ABSTRACT
Background: Tuberculosis [TB] is a serious infectious disease especially among patient with low immunity as chronic liver disease and long term treatment should be started early
Purpose: Rapid, reliable, simple and cost effective method for detection of Mycobacterium tuberculosis complex [MTBC] would be highly desirable. The purpose of this study was to evaluate a FASTPlaque TB [Biotec, Laboratories Ltd., Ipswich, UK] for the diagnosis of TB
Methods: We evaluated the clinical utility of this new assay by analyzing respiratory specimens of 100 suspect TB patients, using FAST Plaque TB kit and the performance was compared the results and time of detection, sensitivity, specificity and contamination rates with, smear microscopy, and Lowenstein-Jensen [L-J] culture method
Results: Of the total 100 TB "Suspect" patients, [63%] were male, aged from 11-67 years, most of them in age group [25-34 years] [35%], 50 were smear positive and 50 were smear negative, comparison of phage assay with AFB smear, Out of the 50 smear positive cases, 37 were phage positive and 13 were phage negative; 4 of which were identified as Mycobacteria Other Than Tuberculosis [MOTT]. Amongst the 50 smear negative samples, 4 samples were positive by phage assay. The sensitivity, specificity, positive predictive value and negative predictive value of the phage assay with respect to AFB smear positivity were 82%, 100 %, 100% and 83.6 % respectively. In comparison of the results of culture positivity with phage assay, it was noted that of a total of 61 culture positive samples, 41 were phage positive and 20 were phage negative of which 8 were identified as MOTT. The sensitivity, specificity, positive predictive value and negative predictive value of phage assay with respect to growth on L-J media were 77.4%, 100%, 100% and 76.5 % respectively
Conclusions: We believe that this new low cost assay may have wide spread applicability, especially in developing countries, due to its manual format and rapid reporting of results
ABSTRACT
Background: The emergence of drug resistant strains of Mycobacterium tuberculosis is of growing concern. Multi-drug resistance [MDR-TB] where the strain is resistant to both rifampicin [RIF] and isoniazid [INH], has been reported in all regions of the world. Early choice, and rapid determination of drug resistance can allow a customized approach to treatment early in the course of the disease and can potentially reduce morbidity, mortality and infectiousness. It would be helpful for low-resource countries to have simple and inexpensive tests which can rapidly detect resistance to RIF .The excellent performance of the BACTEC MGIT 960 for rapid detection of resistance to first- and second-line anti-TB drugs can be accomplished in days rather than weeks, although still constrained by high cost equipments and consumables. FASTPlaque-Response is a phage amplification-based test for detection of RIF resistance and has been developed for direct use on sputum specimens
Aim: The present study was undertaken to compare between BACTEC MGIT 960 method and FASTPlaque-Response method for the time, specificity and sensitivity determination of RIF susceptibility in sputum of both positive [+ve] and negative [-ve] AFB-smear of Mycobacterium tuberculosis patients
Results: In this study, a total of 60 specimens were collected and divided according to Z-N staining into two groups : group[1] which was Z.N [+ve]comprising 47 specimens ranged from+1 to +3 positivity, and group[2] which was Z.N -[-ve] comprising 13 specimens. The turnaround-time [TAT] of group[1] by BACTEC MGIT 960 ranged from 8 to 39.2 days with Mean +/- SD 13.9 +/- 3.4 days for positivity and ranged from 4 to 12.96 days with Mean +/- SD[8.02 +/- 1.98] days for susceptibility pattern, while in group[2] the TAT ranged from 8.2 to 41.75 days with Mean +/- SD[15 +/- 5.2] days for positivity and ranged from 4.04 to 13 days with Mean +/- SD [8. 6 +/- 2.2] days for susceptibility pattern ,In contrast to BACTEC MGIT960, FASTPlaque-Response susceptibility pattern was completed in just 48 hours. Susceptibility pattern of RIF by BACTEC MGIT 960 and FASTPlaque-Response showed the same results in 35 out of 60 specimens [58%] which were [26,6 and 3] Sensitive, resistant, and contaminant respectively, While the other 25 specimens [42%] showed discrepant results. In group [1]: 34 out of the 47 specimens [72 %] showed the same results by FASTPlaque- Response and BACTEC MGIT 960, while discrepancy occurred in the other 13 specimens [28 %], in which 12 specimens were RIF sensitive by the BACTEC MGIT 960 and showed different results by FASTPlaque- Response [6,2 and 4 were resistant ,contaminant and no growth respectively],while the 13th specimen which was resistant by BACTEC MGIT960 became sensitive with FASTPlaque- Response .In group[2] the results