King Fahad National Guard Hospital Research Articles

Obesity Prevalence and Its Impact on Maternal and Neonatal Outcomes among Pregnant Women: A Retrospective Cross-Sectional Study Design.

The escalating prevalence of obesity in women of reproductive age raises concerns about its impact on maternal and fetal health during pregnancy. This study aimed to thoroughly assess how obesity affects pregnancy and neonatal outcomes among Saudi pregnant women. In a retrospective cross-sectional study, we analyzed 8426 pregnant women who delivered at King Fahad National Guard Hospital in Riyadh in 2021. Of these, 3416 had obesity, and 341 of them, meeting the inclusion criteria, were selected. Maternal and neonatal outcomes were compiled using a structured questionnaire and extracted from the hospital's "Best Care" data-based registration system. The findings highlighted that 40.5% of pregnant women were classified as obese, with almost half falling into obesity class II based on BMI. Obesity correlated significantly with adverse maternal outcomes like gestational diabetes and increased rates of cesarean deliveries. Additionally, maternal obesity was linked to unfavorable fetal outcomes, including higher rates of newborn intensive care unit admissions, lower APGAR scores at 1 min, and a greater likelihood of macrosomia. This study underscores the important impact of maternal obesity on both maternal and fetal health during pregnancy. Addressing this high-risk condition demands targeted educational programs for women of reproductive age focusing on BMI control, dietary adjustments, and lifestyle modifications to mitigate obesity-related complications during pregnancy.

Idiopathic Intussusception in Infants and Children: Different Outcomes in Relation to Interventions.

Background Intussusception is a pediatric emergency causing bowel obstruction that can progress to gangrene or perforation. Patients usually present with vomiting, abdominal discomfort or pain, or rectal bleeding. Specialized infant and child care is important to detect and manage such cases. Methodology This retrospective, cross-sectional study analyzed 45 cases of idiopathic pediatric intussusception presented to and managed by specialized pediatric healthcare services over 12 years. The medical records of children who presented with idiopathic intussusception from January 2010 to December 2022 at King Fahad National Guard Hospital, Riyadh, Kingdom of Saudi Arabia were reviewed. The data obtained included age, sex, clinical presentation, symptom duration, diagnostic investigations, mode of treatment, length of hospital stay, and outcomes. Results A total of 45 children were included (25 male, 20 female). The median age was 10 months ranging between five and eight months. The majority presented with abdominal pain or colic (78%), vomiting (76%), and rectal bleeding (47%). The diagnosis was done by an ultrasound preceded by pneumatic enema reduction that was successful in 33 (80%) children. Only four (9%) children underwent surgery as initial management. Ileocolic intussusception (73%) was the most prevalent, followed by colicolic (18%) and ilioiliac (10%). Among the children who underwent surgical reduction, 11 (92%) underwent laparotomy reduction. In total, 11 children underwent surgical reduction as well as an appendectomy, and four children required bowel resection. Only two children developed perforation, and recurrence occurred in two other children. The mean duration of symptoms before presentation was 46.73 hours, and the mean hospital stay was 3.4 days for all cases. Rectal bleeding was a predicting factor for surgical reduction. Conclusions Ileocolic was the most common site of intussusception. Abdominal pain, vomiting, and rectal bleeding were frequently seen on presentation. In addition, surgical reduction was associated with rectal bleeding. However, pneumatic reduction was successful in 80% of the cases. Unlike the previous study, this study reports fewer children requiring surgical intervention as well as lower hospital stay duration. Thus, this study emphasizes the importance of specialized pediatric services to enhance outcomes.

Advance directive preferences of patients with chronic and terminal illness towards end of life decisions: a sample from Saudi Arabia.

Advance directives towards end of life decisions are seldom used among Arabs. This study aimed at investigating advance care preferences among a sample of Arab patients. This cross-sectional study was undertaken over the period March 2012-March 2013 on a sample of 300 patients with chronic illness in King Fahad National Guard Hospital, Riyadh, a major tertiary care hospital in Saudi Arabia. Mean age of patients in the study was 48.7 years (standard deviation 16.4). There were 104 patients on haemodialysis, 73 with advanced malignancy, 81 with chronic liver disease and 35 with chronic respiratory disease. More than 80% of the respondents felt that the physician should make the decision about cardiopulmonary resuscitation. Over 60% wished to remain at home when their condition deteriorated to impending death. There were no significant correlations between the patients' end of life decision preferences and religiosity, quality of life, disease duration, or other demographic characteristics. Despite a significant lack of knowledge among our participants regarding resuscitation, a majority of patients with chronic illness were willing to discuss the options and were capable of making advance directive plans regarding their health status.

