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Ziad A Memish

Publications and source records attributed to Ziad A Memish.

At least 19 recordsLinked to original sources
PubMed2006

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

BACKGROUND: 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. METHODS: 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. RESULTS: 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%). CONCLUSIONS: 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.

Adolescent↗
PubMed2006

Health risks at the Hajj.

Annually, millions of Muslims embark on a religious pilgrimage called the "Hajj" to Mecca in Saudi Arabia. The mass migration during the Hajj is unparalleled in scale, and pilgrims face numerous health hazards. The extreme congestion of people and vehicles during this time amplifies health risks, such as those from infectious diseases, that vary each year. Since the Hajj is dictated by the lunar calendar, which is shorter than the Gregorian calendar, it presents public-health policy planners with a moving target, demanding constant preparedness. We review the communicable and non-communicable hazards that pilgrims face. With the rise in global travel, preventing disease transmission has become paramount to avoid the spread of infectious diseases, including SARS (severe acute respiratory syndrome), avian influenza, and haemorrhagic fever. We examine the response of clinicians, the Saudi Ministry of Health, and Hajj authorities to these unique problems, and list health recommendations for prospective pilgrims.

Adult↗
PubMed2006

Effect of corticosteroids on adult varicella pneumonia: cohort study and literature review.

BACKGROUND: Varicella pneumonia (VP) is a serious entity associated with morbidity and mortality. There have been sporadic reports using corticosteroids in life-threatening VP. We report a case series of VP to examine the outcome and the effect of corticosteroid use. METHODS: A retrospective chart review was conducted on all adult patients admitted to a tertiary care hospital with VP during a 14-year period. We documented oxygenation (SpO2, PaO2/FIO2) on admission and after 48 h, whether the patients were admitted to an intensive care unit (ICU), the use of mechanical ventilation, ICU and hospital length of stay (LOS) and patient outcome. We compared those patients who received corticosteroids with those who did not. RESULTS: We identified 19 patients with VP. Ten received corticosteroids, in addition to antiviral and supportive treatment. Patients who received corticosteroids were significantly more hypoxaemic on admission and all were admitted to ICU with seven of them intubated. Only two of the nine in non-steroid group were intubated. Despite their greater severity, the corticosteroid group showed a much more rapid improvement in oxygenation and a trend towards shorter duration of mechanical ventilation. The duration of ICU and hospital LOS were not significantly different. All patients survived. CONCLUSIONS: Corticosteroids in severe VP accelerate the physiological recovery and may shorten the duration of mechanical ventilation.

Adrenal Cortex Hormones↗
PubMed2006

Carriage of Staphylococcus aureus among Hajj pilgrims.

OBJECTIVE: To evaluate the prevalence of methicillin resistant Staphylococcus aureus (MRSA) carriage among a cohort of pilgrims during 2004 Hajj season. METHODS: Pilgrims attending the 2004 Hajj season were recruited and screened for carriage of MRSA. Standard microbiological techniques were used to screen for the presence of MRSA. RESULTS: Out of 411 individuals screened, 85 (20.6%) were positive for Staphylococcus aureus (S. aureus) of which only 6 (1.46 %) were MRSA. Four individuals (4.6%) had the S. aureus organism in both nasal and axillary swabs, while 7 individuals (8%) had the organism in their axillae only. The other 74 individuals (87.1%) had the organism in their nares only. The 6 MRSA isolates were positive for the mecA gene by polymerase chain reaction method. None of the pilgrims examined had any risk factors for community-acquired methicillin resistant S. aureus (CAMRSA). Overall, the prevalence of MRSA in the population of pilgrims examined was found to be low (1.46%) in comparison with most community based studies. CONCLUSION: A low rate of MRSA carriage was noticed among the screened cohort. Physicians treating patients suspected of S. aureus infection during the Hajj pilgrimage should bear in mind the possibility of community acquired - MRSA and should obtain appropriate samples for bacterial cultures and susceptibility testing so that antimicrobial agents could be introduced when necessary at a later stage.

