Saudi Tertiary Care Hospital Research Articles

Assessment of Nurses’ Knowledge of the Glasgow Coma Scale in a Saudi Tertiary Care Hospital: A Cross-Sectional Study

Assessment of Nurses’ Knowledge of the Glasgow Coma Scale in a Saudi Tertiary Care Hospital: A Cross-Sectional Study

Characterization and Antimicrobial Susceptibility Patterns of Enterococcus Species Isolated from Nosocomial Infections in a Saudi Tertiary Care Hospital over a Ten-Year Period (2012-2021).

The Enterococcus genus is a common cause of nosocomial infections, with vancomycin-resistant enterococci (VRE) posing a significant treatment challenge. This retrospective study, spanning ten years (2012 to 2021), analyzes antimicrobial susceptibility patterns of Enterococcus species from clinical samples in a Saudi Arabian tertiary care hospital. A total of 1034 Enterococcus isolates were collected, 729 from general wards and 305 from intensive care unit (ICU) patients. VRE accounted for 15.9% of isolates. E. faecalis was the most common species (54.3% of isolates and 2.7% of VRE), followed by E. faecium (33.6% of isolates and 41.2% of VRE). E. faecium exhibited the highest resistance to ciprofloxacin (84.1%), ampicillin (81.6%), and rifampicin (80%), with daptomycin (0.6%) and linezolid (3.1%) showing the lowest resistance. In E. faecalis, ciprofloxacin resistance was highest (59.7%), followed by rifampicin (20.1%) and ampicillin (11.8%). Daptomycin (0%), linezolid (1.5%), and vancomycin (2.7%) had the lowest resistance. VRE cases had higher mortality rates compared to vancomycin-sensitive enterococci (VSE). Eight different strains of Enterocci were identified. E. faecalis was the most commonly identified strain, while E. faecium had the highest percentage of VRE. VRE cases had a significantly higher mortality rate than VSE cases.

Computed Tomography Angiograms Performed for Patients with Suspected Pulmonary Embolism

Background: Pulmonary embolism is a known condition in the emergency department with high morbidity and mortality. Computed tomography pulmonary angiography (CTPA) is a rapid diagnostic tool to detect pulmonary embolism however, the number of positive scans has decreased and the frequency of observed non-embolic findings has increased over time as this tool has been overutilized to provide other alternative diagnoses. Objective: This study aims to estimate the prevalence of pulmonary embolism and non-embolic findings in patients who underwent CT pulmonary angiography for suspected pulmonary embolism. Design and Setting: In this cross-sectional study we retrospectively analyzed consecutive 158 CTPA images and reports performed for suspected pulmonary embolism at a Saudi tertiary care hospital. The non-embolic findings were classified based on their location. Results: The prevalence of pulmonary embolism was 26.6%. No statistically significant difference was found between the diagnosis of pulmonary embolism with respect to gender and age. The prevalence of non-embolic findings among the whole study was 86.7%. Pulmonary findings represented 45.2% of all non-embolic findings followed by pleural findings in 18.3%. Lung opacification and pleural effusion were the most commonly occurring findings. Conclusion: Relative to other studies our center has a reasonable prevalence of CTPA studies being positive for pulmonary embolism however, we encourage balancing the potential benefits and harms by following a well-structured clinical approach to improve the healthcare quality and safety.

Risk factors, outcomes, and predictors of resolution of acute kidney injury in children with diabetic ketoacidosis.