How do patient demographics, time-related variables, reasons for cancellation, and clinical procedures affect frequency of same-day operating room surgery cancelation? A maximum likelihood method

BackgroundCancelation of same-day surgery is a common global problem, wasting valuable hospitals’ operating room (OR) times and imposing significant economic costs. There is limited evidence to support the association between frequency of same-day surgery cancelation and patient demographics, time-related variables, healthcare provider reasons for cancelation, and clinical procedures in Saudi Arabia. The aim of this study was to explore this relationship, providing an understanding of the local context.MethodsA retrospective cross-sectional study that retrieved medical records to examine the association between the frequency of same-day surgery cancelation and covariates including patient demographics, time-related variables, healthcare provider reason for cancelation, and clinical procedures. The data covered from January 2014 to December 2014 at King Fahad National Guard Hospital in Riyadh. We considered 440 patients that met the inclusion criteria for final analysis. The cancelation was regarded less frequent if a patient canceled once in the12 months and more frequent if a patient canceled two times or more in the same period. We used descriptive statistics to summarize data and employed a probit regression to estimate the association of frequency of same-day surgery cancelation and covariates via maximum likelihood method. King Abdullah International Medical Research Center granted the institutional approval.ResultsOur study suggests that while reasons of unavailability of OR time were associated with less frequent same-day surgery cancelation, scheduling issues were linked to more frequent cancelations, compared with reasons for patients being unwell on the day of surgery. Waiting time of more than six hours and morning sessions were associated with less frequent cancelations compared to shorter waiting time and afternoon sessions. Compared to general procedures, specialized clinical procedures were associated with cancelations that are more frequent. Further, female patients were more likely to have more cancelations. Finally, being married was associated with the less frequent cancelation of same-day surgery.ConclusionOur findings provide evidence of determinants of the frequency of same-day surgery cancelations. This study draws several important implications for hospitals, especially on optimal utilization of resources and minimization of same-day surgery cancellations. The study also offers several recommendations that we believe will spur future research.

The clinical profile of childhood osteomyelitis: A Saudi experience

Our aim is to study the demographic features, clinical presentations, laboratory and radiographic findings, management, and outcome of children with acute osteomyelitis in Kingdom of Saudi Arabia. A retrospective chart review study of children 14 years of age and younger, with acute osteomyelitis hospitalized in King Fahad National Guard Hospital, Riyadh during the 10-years period, and January 1997 through December 2006. Seventy-five patients (67% males), aged 9 days to 12 years of age, were studied. The peak incidence rate of osteomyelitis was during the first year of life. Pain, fever and localized signs were the most frequent symptoms and signs. The white blood cell count and erythrocyte sedimentation rate were elevated in 27% and 87% of cases respectively. Cultures of blood and tissue were positive in 27% and 73% of patients respectively. Staphylococcus aureus was the commonest causative agent, isolated from 55% of patients. No methicillin-resistant S. aureus was recovered from these patients. Abnormal plain radiographs were seen in 54%, positive skeletal scintigraphy in 93%, and diagnostic magnetic resonance imaging in 100% of cases in whom these investigations were performed. The most commonly involved bones were those of the lower extremities (76%). The majority of patients (38%) were initially treated with either intravenous cloxacillin or cefuroxime. In all patients infected with S. aureus the intravenous therapy was followed by oral first generation cephalosporin's until the 3 weeks course was completed. In patients infected with other organisms appropriate antibiotic therapy directed by susceptibility testing was initiated. The infection resolved in 73 (97%) of children and persisted in two (3%). Our data indicate that acute osteomyelitis is as common in young infants of this series from Kingdom of Saudi Arabia as it is from other parts of the world. The early diagnosis and administration of appropriate antimicrobial therapy results in good outcome.

