Saudi Aramco Medical Services Organization Research Articles

Urinary stones in Eastern Saudi Arabia.

Introduction:Nephrolithiasis is a common problem worldwide especially in areas of the hot climate like Saudi Arabia. The aim of this analysis was to study the characteristics of urinary stones in Eastern Saudi Arabia and to report the following: Composition of urinary stones, age and gender distribution, seasonal variation of stone development, comorbid conditions associated with stone development and the incidence of urinary stones.Methods:All urinary stones that were submitted to the Johns Hopkins Aramco Healthcare, previously Saudi Aramco Medical Services Organization for analysis from January 2011 through January 2013 were analyzed.Results:A total of 384 urinary stones were collected and submitted for analysis from 347 patients. There was a male predominance with a male: female ratio of 3.9:1. The average age was 48.5 ± 12.8 years. Weight abnormality was predominant in both genders, and especially females. Calcium-based stones constituted the great majority (84.6%) followed by uric acid stones (12.8%). The other forms of stones were rare. More stones were recovered during the hot season, May to September. The calculated annual incidence of urolithiasis was 111/100,000 individuals.Conclusion:Calcium based stones are the most common urinary stones observed in Eastern Saudi Arabia. There is a clear association between the diagnosis of urinary stones and the hot season

Implementation of Pharmacist-Managed Anticoagulation Clinic in a Saudi Arabian Health Center

During the past 2 decades, a paradigm shift in the management of oral anticoagulation therapy has occurred. A multidisciplinary approach has been used and has proved beneficial from both a cost and quality perspective. However, this approach to anticoagulation therapy is not well established in Saudi Arabia and the Middle East, and the traditional way of managing anticoagulation patients is still the mainstay of care. The Pharmacy Services Division (PSD) in collaboration with physician, nursing, and medical support enterprises at the Dhahran Health Center established the pharmacy-managed anticoagulation clinic (ACC). To describe the implementation process of the first pharmacist-managed anticoagulation clinic in the eastern province of Saudi Arabia and its impact on patient care. The PSD in collaboration with medical staff successfully created a care delivery model utilizing clinical pharmacists' expertise to provide comprehensive anticoagulation management services at Saudi Aramco Medical Services Organization (SAMSO). Planning included analyzing existing practices, reviewing the relevant literature, obtaining physician input, formulating a business proposal, and developing clinical protocols and guidelines. Collaborative relationships were established with the center laboratory, scheduling services, and nursing and medical departments. Clinic services include patient assessment, anticoagulation monitoring, warfarin dosage adjustment, medication dispensing at the clinic, patient education, and feedback to referring physicians. Data (2 years before and after clinic inception) for all patients enrolled at the anticoagulation clinic were reviewed to evaluate the impact of the clinic on anticoagulation management, adverse events, and patient satisfaction. A total of 578 patients were enrolled in the ACC. The total percentage of international normalized ratio (INR) within the target range was 59% versus 48% when compared to the previous traditional practice. The number of INR tests per patient dropped by 19%. Minor and major adverse events occurred in 10% and 1.5% of patients, respectively. Overall, the patients were very satisfied with the new clinic compared to the previous practice. Implementation of the pharmacist-managed ACC in the eastern province of Saudi Arabia had a positive impact on patient care based on the improvements in the number of patients whose INR was within therapeutic range and patient satisfaction scores.

Family Medicine in Saudi Arabia-Next Steps

The increased prevalence of communicable, non-comunicable diseases, the global expanding of the elderly population, significant mental health issues,rising health costs,overutilization and medicalization of illnesses necessitate the need for a reliable community-based health care team. Efforts towards efficient, well organized family medicine speciality programs will produce needed, commited, and skilled primary care or family physicians that qualify them to provide continuous, comprehensive and accountable evidence-based health care for patients of all age groups. The Saudi Aramco Medical Services Organization (SAMSO), the first JCIA accredited hospital in the Middle East has taken significant strides to address the challenges facing the family medicine discipline.We aim through the following review to emphasize the role of family physicians, highlight some challenges globally and in Saudi Araba and provide list ofgeneral recommendations that would support the model.