Adolescent↗
PubMed2005

Chickenpox complications in Saudi Arabia: Is it time for routine varicella vaccination?

INTRODUCTION: Varicella zoster (chickenpox) infection is a common and benign disease of childhood. The predominance of uncomplicated cases in children tends to overshadow the morbidity associated with severe cases and the resultant hospitalization. OBJECTIVE: The objective was to establish the complication rate of chickenpox in the Saudi National Guard population over a 2(1/2)-year period. METHODS: All reported cases of chickenpox at the King Abdulaziz Medical City, Riyadh were prospectively followed for development of complications during the period between 1 June 2001 and 30 December 2003. RESULTS: A total of 3802 cases of chickenpox were reported and followed during the acute illness phase. The majority of cases, 2984 (78%), occurred in children less than 15 years of age. Among all chickenpox cases, 78 (2%) required hospitalization, and 50 patients developed 58 (1.5%) complications. Skin and soft tissue infections were the most common complications, 20 (34%), followed by pneumonia in 16 (28%), bacteremia in six (10%), encephalitis in four (7%) and necrotizing fasciitis in four (7%). Complications were less common in children (36/2984, 1.2%) as compared to adults (14/818, 1.7%) (p = 0.26). However, pneumonia (p = 0.03) and hospitalization (p = 0.004) were more common in adults as compared to children. The overall fatality rate was 0.05%; two patients died, one aged two months the other 28 years. CONCLUSION: These data provide a baseline for morbidity and mortality from chickenpox, and further support the inclusion of varicella vaccine in the routine childhood immunization program in Saudi Arabia.

Adolescent↗
PubMed2005

International travel and sexually transmitted diseases.

Despite concerted efforts to control sexually transmitted diseases (STDs) worldwide, they still remain a major public health problem. Out of the 25 organisms known to be transmitted sexually, travelers are at greater risk of acquiring HIV and other STDs in developing countries in view of the high prevalence rates in these countries, particularly after sexual exposure to local commercial sex workers (CSWs). Some of the STDs acquired during international travel are more likely to be resistant to standard antimicrobial regimens for the STDs. HIV, gonorrhoea, syphilis, non-specific urethritis, hepatitis B, hepatitis C, and other STDs are a significant risk for travelers who engage in unprotected sex, especially with overseas CSWs. It is recognized that barrier contraceptives provide considerable protection against STDs, but they are not regarded as 100% protective. Sexual abstinence and sexual monogamy with a 'known' partner carry a much lower risk than the safest of 'safer sex' practices. However, in the event of a sexual exposure to a new partner in the country being visited, prior hepatitis B immunization and the consistent and proper use of a latex condom are strongly advised, followed by proper medical investigations and physical examination on returning home, before sexual activity is resumed.

Anti-Infective Agents↗
PubMed2005

Assessing the potential health impact of the 1991 Gulf War on Saudi Arabian National Guard soldiers.

BACKGROUND: There has been considerable publicity that the 1991 Gulf War may have caused a wide array of health problems in military personnel. Although post-war health outcomes have been studied in US, British, Canadian, Danish, and other deployed troops, this issue has not been previously evaluated in coalition forces native to the Gulf region. METHODS: A collaborative team of US and Saudi health researchers was assembled, data sources evaluated, and hospitalizations among Saudi Arabian National Guard (SANG) soldiers between 1991 and 1999 analysed. Multivariate modelling was used to evaluate differences between 8342 soldiers exposed to combat at Al Khafji and a comparison group of 7270 soldiers in the Riyadh area. RESULTS: Among 15 612 SANG soldiers, we identified 148 with at least one hospitalization over the 9 years following the war. The adjusted rate of hospitalization was higher in the combat-exposed group (risk ratio (RR) = 1.80, 95% confidence interval (CI) 1.25-2.59). No unusual patterns of diagnoses were found and, because the overall number of hospitalizations was low, the absolute difference in risk was found to be very small. CONCLUSIONS: This is the first reported epidemiological investigation of post-war hospitalizations among coalition forces native to the Gulf region that participated in the 1991 Gulf War. A very small increase in hospitalizations was identified in SANG soldiers exposed to combat at Al Khafji. However, because of data limitations, the clinical relevance of this finding should be interpreted with caution. Future collaborative studies to better understand the health effects of deployment should be encouraged.