Dermoscopy-Assisted Sclerotherapy for Spider Leg Veins

1Department of Dermatology and Skin Science, University of British Columbia, Vancouver General Hospital, Vancouver, British Columbia, Canada 2Division of Dermatology, Department of Medicine, King Saud Bin Abdulaziz University for Health Sciences, King Fahad National Guard Hospital, King Abdulaziz Medical City, Riyadh, Saudi Arabia

King Fahad National Guard Hospital Internal Medicine Consultation Service: Contributing Co-Morbidities and Reasons for Consultation

Background: Inpatient medical consultations have become an essential service in the specialty of Internal Medicine. Research in this new subspecialty will help improve the quality as well as the cost-effectiveness of this vital service.
 Method: Data for all patients who were referred to the service were entered in a pre-designed form.
 Results: One hundred and seventy-six adult patients with an average age of 53.3 years were seen by the service over a 4 months period. Consultations to the service were primarily from the departments of Surgery (110, 62.50%), Obstetrics and Gynecology (57, 32.39%). Co-morbidities were common specially diabetes mellitus (59.1%) and hypertension (41.5%). Most of the consultations were for emergency patients (99, 56.3%) rather than for electively (77, 43.7%) admitted cases. For operative patients, there was an equal share between pre- and post-operative cases (58.8% and 58.0% respectively). Prior referral to outpatient pre-operative clinics was unsatisfactory with the service requesting postponements of surgery for 22.1 percent of pre-operative cases. The major reasons for referral to the service were diabetes mellitus (49.4%), hypertension (30.7%) and respiratory problems (22.7%). Thirty-three percent of cases had more than one reason for referral. Active intervention by the service was frequent. The average length of care under the service was 5.2 days with a range of 1 to 90 days.
 Conclusions: The service needs to be structured with regards to staff education and training; emphasizing on diabetes mellitus, hypertension and respiratory problems care. A joint interdepartmental effort along the above lines and better use of the pre-operative outpatient clinics are recommended.

King Fahad National Guard Hospital Internal Medicine Consultation Service: Contributing Co-Morbidities and Reasons for Consultation

Background: Inpatient medical consultations have become an essential service in the specialty of Internal Medicine. Research in this new subspecialty will help improve the quality as well as the cost-effectiveness of this vital service.
 Method: Data for all patients who were referred to the service were entered in a pre-designed form.
 Results: One hundred and seventy-six adult patients with an average age of 53.3 years were seen by the service over a 4 months period. Consultations to the service were primarily from the departments of Surgery (110, 62.50%), Obstetrics and Gynecology (57, 32.39%). Co-morbidities were common specially diabetes mellitus (59.1%) and hypertension (41.5%). Most of the consultations were for emergency patients (99, 56.3%) rather than for electively (77, 43.7%) admitted cases. For operative patients, there was an equal share between pre- and post-operative cases (58.8% and 58.0% respectively). Prior referral to outpatient pre-operative clinics was unsatisfactory with the service requesting postponements of surgery for 22.1 percent of pre-operative cases. The major reasons for referral to the service were diabetes mellitus (49.4%), hypertension (30.7%) and respiratory problems (22.7%). Thirty-three percent of cases had more than one reason for referral. Active intervention by the service was frequent. The average length of care under the service was 5.2 days with a range of 1 to 90 days.
 Conclusions: The service needs to be structured with regards to staff education and training; emphasizing on diabetes mellitus, hypertension and respiratory problems care. A joint interdepartmental effort along the above lines and better use of the pre-operative outpatient clinics are recommended.

Flagellate pigmentation: a unique adverse effect of bleomycin therapy

ejd.2010.1213 Auteur(s) : Sultan Al-KHENAIZAN khenaizans@ngha.med.sa, Bassim AL-BEROUTI Division of Dermatology, Department of Medicine, King Fahad National Guard Hospital, P.O. Box 22490, Riyadh 11426, Kingdom of Saudi Arabia An 18-year-old, Saudi, male, single, university student, presented with an asymptomatic skin eruption for 4 weeks. The eruption appeared 3 weeks following chemotherapy for stage IIA Burkitt's lymphoma, which included, among others, bleomycin in a total cumulative dose [...]