Reduction and surveillance of device-associated infections in adult intensive care units at a Saudi Arabian hospital, 2004–2011

Device-associated infections (DAI) are recognized as a marker of patient safety. Data regarding DAI rates in Saudi Arabia are sparse. This was a prospective surveillance study of DAI rates conducted in the adult intensive care units of the Saudi Aramco Medical Services Organization, carried out using the DAI definition provided by the Centers for Disease Control and Prevention's National Healthcare Safety Network. DAI prevention bundles were introduced in 2006 for ventilator-associated pneumonia (VAP), in mid-2010 for catheter-associated urinary tract infections (CAUTI), and in 2008 for central line-associated blood stream infections (CLABSI). DAI rates for VAP, CLABSI, and CAUTI are reported for the study period from 2004 to 2011. CAUTI was the most common DAI (42.2%), followed by CLABSI (38.5%) and VAP (19.3%). The overall rate of each infection type per 1000 device-days was 8.18 for CAUTI, 10 for CLABSI, and 4.52 for VAP. Annual DAI rates showed a significant reduction over time from the beginning of the study to the end of the study for CLABSI (16.3 vs. 6.06), CAUTI (6.75 vs. 3.41), and VAP (9.8 vs. 1.3) (p<0.05). CAUTI was the most common infection, and the use of DAI prevention bundles was associated with a significant decrease in DAI rates over time.

Mass gathering medicine: a leisure or necessity?

International Journal of Clinical PracticeVolume 66, Issue 6 p. 530-532 PERSPECTIVE Mass gathering medicine: a leisure or necessity? J. A. Al-Tawfiq, J. A. Al-Tawfiq Saudi Aramco Medical Services Organization, Dhahran, Kingdom of Saudi ArabiaSearch for more papers by this authorZ. A Memish, Z. A Memish Ministry of Health, Riyadh, Professor, College of Medicine, Al Faisal University, Riyadh, Kingdom of Saudi ArabiaSearch for more papers by this author J. A. Al-Tawfiq, J. A. Al-Tawfiq Saudi Aramco Medical Services Organization, Dhahran, Kingdom of Saudi ArabiaSearch for more papers by this authorZ. A Memish, Z. A Memish Ministry of Health, Riyadh, Professor, College of Medicine, Al Faisal University, Riyadh, Kingdom of Saudi ArabiaSearch for more papers by this author First published: 07 May 2012 https://doi.org/10.1111/j.1742-1241.2012.02923.x Ziad A. Memish, Ministry of Health, P.O. Box 54146, Riyadh 11514, Kingdom of Saudi Arabia Tel.:+966 1 2124052 Fax: +966 1 2125052 Email: zmemish@yahoo.com Read the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinked InRedditWechat Volume66, Issue6June 2012Pages 530-532 RelatedInformation

The analysis of pathological findings for cervical lymph node biopsies in eastern Saudi Arabia

Lymphadenopathy is a common medical problem. A lymph node biopsy may be necessary for definitive diagnosis in selected cases. The study group included a retrospective, hospital-based series of patients who had a cervical lymph node biopsy at the Saudi Aramco Medical Services organization between 1997 and 2008. During the study period, there were a total of 452 cervical lymph node biopsies. Biopsies were performed on 122 (27%) children ≤18 years and 81 (18%) patients >60 years. The most common histopathological diagnosis was reactive disease (52.2%, n=236), which was followed by granulomatous disease (15.5%, n=70). We detected carcinoma in 14.6% of the patients (n=66), Hodgkin's lymphoma in 8.8% (n=40) and non-Hodgkin's disease in 8.8% (n=40). Malignancy was more common in adults than children (19.5% vs. 1.6%, respectively and reactive disease was more common in children than adults (65.3% vs. 47.3%, respectively). Metastatic disease was more likely in the older age group (17.7% vs. 0%), Hodgkin's disease was found in 12.5% of the adolescents, and non-Hodgkin's disease was present in 10.3% of the adults and elderly. The most common histopathological findings for cervical lymph node biopsies in eastern Saudi Arabia were reactive disease and granulomatous disease.

Willingness of health care workers of various nationalities to accept H1N1 (2009) pandemic influenza A vaccination