Acute kidney injury (AKI) is a common complication in patients with diabetic ketoacidosis (DKA) (incidence 35-77%). AKI evolution during DKA treatment/recovery is poorly understood. Our aim was to assess children with DKA for prevalence, short-term kidney outcomes, severity, and predictors of AKI development and resolution. This retrospective cohort study included children aged 2-14years admitted with DKA between January 2016 and May 2020 in a Saudi tertiary care hospital. We defined AKI as an increase in serum creatinine of > 1.5 times baseline or > 3mg/dL (26mmol/L) within 48h. Of 213 patients admitted with DKA, 172 (80.75%) developed AKI: stage 1 in 83 (38.96%), stage 2 in 86 (40.37%), and stage 3 in 3 (1.4%). No patient required dialysis. Multivariate analysis showed an increased risk of developing AKI with male gender (OR = 2.85) and lower serum bicarbonate (OR = 0.83) when adjusted for initial heart rate, hematocrit, new onset diabetes, and recurrent AKI. The mean time to AKI resolution was 13.21 ± 6.78h. Factors leading to prolonged recovery from AKI in linear regression analysis were older age (B coefficient = 0.44, p = 0.01), recurrent DKA episodes (B coefficient = 3.70, p value 0.003), increased acidosis severity (B coefficient = - 0.44, p = 0.04), increased time to anion gap normalization (B coefficient = 0.44, p = 0.019), and increased initial glucose (B coefficient = 0.01, p = 0.011). In our cohort, AKI is a common, but mostly transient complication in children presenting with DKA, and its severity is associated with longer intensive care stays and time for acidosis resolution. AKI was associated with male gender, and lower serum bicarbonate. Proper consideration of such risk factors is needed for AKI assessment and management in future DKA clinical practice guidelines. A higher resolution version of the Graphical abstract is available as Supplementary information.

Adherence to the guidelines for surgical antimicrobial prophylaxis in a Saudi tertiary care hospital.

ObjectiveThe study evaluated the adherence to the guidelines for surgical antimicrobial prophylaxis in a Saudi tertiary care hospital.MethodsThe medical records of 707 patients from the surgical units over a selected 3-month period were selected. The data were reviewed and statistically analysed.ResultsOf the 707 respondents, 51.2% were women and most were older than 50 years. The most common surgical procedures involved orthopaedics (28.3%), followed by vascular surgery (15.1%). One hundred and thirty-eight (19.5%) patients received antibiotics according to the guidelines for surgical prophylaxis. More than half of the patients (399/56.4%) received antibiotics for more than 24 h and 129 (18.2%) received antibiotics for less than 24 h. Single dose antibiotic therapy was used in 179 (25.3%) patients. Two hundred and ninety-seven (42%) patients underwent clean surgery, 284 (40%) clean-contaminated and 128 (18%) contaminated surgery. A significant difference was evident between the antibiotics administered according to the recommended guidelines and the duration of antibiotic therapy (p = 0.001), duration (p = 0.001) and the type of surgical procedure (p = 0.00).ConclusionThe findings of this study suggest that healthcare professionals do not strictly adhere to the guidelines for surgical antibiotic prophylaxis. Physicians are therefore encouraged to follow the recommendations appropriately and to regularly implement surgical antimicrobial prophylaxis for patient safety.

Glycemic and Cardiovascular Risk Control among Patients with Type 2 Diabetes: A Saudi Tertiary Care Hospital Experience

AbstractIntroduction: Data on concomitant control of both glycemia and cardiovascular risk factors among patients with type 2 diabetes (T2D) are very limited in Saudi Arabia. The aim of this study was to assess the degree of achieving glycemic control and concomitant control of cardiovascular risk factors at a primary care setting. Methods: Between February and March 2017, we retrospectively reviewed the charts and laboratory records of adult patients with T2D who received primary care services at Family Medicine clinics at King Fahad Medical City for at least a year. Outcome goals were based on 2016 American Diabetic Association (ADA) standards of diabetic care. Results: A total of 268 patients were included in the study. The mean age was 55.0 ± 10.7 years and 60% of the patients were women. Patients who achieved ADA-recommended diabetic care goals were 43.7% for glycemic control, 46.7% for blood pressure, 87.9% for total cholesterol, 52.7% for low-density lipoprotein cholesterol, 44.7% for high-density lipoprotein cholesterol, 70.8% for triglycerides, 9.4% for diet control, 1.9% for practicing exercises, 98.1% for receiving health education, and finally 38.8% for the recommended number of glycated hemoglobin testing. In addition to glycemic control, concomitant control of blood pressure, blood lipids, and both blood pressure/blood lipids were 21.3%, 9.4%, and 4.9%, respectively. In multivariate analysis, glycemic control was independently associated with the type of diabetic medications, diet control, and smoking status. Conclusion: The concomitant control of multiple diabetic care goals is alarmingly low. Further research is required to better understand the responsible system barriers and strategies to improve.

