ABSTRACT
Tuberculosis is a growing international health concern. It is the biggest killer among the infectious diseases in the world today. Early detection of drug resistance allows starting of an appropriate treatment. We evaluated the MODS assay for diagnosis of TB and detection of multidrug- resistance, 95 consecutive sputum samples collected from patients with suspected T8, were tested by smear, proportion method of susceptibility test using Lowenstein Jensen media and MODS. The results of MODS against proportion method of susceptibility test using Lowenstein Jensen media as the gold standard was evaluated. Out of 48 acid fast positive specimens, 14 [29.1%] isolates were resistant to one or the two of the tested anti-tuberculous drugs. Seven isolates [14.6%] had single drug resistance, including one isolate with rifampcin [RIF] monoresistance. Seven isolates [14.6%] were multidrug-resistant [resistant to both drugs]. 13 [27.1%] isolates were resistant to isoniazid [lNH], 8 [16.7%] isolates were resistant to RIF, thirty four test isolates [70.8%] and the control strain were susceptible. There was 97.9- 100% agreement between both reference method and MODS. The turnaround times from specimen processing to reporting of susceptibility results ranged between 6 and 11 [mean, 8 +/- 2.14] days by the MODS method, 41 and 63 [mean, 53.3 +/- 11.58] days by the reference proportion method. The detection rates were significantly faster for MODS than for proportion susceptibility test [P<0.001]. In conclusion, MODS appears to be a reliable, rapid, and convenient method for early diagnosis of tuberculosis [TB] and performing direct drug susceptibility tests in low-resource settings
ABSTRACT
No previous data regarding the incidence of surgical site infection [SSI] are available in Egyptian University Hospitals. The magnitude of the problem resulting from SSI at the national level could not be assessed. The purpose of this study was to estimate the incidence of SSI in patients undergoing elective general surgical operations in Tanta University Hospital, together with the assessment of risk factors for SSI, common causative pathogens and their antibiotic resistance pattern. The study was carried out on 292 patients recruited from those admitted to the General Surgery Department of Tanta University Hospital for elective surgery during a period of 6 months. The patients were examined for the development of SSI during the postoperative hospital stay, the causative organisms and antibiotic resistance pattern of pathogens isolated from infection sites were investigated. Overall incidence of SSI was 22.6% . In univariate analysis, age, body mass index [BMI], smoking, concurrent corticosteroid or immunosuppressive therapy, abdominal operations, co-morbid conditions, preoperative hospital stay, duration of operation, order of operation, surgical site drains and expertise of the surgeon were significantly [p <0.05] associated with the development of SSI during postoperative hospital stay. Using the multivariate step-wise multiple logistic regression techniques, preoperative stay period, wound class, abdominal operations, duration of operation, order of the operation and expertise of the surgeon were the independent risk factors for prediction of SSI. Staph. aureus was the most frequently isolated pathogen followed by E. coli, Klebsiella, Proteus and Pseudomonas. As regards to Staph. aureus, 60.7% of the isolated strains were MRSA. On the other hand, there was emerging resistance among gram negative bacilli isolated to many antibiotics, as well as to Imipenem
In conclusion, risk factors for SSI that detected in this study should be considered in relevant infection control plans to reduce the infection rates to a considerable extent. Infection control precautions should be directed towards establishment of antibiotic policy regarding the most common organisms isolated and their antibiotic susceptibilities
ABSTRACT
Treatment of community acquired urinary tract infections [CA-UTIs] in Egypt is usually based on empirical drugs. So, this study was conducted to determine the most common causative organisms and their antibiotic susceptibility aiming at evaluation of empirical drugs used and its modification if necessary. Urine samples from 192 patients with CA-UTI were cultured on suitable media and its sensitivity to different antibiotics were tested where 136 out of them showed positive growth. Gram positive cocci isolated from 13.97% of cases whereas gram negative bacilli from 84.56% and candida was 1.47% . The commonest organisms isolated were Escherichia coli [61.76%] and Klebsiella species [12.5%] followed by Enterococcus [7.35%] and Staph. Aureus [6.61%]. The widest coverage against gram negative bacilli isolates was done by imipenem, [100%], followed by amikacin [90.4%], and Nitrofurantoin [66%]. On the other hand, the least effective antibiotic was Ampicillin/sulbactam [4.3%]. While the best sensitivity against gram positive cocci isolate was done by vancomycin [100%], followed by Nitrofurantoin [95%], Amoxicillin/ clavulanic acid and Ampicillin/sulbactam [60%]. There were also high percentages of multidrug resistant gram negative bacilli in the current work [58.26%] with 32.65% of them showed positive extended spectrum beta lactamase
In conclusion: the most common cause of our CA-UTI is gram negative bacilli. Because of alarming rate of resistance to cephalosporin, quinolones and SXT that threatens its use in our country, Nitrofurantoin and amikacin remains the choice among empirical antibiotics used in CA-UTI. Moreover, this study highlights the increasing problem of antimicrobial multidrug resistance; even in community which is alarming sign calls for judicious use of imipenem only for these severe resistant cases