Faris S. Alnezary

Background/Objectives: Pseudomonas aeruginosa is a major cause of healthcare-associated infections with increasing antimicrobial resistance. This study investigated its clinical characteristics, antimicrobial susceptibility patterns, and factors associated with in-hospital mortality. Materials and Methods: This single-center retrospective cohort study was conducted at Maternity and Children Hospital, Buraydah, Qassim Region, Saudi Arabia, from January 2022 to January 2025. Medical records of patients with clinically confirmed P. aeruginosa infection were reviewed. Demographic, clinical, microbiological, antimicrobial susceptibility, and outcome data were collected. Statistical analyses were performed using SPSS version 22 and R version 4.4.1. Results: Among 198 patients, 62.1% were children aged 1–10 years, and 24.7% were admitted to the neonatal intensive care unit (NICU)/neonatology ward. Respiratory tract infection was the most common diagnosis (22.7%). Among the tested isolates, susceptibility was highest to amikacin (170/182, 93.4%), gentamicin (142/159, 89.3%), piperacillin/tazobactam (155/183, 84.7%), cefepime (65/77, 84.4%), imipenem (146/176, 83.0%), meropenem (62/75, 82.7%), and ceftazidime (145/181, 80.1%). Agents with intrinsic resistance or limited/non-applicable activity against P. aeruginosa were not interpreted as evidence of acquired antimicrobial resistance. Firth multivariable logistic regression identified NICU/neonatology admission (adjusted odds ratio [AOR] = 7.16, 95% CI: 2.77–19.87; p < 0.001) and bloodstream infection (AOR = 13.20, 95% CI: 2.25–80.44; p = 0.005) as independent predictors of in-hospital mortality. Conclusions: Pseudomonas aeruginosa demonstrated substantial antimicrobial resistance, although several clinically relevant antipseudomonal agents, particularly amikacin, retained high activity. NICU/neonatology admission and bloodstream infection were associated with increased mortality, highlighting the importance of early recognition and continued local antimicrobial resistance surveillance.

Introduction: Acute otitis media (AOM) is a common pediatric condition requiring careful assessment to distinguish children needing medical referral from those suitable for watchful waiting. Community pharmacists are often the first healthcare professionals consulted; however, evidence regarding the quality and guideline concordance of their AOM management remains limited. This study evaluated community pharmacists’ management of pediatric AOM across scenarios of varying clinical severity. Methods: A cross-sectional simulated patient study was conducted using three standardized pediatric AOM scenarios: a 5-month-old infant requiring referral, an 18-month-old child suitable for watchful waiting, and a 5-year-old child with multiple red flags requiring urgent referral. Trained simulated caregivers completed 203 community pharmacy visits. The primary outcome was scenario-specific guideline-concordant management. Secondary outcomes included referral, watchful waiting, antimicrobial recommendations, information gathering, counseling, and communication quality. Generalized estimating equation (GEE) logistic regression models accounted for clustering by simulated patient. Results: Guideline-concordant management was provided in 58.8% of Case 1 visits, 8.8% of Case 2 visits, and 58.2% of Case 3 visits. Referral was recommended in 60.3%, 47.1%, and 58.2% of visits, respectively, whereas watchful waiting was recommended in only 13.2% of the low-severity Case 2 visits. Antimicrobials were recommended in 7.4%, 22.1%, and 22.4% of visits, predominantly as topical antibiotics. Although pharmacists commonly assessed patient age and generally communicated professionally, assessment of symptoms, fever, ear discharge, medication use, allergies, and recurrent infections was inconsistent. Compared with Case 2, Cases 1 and 3 had substantially greater odds of guideline-concordant management. Conclusions: Community pharmacists’ management of suspected pediatric AOM varied considerably by clinical presentation. Major gaps were observed in watchful waiting, systematic clinical assessment, and antimicrobial stewardship. Standardized triage protocols and targeted professional training are needed to improve safe, guideline-concordant management.

Background: Nosocomial infections, or healthcare-associated infections (HAIs), represent a significant global health challenge frequently associated with invasive medical procedures and extended hospitalizations. This study was designed to evaluate the current level of knowledge and the perceptions of inpatients regarding HAIs within a high-risk tertiary hospital in the Qassim region of Saudi Arabia. Method: A descriptive cross-sectional study was conducted from August 2024 to February 2025 at a tertiary facility in the Qassim region. The study population included 500 inpatients aged 18 years and older who consented to participate. Data were collected via individual interviews using a closed-ended questionnaire, which assessed demographics, knowledge and perceptions of HAIs on a 4-point Likert scale. Results: Among 500 study participants, good knowledge, fair knowledge and poor knowledge regarding HAIs were demonstrated by 57%, 38.4% and 4.6%, respectively. More than 98% of participants achieved a perception score of above 70%, indicating a profoundly positive perception level. Knowledge was significantly associated with age (p = 0.018), educational status (p < 0.01), and nationality (p < 0.01). Participants most commonly recognized contaminated hospital beds (95.6%), airborne transmission (91.2%), and unsterilized equipment (90%) as the potential modes of infection transmission. Conclusions: Sustaining ongoing infection prevention efforts and fostering improved awareness among inpatients regarding HAIs are of paramount importance in implementing effective public health prevention measures.