PP-03 - The significant application of the 4T criteria in assessing the proper need for a HIT study assay in a Saudi tertiary care hospital

PP-03 - The significant application of the 4T criteria in assessing the proper need for a HIT study assay in a Saudi tertiary care hospital

Off-label and unlicensed drug use in hospitalized newborns in a Saudi tertiary care hospital: a cohort study.

Objective To determine the extent of off-label and unlicensed prescribing in hospitalized newborns and to identify patient-related risk factors associated with off-label prescribing. Methods A prospective cohort study was conducted between January and March 2016 at a neonatology department of a tertiary-care hospital in the Eastern province. All consecutive admissions to all neonatal care levels meeting the inclusion and exclusion criteria were eligible for enrollment. All prescriptions were classified as off-label or unlicensed according to drug product monograph. Clinical and prescription data were extracted using a pilot-tested structured data collection sheet. Results During the study period583 prescriptions were made for 138 newborns, of which 29.7% (173/583) and 12.9% (75/583) were classified as off-label and unlicensed drugs respectively for use in neonates. Thirty-four percent (47/138) of patients received at least one off-label/unlicensed medicine. Mechanical ventilation, admission to the neonatal intensive care unit and length of hospital stay were identified as independent risk factors associated with prescribing of at least one off-label medication. Conclusion Use of off-label and unlicensed drugs in hospitalized newborns seems to be a common practicein this Saudi hospital. Future research should evaluate safety and efficacy of off-label and/or unlicensed use of drugs in neonates.

The Demographic Characteristics and the Risk Factors of Dementia in SAUDI Elderly

There is a little information about dementia in Saudis. This is a retrospective chart review study from1995 -2010. to describe the demographic characteristics and the risk factors of dementia, the prevalence of different types of dementia, and the current clinical practice of dementia in Saudi tertiary care hospital. A total of 418 demented patients (236 males, 182 females) their mean age was 78.8. Prevalence of diabetes 32%, hypertension 71.53%, dyslipidemia 30.05% and depression 24.41%. Clinically 64.37% of patients had memory impairment, 54.25% had confusion and 34.63% had personality changing. The commonest type of dementia was mixed dementia 18.37% followed by Alzheimer disease15.87%. 16.10% of patients had received cholinesterase inhibitor and 9.78% had received memantine. Infection was the commonest cause of frequent admission (40%) Mortality rate was 77.99%. The commonest cause of death was infection (38.34%) followed by cardiovascular causes like stroke (23.34%) and cardiac diseases (17.48%). Conclusion: (1) Mixed dementia is the commonest type of dementia in Saudis due to high prevalence of cardiovascular diseases risk factors. (2) High prevalence of depression among demented Saudi patients. It requires early recognition and treatment. (3) Demented patients have frequent admissions and long stay in hospital which makes the economic cost is very high. (4) Mortality rate among demented patients is high and the outcome of dementia is expected to be poor. The underlying message of this study is to increase awareness of the public and health system about the impact of dementia in Saudis and the need for prevention strategies, trained physicians and more research.

