Malaria, leptospirosis, and undiagnosed fever were the main etiologies followed by pneumonia, urinary tract infections, and pancreatitis. Both the PaO 2 /FiO 2 ratio and lung injury score (LIS) at the time of admission were significant predictors of the outcome and of necessity of mechanical ventilation. PaO 2 /FiO 2 was a better predictor of duration of stay at the intensive care unit than the LIS. Sepsis, acidosis, hypotension, and multiorgan failure were individual predictors of mortality in patients with ALI/ARDS while age, sex, anemia, thrombocytopenia, renal failure, hepatic failure, and X-ray picture were not predictors of the outcome.

Blood stream infections (BSI) lead to sepsis and septic shock, which continue to be important causes of morbidity and mortality. A vast body of literature has been devoted to this. Worldwide studies about the epidemiology, microbiological etiology and prognosis of BSI have been performed over the last six decades. These have shown changing patterns of the pathogens involved, namely the emergence of gram-negative pathogens as a major cause of bacteremia after the beginning of the antimicrobial era, 1,2 and the recent re-emergence of grampositive pathogens and fungi, especially among the growing population of immunocompromised patients. 3,4 While many studies are available from Western countries, mostly conducted in major teaching or research institutions, little work has been published from the developing countries. Extrapolation of data to hospitals in developing countries may be misleading because of the differing effects of factors such as endemic pathogens, underlying diseases, and antimicrobial prescribing habits.The present study aims to define the pattern of blood stream infections over a five-year period in a general referral hospital in a developing country, to compare it with previously published work from Saudi Arabia and other countries, to point out differences in the spectrum of micro-organisms, community-acquired and hospital-acquired BSI, and to determine the case fatality rate in relation to different micro-organisms and patient age groups. Materials and MethodsThis study was carried out in Qatif Central Hospital (QCH). Qatif is located on the Gulf in the Eastern Province of Saudi Arabia, and the hospital is a 400-bed referral facility that provides all medical services. Data from the hospital's Department of Microbiology and from patients' records were reviewed. Patients with bacteremia and fungemia diagnosed by blood culture from May 1990 through May 1995 were identified and included in the study. The course of each episode of bacteremia or fungemia was followed until its conclusion.Ten and 3 mL of blood samples were drawn aseptically from adult and pediatric patients with suspected BSI, respectively. Each blood sample was divided into two bottles: NR6A (enriched soybean casein digest broth with CO 2 ) for aerobic cultures, and NR7A (prereduced enriched soybean casein digest broth with CO 2 ) for anaerobic cultures. Both bottles were incubated for seven days (eight weeks for brucella) at 37 C, and read daily on a Bactec NR 660 (Becton Dickinson). Subcultures on blood agar, chocolate agar and MacConkey agar were incubated aerobically with CO 2 , and subcultures on blood agar were also incubated anaerobically for 48 hours. A total of 23,704 paired bottles were processed during the study period.The significance of isolates was judged according to the growth in different blood cultures, the clinical findings and the isolates obtained from other body sites. Microorganisms isolated were identified by standard techniques 5 or by API 20 E system. An episode of bacteremia was defined by the isolation of...

Moraxella (Branhamella) catarrhalis is now recognized as an important cause of respiratory tract infections. Over a two year period, Moraxella (Branhamella) catarrhalis was isolated in pure culture from 3.4% of the sputums collected from patients with symptoms of acute respiratory tract infections. It was the third most important pathogen isolated after Haemophilus influenzae and Streptococcus pneumoniae; 77% of the patients had an underlying chronic pulmonary condition. Prevalence, antibiotic sensitivity, and treatment options, will be discussed. It has generally been regarded as an oropharyngeal commensal. In the early 1980s, B. catarrhalis began to be recognized as an increasingly important pathogen when it was cultured from aspirates from infected sinuses [1] and from the middle ear in children with otitis media [2]. Its association with bronchopulmonary infections in older patients with underlying pulmonary disease has been particulary well noted [3,4].At Qatif Central Hospital in the eastern region of Saudi Arabia, there has been a marked increase in the isolation of B. catarrhalis from the sputum of patients with symptoms of bronchopulmonary infection.In this report, the prevalence and antibiotic susceptibility of B. catarrhalis in respiratory infection is described. To the best of our knowledge, this is the first report from Saudi Arabia about this potential pathogen. MethodsOur study is based on sputum cultures obtained at Qatif Central Hospital between January 1989 and December 1990; cultures positive for B. catarrhalis were identified.All sputa were screened for acceptability using published cellular criteria [5,6]. A purulent part of each sputum specimen received was examined with gram film inoculated on blood agar and heated blood plates.The plates were incubated in 7% carbon dioxide for 18 hours. Only moderate or profuse growth in the primary plate was reported. Moraxella (Branhamella) catarrhalis was identified by the presence of extraleucocytes and intraleucocytes gram negative diplococci in the gram film, by colonial and morphological appearance and by positive oxidase and catalase reactions. The identification was confirmed with the rapid carbohydrate utilization test [7].All strains were tested for deoxyribonuclease activity [8]. Tests for sensitivity to penicillin, ampicillin, amoxycillin-clavulanate, tetracycline, chloramphenicol, cotrimoxazole, erythromycin, cefuroxime, ceftrizoxime, and ceftriaxone were performed using the Stokes disc diffusion method [9].A retrospective study of the case notes and radiology reports was made for all patients who yielded a pure culture of B. catarrhalis in the sputum. Mixed infections in which organisms such as Strept. pneumoniae or H. influenzae were isolated along side B. catarrhalis were excluded from this study.