High prevalence of CTX-M-15 extended spectrum beta-lactamase-producing bacterial clinical isolates in both community and hospital settings in Egypt

High prevalence of infections caused by extended-spectrum beta-lactamase [ESBL]-producing isolates, notably Escherichia coli, has been suggested in Egypt. As little is known about the genetic background of these isolates, ESBL-positive E. coli isolates obtained among 520 Enterobacteriaceae prospectively collected [May 2007 -August 2008] from inpatients [n=320] and outpatients [n=200] seen at the Theodor Bilharz Research Institute [Cairo], were characterized. Clinical epidemiology, antibiotic susceptibility, and genetic traits including bla gene, phylogenetic group, ERIC-2 PCR profile, multilocus sequence type [ST] were determined. Among the 520 collected Enterobacteriaceae, were 291 [56%] E. coli and 165 [32%] Klebsiella pneumoniae. A total of 16% of all Enterobacteriaceae were ESBL-producers: 19% in E. coli and 14% in K. pneumoniae. Of the E. coli ESBL-producers, 75% [n=41] were isolated from urine. Rates of ESBL producers did not differ significantly between in and outpatients for E. coli [20 vs 17%] but significantly for non E. coli ESBL producers [18.5 vs 1.2 %: p= 0.0001]. CTX-M-15 was identified in all ESBL producers. Of the E. coli ESBL producers, 40% belonged to phylogenetic group A, 32% to D and 26% to B2. The ERIC-2 PCR method showed genetic background diversity with clusters in each group having profiles indistinguishable to that of previously published clones: complex ST10 and ST131. MLST showed that 75% of E. coli group B2 belonged to clone ST131 and 15% to clones previously detected worldwide, ST73 and ST405. This study illustrates the dissemination of different E. coli clones producing CTX-M-15 in Africa, notably in outpatients

Easy and accurate test for evaluation of candida species and their susceptibility to antifungal agents in urinary tract infections

The present study was done to evaluate the role of Candida species in patients with urinary tract infections [UTI] either with no underlying disease or complicating urinary schistosomiasis and or cancer bladder. Isolation and identification of Candida species from urine samples was undertaken, in addition their susceptibility to different antifungal agents was tested. Four groups were studied, the first included 80 male patients with UTI, the second included 80 male patients with UTI complicating urinary schistosomiasis, the third included 36 male patients with UTI complicating cancer bladder [31 schistosomal and 5 non-schistosomal]. The fourth group included 30 normal. subjects as controls. Mixed urine specimens were cultured on Sabouraud's dextrose and candida selective agar plates. Colonies suspected as Candida species were selected for inoculation of candifast strips. Among all patients tested [196], Candida species were isolated from 38 patients [19.4%]. No yeast isolates were detected among the control group. Cialbicans was the most common of all candida isolates [73.7%], while C. krusei and C. stellatoida represent 15.8% and 10.5% of the isolates respectively. Regarding antifungal susceptibility, it was found that amphotericin-B. nystatin and fluocytosine are the drugs of choice in treatment of all Candida species isolated. Ketonazole, being new safe drug proved very excellent as antifungal agent against C. albicans, c. krusei-and C. stellatoida, it can be used for treatment as alternative drug whenever feasible. Econazole and fluconazole gave excellent antifungal activity against C. albicans isolates, they can be used successfully for treatment of the important C. albicans infections. Both drugs gave no activity against C. krusei and very poor activity against C. stellatoida, so they can be used with special susceptible infections after in-vitro susceptibility testing. Miconazole proved very weak as antifungal agent against all Candida species isolated. Occurrence of Urea plasma urealyticum and Mycoplasma hominis in Egyptian Schistosomal Patients with Urinary Tract Infections, Cancer Bladder and Urinary Stones. The present study was done to elucidate the role of Ureaplasma urealyticum [U. urealyticum] and Mycoplasma hominis [M. hominis] in Egyptian schistosomal patients with urinary tract infections [UT1], cancer bladder and urinary stones. Four groups were studied, the first included 40 male patients with simple urinary schistosomiasis, the second and third groups [30 patients each] included schistosomal patients complicated with urinary stones and cancer bladder respectively, while the fourth group included 40 normal subjects as controls. Mid stream urine, bladder urine and stones in the second group were tested for M. hominis and U. urealyticum by culture on A[7] agar, U[9] broth, mycoplasma agar, mycoplasma broth and inoculation into Mycofast All-In. U. urealyticum and M. hominis were isolated from both mid stream and bladder urine samples in patients with urinary. stones in 23. 3%. In cancer bladder patients 13. 3% were positive, while patients with simple urinary schistosomiasis were positive in 17. 5%. Stone culture revealed 20% positivity. In the contorl group only mid stream urine revealed 7. 5% positivity. Comparing the results obtained on A[7] agar, U[9] broth and mycoplasma agar and broth [classic ordinary culture media for mycoplasmas] with those obtained by Mycofast All in method, same results were obtained. The current work revealed that mycoplasmas may be regarded as a considerable aetiological agents in urinary tract infections especially in patients complicated with cancer bladder, urinary schistosomiasis and urinary stones which necessitates proper indentification and treatment. The Mycofast All-In test may be used as an alternative rapid and easy method for diagnosis of mycoplasmas