Surgical Site Infections at a Saudi Hospital: The Need for a National Surveillance Program

Surgical site infection (SSI) continues to be a global health problem that causes increased morbidity and mortality, especially in developing countries. This study aimed to determine the prevalence of SSI, the microbial pathogens, and their resistance patterns, as well as to identify risk factors associated with this infection at a Saudi tertiary care hospital. This cross-sectional observational study involved all patients who had undergone surgery and who stayed in the hospital for at least 48 hours during a 1-year period. SSI was diagnosed using the guidelines of the US Centers for Disease Control and Prevention. A total of 2160 patients were included, and the overall SSI rate was 10.2%. Malignancy [odds ratio (OR) = 1.63], duration of operation (OR = 1.41), high American Society of Anesthesiologists score (OR = 1.8), and clean-contaminated (OR = 1.5) and contaminated (OR = 3.2) operations were found to be statistically significant risk factors for SSI. The most frequently isolated microorganisms were Acinetobacter spp (31.5%), Escherichia coli (25.5%), and Pseudomonas spp (17.9%). This study further illustrates the burden of SSI in a typical hospital situation in developing countries. Our findings highlight the urgent need to develop a consistent national surveillance program for SSI, with accurate feedback of appropriate data to help surgeons control and reduce the SSI rates in developing countries.

3. Gender differences in cardiorespiratory fitness among saudi patients referred for treadmil exercise stress testing

Abstract type Clinical Research. Presentation type Poster Presentation. Introduction Cardiorespiratory fitness (CRF) is an independent predictor of morbidity and cardiac mortality. The gender differences of cardiorespiratory fitness in Saudi population is not well-descriped. The aim of the study is to determine the gender differences in CRF (workload achieved and chronotropic incompitance(CI)) among Saudi patients referred for treadmil exercise stress testing. Methodology A cross-sectional study that included patients who underwent a clinically indicated treadmail exercise stress testing following Bruce protocol between 2001 and 2015 in a Saudi tertiary care hospital. Patients yonger than 18 years old, or had a non-Bruce protocol exercise stress testing or pharmacoloical stress testing were excluded from the study. Linear and logistic regressions were used to determine the impact of gender on the choronotropic incompitance and workload achieved measured in metabolic equivelant of task (METs). Results A total of 10,673 were included in the study. The prevalence of hypertension, diabetes and dyslipidemia were 40.4%, 63.4% and 17.5%, respectively. In general, male patients had a higher METs achieved (11 vs. 8) than female patients. On the other hand, male patients had more often CI. Using multivariate loginstic regression, males had higher tendency (7 times) than females to achieve 10 METs or more with no differences in CI. Conclusion Our studyhighlight an existence of a significant wide CRF gap between males and females in the Saudi population. The prognostic impact of these findings need further evaluation.

Evaluation of the causes and cost impact of returned intravenous medications at a tertiary care hospital in Riyadh, Saudi Arabia

Purpose: To evaluate the main reasons for returning intravenous (IV) medications and to determine its cost impact in an in-patient setting in a Saudi tertiary care hospital. Methods: The study was conducted over a one-month period at the central IV room of the in-patient pharmacy unit at King Abdulaziz Medical City (KAMC), Riyadh, Saudi Arabia. All returned IV medications were evaluated in terms of frequency, causes and cost. Results: The total number of IV medications returned was 2,061 items. The most common reasons for returning IV medications were drug discontinuation (933 items, 45.3 %), dispensing of an extra quantity (396 items, 19.2 %), patient deaths (173 items, 8.4 %), dose changes (171 items, 8.3 %) and drugs being held (150 items, 7.3 %). The total cost of all the returned IV medications was US$26,805.80), which accounts for (13.65 %) of the total pharmacy’s budget. Wasted medication cost was US$13,877.80) which constitute 51.77 % of returned medication cost. Conclusions: The results of this study indicate that IV medication wastage is a serious problem with significant cost impact, with drug discontinuation and dispensing of an extra quantity of medication being the two main reasons for returning IV medications. Effective communication among health care professionals, pharmacist training, and adherence to standard practice guidelines might be the most vital strategies to reduce medication wastage. Keywords: Medication wastage, In-patient, Cost impact, Intravenous medications, Tertiary care

Clinical significance of coagulase-negative staphylococci isolates from nosocomial bloodstream infections