BACKGROUND AND OBJECTIVESMedia attention on 2009 H1N1 vaccination has been negative. Information on the willingness of health care workers (HCWs) to accept vaccination against the 2009 pandemic influenza is sparse. Thus, we undertook this study to investigate the attitude of HCWs toward this vaccine and possible factors associated with vaccine acceptance.DESIGN AND SETTINGCross-sectional observational study of HCWs conducted at Saudi Aramco Medical Services Organization (SAMSO) in February 2009.PATIENTS AND METHODSA self-administered questionnaire was distributed to 250 individuals and 161 (64.4%) were completed.RESULTSOf the total respondents, 66 (41%) were Arab, 55 (34.2%) were Asian/Far East, and 40 (24.8%) were of other nationalities. A total of 65 (40.4%) responses were from physicians and nurses, and 96 (59.6%) were from other HCWs. Of all the responders, 152 (94.4%) were aware of the H1N1 influenza situation, and 135 (83.9%) stated they had received enough information about the current situation. Of all the respondents, 59 (36.6%) stated that they received the seasonal influenza vaccination in 2008–2009, and 50 (31.1%) expressed their willingness to take the 2009 H1N1 vaccine. A total of 24 (14.9%) stated that the vaccine contains thiomersal, 21 (13%) stated that the vaccine contains adjuvants, 19 (11.8%) stated it contains squalene, 17 (10.6%) thought the vaccine causes infertility, and 29 (18%) thought the vaccine causes Guillain-Barré syndrome. In a multivariate analysis, the following factors were noted to be important in choosing to be vaccinated: being Asian, not being a doctor or a nurse, and previous acceptance of the seasonal influenza vaccine (P≤.01).CONCLUSIONSThe acceptance of the current 2009 pandemic H1N1 vaccine was low. Important factors associated with the increasing H1N1 influenza vaccine acceptance include being Asian, not being a doctor or a nurse, and previous acceptance of the seasonal influenza vaccine.

Improving adherence to venous thromoembolism prophylaxis using multiple interventions

OBJECTIVE:In hospital, deep vein thrombosis (DVT) increases the morbidity and mortality in patients with acute medical illness. DVT prophylaxis is well known to be effective in preventing venous thromoembolism (VTE). However, its use remains suboptimal. The objective of this study was to evaluate the impact of quality improvement project on adherence with VTE prophylaxis guidelines and on the incidence of hospital-acquired VTEs in medical patients.METHODS:The study was conducted at Saudi Aramco Medical Services Organization from June 2008 to August 2009. Quality improvement strategies included education of physicians, the development of a protocol, and weekly monitoring of compliance with the recommendations for VTE prophylaxis as included in the multidisciplinary rounds. A feedback was provided whenever a deviation from the protocol occurs.RESULTS:During the study period, a total of 560 general internal medicine patients met the criteria for VTE prophylaxis. Of those, 513 (91%) patients actually received the recommended VTE prophylaxis. The weekly compliance rate in the initial stage of the intervention was 63% (14 of 22) and increased to an overall rate of 100% (39 of 39) (P = 0.002). Hospital-acquired DVT rate was 0.8 per 1000 discharges in the preintervention period and 0.5 per 1000 discharges in the postintervention period, P = 0.51. However, there was a significant increase in the time-free period of the VTE and we had 11 months with no single DVT.CONCLUSION:In this study, the use of multiple interventions increased VTE prophylaxis compliance rate.

Therapeutic interchange: an effective strategy for statin cost containment at a Saudi medical centre

Objective To evaluate the impact of therapeutic interchange on the pharmacy budget at Saudi Aramco Medical Services Organization (SAMSO). Methods In 2006, Pharmacy Services Division (PSD) evaluated the top 50 medications by expense and identified the 3-hydroxy-3-methylglutaryl CoA reductase inhibitors (statins) class of medications as the top drug class, by expense, for SAMSO. The three available medications at SAMSO from this class were atorvastatin, simvastatin and pravastatin. Atorvastatin was the number one drug, by expense, for the pharmacy budget. The cost of atorvastatin was approximately 10 times that of simvastatin, in addition, there is strong literature support for therapeutic interchange of atorvastatin with simvastatin. An internal analytical tool called Therapeutic Interchange Management Program (TIMP) was developed and utilized. TIMP utilizes a five step process: a preliminary proposal with literature support, collaboration with key stakeholders, obtain approval from appropriate authorities, design a process to facilitate implementation, and education of all involved. Key findings Approximately 50% of patients have been switched from atorvastatin to simvastatin resulting in a cost savings of approximately US$500 000 over a one year period for SAMSO. Conclusions Targeted therapeutic interchange is an effective strategy to help curb the rising cost of pharmaceuticals in a hospital setting. TIMP is a useful tool for implementation of therapeutic interchange in a hospital environment.

