8% at 6 months and 24 months after surgery, respectively. While, Escherichia coli was the most common implicated pathogen (22/55, 40.0%), Enterococcus spp. were the most common pathogen during the first month after surgery (18/33, 54.5%). In multivariate logistic regression analysis, ureteral stricture was an independent risk factor associated with febrile UTI (OR 5.93, P = 0.023). However, ureteral stricture accounted for only 6 episodes (10.9%, 6/55) of febrile UTI. Most episodes of febrile UTI occurred within 6 months after surgery. Thus, to identify risk factors associated with febrile UTI in the initial postoperative period, we assessed videourodynamics within 6 months after surgery in 38 patients. On videourodyamic examination, vesicoureteral reflux (VUR) was identified in 16 patients (42.1%). The rate of VUR presence in patients who had febrile UTI was not significantly different from those in patients without febrile UTI (50% vs. 39.3%, P = 0.556). Patients with febrile UTI had significantly larger residual urine volume (212.0 ± 193.7 vs. 90.5 ± 148.2, P = 0.048) than those without. E. coli and Enterococcus spp. are common pathogens and ureteral stricture and residual urine are risk factors for UTI after ileal neobladder reconstruction.
Aged ; Anti-Bacterial Agents/therapeutic use ; Cystectomy/adverse effects ; Enterococcus/isolation & purification ; Escherichia coli/isolation & purification ; Female ; Humans ; Ileum/*surgery ; Incidence ; Logistic Models ; Male ; Middle Aged ; Multivariate Analysis ; Postoperative Complications ; Reconstructive Surgical Procedures ; Retrospective Studies ; Risk Factors ; Urinary Bladder Neoplasms/*surgery ; Urinary Tract Infections/drug therapy/*epidemiology/etiology/microbiology ; Urodynamics

This multicenter study was undertaken to determine the efficacy of antibiotic prophylaxis and identify the risk factors for infectious complications after prostate surgery in Korean patients. A total of 424 patients who underwent surgery of the prostate were reviewed. All patients underwent urinalysis and urine culture preoperatively and postoperatively. Efficacy of antibiotic prophylaxis and risk factors for infectious complications were investigated. Infectious complications were observed in 34.9% of all patients. Factors independently associated with infectious complications were diabetes mellitus (adjusted OR, 1.99; 95% CI, 1.09-3.65, P=0.025) and operation time (adjusted OR, 1.08; 95% CI, 1.03-1.13, P=0.004). Clinicians should be aware of the high risk of infectious complications in patients with diabetes and those who undergo a prolonged operation time. Neither the type nor duration of prophylactic antibiotics resulted in differences in infectious complications.
Aged ; Anti-Bacterial Agents/pharmacology/therapeutic use ; Antibiotic Prophylaxis ; Diabetes Mellitus, Type 2/complications ; Drug Resistance, Bacterial/drug effects ; Enterococcus/drug effects/isolation & purification ; Escherichia coli/isolation & purification ; Humans ; Klebsiella pneumoniae/drug effects/isolation & purification ; Male ; Middle Aged ; Odds Ratio ; Postoperative Complications/microbiology/prevention & control ; Prospective Studies ; Prostatic Neoplasms/complications/*surgery ; Quinolones/pharmacology ; Risk Factors ; Time Factors ; Transurethral Resection of Prostate ; Urinalysis ; Urinary Tract Infections/microbiology

The crude extracts of the fermentation broth from a marine sediment-derived actinomycete strain, Saccharothrix sp. 10-10, showed significant antibacterial activities against drug-resistant pathogens. A genome-mining PCR-based experiment targeting the genes encoding key enzymes involved in the biosynthesis of secondary metabolites indicated that the strain 10-10 showed the potential to produce tetracenomycin-like compounds. Further chemical investigation of the cultures of this strain led to the identification of two antibiotics, including a tetracenomycin (Tcm) analogs, Tcm X (1), and a tomaymycin derivative, oxotomaymycin (2). Their structures were identified by spectroscopic data analysis, including UV, 1D-NMR, 2D-NMR and MS spectra. Tcm X (1) showed moderate antibacterial activities against a number of drug-resistant pathogens, including methicillin-resistant Staphylococcus aureus (MRSA) and vancomycin-resistant Enterococci (VRE) pathogens, with the MIC values in the range of 32-64 microg x mL(-1). In addition, 1 also displayed significant cytotoxic activities against human cancer cell lines, including HL60 (leukemia), HepG2 (liver), and MCF-7 (breast) with the IC 50 values of 5.1, 9.7 and 18.0 micromol x L(-1), respectively. Guided by the PCR-based gene sequence analysis, Tcm X (1) and oxotomaymycin (2) were identified from the genus of Saccharothrix and their 13C NMR data were correctly assigned on the basis of 2D NMR spectroscopic data analysis for the first time.
Actinomycetales ; chemistry ; genetics ; Anti-Bacterial Agents ; chemistry ; isolation & purification ; pharmacology ; Antineoplastic Agents ; chemistry ; isolation & purification ; pharmacology ; Benzodiazepinones ; chemistry ; isolation & purification ; pharmacology ; Cell Line, Tumor ; Data Mining ; methods ; Drug Resistance, Bacterial ; Enterococcus faecalis ; drug effects ; Fermentation ; Genomics ; Humans ; Inhibitory Concentration 50 ; Marine Biology ; Methicillin-Resistant Staphylococcus aureus ; drug effects ; Microbial Sensitivity Tests ; Molecular Structure ; Naphthacenes ; chemistry ; isolation & purification ; pharmacology ; Phylogeny ; Staphylococcus epidermidis ; drug effects

