Abdullah Balkhair

Background: Urinary tract infections (UTIs) are a major driver of laboratory testing and antimicrobial prescribing, yet inappropriate urine collection and specimen handling, due to limited patient and nursing engagement, can compromise diagnostic accuracy and contribute to unnecessary or inappropriate antibiotic use. This study evaluated knowledge, attitudes, and practices (KAPs) related to pre-analytical diagnostic stewardship (DS), infection prevention and control (IPC), and antimicrobial stewardship (AMS) amongst nurses and hospitalized patients evaluated for urinary tract infection or undergoing urine culture workup. Methods: A cross-sectional study was conducted at two tertiary hospitals in Oman between September 2022 and August 2023. Three structured, internally validated questionnaires assessed pre-analytical DS, IPC, and AMS amongst nurses and patients. A total of 172 nurses were approached, with 165 completing the pre-analytical DS questionnaire and 162 completing the IPC/AMS questionnaire (with overlapping respondents across modules); 77 hospitalized patients evaluated for urinary tract infection or undergoing urine culture workup completed the patient questionnaire (out of 79 initially assessed, with two excluded due to incomplete clinical data). KAP domain scores were standardized to a 0–100 scale and summarized as mean ± SD. MANOVA assessed the effects of covariates on combined KAP outcomes. Mann–Whitney U, Kruskal–Wallis tests compared KAP scores across demographic and professional groups. Results: Patients demonstrated strong awareness of the importance of correct urine collection (91%); however, only 7.9% reported receiving midstream urine instructions, contrasting with 86.1% of nurses who reported providing them, pointing to a discordance between nurse-reported practice and patient-reported experience. Patients demonstrated high IPC engagement with 88.3% willing to prompt hand hygiene/glove use among doctors and nurses, and 74% would question antibiotic necessity. Amongst nurses, gaps persisted in inserting new catheters before culture (66.7%) and refrigeration of specimens if delay was expected (36.4%). Work experience significantly influenced nurses’ pre-analytical diagnostic stewardship knowledge and practice scores (p = 0.002 for MANOVA global effect; univariate practice score p < 0.001). Knowledge amongst nurses was high for hand hygiene, IPC prevention and antibiotic resistance drivers; however, 56.3% incorrectly associated antibiotics with pain/inflammation. Institutional affiliation significantly influenced overall KAP outcomes (p = 0.004 for MANOVA global effect, with univariate practice scores showing p < 0.001). Overall, findings revealed motivated stakeholders alongside discrete, actionable weaknesses in diagnostic and antimicrobial stewardship workflows. Conclusions: This study identifies a critical but modifiable gap between perceived and patient-experienced pre-analytical DS practices in UTIs. Strengthening microbiology and nursing collaborative diagnostic stewardship, standardizing patient instructions, improving specimen-handling infrastructure, and actively engaging patients represent practical, high-impact strategies to enhance diagnostic accuracy, infection prevention, and antimicrobial stewardship in Oman.

Background: Urinary tract infections (UTI) are a major driver of laboratory testing and antimicrobial prescribing, yet inappropriate urine collection, specimen handling, due to limited patient and nursing engagement can compromise diagnostic accuracy and contribute to unnecessary or inappropriate antibiotic use. This study evaluated knowledge, attitudes, and practices (KAP) related to pre-analytical diagnostic stewardship (DS), infection prevention and control (IPC), and antimicrobial stewardship (AMS) amongst nurses and hospitalized UTI patients. Methods: A cross-sectional study was conducted at two tertiary hospitals in Oman between September 2022 and August 2023. Three structured, internally validated questionnaires assessed pre-analytical DS, IPC, and AMS amongst nurses and patients. A total of 327 nurses participated, including 165 for the pre-analytical DS survey and 162 for the IPC and AMS survey; 77 hospitalized patients with UTI completed the patient questionnaire. KAP domain scores were standardized to a 0–100 scale and summarized as mean ± SD. MANOVA assessed the effects of covariates on combined KAP outcomes. Mann–Whitney U, Kruskal–Wallis tests compared KAP scores across demographic and professional groups. Results: Patients demonstrated strong awareness of importance of correct urine collection (91%); however, only 7.9% reported receiving midstream urine instructions, contrasting with 86.1% of nurses who reported providing them. They demonstrated high IPC engagement with 88.3% willing to prompt hand hygiene/glove use among doctors and nurses, and 74% would question antibiotic necessity. Amongst nurses gaps persisted in inserting new catheter before culture (66.7%) and refrigeration of specimens if delay expected (36.4%). Work experience significantly influenced pre-analytical KAP outcomes (p=0.002). Knowledge amongst nurses was high for hand hygiene, IPC prevention and antibiotic resistance drivers; however, 56.3% incorrectly associated antibiotics with pain/inflammation. Institutional affiliation significantly influenced IPC/AMS practice scores (p=0.004). Overall, findings revealed motivated stakeholders alongside discrete, actionable weaknesses in diagnostic and antimicrobial stewardship workflows. Conclusion: This study identifies a critical but modifiable gap between perceived and patient-experienced pre-analytical DS practices in UTI . Strengthening microbiology and nursing collaborative diagnostic stewardship, standardizing patient instructions, improving specimen-handling infrastructure, and actively engaging patients represent practical, high-impact strategies to enhance diagnostic accuracy, infection prevention, and antimicrobial stewardship in Oman.