Infective endocarditis at a hospital in Saudi Arabia: epidemiology, bacterial pathogens and outcome

BACKGROUND AND OBJECTIVE:Data on infective endocarditis prevalence, epidemiology and etiology from Saudi Arabia and the Gulf region are sparse. We undertook this study to describe the pattern and the causative agents of endocarditis at a hospital in Saudi Arabia.METHODS:We conducted a retrospective analysis of all reported endocarditis cases at the Dhahran Health Center from January 1995 to December 2008.RESULTS:Of the 83 cases of endocarditis, 54 (65%) were definite endocarditis and the remaining 29 (35%) were possible endocarditis based on the Duke criteria. Patients with definite endocarditis included 39 males and 15 females (ratio of 2.6:1) with a mean age (SD) of 59.7 (18.2) years. Of the definite endocarditis cases, native valve endocarditis occurred in 44 (81.5%) cases of and prosthetic valve endocarditis was observed in 10 (18.5%). The most commonly involved valves were mitral (n=24; 44.4%) and aortic (n=20; 39.2%). The most common organisms were S aureus (n=23; 42.6%), Enterococcus faecalis (n=12; 22.2%) and viridans streptococci (n=9; 16.7%). Surgical intervention was required in 17 (31.4%) cases and the in-hospital mortality rate was 29.4% (n=15). Of all the patients, 3 (5.5%) had embolic stroke as a complication.CONCLUSION:Native valve endocarditis is the predominant type of endocarditis. The patients were older adults and the most common organisms were S aureus, E faecalis and viridans streptococci.

Is Umbilical Cord Blood Total Thyroxin Measurement Effective in Newborn Screening for Hypothyroidism?

To assess the performance of the use of umbilical cord blood for screening of primary congenital hypothyroidism in the Saudi Aramco Medical Services Organization newborn thyroid screening programme. Umbilical cord blood total thyroxin (CB-TT4) was measured. In samples with low T4 concentrations, an additional measurement of cord blood thyroid-stimulating hormone was made. A total of 96,015 newborn infants were screened in the period January 1990-December 2007. Twenty-six cases of primary congenital hypothyroidism, six cases of transient hypothyroidism and 13 cases of central hypothyroidism were detected. This method of screening resulted in 100% sensitivity and 98% specificity (95% CI 84-100, and 95% CI 98-98.2, respectively). However, there was a high mean recall rate of 1.9%. The use of CB-TT4 is a valid screening strategy for primary congenital hypothyroidism. It meets the metabolic screening demands of early discharge policy and guarantees screening all newborns delivered in the hospital.

Presentation and Outcome of Diabetic Foot Ulcers in Saudi Arabian Patients

The purpose of this study was to evaluate associated risk factors, clinical presentation, and outcome of diabetic foot ulcers (DFUs) in a Saudi Arabian hospital. This is a prospective study of diabetic patients with foot ulcers at Saudi Aramco Medical Services Organization. The participants were referred to a wound care specialist. The study was conducted from December 2003 to December 2004 and included a total of 62 patients (30 men and 32 women). The mean age (SD) was 64.8 years (+ 12 years), with a range from 39 to 82 years. During the study period, 19% (12 of 62) of patients had amputations represented by 2 above-knee amputations, 3 below-knee amputations, and 7 limb-sparing surgeries. All patients with DFUs who underwent surgical amputation had a Wagner Classification of grade 4 (n = 9; 75%) or grade 5 (n = 3; 25%). Three patients (25%) had prior surgical limb-sparing amputations, and 11 (91%) patients were on insulin therapy. The associated risk factors with amputation were hypertension, peripheral vascular disease, absence of pedal pulses, and ischemic heart disease (P < .05). DFUs continue to be an important cause of morbidity and resulted in an amputation rate of 19%.

Bordetella pertussis infection in a highly vaccinated population in Saudi Arabia, 1996–2004

The objective of this study was to describe the features and presentations of Bordetella pertussis infection at Saudi Aramco Medical Services Organization (SAMSO) in Saudi Arabia. This is a retrospective analysis of the reported cases of B. pertussis from January 1996 to December 2004. During the study period, there were a total of 156 confirmed cases of B. pertussis infection. There were 88 males and 68 females, with male to female ratio of 1.3:1. Most (n=81; 52%) of the patients were less than six months of age. A large number (n=71; 45.5%) of patients were reported in 2003; 26.8% (n=19) were between 10-19 years and 22.5% (n=16) were >/=20 years of age. Of all the patients, 65 (42%) patients were hospitalized for a median of five days (range: 2-21 days). Of the total cases, 47 (30%) patients were fully vaccinated (>/=3 doses), 48 (30%) had not received any dose of vaccine, 33 (21%) had received one dose and six (3.8%) had received two doses. The vaccination status was not known for 22 (14%) patients. However, many of the infected infants were too young to have been eligible for vaccine. A total of 81 patients were less than six months of age and of those 58% (n=47) did not receive any doses, 39.5% (n=32) received one dose and 2.5% (n=2) received two doses. In this sample of cases of whooping cough arising in the highly vaccinated population of Saudi Arabia, the overwhelming majority of cases were infants less than six months of age and older adults.