Adolescent↗
PubMed2005

Ventriculostomy-associated infections: incidence and risk factors.

BACKGROUND: The objective of this study was to assess the incidence of ventriculostomy-associated infections (VAI) and to examine the related risk factors. METHODS: Data on all consecutive patients with ventriculostomy catheters admitted to the intensive care unit (ICU) in a tertiary care center over a 3-year period were identified from the ICU database and from medical records. VAI was documented using a preset definition. The following patient data were documented: demographics, severity of illness measures, indication for the catheter, presence of cerebrospinal fluid (CSF) leak, and length of stay and mortality. The following catheter data were collected: venue of catheter placement (operating room or nonoperating room areas), use of antibiotic irrigation and prophylactic systemic antibiotics, and number of catheter days. The frequency of CSF sampling was documented. RESULTS: In 84 patients, 99 catheters were placed, of which 19% developed VAI. There was a total of 586 catheter days (infection rate, 32 per 1000 catheter days). The risk of VAI increased steadily until catheter day 7 then reached a plateau. Among patients' factors, repeat catheter insertion was associated with a significant increase in VAI. There were no significant associations with age, severity of illness, indication for the catheter, craniatomy, or presence of CSF leak. Among catheter factors, the number of catheter days and repeat catheter insertion emerged as significant independent predictors on multivariate analysis. Placement outside the operating room was associated with a trend toward higher VAI. The use of prophylactic antibiotic or antibiotic irrigation did not significantly alter VAI rates. Routine surveillance cultures of CSF were no more likely to detect infection than cultures obtained when clinically indicated. Gram-negative bacilli were responsible for 50% of the infections, followed by gram-positive cocci (29%) and others (21%). CONCLUSIONS: The risk of VAI increases with increasing duration of catheterization and with repeated insertions. The use of local antibiotic irrigation or systemic antibiotics does not appear to reduce the risk of VAI. Routine surveillance cultures of CSF were no more likely to detect infection than cultures obtained when clinically indicated. These findings need to be considered in infection control policies addressing this important issue.

Adult↗
PubMed2005

A National Guard outbreak of Burkholderia cepacia infection and colonization secondary to intrinsic contamination of albuterol nebulization solution.

BACKGROUND: Burkholderia cepacia, a gram-negative pathogen, has been a known cause of hospital outbreaks because of a contaminated common source such as multidose medications. We describe an outbreak with Burkholderia cepacia infection in 2 major hospitals affiliated to the National Guard, related to an intrinsic contamination of a locally manufactured, multidose Albuterol nebulization solution (Tabouk Pharmaceutical Company, Tabouk, Saudi Arabia) and we report the interventions taken to interrupt this outbreak. METHODS: During the outbreak period between May 2003 and March 2004, a combined prospective surveillance and a retrospective chart and microbiologic data review were conducted in 4 major hospitals affiliated to the National Guard. Microbiologic cultures were also performed on environmental objects of concern, as well as certain medications. In addition, a questionnaire was distributed to the respiratory therapy staff to evaluate the process of administering respiratory medications and their adherence to sound infection control practices. RESULTS: An intrinsic contamination of a locally manufactured brand of multidose Albuterol nebulization with B cepacia was identified. Two of the 4 hospitals were found to be involved: hospital A a 700-bed tertiary care center and Hospital B a 150-bed hospital. A total of 2121 patients were exposed to Albuterol nebulization as inpatients at hospital A and 318 as outpatients. For hospital B, a total of 283 inpatients and 34 outpatients were exposed to the Albuterol nebulization. Forty and 12 patients, from hospital A and hospital B, respectively, were found to have at least 1 positive culture for B cepacia. From hospital A, most samples were respiratory, and, from hospital B, most were from blood. Molecular typing of 34 available isolates showed that 23 cases were of a single strain of B cepacia that matched the strain isolated from the 3 different batches of multidose Albuterol nebulization. Three culture-positive patients never received Albuterol nebulization of that brand but were in the same room of a patient who had been receiving the medication. CONCLUSIONS: We identified a large outbreak of B cepacia in 2 major hospitals affiliated with the National Guard, linked to an intrinsic contamination of a multidose Albuterol nebulization solution. During the period of prospective surveillance, only a few cases were identified as a result of nosocomial transmission. Immediate notification of the Ministry of Health and withdrawal of the medication and revisiting the respiratory therapy practices were necessary to halt this outbreak.

