ABSTRACT
RANTES [Regulated upon Activation, Normal T cells Expressed and Secreted] is a potent chemoattractant peptide that has been shown to play a crucial role in inflammation. The aim of this study was to measure serum RANTES concentration and clarify the effect of its functional promoter polymorphisms on the risk and activity of Rheumatoid arthritis [RA]. Serum RANTES level was measured using ELIZA in 47 patients with RA and 15 healthy controls. They also were genotyped for RANTES-403G/A and -28C/G polymorphisms using PCR-restriction fragment length polymorphism [PCR-RFLP]. A significant increase in serum RANTES level was observed between the RA groups and controls with positive correlations with parameters of the disease activity in active group. As regards to RANTES [-403 G/A] polymorphism, individuals with A allele were at significant positive risk for RA but G allele were at negative risk for RA. It is noteworthy that this polymorphism was also associated with activity of the disease. On the other hand, there was no significant difference in genotype and allele frequencies of the RANTES -28C/G polymorphisms when the active RA, inactive RA, and control groups were compared. In conclusion, High serum RANTES level in patients with RA especially active ones confirmed its role in RA pathogenesis. Its interesting association with parameters of disease activity may enable rheumatologists to define RA patients who are at risk of developing activity within short periods of time. G-403A polymorphism is associated with the development and activity of RA in Egyptians. However, further larger scale population studies are necessary to clarify the role of this polymorphism in RA. If this will be proven, therapeutic antagonists to RANTES may lead to the development of effective alternative treatment for RA, particularly in patients carrying the RANTES -403 A allele
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
This study was carried out in Neonatal Intensive Care Unit [NICU] Tanta University Hospital over a period of one year on 70 neonates diagnosed as neonatal sepsis and a control group composed of 10 neonates having physiological jaundice only. Blood cultures were done for patients and MRSA was detected using oxacillin and cefoxitin disc diffusion, oxacillin agar screening and dilution methods. Blood samples were tested for total leucocytic count and for C-reactive protein and serum samples were tested by ELIZA for Soluble IL-2 receptor [sIL-2R]. Staph. aureus was detected in 15% of early onset and 60% in late onset sepsis. In early onset sepsis, MRSA was detected in 33.3% by oxacillin disc diffusion method, agar screening method and in 66.7% using agar dilution and cefoxitin disc diffusion methods. In late onset sepsis MRSA was detected in 38.9% by oxacillin disc diffusion, 44.4% by agar screening, and 83.3% by agar dilution and cefoxitin disc diffusion methods. sIL-2R had a high ability to confirm the diagnosis of early neonatal sepsis, i.e. its sensitivity was high [85%]. This ability to confirm positive cases was more profound in late onset sepsis [96.7%]. Using the ROC curve for comparison between sIL-2R and CRP revealed that sIL-2R is more diagnostic, while comparing sIL-2R with TLC proved that the latter is more diagnostic. In Conclusion, MRSA is becoming a problem in our NICU. Cefoxitin disc diffusion as well as oxacillin agar dilution methods are reliable predictors of MRSA. As a diagnostic marker for infection, sIL-2R is useful especially when combined with CRP and TLC
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
ABSTRACT
Metallo- beta lactamases [MBLs] have been increasingly recognized from bacterial isolates worldwide where they are considered to be one of the most worrisome antibiotic resistance mechanisms. They differ from other beta-lactamases in their need of metallic cofactor for enzymatic activity which could be inhibited by metallic chelators, in their ability to resist beta-lactamase inhibitors and in being able to hydrolyze all beta lactams including carbapenems. In the present study, the most common MBLs- genes [the VIM and IMP genes] were detected using multiplex polymerase chain reaction [PCR] in nosocomial isolates of 40 Imipenem [IPM] resistant and 20 Imipenem sensitive Pseudomonas aeruginosa. The results revealed that none of the Imipenem sensitive isolates had any MBLs-gene while 16/40 [40%] of the Imipenem resistant isolates were positive for MBL-VIM gene and none of them had MBL-IMP gene. So, MBL-VIM gene was found to be significantly associated with IPM resisting than IPM sensitive isolates [P<0.001]. Among the IPM resisting P. aeruginosa, isolates which had the VIM gene were found to be more prevalent in blood [87.5 %] and sputum [60 %] than urine [20 %] and infected post operative wounds or burns [8.3 %]. It was also found that VIM positive isolates were more resistant to Amikacin [75% versus 66.7%, P 1.000], Ceftazidime [93.8% versus 45.8 %, P 0.034], Ciprofloxacin [100% versus 29.2%, P 0.000], Gentamycin [87.5% versus 50%, P 0.020] and Tobramycin [81.3% versus 41.7%, P 0.022], and less resistant to Piperacillin [50% versus 75%, P 0.205] than VIM negative isolates. Moreover, case fatality rate was found to be significantly higher in patients infected with VIM positive isolates than those infected with VIM negative isolates [50 % versus 8.4 %, P 0.005]. It could be concluded that isolates of IPM - resistant P. aeruginosa which had MBL-gene [MBL-producers] were more resistant to antibiotics and more associated with serious infections and higher mortality rate than those which have other mechanisms of beta lactam resistance. So, as it is thought that emergence of such enzymes could bring us to feared end of antibiotics, it has to be recommended that all IPM-resistant isolates should be tested for MBLs production. This will ensure the early recognition of an outbreak and introduction of appropriate infection control measures to prevent further nosocomial spreading of such multiresistant highly virulent strains