Objectives: Hospitalisations related to COVID-19 pneumonia have increased the risk of healthcare-associated infections (HCAIs), including those caused by multidrug-resistant organisms (MDROs). This study aimed to investigate the epidemiology of HCAIs secondary to MDROs among hospitalised patients with COVID-19 pneumonia. Methods: This retrospective study population included patients with COVID-19 pneumonia aged 18 years and older who were admitted to Sultan Qaboos University Hospital, Muscat, Oman, for more than 48 hours between March 2020 and December 2021. Results: A total of 486 patients were included in this study. Among the cohort, 76 patients (15.6%) were diagnosed with concurrent HCAIs with an MDRO as the causative pathogen. Of these patients, 31 (40.8%) had infections caused by MDR Acinetobacter baumannii, 15 (19.7%) had infections secondary to carbapenem-resistant Klebsiella pneumoniae and 8 (10.5%) had infections caused by extended-spectrum betalactamase Escherichia coli. Pneumonia and bacteraemia were the two most common concurrent healthcare-associated MDRO infection sites, accounting for 42% and 36% of all events, respectively. Among the 486 patients, 155 died (31.9%). Among these, 64 (41.3%) had concurrent HCAIs caused by 1 or more MDROs. Contrarily, among the 331 patients with COVID-19 pneumonia who recovered, only 12 (3.6%) had concurrent HCAIs. Conclusions: There is high prevalence of healthcare-associated MDRO infections.predominantly pneumonia and bacteraemia.in hospitalised patients with COVID-19 pneumonia. This reveals a significant association between infection with MDROs and death underlining the substantial impact of infection with MDROs in this vulnerable patient population.

Background: While mapping Escherichia coli susceptibility in community acquired simple UTIs across 38 centres, DASH to Protect Antibiotics, (https://dashuti.com/), a multiregional study also assessed impact of socio-economic conditions and climate on antimicrobial susceptibility. Methods: The centres were located in the Indian subcontinent, Middle East, North and West Africa, Eurasia, Europe, and North America. Harmonic means were used for comparative analysis of the antimicrobial susceptibility of E. coli in simple cystitis. Kruskal-Wallis test was utilized to compare susceptibility means between the antimicrobials and the GDP. A two-way ANOVA to simultaneously analyzed the impact of the antimicrobials and GDP on the proportion of susceptible E. coli while adjusting for variables (low and high temperature, humidity and population density per sqkm). Findings: Antimicrobial susceptibility varied between regions and within large countries like India and Pakistan. Nitrofurantoin (89%) and fosfomycin (96%) emerged as the most effective antimicrobials. In majority of the centres, susceptibility to other oral antimicrobials was low: cotrimoxazole.

Background: There is scarce literature from the region pertinent to university students' HIV-related knowledge, perception, attitudes, and behavior toward people living with HIV. Moreover, university students in Oman are remarkably uninformed about HIV, resulting in misconceptions and stigmatization among students. Objective: This research aimed to examine HIV-related knowledge and attitudes of undergraduate medical and non-medical university students toward people living with HIV in Oman. Methods: This was a qualitative cross-sectional study using convenience sampling to recruit participants from nine colleges at Sultan Qaboos University, Muscat, Oman. An online questionnaire composed of 17 Likert scale statements examining students' knowledge and nine Likert scale statements exploring students' attitudes was used. A knowledge score >= the mean was considered good knowledge, whereas a stigma score > the mean was regarded as stigmatization. A sample size of 376 students was computed using a Raosoft calculator (Raosoft, Inc., Seattle, Washington, United States) with a confidence level of 95% and a margin of error of 5%. Cronbach's alpha for the 26-item questionnaire was alpha = 0.716. Responses were collected and analyzed using IBM SPSS Statistics for Windows, Version 26, (Released 2019; IBM Corp., Armonk, New York, United States). The questionnaire and the study protocol were approved by the institution's medical research and ethics committee. Results: A total of 678 undergraduate university students responded to the questionnaire including 450 (66.4%) and 228 (33.6%) female and male students, respectively. Medical students represented 20.8% of the responders. The mean knowledge score was 12.3 +/- 1 signifying good knowledge in 72% of the students and the mean stigma score was 6.03 +/- 3.51 indicating that 43.4% of the responders had a negative and stigmatizing attitude. Medical students had the highest mean knowledge score (14.2 +/- 1.8) denoting good knowledge in 83.5% of the students. Additionally, medical students had the lowest mean stigma score (4.64 +/- 3.32) implying that 29% of the surveyed medical students had negative attitudes toward people living with HIV. No significant association was found between students' academic performance or students' sex with mean knowledge scores. Contrarily, male sex was found to be significantly associated with lower mean stigma scores. No significant relationship between students' knowledge scores and stigma scores was observed. Conclusion: The findings of this study denote a substantial gap in HIV-related knowledge among university students, leading to undesirable attitudes toward people living with HIV. These findings call for an urgent need to escalate HIV awareness and educational programs tailored to university students in Oman.