Antimicrobial Susceptibility of Salmonella typhi and Non-typhi in a Hospital in Eastern Saudi Arabia

The objective of this study was to determine the antimicrobial susceptibility of Salmonella typhi and non-typhi at Saudi Aramco Medical Services Organization (SAMSO). We retrospectively identified isolates of S. typhi and non-typhi from January 1996 to December 2003. Antimicrobial sensitivity and clinical data were collected and analyzed. A total of 266 distinct isolates of S. typhi and non-typhi were available for analysis. Of the total isolates, 21.4% (n= 57) were S. typhi and 78.6% (n= 209) were Salmonella non-typhi and their most common serogroups were D (20.3%), C (19.5%) and B (15.8%). None of Salmonella spp. was resistant to ceftriaxone or ciprofloxacin. The susceptibility of S. typhi and non-typhi to trimethoprim-sulfamethoxazole (TMP-SMX) was 89% and 84% (P = 0.3) and to tetracycline was 81.3% and 56.6%, respectively (P <0.001). Ampicillin susceptibility was detected in 89% and 77% of S. typhi and non-typhi, respectively (P = 0.038). Multidrug resistance was present in 20% of S. typhi and 18.9% of Salmonella nontyphi.There was no difference in the susceptibility pattern of salmonella between Saudi and non-Saudi patients except for gentamicin susceptibility (97.3% vs. 65.9%, P < 0.001).

Antimicrobial resistance of Klebsiella pneumoniae in a Saudi Arabian hospital: results of a 6-year surveillance study, 1998–2003

There are few data regarding the prevalence and trends of antibiotic resistance to Klebsiella pneumoniae in Saudi Arabia over time. Thus, we evaluated the prevalence and the trends in antibiotic resistance of K. pneumoniae at the Saudi Aramco Medical Services Organization over a 6-year period. This was a retrospective study of the in vitro pattern and trends of antibiotic resistance of K. pneumoniae from 1998 to 2003. A total of 3070 distinct isolates of K. pneumoniae were analyzed. Hospital-acquired isolates were more resistant to the tested antibiotics than the outpatient isolates. The resistance rates to cefazolin, trimethoprim-sulfamethoxazole, and ciprofloxacin were 10.8% (n = 79/730), 5% (n = 103/2093), and 15.8% (n = 93/586) for hospital-acquired isolates; and 11% (n = 216/1964), 9.6% (n = 60/624), and 4.4% (n = 68/1526) for outpatient isolates. Resistance to ceftriaxone and ceftazidime was detected in 5.6% (n = 37/659) and 13.8% (n = 24/174) of hospital-acquired isolates and in 1% (n = 17/1713) and 2.7% (n = 6/219) of outpatient isolates, respectively. All tested isolates were susceptible to imipenem. Resistance to three or more classes of antibiotics was present in 1.7% (n = 8/468) of the hospital-acquired isolates and in 0.6% (n = 9/1389) of the outpatient isolates. The data showed increased resistance rates of hospital-acquired isolates of K. pneumoniae to ceftriaxone, gentamicin, and ciprofloxacin; the data also showed that hospital-acquired, rather than outpatient isolates, were more likely to be resistant to multiple antibiotics.

Effects of an Automated Drug Dispensing System on Medication Adverse Event Occurrences and Cost Containment at SAMSO

Purpose To evaluate the impact of an automated drug dispensing system (ADDS) on cost containment and medication adverse event (MAE) occurrences at Saudi Aramco Medical Services Organization (SAMSO). Method An ADDS replaced the traditional unit-dose cassette-exchange and open floor-stock medication systems at SAMSO in early 2005 on five nursing units. Data collection for MAE occurrences and pharmacy medication supply to these units were performed pre- and postimplementation of the ADDS. Results Reported MAEs decreased by approximately 27%. The overall medication issuance decreased by an average of 43%, corresponding to overall medication cost reduction by an average of 42%. Conclusion Implementation of an ADDS improved the efficiency of drug distribution, assisted in cost containment, and decreased the total number of MAEs.

