Hashim Ba Wazir

Methicillin-resistant Staphylococcus aureus (MRSA) causes a wide spectrum of infections ranging from simple cutaneous infections to serious invasive infections, including endocarditis and central nervous system (CNS) infections. Multi-site involvement is not infrequently encountered with MRSA infections. Herein, we present a case of complicated MRSA bacteremia presenting as community-onset meningoencephalitis. A 45-year-old man presented to the emergency department with fever, altered sensorium, and disorientation after receiving diclofenac intramuscular injections. He was diagnosed with meningitis due to MRSA. He was treated with vancomycin and rifampicin. He reported significant low back pain, and lumbaosacral spine MRI showed spondylodiscitis. Moreover, the patient developed right shoulder pain and reduction of movement; a shoulder ultrasound revealed mild joint effusion. As he continued to spike and developed the shoulder pain while on vancomycin/rifampicin, IV linezolid was commenced. As a result, the patient's condition improved and was discharged on oral linezolid followed by cotrimoxazole.

Objectives: This study aimed to describe the prevalence, clinical characteristics and outcomes of bacteraemia caused by Enterococcus species at a university hospital in Oman. Methods: This observational retrospective study was conducted over a 5-year period from 2015 to 2019 at Sultan Qaboos University Hospital, Muscat, Oman. Adult patients (18 years and above) with bacteraemia caused by Enterococcus species were included. Data were collected retrospectively from the hospital information system using a standardised data collection form. Results: A total of 142 cases of bacteraemia were observed, with E. faecalis being isolated in the majority of cases (n = 88, 62%) compared to E. faecium (n = 40, 28.2%); 83 (58.5%) cases were identified as nosocomial bacteraemia. The incidence of infection was higher among males (n = 96, 67.6%) than females (n = 46, 32.4%). There were 43 cases of polymicrobial bacteraemia along with Enterococcus species. Indwelling bladder catheter, ventilation and central venous catheters were identified as significant predisposing factors for bacteraemia. The 30-day mortality rate was 32% (n = 28) among E. faecalis and 45% (n = 18) among E. faecium bacteraemia patients. Infective endocarditis was observed in 8 (5.6%) patients, with E. faecalis being isolated in 6 (4.2%) of them. Echo findings showed tricuspid valve involvement as the most involved valve. Conclusion: This study showed that E. faecalis and E. faecium were the most common Enterococcus species isolated. A high proportion of E. faecium isolates were resistant to ampicillin and vancomycin. Enterococcus bacteraemia remains a significant cause of healthcare-associated infections.

Objectives: This study aimed to examine a decade-long epidemiology of candidaemia to explore the risk factors associated with it, and describe its clinical outcomes in hospitalised adult patients. Methods: This retrospective observational study was conducted at Sultan Qaboos University Hospital, Muscat, Oman. Adult patients with candidaemia hospitalised between January 2007 and December 2016 were included. The hospital infection control department surveillance registry on bloodstream infections (BSIs) was used to identify Candida BSIs. Patients' electronic medical records were searched for demographic characteristics, clinical risk factors and outcomes. Results: Candida albicans was the most common Candida species among 152 patients with candidaemia comprising 25.0% of all Candida blood culture isolates. Nakaseomyces glabrata, C. tropicalis and C. parapsilosis were the most frequently isolated non-albicans species. Past antibiotics use, presence of central venous catheters, intensive care unit admission, diabetes mellitus, sickle cell disease and solid cancer were the most commonly identified underlying risk factors for candidaemia. A total of 30 days' all-cause mortality was 53.3% among all patients with candidaemia. Conclusions: This study found an increasing trend of non-albicans Candida. Diabetes was the most identified risk factor for candidaemia. A relatively low rate of initiation of empirical antifungal therapy in at-risk patients was found. Unacceptably high mortality rates and prolonged hospital stay of patients with candidaemia are a call for action.