Adolescent↗
PubMed2005

The utility and interpretation of tuberculin skin tests in the Middle East.

Tuberculin skin test (TST) interpretation can be confounded by Bacillus Calmette-Guerin (BCG) vaccination and infection with nontuberculosis mycobacteria (NTM). However, a wealth of epidemiologic information has allowed the formulation of recommendations for reasonably informed interpretation of the TST in most clinical situations. In the Middle East, the TST remains a useful test. BCG vaccination is given at birth, which should have minimal effect on TST reactions in adolescents or adults. In countries of the Middle East with moderate to high incidence of active smear-positive pulmonary TB (>20 per 100,000 per year), a positive TST will almost always indicate true TB infection. However, in Middle East countries with very low incidence of active TB (<10 per 100,000 per year), a positive TST will more likely be false positive because BCG vaccination is still routinely given; until BCG vaccination is abandoned, the TST will be less useful in these countries. These findings are applicable to countries in other regions of the world, and the utility TST will also be increased where the likelihood of TB infection is higher and lowered where TB infection is unlikely, yet BCG vaccination is still given.

BCG Vaccine↗
PubMed2005

Saudi Arabia-United States collaboration in health research: a formula for success.

The aim of this article is to share our experiences from an international collaborative effort to study health outcomes among Saudi Arabian National Guard (SANG) soldiers following the 1991 Gulf War. By paying particular attention to distinct social and religious customs, geopolitical differences, and unique aspects of the health care system, we achieved a successful international collaboration in health research.

Cultural Characteristics↗
PubMed2005

Acute brucellosis in Saudi families: relationship between brucella serology and clinical symptoms.

OBJECTIVE: To determine if screening family members of patients with acute brucellosis will enhance the detection rate of brucellosis and also to determine the relationship between symptoms and brucella serology. MATERIALS AND METHODS: Family members from patients with acute brucellosis were interviewed and serologically screened. All seropositive family members were clinically and serologically followed for six months. RESULTS: Twenty-five acute brucellosis patients and their 178 family members were enrolled from January 2001 to February 2002. Of the 178 family members, 40 (23%) manifested various symptoms, 138 (77%) were asymptomatic, with an overall seroprevalence rate of 34 (19%). The rate of seropositivity among the symptomatic family members was 23 (58%) and for the asymptomatic was 11 (8%) (P<0.001). The majority of the symptomatic family members (13 (57%)) had a high Brucella titer in comparison to one (9%) of the asymptomatic group (P<0.001). Acute brucellosis was diagnosed and treated in 18 (78%) of the symptomatic seropositive family members and in four (36%), of the asymptomatic seropositive family members with an acute brucellosis prevalence rate of 22 (12%). All family members with acute infection recovered without sequelae; one patient relapsed (5%). CONCLUSION: Symptomatic family members are more likely to be seropositive with a high titer in comparison to the asymptomatic members.

Acute Disease↗