Frequency of isolation of pathogens from nosocomial bloodstream infection in a tertiary referral hospital in the United Arab Emirates

Data on antimicrobial resistance and patterns of nosocomial infection are lacking for the United Arab Emirates (UAE).1Trad O. Jumaa P.A. Afify Z. The changing pattern of bloodstream infection in pediatric oncology patients in the United Arab Emirates.Pediatr Hematol Oncol. 2003; 20: 281-289Crossref PubMed Scopus (7) Google Scholar From February 2001 to May 2002, we performed a surveillance study on nosocomial bloodstream infection in a tertiary referral hospital in the UAE. The laboratory and clinical data on all positive blood cultures were reviewed prospectively. Parameters used to define strains as clinically significant and representing true infection rather than contamination, included the identity of the microorganism, the presence of more than one blood culture with the same microorganism and the presence of the same microorganism as that found in the blood in another site. Nosocomial bloodstream infection was defined as bacteremia occurring >48 hours or longer after admission.2Garner J.S. Jarvis W.R. Emori T.G. Horan T.C. Hughes J.M. CDC definitions for nosocomial infections, 1988.Am J Infect Control. 1988; 16: 128-140Abstract Full Text PDF PubMed Scopus (5166) Google Scholar Blood cultures were analyzed using the Vital analyzer (BioMerieux, France). All antimicrobial tests were performed by disc diffusion in accordance with criteria from the National Committee for Clinical Laboratory Standards (NCCLS), wherever possible.3National Committee for Clinical laboratory Standards (NCCLS). Performance standards for antimicrobial susceptibility testing. Villanova, PA: NCCLS; 2000.Google Scholar Consecutive isolates and their susceptibility patterns were entered manually into a database. During the period 2000–2001, Epi Info version 6.02 was used and in 2002, WHONET.4Epi Info Version 6.02: a word processing and statistics program for epidemiology on microcomputers. Centers for Disease Control and Prevention, Atlanta, Georgia, USA; 1994.Google Scholar, 5WHONET 5 1999.World Health Organization Geneva Switzerland and WHO Collaborating Center for Surveillance of Antimicrobial Resistance, Boston, MA, USA. Available from: URL: http://www.who.int/csr/drugresist/whonetsoftware/en/index.html.Google Scholar There were 281 clinically significant isolates. Gram-positive organisms accounted for 47% of isolates, Gram-negative 48% and fungi 5%. Anaerobes were isolated from one episode. Eighteen percent of episodes were polymicrobial. Table 1 shows the ranked order of isolates.Table 1Ranked order of the commonest causes of nosocomial bloodstream infection, Tawam Hospital, February 2001 to May 2002RankOrganismn = 281 (%)1Coagulase-negative staphylococci84 (29.9)2Klebsiella spp29 (10.3)3Enterobacter spp24 (8.5)4Acinetobacter spp22 (7.8)5Escherichia coli20 (7.1)6Staphylococcus aureus17 (6.0)a1/17 (5.9%) S. aureus strains were methicillin-resistant (MRSA).7Pseudomonas aeruginosa15 (5.3)8Candida spp15 (5.3)9Enterococcus spp9 (3.2)bGlycopeptide-resistant enterococci (GRE) were not detected.10Viridans streptococci7 (2.5)a 1/17 (5.9%) S. aureus strains were methicillin-resistant (MRSA).b Glycopeptide-resistant enterococci (GRE) were not detected. Open table in a new tab The pattern of organisms was different from those reported elsewhere in the world.6Fluit A.C. Jones M.E. Schmitz F.J. Acar J. Gupta R. Verhoef J. the SENTRY participants groupAntimicrobial susceptibility and frequency of occurrence of clinical blood isolates in Europe from 1997 and 1998.Clin Infect Dis. 2000; 30: 454-460Crossref PubMed Scopus (270) Google Scholar, 7Fluit A.C. Schmitz F.J. Verhoef J. the European SENTRY participants groupFrequency of isolation of pathogens from bloodstream, nosocomial pneumonia, skin and soft tissue, and urinary tract infections occurring in European patients.Eur J Clin Microbiol Infect Dis. 2001; 20: 188-191PubMed Google Scholar, 8Wisplinghoff H. Bischoff T. Tallent S.M. Seifert H. Wenzel R.P. Edmond M.B. Nosocomial bloodstream infections in US hospitals: analysis of 24,179 cases from a prospective nationwide surveillance study.Clin Infect Dis. 2004; 39: 309-317Crossref PubMed Scopus (3402) Google Scholar, 9Diekema D.J. Pfaller M.A. Jones R.N. Doern G.V. Kugler K.C. Beach M.L. et al.The SENTRY participants group. Trends in antimicrobial susceptibility of bacterial pathogens isolated from patients with bloodstream infections in the USA, Canada and Latin America.Int J Antimicrob Agents. 2000; 13: 257-271Abstract Full Text Full Text PDF PubMed Scopus (129) Google Scholar The most notable difference was the predominance of Gram-negative organisms compared with Gram-positive. Although coagulase-negative staphylococci (CoNS) made up a similar proportion to that found in other reports (29.9%), Enterococcus spp were infrequent isolates (3.2%). Of the 6% proportion of Staphylococcus aureus strains, 5.9% were methicillin-resistant (MRSA) and glycopeptide-resistant enterococci (GRE) were not detected during the study period. Acinetobacter spp (7.8%) were common pathogens compared with other Gram-negative organisms. The pattern of organisms is very different from that found in North America and most of Europe, but shares some similarities, such as the predominance of Gram-negative organisms, the low frequency of Enterococcus spp and the relatively higher frequency of Acinetobacter spp, with data reported from Latin America.9Diekema D.J. Pfaller M.A. Jones R.N. Doern G.V. Kugler K.C. Beach M.L. et al.The SENTRY participants group. Trends in antimicrobial susceptibility of bacterial pathogens isolated from patients with bloodstream infections in the USA, Canada and Latin America.Int J Antimicrob Agents. 2000; 13: 257-271Abstract Full Text Full Text PDF PubMed Scopus (129) Google Scholar The incidence of Candida spp is higher than reports from Europe, but lower than from the USA.6Fluit A.C. Jones M.E. Schmitz F.J. Acar J. Gupta R. Verhoef J. the SENTRY participants groupAntimicrobial susceptibility and frequency of occurrence of clinical blood isolates in Europe from 1997 and 1998.Clin Infect Dis. 2000; 30: 454-460Crossref PubMed Scopus (270) Google Scholar, 8Wisplinghoff H. Bischoff T. Tallent S.M. Seifert H. Wenzel R.P. Edmond M.B. Nosocomial bloodstream infections in US hospitals: analysis of 24,179 cases from a prospective nationwide surveillance study.Clin Infect Dis. 2004; 39: 309-317Crossref PubMed Scopus (3402) Google Scholar Overall, while there are similarities with worldwide data, the pattern is apparently unique. These data emphasize the fact that patterns of infection vary geographically and hence there is a need for local data. Comparable data from the UAE are not available in the literature and further work is needed to establish whether the patterns of organisms reported here are typical for the UAE.Conflict of interest: No conflict of interest to declare.

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