PURPOSE: The purpose of this study was to identify vancomycin-resistant enterococcus (VRE) colonization rate in patients admitted to the intensive care unit (ICU), associated risk factors and clinical outcomes for VRE colonization. METHODS: Of the 7,703 patients admitted to the ICUs between January, 2008 and December, 2010, medical records of 554 VRE colonized and 503 uncolonized patients were reviewed retrospectively. To analyzed the impact of colonization on patients' clinical outcomes, 199 VRE colonized patients were matched with 199 uncolonized patients using a propensity score matching method. RESULTS: During the study period, 567 (7.2%) of the 7,703 patients were colonized with VRE. Multivariate analysis identified the following independent risk factors for VRE colonization: use of antibiotics (odds ratio [OR]=3.33), having bedsores (OR=2.92), having invasive devices (OR=2.29), methicillin-resistant Staphylococcus aureus co-colonization (OR=1.84), and previous hospitalization (OR=1.74). VRE colonized patients were more likely to have infectious diseases than uncolonized patients. VRE colonization was associated with prolonged hospitalization and higher mortality. CONCLUSION: Strict infection control program including preemptive isolation for high-risk group may be helpful. Further research needs to be done to investigate the effects of active surveillance program on the incidence of colonization or infection with VRE in the ICU.
Adult ; Aged ; Anti-Bacterial Agents/pharmacology ; Enterococcus/drug effects/*isolation & purification ; Female ; Hospitalization ; Hospitals, University ; Humans ; Infection Control ; Intensive Care Units ; Length of Stay ; Male ; Methicillin-Resistant Staphylococcus aureus/isolation & purification ; Middle Aged ; Retrospective Studies ; Risk Factors ; Staphylococcal Infections/*epidemiology ; Vancomycin/pharmacology ; Vancomycin Resistance/drug effects

INTRODUCTIONVancomycin-resistant enterococci (VRE) have emerged as one of the major nosocomial antimicrobial-resistant pathogens globally. In this article, we describe the epidemiology of VRE in Singaporean public hospitals in the 5 years following the major local VRE outbreak in 2005.

MATERIALS AND METHODSA passive laboratory surveillance programme identified non-duplicate VRE isolates from 7 hospitals from 2006 to 2010. Descriptive statistics and time-series analysis was performed on all clinical VRE isolates for each individual hospital as well as for the combined dataset.

RESULTSThere were a total of 418 VRE isolates over 5 years, of which 102 isolates (24.4%) were from clinical cultures. Between 0.4% and 0.7% of all clinical enterococcal isolates were resistant to vancomycin. The overall incidence-density of VRE did not change over time in Singapore despite 2 separate outbreaks in tertiary hospitals in 2009 and 2010. Incidence-density of clinical VRE cases fell in 2 secondary hospitals, while another 2 hospitals experienced no significant VRE infections after 2008.

CONCLUSIONThe prevalence of VRE clinical isolates remains low in Singaporean public sector hospitals. However, the presence of at least 2 outbreaks in separate hospitals over the past 5 years indicates the need for continued vigilance in order to prevent any further increase in VRE prevalence locally.