Background Identification of coagulase-negative staphylococci (CoNS) as nosocomial pathogens or contaminants is significant for microbiologists and clinicians. This study aimed to determine the frequency of isolation and antimicrobial resistance patterns of CoNS isolates from nosocomial bloodstream infections (BSIs) and to identify risk factors associated with true bacteremia caused by these emerging pathogens in a Saudi tertiary care hospital. Methods All CoNS-positive cultures from inpatients were identified using the standard methods during a 10-month period. Antimicrobial susceptibility testing was done using the reference broth microdilution method. Results A total of 208 isolates were identified; of these 75 (32.2%) were considered infection associated, and 133 (67.8%) were considered contamination. S. epidermidis accounted for 34.7% of bacteremia cases, followed by S. hominis (21.3%), S. haemolyticus (16%), and S. saprophyticus (12%). Central venous catheters (p ≤ 0.0001), prior antibiotic therapy (p ≤ 0.0001), the occurrence of more than one positive blood culture (p ≤ 0.0001), and intensive care unit (ICU) admission (p = 0.007) were all independently associated with CoNS bacteremia. Overall, all isolates were highly resistant to penicillin (94.7%), oxacillin (90.7%), and erythromycin (85.3%). The rates of susceptibility to vancomycin, daptomycin, and teicoplanin were 98.7%, 98.7%, and 93.3%, respectively. Conclusions Our results further highlight that accurate identification and susceptibility testing of CoNS isolates from nosocomial BSIs are crucial to minimize excessive antibiotic use and unnecessary catheter removal. In addition, daptomycin may be an efficient alternative therapeutic option for CoNS resistant to oxacillin and other commonly used antibiotics.

Consumption of carbapenems in different intensive care units in a Saudi tertiary care hospital

Surveillance of antimicrobial consumption is a necessary step to develop and monitor policies to limit antimicrobial overuse/misuse and to decrease the risk of bacterial resistance. In Saudi Arabia, such surveillance data are lacking.

Molecular characterization of oxacillinases among carbapenem-resistant Acinetobacter baumannii nosocomial isolates in a Saudi hospital.

Acinetobacter baumannii has successfully become a significant nosocomial pathogen because of its remarkable ability to acquire antibiotic resistance and to survive in nosocomial environments. This study aimed to determine the drug susceptibility patterns and the distribution of four subgroups of carbapenem-hydrolyzing class D β-lactamases (OXA-carbapenemases), as well as their insertion sequences (ISAba1), among A. baumannii nosocomial isolates from a Saudi tertiary care hospital. A total of 108 non-duplicate A. baumannii isolates were identified, and their susceptibilities to different antibiotics were determined using the breakpoint method. Isolates were then subjected to multiplex-PCR targeting blaOXA genes. More than 75% of the isolates showed resistance to different antibiotics. The rates of susceptibility to colistin, meropenem, imipenem and trimethoprim-sulfamethoxazole were 95.6, 50, 48.1 and 34.3%, respectively. All isolates possessed a blaOXA-51-like gene. Of the 56 carbapenem-resistant isolates, 48 isolates (85.7%) carried blaOXA-23-like, 3 isolates (5.4%) carried blaOXA-40-like and two isolates (3.6%) had blaOXA-58-like genes. The ISAba1 element was found upstream of the blaOXA-23 and blaOXA-24 genes in 40 (71.4%) and 3 (5.4%) isolates, respectively, while it was detected upstream of blaOXA-51 in only one (1.8%) isolate. Our findings further illustrate the challenge of increasing carbapenem-resistance in A. baumannii isolates in Saudi Arabia. The high distribution of class D carbapenemase-encoding genes, mainly ISAba1/OXA-23 and ISAba1/OXA-24 carbapenemases, is worrisome and presents an emerging threat in our hospital. Local molecular surveillance is essential to help control carbapenem-resistant A. baumannii nosocomial infections and to prevent DNA exchange among endemic nosocomial pathogens.

