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Background Studying temporal changes in resistant pathogens causing healthcare-associated infections (HAIs) is crucial in improving local antimicrobial and infection control practices. The objective was to describe ten-year trends of resistance in pathogens causing HAIs in a tertiary care setting in Saudi Arabia and to compare such trends with those of US National Health Surveillance Network (NHSN). Methods Pooled analysis of surveillance data that were prospectively collected between 2007 and 2016 in four hospitals of Ministry of National Guard Health Affairs. Definitions and methodology of HAIs and antimicrobial resistance were based on NHSN. Consecutive NHSN reports were used for comparisons. Results A total 1544 pathogens causing 1531 HAI events were included. Gram negative pathogens (GNP) were responsible for 63% of HAIs, with a significant increasing trend in Klebsiella spp. and a decreasing trend in Acinetobacter. Methicillin-resistant Staphylococcus aureus (27.0%) was consistently less frequent than NHSN. Vancomycin-resistant Enterococci (VRE, 20.3%) were more than doubled during the study, closing the gap with NHSN. Carbapenem resistance was highest with Acinetobacter (68.3%) and Pseudomonas (36.8%). Increasing trends of carbapenem resistance were highest in Pseudomonas and Enterobacteriaceae, closing initial gaps with NHSN. With the exception of Klebsiella and Enterobacter, multidrug-resistant (MDR) GNPs were generally decreasing, mainly due to the decreasing resistance towards cephalosporins, fluoroquinolones, and aminoglycosides. Conclusion The findings showed increasing trends of carbapenem resistance and VRE, which may reflect heavy use of carbapenems and vancomycin. These findings may highlight the need for effective antimicrobial stewardship programs, including monitoring and feedback on antimicrobial use and resistance.

Objectives: There is local and regional deficiency in the data examining the contribution of resistant pathogens to device-associated healthcare-associated infections (DA-HAIs). We examined such data in a multihospital system in Saudi Arabia in comparison with the US NHSN reports. Methods: Surveillance of DA-HAIs was prospectively conducted between 2008 and 2016 in 4 hospitals of Ministry of National Guard Health Affairs. Consecutive NHSN reports were used for comparison. Definitions and methodology of DA-HAIs and bacterial resistance were based on the NHSN reports. Results: In total, 1,260 pathogens causing 1,141 DA-HAI events were included. Gram-negative pathogens (GNPs) were responsible for 62.5% of DA-HAIs, with significantly higher Klebsiella, Pseudomonas, Acinetobacter, and Enterobacter than NHSN hospitals. Approximately 28.3% of GNPs and 23.5% of gram-positive pathogens (GPPs) exhibited some type of resistance. Nearly 34.3% of Klebsiella were cephalosporin-resistant; 4.8% of Enterobacteriaceae were carbapenem-resistant (CRE); 24.4% of Staphylococcus aureus were methicillin-resistant (MRSA; and 21.9% of Enterococci were Vancomycin-resistant (VRE). The multidrug resistance (MDR) rates were 65.0% for Acinetobacter, 26.4% for Escherichia coli, 23.0% for Klebsiella, and 14.9% for Pseudomonas. Resistant GNPs including cephalosporin-resistant Klebsiella, MDR Klebsiella, and MDR Escherichia coli were significantly more frequent than in NHSN hospitals, whereas resistant GPPs including MRSA and VRE were significantly less frequent than in NHSN hospitals. Conclusion: Compared with American hospitals, GNPs that contribute to DA-HAIs in Saudi hospitals show more resistance. The higher resistance rates in Klebsiella and Escherichia coli are alarming and call for effective antimicrobial stewardship programs.Funding: NoneDisclosures: None