by the two methods were the same in only one out of 13 specimens [8 %], whereas the discrepancy was in the other 12 specimens [92 %] in which 8 specimens were sensitive with the BACTEC MGIT 960, 7of them showed no growth and the 8th was contaminant by FASTPlaque-Response, while 3 specimens were resistant by BACTEC MGIT 960, 2 of them were contaminant and 1 showed no growth by FASTPlaqueTB- Response, whereas, the 12th specimen was contaminant by BACTEC MGIT 960,but showed no growth with FASTPlaqueTB-Response . In group[1]; 4 out 47 specimens[8.5%] were contaminants and 4 specimens[8.5%] showed no growth by FASTPlaque- Response ,while,2 specimens[4.2%] were contaminants and no specimens showed no growth by BACTEC MGIT 960. In group[2];5 specimens out of 13 [38.5%] were contaminants and 8 specimens [61.5%] showed no growth by FASTPlaque- Response ,while,2 specimens[15.3%] were contaminants and no specimens showed no growth by BACTEC MGIT 960
Recommendation: Standardization of phage method to minimize the number of contaminated or incorrect results is necessary before this diagnostic tool can be implemented widely, and improvement needed to become highly sensitive and specific in that cases to become routinely used
ABSTRACT
The frequency of multi-drug resistance Pseudomonas aeruginosa infections are increasingly recognized worldwide. P. aeruginosa isolates resistant to all antimicrobial agents have been detected in many areas. Since IMP1 producers tend to demonstrate a wide range of resistance to various broad-spectrum beta-lactam including oxyimino cephalosporin, cephamycine and carbapenemes, early recognifion of IMP-1 producers is very important for rigorous infection control. The present study was designed to detect the incidence of P. aeruginosa infection, characterize the antimicrobial resistance profiles and screen for the IMP-1 producers strains. From 1[st]of July 2007 to 30 June 2008, A total of 4031 isolates were obtained of these 837 [20.76%] were identified as Pseudomonas, the great majority of them was P. aeruginosa [n=816; 97.5%] and the most of which was isolated from the wounds [n=256; 30.6%] , sputum [n= 242; 28.9%] , urine [n=64; 7.6%], Tracheal aspirate [n=55; 6.65] and lastly ear swab [n=3; 0.35%]. Intensive care unit accounts the most source of infection [n= 171; 20.4%] then burns unit [n=111; 13.3%] and lastly obstetric department [n=8; 0.9%]. High resistance rates were observed for all antibiotics studied. imipenem appeared to be the most active agent against the majority of isolates [ S=78%], then levofloxacin [S=75%], followed by piperacillin / tazobactam [S= 71%], amikacin [S= 67%], tobramycin [S=65%], ciprofloxacin [S= 63%], cefepime [S=60%], gentamycin [S= 59%], pipracillin and ceftazidime [S= 57% for each], while ceftriaxone and cefotaxime were the least active agents with a sensitivity [35%] only. IMP-1 Metallo-beta-lactamas were detected in 148 [41% of the 360 CAZ- resistant isolates] out of 816 P. aeruginosa iso1ates. After the results of this study we concluded that the rates of P. aeruginosa infection were high with increasing in IMP-1 Metallo-beta-lactamase producers strains. Infection control procedures for multi drug resistance need to be re-viewed urgently. There is also a pressing need for new, and hopefully novel, compounds active against pan-resistant Gram-negative bacteria a growing problem that needs to be addressed by both governments and industries
ABSTRACT
Objective: an increase 1n community-associated methicillin-resistant Staphylococcus aureus [CA-MRSA] infections has been reported in the literature. Most severe, life-threatening infections were previously thought to be associated with chronically ill patients. Our pediatric intensive care unit [PICU] in Zagazig University hospital and National Liver institute, Al- Minufiya University, Egypt has reported a recent dramatic increase in primary, severe invasive CA-MRSA infections in healthy children
Design: we have prospectively identified patients admitted to the 2 PICUs with a diagnosis of culture-proven severe sepsis during the period from June 2007 till March 2008. Patient records were reviewed, and MRSA isolates were obtained for susceptibility testing and DNA extraction. Isolates were tested for the presence of virulence gene Panton-Valentine leucocidin [PVL]
Results: eight previously healthy patients were admitted to our PJCUs with severe primary, invasive CA-MRSA during the study period. MRSA positive cultures represented 20% of the total positive blood cultures in this period [24/120].Thirty three percent [8/24] were proved to be CA-MRSA and 66% [16/24] were HA-MRSA. The mortality rate of the CA-MRSA was 25% compared with an overall PJCU mortality rate during the study period of 10% and 12% in both PICUs. The mean PJCU length of stay of these patients was 9 days compared with an Average PJCU length of stay of 5.5 days. Six patients had pulmonary involvement in the form of bilateral necrotizing pneumonia requiring prolonged mechanical ventilation. Despite initiation of treatment with vancomycin at admission to the PICU in the eight patients, patients took a mean of 5.6 days to convert to negative blood cultures. Six patients had bacteremia longer than 5 days