Distribution and epidemiology of Candida species causing fungemia at a Saudi Arabian hospital, 1996–2004

The objective of this study was to evaluate the Candida species and the change over time in the organisms causing candidemia at Saudi Aramco Medical Services Organization in Saudi Arabia. We also describe the risk factors associated with mortality. This was a retrospective study of candidemia over nine years (1996-2004). A total of 98 distinct episodes of candidemia were identified over the study period. The annual incidence of candidemia ranged between 0.2 and 0.76 cases/1000 hospital discharges with an incidence per 10 000 patient-days per year of 0.45 to 1.6. The most frequent Candida species were Candida albicans (53%), Candida tropicalis (19%), Candida parapsilosis (16%), and Candida glabrata (7%). In relation to predisposing factors, 83% of candidemia occurred in patients with central venous catheters and 96% had received broad-spectrum antibiotics. Other predisposing factors included complicated abdominal surgeries (22%), total parenteral nutrition (52%), neutropenia (9%), acute renal failure (24%), malignancy (26%) and burns (15%). However, prior fluconazole use was low (8%). The overall crude mortality rate was 43% for all candidemia. Logistic regression analysis identified two independent determinants of death, C. albicans (OR 5.91, 95% CI 1.50, 23.24, p=0.01) and acute renal failure (OR 5.15, 95% CI 1.18, 22.55, p=0.03). The study showed that the rate of candidemia was low in our hospital and that C. albicans was the major species followed by C. tropicalis and C. parapsilosis. Future studies are needed to evaluate the antifungal susceptibility pattern in our hospital.

Vaginal birth following two cesarean deliveries--are the risks exaggerated?

BackgroundPrior to 1996, most women who had undergone two previous cesarean deliveries were offered only cesarean delivery at Al-Hasa Health Centre. A policy of trial of labor was instituted in 1996. We compared the outcome of trial of labor versus cesarean delivery in women with a history of two previous cesarean deliveries who delivered between 1997 and 2002.Patients and MethodsAll patients with a history of two previous lower segment cesarean deliveries were included in the study. Those considered suitable were permitted a trial of labor that was neither induced nor augmented at any stage.ResultsOf the 205 patients in the study, 66 delivered vaginally (32.2%), 68 had an emergency cesarean delivery (33.2%), and 71 an elective cesarean delivery (34.6%). No scar dehiscence was observed, nor was hysterectomy performed in either group. The rate of complications was lower in the vaginal delivery group (4.5%) than in the cesarean delivery group (19.4%).ConclusionTrial of labor in women with a history of two cesarean deliveries is a reasonable consideration, and when carried out without the use of oxytocics or prostaglandins, is associated with reduced maternal morbidity with no difference in perinatal morbidity.

Pattern of Antibiotic Resistance of Streptococcus pneumoniae in a Hospital in the Eastern Province of Saudi Arabia

Internal Medicine Specialty Services Division, Dhahran Health Center, Saudi Aramco Medical Services Organization, Saudi Aramco, Dhahran, Saudi Arabia. The objective of the study was to evaluate the pattern of antibiotic resistance of Streptococcus pneumoniae at Saudi Aramco Medical Services Organization (SAMSO) in the Eastern Province of Saudi Arabia. We identified, retrospectively S. pneumoniae isolates from January 1999 to December 2002. Antimicrobial susceptibility and clinical data were collected and analyzed. A total of 162 isolates of S . pneumoniae were identified in the study period. Of these isolates, 94 (58%) isolates were obtained from out-patients and 68 (42%) were obtained from in-patients. Thirty-five percent of isolates were from blood, 46% from the respiratory tract, and the remainder were obtained from other sites. Of these isolates, 83 (51%) were penicillin-susceptible and the remaining 79 (48.8%) were not penicillin susceptible. High-level resistance to penicillin existed in 19.8% of the total isolates. Prevalence of resistance to erythromycin, tetracycline and trimethoprim-sulfamethoxazole was 25%, 29%, and 42% respectively. None of the isolates was resistant to vancomycin or ceftriaxone. However, 12% of the isolates showed multi-drug resistance.Streptococcus pneumoniae shows 19.8% high-level penicillin resistance and 12% multi-drug resistance. These findings call for wiser use of antibiotics.

Acute Appendicitis in Infants: Still a Diagnostic Dilemma

Acute Appendicitis in Infants: Still a Diagnostic Dilemma