Role of mycoplasma hominis and ureaplasma urealyticum in patients with chronic prostatitis

This study was done to elucidate the role of Mycoplasma hominis [M. hominis] and Ureaplasma urealyticum [U. urealyticum] in patients with chronic prostatitis. The study was done on two groups. The first group included 50 male patients with chronic prostatitis, the second group included 10 normal subjects as controls. Urine samples before and after prostatic massage and prostatic secretions were collected from all patients and controls. Prostatic secretions were used for preparation of wet and Gram stained films, culture on conventional culture media and to inoculate Mycofast AlI- In trays. Conventional cultures revealed positive growth in 74% of cases. Strept faecalis and Staph epidermides were the commonest organisms isolated. 26% of cases and all the controls revealed no growth. The overall isolation rate of U. urealyticum and M. hominis was 12%. Each of U. urealyticum and M. hominis was detected in 4% of cases and both organisms occured in 4% of cases. All controls were negative for mycoplasmas. Regarding antibiotic susceptibility, all M. hominis and U. urealyticum strains were susceptible to minocycline, tetracycline and ciprofloxacin except one strain of U. urealyticum which was resistant to ciprofloxacine. We concluded that mycoplasmas may be considered as an aetiological agent in chronic prostatitis either solely or in combination with other bacteria. Also, it is concluded that mycofast All-In kit, which is a rapid and easy test, can be used for routine diagnosis of mycoplasma infections

Doxycycline treatment in mycoplasma and ureaplasma urinary tract infections

Mycoplasma hominis [M. hominis] and Urea plasma urealyticum [U. urealyticum] were documented to play a significant role in recurrent urinary tract infections [UTI] in Egyptian patients especially when associated with urinary schistosomiasis. Doxycycline is the drug of choice used to treat these infections at TBRI [100 mgtwice daily for 2 weeks] and this study was conducted to evaluate its efficacy. Fifty six patients with M. hominis and/or U. urealyticum UTI were included and classified into two groups according to association with urinary schistosomiasis. Cure rates of 39.4% and 34.8% were achieved after one course of treatment in group [I] [schistosomal] and in group [II] [non-schistosomal] patients respectively. Higher rates were achieved after a second course of doxycycline in resistant cases [88% and 91% respectively] Test-of-cure cultures obtained 10-15 days after completion of therapy showed treatment failure in only 6 patients [10.9%], four of them had urinary tract stones and their urine samples grew U. urealyticum, three of these patients were schistosomal. It is concluded that a high cure rate [89%] could be achieved by repeating the doxycycline course. Patients with urinary stones should be managed operatively before successful doxycycline therapy