Nocardiosis in a tertiary care hospital in Saudi Arabia

Background:Nocardiosis is an uncommon bacterial infection that is caused by aerobic actinomycetes of the genus Nocardia. This pathogen has emerged as an important cause of mortality and morbidity among both immunocompetent and (more commonly) immunocompromised hosts. The prevalence of nocardiosis is unknown in Saudi Arabia. Only sporadic cases of cutaneous nocardiosis have been reported. In this study, we performed a 10-year retrospective review of all cases of nocardiosis identified at the King Fahad National Guard Hospital in Riyadh. Clinical presentation, risk factors, site of disease involvement, radiological features, and outcomes of 30 patients with pulmonary and disseminated nocardiosis are presented.Materials and Methods:A retrospective chart review of all cases of nocardiosis over the last ten years.Results:Thirty cases of nocardiosis were identified. The disease was more common in males. Fever and cough was the most common presentation. Most of the patients had an underlying pulmonary disease. Consolidation was the most prevalent radiological feature. Pleural effusion was common. Unfortunately, none of the isolates were sub-speciated. Cure was possible in 40% of the cases. Ten percent of patients died, while follow-up on the rest of the patients was lost.Conclusion:Nocardiosis is not uncommon in Saudi Arabia. Cases are not restricted to the classical immunocompromised host. A database is urgently needed to better evaluate the prevalence of the illness among the Saudi population.

Prevalence of antimicrobial resistance among gram-negative isolates in an adult intensive care unit at a tertiary care center in Saudi Arabia

BACKGROUND AND OBJECTIVES:Patients in the ICU have encountered an increasing emergence and spread of antibiotic-resistant pathogens. We examined patterns of antimicrobial susceptibility in gram-negative isolates to commonly used drugs in an adult ICU at a tertiary care hospital in Riyadh, Saudi Arabia.METHODS:A retrospective study was carried out of gram-negative isolates from the adult ICU of King Fahad National Guard Hospital (KFNGH) between 2004 and 2009. Organisms were identified and tested by an automated identification and susceptibility system, and the antibiotic susceptibility testing was confirmed by the disk diffusion method.RESULTS:The most frequently isolated organism was Acinetobacter baumannii, followed by Pseudomonas aeruginosa, Escherichia coli, Klebsiella pnemoniae, Stenotrophomonas maltophilia, and Enterobacter. Antibiotic susceptibility patterns significantly declined in many organisms, especially A baumannii, E coli, S marcescens, and Enterobacter. A baumannii susceptibility was significantly decreased to imipenem (55% to 10%), meropenem (33% to 10%), ciprofloxacin (22% to 10%), and amikacin (12% to 6%). E coli susceptibility was markedly decreased (from 75% to 50% or less) to cefuroxime, ceftazidime, cefotaxime, and cefepime. S marcescens susceptibility was markedly decreased to cefotaxime (100% to 32%), ceftazidime (100% to 35%), and cefepime (100% to 66%). Enterobacter susceptibility was markedly decreased to ceftazidime (34% to 5%), cefotaxime (34% to 6%), and pipracillin-tazobactam (51% to 35%). Respiratory samples were the most frequently indicative of multidrug-resistant pathogens (63%), followed by urinary samples (57%).CONCLUSION:Antimicrobial resistance is an emerging problem in the KFNGH ICU, justifying new more stringent antibiotic prescription guidelines. Continuous monitoring of antimicrobial susceptibility and strict adherence to infection prevention guidelines are essential to eliminate major outbreaks in the future.

Snake bite envenomation: experience at King Abdulaziz Medical City, Riyadh

We surveyed the records of 21 of the 28 snakebite victims seen at King Fahad National Guard Hospital in Riyadh over the 20-year period 1986-2005. The most common symptoms were local pain and swelling and the most common signs oedema and tenderness. Neurotoxicity was not noted in any case. Coagulopathy was recorded for 14/21 patients (66.7%) and 5/19 (26.4%) had leukocytosis. All patients were given tetanus toxoid (100%) and 20 (95.2%) received antivenom. Blood products were administered in 2 cases and prophylactic antibiotics in 10 (47.6%). No allergic reaction to antivenom was reported.