Anti-Bacterial Agents ; pharmacology ; Cross Infection ; epidemiology ; Enterococcus ; drug effects ; isolation & purification ; Gram-Positive Bacterial Infections ; drug therapy ; Hospitals, Public ; Humans ; Population Surveillance ; Singapore ; epidemiology ; Vancomycin ; therapeutic use ; Vancomycin Resistance ; drug effects

Strongyloides stercoralis is a soil transmitted intestinal nematode that is endemic in the tropical and subtropical regions. In most individuals who are infected, chronic, usually asymptomatic, gastrointestinal infection persists. But, in immunocompromized hosts or in patients receiving immunosuppressive therapy, autoinfection of S. stercoralis may result in the dissemination of larvae, leading to fatal hyperinfection and increased rate of complications. We report a case of hyperinfective strongyloidiasis with bacterial meningitis in a patient receiving steroid therapy. Strongyloidiasis was diagnosed by the presence of filariform larvae of S. stercoralis in the bronchoalveolar lavage cytology and upper gastrointestinal endoscopic biopsy specimen. Her clinical symptoms had progressively aggravated and developed bacterial meningitis during treatment. She died despite aggressive antibiotic and antihelminthic therapy.
Adrenal Insufficiency/drug therapy ; Aged ; Animals ; Bronchoalveolar Lavage Fluid/parasitology ; Endoscopy, Gastrointestinal ; Enterococcus faecium/isolation & purification ; Female ; Humans ; Immunocompromised Host ; Intestinal Mucosa/pathology ; Larva/physiology ; Magnetic Resonance Imaging ; Meningitis, Bacterial/complications/*diagnosis/microbiology ; Steroids/adverse effects/therapeutic use ; Strongyloides stercoralis/growth & development/isolation & purification ; Strongyloidiasis/complications/*diagnosis/parasitology

In July 2010, we identified an outbreak of vancomycin-resistant enterococci (VRE) in our 26-bed neonatal intensive care unit. We performed an epidemiological investigation after clinical cultures of 2 neonates were positive for VRE. Identification, susceptibility testing, and molecular characterization were performed. Cultures of 3 surveillance stool samples of inpatients and 5 environmental samples were positive for VRE. All isolates were identified as Enterococcus faecium containing the vanA gene. Two distinct clones were identified by performing pulsed-field gel electrophoresis. The 2 clones exhibited different pulsotypes, but they represented identical Tn1546 types. Two sequence types, ST18 and ST192, were identified among all of the isolates with multilocus sequence typing. Our investigation determined that the outbreak in the neonatal intensive care unit was caused by 2 genetically different clones. The outbreak may have occurred through clonal spread and horizontal transfer of the van gene.
Anti-Bacterial Agents/pharmacology ; Bacterial Proteins/genetics ; Bacterial Typing Techniques ; Carbon-Oxygen Ligases/genetics ; DNA, Bacterial/analysis ; *Disease Outbreaks ; Electrophoresis, Gel, Pulsed-Field ; Enterococcus faecium/drug effects/*genetics/isolation & purification ; Feces/microbiology ; Genotype ; Gram-Positive Bacterial Infections/diagnosis/epidemiology/*microbiology ; Humans ; Infant, Newborn ; Intensive Care Units, Neonatal ; Male ; Multilocus Sequence Typing ; Vancomycin/pharmacology ; *Vancomycin Resistance

BACKGROUND: Accurate and early detection of vancomycin-resistant enterococci (VRE) is critical for controlling nosocomial infection. In this study, we evaluated the usefulness of a selective chromogenic agar medium and of multiplex PCR for detection of VRE, and both these techniques were compared with the conventional culture method for VRE detection. METHODS: We performed the following 3 methods for detecting VRE infection in stool specimens: the routine culture method, culturing in selective chromogenic agar medium (chromID VRE, bioMerieux, France), and multiplex PCR using the Seeplex(R) VRE ACE Detection kit (Seegene Inc., Korea) with additional PCR for vanC genes. RESULTS: We isolated 109 VRE strains from 100 stool specimens by the routine culture method. In chromID VRE, all the isolates showed purple colonies, including Enterococcus gallinarum and E. raffinosus, which were later identified using the Vitek card. All VRE isolates were identified by the multiplex PCR method; 100 were vanA-positive E. faecium, 8 were vanA- and vanC-1-positive E. gallinarum, and 1 was vanA-positive E. raffinosus. CONCLUSIONS: For VRE surveillance, culturing the isolates in chromID VRE after broth enrichment appears to be an accurate, rapid, and easy method for routine screening test. Multiplex PCR is relatively expensive and needs skilled techniques for detecting VRE, but it can be an auxiliary tool for rapid detection of genotype during a VRE outbreak.
Agar/chemistry ; Chromogenic Compounds/*chemistry ; Enterococcus/drug effects/genetics/*isolation & purification ; Enterococcus faecium/genetics/isolation & purification ; Feces/microbiology ; Genotype ; Humans ; Phenotype ; Polymerase Chain Reaction/*methods ; Reagent Kits, Diagnostic ; *Vancomycin Resistance