Background: Polymicrobial skin and soft tissue infections (SSTIs) are frequently complicated by methicillin-resistant Staphylococcus aureus (MRSA) and co-colonizing Gram-negative pathogens like Pseudomonas aeruginosa (P. aeruginosa). Mupirocin, the clinical gold standard, is limited by rising resistance and an intrinsic “mupirocin gap” against P. aeruginosa. This study evaluates a novel Nigella sativa (NS) seed oil topical formulation as an alternative. Methods: A 4-tier preclinical platform assessed the NS formulation against MRSA, methicillin-sensitive S. aureus (MSSA), Streptococcus pyogenes, and P. aeruginosa. The pipeline included: (1) in vitro agar diffusion, (2) a gauze biofilm prevention model, (3) an ex vivo porcine ear skin model challenging epidermal lipid barriers, and (4) an in vivo Galleria mellonella model evaluating trans-cuticular systemic protection. Results: The NS formulation produced extensive diffusion zones, completely inhibiting S. pyogenes and outperforming controls against MSSA and P. aeruginosa. In the gauze model, NS achieved complete eradication of MSSA and S. pyogenes, while significantly suppressing MRSA and P. aeruginosa biofilms (p < 0.001). In the ex vivo porcine model, NS yielded >1.5 to >2.5 log reductions across all pathogens at 24 h (p < 0.001). Furthermore, in the in vivo G. mellonella model, topical NS significantly reduced the systemic bioburden of MSSA, S. pyogenes, and P. aeruginosa (p < 0.001), though MRSA reduction lacked statistical significance. Conclusions: The novel NS formulation demonstrates potent broad-spectrum antimicrobial activity. By effectively bridging the “mupirocin gap” against P. aeruginosa and demonstrating significant efficacy against MRSA in in vitro and ex vivo environments, it represents a promising plant-based pre-clinical candidate that strongly warrants future evaluation in live mammalian wound healing models.

Colistin has served as a last-resort agent against multidrug-resistant Gram-negative bacilli (MDR-GNB). However, the emergence of resistance has substantia

Invasive fungal infections (IFIs) are a major cause of morbidity and mortality in critically ill patients. While early empirical antifungal therapy (EAFT) is a common strategy to combat diagnostic delays, the choice of agent and its overall benefit remain debated. This study evaluates the clinical outcomes and safety profiles associated with different empirical antifungal strategies in non-neutropenic ICU patients with suspected IFIs. A retrospective observational study was conducted on 324 non-neutropenic patients who received EAFT in eight ICUs from 2015 to 2023. Data on demographics, comorbidities, treatments, and outcomes were collected from medical records. The primary endpoints were survival, clinical improvement, and incidence of confirmed fungal infection. Mortality predictors were identified using multivariate logistic regression. Among the 324 patients, the overall in-hospital mortality rate was 78.70%. Mortality was significantly lower in the group receiving fluconazole (63.16%) compared to those receiving caspofungin (76.80%), liposomal amphotericin B (75%), and anidulafungin (84.83%) (p = 0.028). Regarding safety, fluconazole demonstrated the lowest incidence of hepatotoxicity (13.16%) and nephrotoxicity (7.89%). In contrast, anidulafungin was associated with the highest rate of hepatotoxicity (33.79%, p=0.035), and caspofungin was associated with the highest rate of nephrotoxicity (39.52%, p=0.003). Only 17.28% of patients achieved clinical improvement. After the initiation of EAFT, a fungal infection was confirmed in only 7.41% of patients. Fluconazole-based EAFT was associated with lower mortality rates compared to other antifungal agents. However, with a confirmed fungal infection rate of only 7.41%, these findings suggest that current patient selection for EAFT is suboptimal. The high overall mortality, coupled with the low infection confirmation rate, underscores the need for improved risk stratification tools to ensure the judicious use of antifungals in this critically ill population.