Motor vehicle injuries in childhood: a hospital-based study in Saudi Arabia

Motor vehicles are a major cause of injury-related deaths in children and may also result in temporary or permanent disability. A retrospective analysis of the medical charts of children aged 12 years and younger, who were involved in motor vehicle injuries during a 10-year period, was undertaken. All children who were admitted and treated at King Fahad National Guard Hospital, Riyadh from January 1994 to December 2003 were included in this study. Data analyzed included age, gender, and mechanism of injury, type of injury, management and outcome. Motor vehicle injuries accounted for approximately 42% of all pediatric traumas. There were 664 children, 469 (71%) male and 195 (29%) female and a male: female ratio 2.4:1. Four hundred and seventy two children were injured as pedestrians (71%), 177 as auto passengers (27%), 11 as bicyclists (1.5%), and 4 as motorcyclists (0.5%). Five hundred and sixty two injured children (85%) were between the ages of 1 and 8 years. The most common injuries were to the head and extremities. Thirty-four children (5.1%) died from their injuries, 30 from head trauma. Thirty-five children (5.3%) were discharged home with neurological impairment from head trauma. In this study, the risk factors associated with high volume of motor vehicle injuries in children include, male, 1-8 years, and pedestrian. Head trauma is the most common cause of morbidity and mortality. This study suggests that nationwide programs should target the use of seatbelts and helmets, and dangerous driving practices.

Hospital- and community-acquired infections: a point prevalence and risk factors survey in a tertiary care center in Saudi Arabia

Point prevalence studies are useful in revealing the prevalence of hospital-acquired infections (HAIs) and community-acquired infections (CAIs). Such information allows prioritization of infection control resources and aids in overall hospital expenditure cut-backs. A one-day point prevalence survey was conducted on May 19, 2003 at the King Fahad National Guard Hospital in Riyadh. Since the survey included HAIs and CAIs all patients were included. Data were collected on the underlying diagnosis, infection if present and whether it was hospital-acquired or community-acquired. We identified the presence of a line-associated blood stream infection (BSI), ventilator-associated pneumonia (VAP), catheter-associated urinary tract infection (UTI) or a surgical site infection (SSI) based on the United States National Nosocomial Infection Surveillance (NNIS) definitions. Five hundred and sixty-two inpatients were included in the survey. There were 38 patients with 45 (8.0%) HAIs and 76 (13.5%) patients with a CAI. Of the HAIs, 31.1% had a line-related BSI, while 28.9% and 24.4% had a VAP and catheter-related UTI, respectively. Most of the HAIs took place in the intensive care units (ICU) (21 (46.7%)), followed by the medical and surgical wards with six (13.3%) cases in each ward. For all HAIs there was a 12.7-fold increased risk with a hospital stay exceeding eight days (OR: 12.7, CI 3.2-50.6). Most of the 76 CAIs were admitted to the medical ward with community-acquired pneumonia (34.9%) as the most common diagnosis. Among the 89 pathogens isolated, Pseudomonas aeruginosa was the most common (21.3%) followed by Enterococcus spp (16.9%). The overall rate of HAIs in our hospital was 8%, with significant risk factors including a hospital stay exceeding eight days. A device-related infection was more likely in a patient with a venous or bladder catheter in place for more than eight days, or a patient mechanically ventilated for more than eight days. Catheter-related UTIs were identified as an important source of infection, requiring ongoing surveillance.

Peripherally Inserted Central Venous Catheters in Newborn Infants: Malpositioning and Spontaneous Correction of Catheter Tips

Peripherally inserted central venous catheters (PICCs) are increasingly used in the neonatal intensive care unit (NICU). Malpositioning of the catheter's tip is a known occurrence that may require repositioning or removal of the catheter. We report our experience with insertion and management of PICCs at the NICU of King Fahad National Guard Hospital in Riyadh, Saudi Arabia, over a 1-year period. We also report on five newborn infants in whom the tips of the catheters were malpositioned. Their subsequent course showed spontaneous correction of the tips of those catheters within 1 day.

Incidence and Management of Biliary Complications After Orthotopic Liver Transplantation: Ten Years’ Experience at King Fahad National Guard Hospital

Background Despite technical modifications and application of various surgical techniques, biliary tract complications remain a major source of morbidity after orthotopic liver transplantation. We sought to assess the incidence and management of biliary complications at a single liver transplant unit. Methods Among 184 consecutive deceased donor liver transplants performed between February 1994 and July 2004, 66 were female patients and 118 male patients of age range 2½ to 69 years. We retrospectively reviewed the data regarding biliary complications in liver transplant recipients, after 115 duct-to-duct anastomoses and 65 hepaticojejunostomy. We analyzed the incidence and type of biliary complications, management sequence, and success rate. We analyzed the correlation between the modality of biliary reconstruction and the type/incidence of biliary complications. Results Thirty-two patients developed biliary complications, giving an overall incidence of 17.4%. There was a higher incidence of complications among patients in the hepaticojejunostomy group (21.5%) than the duct-to-duct technique (15.1%). Bile leakage occurred in 12 patients, including eight successful cases (66.6%) of endoscopic stent insertion/radiological techniques and surgery in four cases (33.3%). Among the 12 patients with initial leaks, six developed a subsequent stricture (50%). There were 26 cases of biliary stricture, including 22 (84.6%) who were initially managed using nonsurgical techniques with a success rate of 59%. Conclusion Biliary complications remain an important cause of morbidity after orthotopic liver transplantation. They can usually be managed percutaneously or endoscopically; however, tight strictures and major leaks frequently required surgical intervention.