Objectives There is local and regional deficiency in the data examining the contribution of resistant pathogens to device-associated healthcare-associated infections (DA-HAIs). The objective was to examine such data in a multi-hospital system in Saudi Arabia in comparison with the US National Health Surveillance Network (NHSN). Methods Surveillance of DA-HAIs was prospectively conducted between 2008 and 2016 in four hospitals of Ministry of National Guard Health Affairs. Consecutive NHSN reports were used for comparisons. Definitions and methodology of DA-HAIs and bacterial resistance were based on NHSN. Results A total 1260 pathogens causing 1141 DA-HAI events were included. Gram negative pathogens (GNPs) were responsible for 62.5% of DA-HAIs, with a significantly higher Klebsiella, Pseudomonas, Acinetobacter, and Enterobacter than NHSN hospitals. Approximately 28.3% of GNPs and 23.5% of gram positive pathogens (GPPs) had some type of resistance. Nearly 34.3% of Klebsiella were resistant to third/fourth generation cephalosporins, 4.8% of Enterobacteriaceae were carbapenem-resistant (CRE), 24.4% of Staphylococcus aureus were methicillin-resistant (MRSA), and 21.9% of Enterococci were vancomycin-resistant (VRE). Multidrug resistance (MDR) was 65.0% in Acinetobacter, 26.4% in Escherichia coli, 23.0% in Klebsiella, and 14.9% in Pseudomonas. Resistant GNPs including cephalosporin-resistant Klebsiella, MDR Klebsiella, and MDR Escherichia coli were significantly more frequent while resistant GPPs including MRSA and VRE were significantly less frequent than NHSN hospitals. Conclusion The current findings showed heavier and more resistant contribution of GNPs to DA-HAIs in Saudi hospitals compared with American hospitals. The higher resistance rates in Klebsiella and Escherichia coli are alarming and call for effective antimicrobial stewardship programs.

Background: Studying temporal changes in resistant pathogens causing healthcare-associated infections (HAIs) is crucial in improving local antimicrobial and infection control practices. We analyzed 10-year trends in resistance in pathogens causing HAIs in a tertiary-care setting in Saudi Arabia and we compared such trends with those of the US NHSN. Methods: We performed a pooled analysis of surveillance data that were prospectively collected between 2007 and 2016 in 4 hospitals of the Ministry of National Guard Health Affairs. Definitions and methodology of HAIs and antimicrobial resistance were based on NHSN methods. Consecutive NHSN reports were used for comparisons. Results: In total, 1,544 pathogens causing 1,531 HAI events were included. Gram-negative pathogens (GNPs) were responsible for 63% of HAIs, with a significant increasing trend in Klebsiella spp and a decreasing trend in Acinetobacter spp. Methicillin-resistant Staphylococcus aureus (27.0%) was consistently less frequent than NHSN reports. Vancomycin-resistant Enterococci (20.3%) more than doubled during the study, closing the gap with the NHSN. Carbapenem resistance was highest for Acinetobacter (68.3%) and Pseudomonas (36.8%). Increasing trends of carbapenem resistance were highest for Pseudomonas and Enterobacteriaceae, closing the initial gaps with the NHSN. With the exception of Klebsiella and Enterobacter, multidrug-resistant (MDR) GNPs generally decreased, mainly due to the decreasing resistance to cephalosporins, fluoroquinolones, and aminoglycosides. Conclusions:The current trends probably reflect multiple local interventions to reduce HAIs and MDR as well as the heavy use of carbapenems and vancomycin. Our main challenge remains to further enhance the newly launched antimicrobial stewardship practices.Funding: NoneDisclosures: None

Gastroduodenal involvement occurs in only 0.3 to 2.3% of patients with tuberculosis (TB). Clinically, it may resemble peptic ulcer disease or malignancy. We present a 36 year old man with gastric outlet obstruction proven to be pyloric stricture due to primary pyloric tuberculosis. Diagnosis was established endoscopically and patient was successfully managed by standard anti-tuberculous therapy. Although rare, tuberculous involvement of the stomach should be considered in the differential diagnosis of gastric outlet obstruction especially in regions where tuberculosis is endemic. This case also emphasizes that medical management with anti-TB medications can be tried solely as the first line therapy for strictured pyloric stenosis. However, surgical intervention is required more often than none in cases where gastrointestinal obstruction is the main clinical problem. Key words: Tuberculosis, Pyloric Stenosis, Gastric Tuberculosis