Introduction: Antimicrobial resistance poses a significant threat to global health, and community pharmacists are positioned to play a crucial role in mitigating this issue. The present study aimed to evaluate the extent of compliance among community pharmacists in Saudi Arabia with relevant regulations and clinical guidelines in the management of suspected infectious diarrhea. Method: This cross-sectional study employed simulated patients presenting with diarrhea to assess the management practices within 200 community pharmacies in two major cities across Saudi Arabia. Trained pharmacy students presented pharmacists with three case scenarios involving adult patients with diarrhea. Statistical analysis included descriptive statistics and chi-square tests to examine the relationships between pharmacist characteristics and practice categories. Results: The findings of this study indicate that the performance of community pharmacists in managing diarrhea is suboptimal. Notably, less adequate practice emerged as the predominant outcome at 63% (n = 126). Only 14% (n = 28) of pharmacists demonstrated adequate practice, while 23% (n = 46) exhibited poor investigative practice. Metronidazole dispensing increased across scenarios, from 16.92% (n = 11) in Scenario 1 to 30.3% (n = 20) in Scenario 3. Most pharmacists inquired about the patient’s age (72%; n = 144); however, only a limited number probed for symptoms of dehydration (5.5%, n = 11) and medication history (3%, n = 6). A significant association was found between geographical location and practice performance (p = 0.015). Conclusions: This study reveals significant deficiencies in the management of infection-related diarrhea, underscoring the urgent need for enhanced training and regulatory measures within community pharmacy settings in Saudi Arabia to improve patient care and effectively address antimicrobial resistance (AMR).

Objective: Despite considerable progress in diagnosis, treatment, and prevention, human immunodeficiency virus (HIV) and acquired immune deficiency syndrome (AIDS) remain major public health issues in Saudi Arabia. Pharmacists must possess adequate knowledge and professional attitudes towards HIV/AIDS in pharmacy practice. This study aimed to examine pharmacy students' level of HIV knowledge, their attitudes toward people living with HIV/AIDS (PLWHA), and their risk perceptions when providing services to PLWHA. Methods: A escriptive cross-sectional survey tool was developed and administered to pharmacy students during their final academic year at Taibah University in Saudi Arabia. Descriptive and Pearson's Chi-Square Test or Fisher's Exact Test as appropriate, were performed to find the difference with a p-value of 0.05. Results: A total of 130 pharmacy students responded to the questionnaire (89.6% response rate). While descriptive results showed students' knowledge about HIV/AIDS was low (the mean knowledge score was 8.22 out of 15). Post-exposure prophylaxis was only known by 36.2% of pharmacy students, and the time it takes HIV to become AIDS was only known by 11.5%. More than half of the students (60.8%) did not realize that antivirals could not treat HIV/AIDS. Only 18.5% of students agreed they could counsel and treat HIV-positive people. A survey of pharmacy students found that 46.2% believed that they did not receive enough education on working with PLWHA in a safe and responsible manner, and 20% were unwilling to assist PLWHA. Among pharmacy students, 54.6% recommended HIV testing for healthcare professionals and 53.9% for patients before surgery. Conclusion: The study highlighted inadequate students’ knowledge, modest attitudes, and negative risk perceptions toward HIV/AIDS. Saudi Arabian educational institautions and health care planners should perform educational interventions to enhance HIV/AIDS understanding among healthcare students.

Methicillin-resistant Staphylococcus aureus (MRSA) pathogens are considered a serious global health threat, leading to increased mortality and antimicrobial resistance. Rates in Saudi Arabia remain high, necessitating continuous surveillance. This study investigates MRSA prevalence and susceptibility at a Saudi maternity and children's hospital. A cross-sectional study was conducted on pediatric (<18 years) and maternal patients with S. aureus infection from Jan. 2020 to March. 2022. Bacterial strains were obtained from patient’s clinical specimens and was identified by standard method. The BD Phoenix™ M50 was used for antibiotic susceptibility tests and MRSA detection. Data were analysed using descriptive and inferential statistics (Chi-square test) with SPSS software. Out of 152 S. aureus cases, 114/152 (75 %) were pediatric and 38/152 (25 %) were maternal patients. The overall MRSA infection was 69/152 (45.4 %). Among pediatrics, 31/54 (57.4 %) MRSA cases were female; over 30/54 (56 %) were under 1 year old; and most MRSA infections were obtained from skin 29/54 (53.7 %) compared to other sites of infections (p = 0.024). Among maternal cases, 15/38 (39.5 %) were MRSA, primarily from wound infections 14/15 (93.3 %) compared to other sites of infections (p = 0.39). All MRSA isolates were sensitive to vancomycin and linezolid. While 51/60(85 %) were sensitive to Trimethoprim/ sulfamethoxazole. This investigation found a high prevalence of MRSA among pediatrics and maternal inpatients, indicating a significant burden. All MRSA isolates were susceptible to vancomycin but demonstrated variable sensitivity to other antibiotics. These findings highlight the need for ongoing surveillance, infection control strategies, and research into alternative treatment options to combat this major public health threat.