Data on patients with invasive Streptococcus anginosus group (SAG) infections is limited, as it's been considered commensal bacteria in the human microbiota. We conducted an analysis of SAG infections to assist clinicians in understanding their burden and clinical outcomes. A retrospective study of medical records, identifying invasive SAG bacteria of sterile-site isolates that were managed from May 2015 to April 2017, at a tertiary care hospital in Riyadh, Saudi Arabia. Demographic data, clinical presentation, site of infection, antibiotic use, and outcome were recorded and analyzed to identify factors associated with poor outcome and/or polymicrobial growth. We identified 105 cases of SAG infections in adults, with 52% of the patients being male and the mean age of 52.4 years with comorbidities occurring in more than half of the cases such as diabetes (38%) and malignancy (15%). Overall mortality was 6%, and it was statistically associated with age older than 65 years, polymicrobial growth and a history of malignancy. The infection frequencies were skin and soft tissue infections (SSTI; 55%), intra-abdominal infections (24%), bacteremia (14%), genitourinary infections (8.5%), and pleuropulmonary infections (5%). Abscesses accounted for 68% of cases. Polymicrobial infection (46%) with Enterobacteriaceae and Gram-negative anaerobes coincided with SAG infection. Polymicrobial growth was significantly associated with abscess formation, intra-abdominal source of infections, and poor outcome. In addition, death in patients with SAG was statistically associated with patients older than 65 years of age and those with history of cancer or transplant. SSTIs and intra-abdominal infections are the most common clinical presentations in our cohort. Bacteremia was uncommon; however, the prognosis is less favorable. Overall susceptibility to penicillin was 91%, therefore β-lactam antibiotics are the drug of choice and additional coverage for anaerobic and gram-negative bacteria should be considered for intra-abdominal collection and solid or organ abscesses.

The global COVID-19 pandemic has caused countries to develop novel methods to detect and trace active cases. These methods aim to limit its spread; however, they can also be used to detect other endemic infectious diseases, such as tuberculosis (TB). The current methods used to detect COVID-19 cases, such as temperature-checking and tracing applications, led to the detection of these specific TB cases and their referral to the hospital. In this study, we present four cases of TB in which the patients come from different working backgrounds. We conclude that the current measures used for COVID-19 could also prove to be beneficial in the context of other infectious diseases, mainly TB.

Background: Inappropriate testing of urine cultures can lead to overuse of antibiotics, antimicrobial resistance, Clostridioides difficile infections, and increased cost. In Saudi Arabia, antimicrobial stewardship programs have improved antibiotic use but lack focus on asymptomatic bacteriuria. Targeted interventions are needed to address this gap. Objective: We assessed the implementation of a clinical decision support (CDS) tool in diagnostic stewardship, focusing on the appropriateness of urine culture orders and antibiotic use. Methods: We examined differences in urine culture testing and antibiotic use before and after implementation of a CDS tool in a 400-bed hospital in Riyadh, Saudi Arabia, from August 2021 to July 2022. We included adult patients with urine culture orders. Our outcomes were the percentage of urine cultures ordered that were inappropriate and antibiotic use after the implementation of the CDS intervention. We used a multivariable logistic regression model to determine factors associated with inappropriate urine culture testing and antibiotic use. Results: The percentage of inappropriate urine culture orders were significantly lower in the postintervention period compared to the preintervention period (821/2254, 36.4% vs 754/1814, 41.6%; P=.001). The CDS intervention was associated with 16.7% lower odds of inappropriate urine culture ordering (adjusted odds ratio [aOR] 0.83, 95% CI 0.73‐0.95; P=.008). Unnecessary antibiotics were significantly lower in the postintervention period (310/2254, 72.9% vs 288/1814, 85.7%; P<.001). The CDS intervention was associated with a 52% reduction in unnecessary antibiotic use (aOR 0.487, 95% CL 0.332‐0.713; P<.001) Conclusions: A CDS initiative can reduce unnecessary urine culture testing and antibiotic overuse.

Background: Carbapenem-resistant Enterobacteriaceae (CRE) prevalence has been increasing in Saudi Arabia, posing a significant public health concern. Antimicrobial stewardship programs (ASPs) play an important role in reducing resistance by ensuring appropriate antibiotic use. Our study aimed to assess the appropriateness of meropenem prescriptions pre-ASP and post-ASP implementation in the Intensive Care Unit (ICU) ward. Method: This is a retrospective quasi-experimental pre–post study conducted over 3 years, from 2020 to 2023 at King Abdullah bin Abdulaziz University Hospital (KAAUH). The study included adult ICU patients who received meropenem therapy. The primary objective was to evaluate the appropriateness of meropenem prescriptions in the ICU before and after ASP implementation. The secondary objectives were to identify reasons for inappropriate prescribing and evaluate the interventions implemented to address inappropriate meropenem use. Result: A total of 113 patients were included: 34 in 2020, 41 in 2022, and 38 in 2023. Appropriate meropenem prescribing increased significantly from 23.5% in 2020 to 26.8% in 2022 and 57.9% in 2023 (p = 0.003), while inappropriate prescribing decreased from 76.5% to 73.2% and 42.1%, respectively. Treatment duration also differed significantly across study periods (p = 0.002), with courses of 7–10 days increasing from 24.2% in 2020 to 53.7% in 2022 and 52.6% in 2023, while courses exceeding 10 days decreased from 51.5% to 12.2% and 18.4%, respectively. Among inappropriate prescriptions, an inappropriate antimicrobial spectrum was the predominant reason (81.9%), with no inappropriate dosing identified. Documented stewardship interventions differed significantly across periods (p < 0.001): de-escalation increased from 0% in 2020 to 43.3% in 2022 and 50.0% in 2023, while prescriptions completed without documented intervention decreased from 69.2% to 23.3% and 18.8%, respectively. Conclusion: ASP implementation was associated with a significant improvement in the appropriateness of meropenem prescribing and a shift toward shorter treatment durations among adult ICU patients. Nevertheless, inappropriate prescribing remained substantial in the second post-implementation year, emphasizing the need for continued antimicrobial stewardship interventions and ongoing monitoring of carbapenem use.