Saudi National Guard donor screening for human T cell lymphotropic virus I/II: time to use molecular biology techniques.

Human T cell lymphotropic virus (HTLV) I/II is a retrovirus that is usually transmitted through transfusion of cellular blood products, sexual contact, and vertically from mother to child through breastfeeding. Policies to screen donated blood for this virus have varied from country to country, based on seroepidemiological data. Before 1991, no such data existed on HTLV-I/II among the Saudi population. Since then, several reports have documented a low seroprevalence rate among Saudi blood donors (0-0.026%). We did a retrospective review of all blood donated at King Fahad National Guard Hospital over the preceding 3 years to assess the seroprevalence of HTLV-I/II. After retesting positive and borderline samples, we were able to detect 1 positive and 38 borderline samples. As well, we reviewed the Saudi literature to identify the national seroprevalence of the disease and propose a cost-effective approach for screening donated blood in Saudi Arabia for HTLV-I/II.

Presumptive diagnosis of brucellosis from contaminated blood cultures in an area of endemicity

Presumptive diagnosis of brucellosis from contaminated blood cultures in an area of endemicity

Effect of intensive surveillance on cesarean-section wound infection rate in a Saudi Arabian hospital

Surveillance for surgical site infection (SSI) in cesarean-section (C-section) in our hospital, carried out between September 1998 and July 1999, identified areas of deficiency in aseptic techniques that have contributed to increased incisional surgical site infection rates (ISSI) rates. On the basis of these findings, we intensified the infection control presence in this area and increased the number of in-services to our staff, with attention to infection control practices. Our senior infection control staff carried out ongoing monitoring of the ISSI rates as well as careful observation of aseptic technique. The aim was to reduce the rates of C-section ISSI in our hospital. We used the Centers for Disease Control and Prevention definitions for infection and the National Nosocomial Infections Surveillance System (NNISS) risk index in measuring the ISSI rates in the 2 time periods. We compared the ISSI rates with those of our preintervention period in an attempt to evaluate our interventional measures. Eight hundred seventy-five (875) C-sections were performed at King Fahad National Guard Hospital between January and December 2000. The overall ISSI rate was 1.37%. The ISSI rate for the NNISS risk category 0 (zero) was 1.2% and for the NNISS risk category 1 was 4.1%. There was a 50% reduction in the overall ISSI rates from our preintervention period (P <.05). Even though there were no objective means by which we measured the effect of infection control presence on the asepsis practices, there were no other changes that could have attributed to this significant reduction in ISSI rates in our C-section population. (Am J Infect Control 2003;31:288-90.)

Brucellosis in children: clinical observations in 115 cases

Objective: Brucellosis is endemic in Saudi Arabia. This report summarizes the epidemiology of brucellosis in children. Method: A retrospective review was made of medical records of all patients admitted to King Fahad National Guard Hospital with brucellosis during the period from 1984 to 1995. Results: Children _ ̌ 12 years constituted 115 545 (21%) of the total brucellosis admissions. The mean age was 5.8 years and 64% of the patients were males. Consumption of unpasteurized milk (often from camel) was the main source of infection. In 70% the clinical picture was dominated by arthritis, 20% of patients presented with a non-specific febrile illness without localizing signs, and 10% had a febrile illness with uncommon presentations. Brucella serology was most helpful in making an early diagnosis. Initial titers of >1:640 were found in 90% of the cases. Bacteremia was observed in 45% and of the isolates speciated, 96% were Brucella melitensis. No increase in resistance to commonly used antimicrobials was noted during the 12-year study period. A combination of rifampin plus cotrimoxazole with or without streptomycin was used in two thirds of the patients. The overall rate of relapse was 9% and one patient died from neurobrucellosis. Conclusion: Brucellosis presents in various ways and should be included in the differential diagnosis of arthritis in endemic countries. Prevention should rely on education including on boiling raw milk.