Background: Bloodstream infections remain a major cause of morbidity and mortality despite notable advances in their diagnosis and treatment. C-reactive protein/serum albumin ratio and the quick Pitt bacteremia score are two useful tools for clinicians to assess severity and predict mortality risk in patients with sepsis attributable to bloodstream infections. This study examined the relationship between C-reactive protein/serum albumin ratio and Q Pitt bacteremia score with all-cause in-hospital mortality in patients with bloodstream infections. Methods: Hospitalized adult patients with bacteremic bloodstream infections between January 1, 2020, and December 31, 2021, were retrospectively reviewed. Patients' demographics and clinical and laboratory data were retrieved from patient electronic records. C-reactive protein/albumin ratio was calculated using CRP (mg/L) and serum albumin (g/L) values obtained within 24 hours of blood culture collection and quick Pitt bacteremia score was calculated for each patient with each of the five variables of the score determined within 24 hours of blood culture collection and each patient was assigned a numerical score of 0-5 accordingly. The relationship between C-reactive protein/albumin ratio and quick Pitt bacteremia score with all-cause in-hospital mortality was determined. Results: A total of 187 hospitalized adult patients with non-repeat bacteremic bloodstream infections were identified. Escherichia coli was the most common Gram-negative blood isolate while Staphylococcus aureus was the predominant Gram-positive isolate. One hundred and five (56.1%) patients were male with a cohort mean age of 56.9 +/- 2.7 years. All-cause in-hospital mortality was 27.3%. The mean CRP/albumin ratio (8.6 +/- 1.7) and mean quick Pitt bacteremia score (2.8 +/- 0.4) were significantly higher in patients with bloodstream infections who died during their hospitalization compared to those who survived. The all-cause in-hospital mortality was 8%, 12%, 22%, 46%, 93%, and 100% for patients with quick Pitt scores of 0, 1, 2, 3, 4, and 5, respectively. Conclusion: In hospitalized patients with bacteremic bloodstream infections, an incremental increase in quick Pitt bacteremia score and mean C-reactive protein/albumin ratio of >8 was associated with higher mortality.

Tuberculosis (TB) originating from expatriates that hail from high TB-burden countries is hypothesized to play a role in continued TB transmission in Oman. Here, we used whole-genome sequencing (WGS) to assess national TB transmission dynamics. The annual incidence per 100,000 population per year was calculated for nationals and expatriates. A convenience sample of Mycobacterium tuberculosis (MTB) isolates from 2018 to 2019 was sequenced and analyzed with publicly available TB sequences from Bangladesh, Tanzania, the Philippines, India, and Pakistan. Relatedness was assessed by generating core-genome single nucleotide polymorphism (SNP) distances. The incidence of TB was five cases per 100,000 persons in 2018 and seven cases per 100,000 persons in 2020 ( R ² = 0.34, P = 0.60). Incidence among nationals was 3.9 per 100,000 persons in 2018 and 3.5 per 100,000 persons in 2020 ( R ² = 0.20 , P = 0.70), and incidence among expatriates was 7.2 per 100,000 persons in 2018 and 12.7 per 100,000 persons in 2020 ( R ² = 0.74, P = 0.34). Sixty-eight local MTB isolates were sequenced and analyzed with 393 global isolates. Isolates belonged to nine distinct spoligotypes. Two isolates, originating from an expatriate and an Omani national, were grouped into a WGS-based cluster (SNP distance < 12), which was corroborated by an epidemiological investigation. Relatedness of local and global isolates (SNP distance < 100) was also seen. The relatedness between MTB strains in Oman and those in expatriate countries of origin can aid inform TB control policy. Our results provide evidence that WGS can complement epidemiological analysis to achieve the End TB strategy goal in Oman. IMPORTANCE: Tuberculosis (TB) incidence in Oman remains above national program control targets. TB transmission originating from expatriates from high TB-burden countries has been hypothesized to play a role. We used whole-genome sequencing (WGS) to assess TB transmission dynamics between expatriates and Omani nationals to inform TB control efforts. Available Mycobacterium tuberculosis isolates from 2018 to 2019 underwent WGS and analysis with publicly available TB sequences from Bangladesh, the Philippines, India, and Pakistan to assess for genetic relatedness. Our analysis revealed evidence of previously unrecognized transmission between an expatriate and an Omani national, which was corroborated by epidemiological investigation. Analysis of local and global isolates revealed evidence of distant relatedness between local and global isolates. Our results provide evidence that WGS can complement classic public health surveillance to inform targeted interventions to achieve the End TB strategy goal in Oman.