The Spectrum of Primary Immunodeficiency Diseases in A Saudi Tertiary Care Hospital Over Two Years

The Spectrum of Primary Immunodeficiency Diseases in A Saudi Tertiary Care Hospital Over Two Years

Emergence of Unusual Nonfermenting Gram-Negative Nosocomial Pathogens in a Saudi Hospital

This study aimed to determine the frequency of isolation and prevalence of drug resistance in nonfermenting Gram-negative bacilli (NFGNB) other than Pseudomonas aeruginosa and predisposing factors for the acquisition of nosocomial infections caused by these emerging pathogens in a Saudi tertiary care hospital. A total of 125 nonduplicating NFGNB nosocomial strains were isolated, of these, 68 (54.4%) were Acinetobacter baumannii, 26 (20.8%) Stenotrophomonas maltophilia, 14 (11.2%) Alcaligenes faecalis, 12 (9.6%) Chryseobacterium indologenes, and 5 (4%) Ralstonia pickettii. MICs of 11 antibiotics were determined using the reference broth microdilution method. With the exception of colistin that inhibited 100% of A. baumannii isolates, trimethoprim/sulfamethoxazole that inhibited 100% of S. maltophilia isolates, and carbapenems that inhibited 100% of A. faecalis isolates, none of the tested antimicrobial agents inhibited 100% of the other NFGNB spp. Our results emphasize that clinicians and microbiologists should consider A. faecalis, C. indologenes, and R. pickettii as emerging nosocomial pathogens. In addition, local resistance data are essential for helping physicians in deciding an appropriate antibiotic for empirical therapy of infections with these emerging and unusual NFGNB.

Pattern of Cancer Deaths in a Saudi Tertiary Care Hospital

The medical records of deceased patients were reviewed to describe the pattern of cancer deaths in a newly established Saudi tertiary care hospital. During eleven months, 87 patients died of cancer. The majority (80 patients, 92%) died of incurable cancer; among which 53% did not receive any systemic anti-cancer therapy (SAT) and 43% received SAT with palliative intent. Younger age (< 65 years), relatively chemosensitive tumours and initial presentation in a potentially curable stage were associated with higher prevalence of palliative SAT administration (p = 0.009, 0.019 and 0.001, respectively). The last palliative SAT was administered during the last two months of life in 66% and during the last two weeks in 14%. During the last admission, 54% of patients were admitted through emergency room, 50% stayed >14 days and 14% died in intensive care unit or emergency room. The results demonstrate that palliative care is a realistic treatment for the majority of patients in our setting and that a significant proportion of these patients receive aggressive care at the end-of-life. There is a need to establish an integrative palliative care program to improve the quality-of-life of dying cancer patients in our region and to minimize the aggressiveness of end-of-life care.

Referral timing of in-hospital cancer deaths to palliative care in a Saudi tertiary care hospital

Introduction: Late referral of advanced cancer patients to palliative care adversely affects their end-of-life care. We conducted this study to determine the referral timing of in-hospital cancer deaths to palliative care in a Saudi tertiary care hospital.Subjects and methods: A retrospective review of cancer referrals to palliative care during a 4-year period who eventually died in-hospital. The effect of different factors on referral timing was studied.Results: From 1567 referrals, 887 (56.6%) were eligible. Referral during the last week of life occurred in 28% of cases. The median survival from the first referral was 19 days (95% CI, 16–22). In multivariate analysis, the survival differed significantly according to the referring specialty and the setting of referral (P = 0.002, and < 0.001; respectively). The survival was shorter for patients referred from the medical, haematology and paediatric oncology specialties and for those referred in the emergency room or while in-patients.Conclusions: Referral of in-hospital cancer deaths to palliative care occurs late in our setting and many patients are referred when death is imminent. The identification of factors related to this late referral attitude may be helpful in future improvement of end-of-life cancer care. Further research is warranted to investigate other reasons that may lead to late referral and to find ways to improve referral timing.