Conclusions: severe CA-MRSA infections in healthy children are increasing at an alarming rate in our institutions. This acute rise in incidence, coupled with an alarmingly high associated mortality rate, raises important questions about the initial empirical antibiotic therapy we use in caring for patients presenting with suspected life threatening CA-MRSA disease. Vancomycin monotherapy may not be adequate treatment for severe CAMRSA infections
ABSTRACT
Enterococci have become important opportunistic pathogens in hospitalized patient's especially vancomycin resistant strains. This study was done to assess the prevalence of enterococci infection including vancomycin resistant enterococci [VRE] among patients admitted of National Liver Institute, to detect the possible risk factors involved in enterococci infection and to analyze the relationship between antimicrobial susceptibility pattern and plasmid profile. After identification of the isolated organisms, they tested the antibiotic susceptibility using the disc diffusion methods determine the MIC and E-test-strips, and plasmid profile analysis by agarose gel electrophoresis. The prevalence of enterococci was 20.5% , most of them were resistant to cefotaxime, ceftazidime and, cephalexin [93%], amikacin [88.4%], and vancomycin [20.91] by disc diffusion, but vancomycin resistant by E test was [23.3%] with 93.2% agreement between both methods. Six different resistance patterns [with minor 32 patterns] were found among enterococci isolates. Plasmid profile analysis showed that [44.2%] were plasmid less, while 55.8% contained plasmids with variable molecular weight ranging from 1.5 MDa to 42 MDa. Moreover, resistance to increasing numbers of antibiotics was associated with high molecular weight plasmids. In conclusion multi-resistant enterococci are important cause of Hospital associated infections. Most of these strains had plasmids, which may be responsible for resistance to antibiotics and its dissemination among the other strains
ABSTRACT
This study reviews the resistance patterns of Mycobacterium tuberculosis complex [MTBC] isolates obtained from 578 patients [369 Saudi and 209 non-Saudi] in the period between the first of January 2001 and the end of December, 2006. Four hundred thirty nine of the isolates were from respiratory sources while the remaining [139] were from non-respiratory sites. The isolates were tested for their susceptibility to isoniazid [INH], rifampin [RIF], ethambutol [EMB], streptomycin [SM] and pyrazinamide [PZA] using the BACTEC MGIT 960 system [Becton Dickinson Medical Systems, Sparks, MD]. The turnaround time for antimicrobial susceptibility testing [to SM, INH, RIF and EMB] ranged from 4.0 to 13.0 days with an average of 8.3 +/- 2.1 days. The turnaround time for susceptibility testing to PZA ranged from 4.04 to 14.25 days with an average of 7.2 +/- 2.2 days. The percentages of resistance to anti-tuberculosis drugs in Saudi and non-Saudi patients respectively were: 25.5% and 35.9% for INH; 13.6% and 21.1% for RIF, 18.4% and 23.4% for SM, 19.5% and 15.3% for EMB, 19.2% and 9.7% for PZA and 10.6% versus 16.7% for multidrug resistant [MDR] TB [resistant at least to INH and RIF]. Resistance to INH and RIF was significantly higher in non-Saudi patients [p < 0.05]. The percentages of resistance to anti-tuberculosis drugs in respiratory samples from Saudi and non-Saudi patients respectively were: 25.5% and 37.6% for INH; 15.0% and 24.2% for RIF, 21.5% and 25.5% for SM, 20.1% and 15.8% for EMB, 16.7% and 10.0% for PZA and 12.4% versus 19.4% for MDRTB. Regarding non-respiratory samples, the percentages of resistance to anti-tuberculosis drugs from Saudi and non-Saudi patients respectively were: 25.3% and 29.5% for INH; 9.5% and 9.1% for RIF, 9.5% and 15.9% for SM, 17.9% and 13.6% for EMB, 25.0% and 8.3% for PZA and 5.3% versus 6.8% for MDR-TB. The overall percentages of resistance to anti-tuberculosis drugs in respiratory and non-respiratory samples respectively were: 30.1% and 26.6% for INH; 18.5% and 9.4% for RIF, 23.0% and 11.5% for SM, 18.5% and 16.5% for EMB, 13.5% and 19.4% for PZA and 15.0% versus 5.8% for MDR-TB. Differences were statistically significant only in cases of RIF, SM and MDR-TB. In general, resistance was higher in respiratory samples obtained from non-Saudi patients. These variations may be mainly due to the differences in the prevalence of MTBC variants between Saudi and non- Saudi patients