ABSTRACT
Background: trimethoprim/sulfamethoxazole [['MPISMX] has been the antimicrobial of choice for treatment of Stenotrophomonas malt philia [S. malt philia] infections. Several reports have shown that the prevalence of strains resistant to TMP/SMX is increasing. We investigated prevalence, risk factors and sulfamethoxazole resistance determinants of TMPISMX resistant S. malt philia in our geographic location
Methods: this study was conducted from January, 2009 till March, 2010 on 625 patients admitted to intensive care units [ICUs] in Mansoura University Hospitals [MUHs]. Nosocomial S. malt philia infections were detected in 90 samples. Antimicrobial susceptibilities were determined using the disk diffusion method. PCR was. Conducted for the detection of sull and sul2
Results: out of 90 S. malt philia isolates, 22 [24.4%] revealed resistances to TMPISMX Significant risk factors were: duration of ICU stay [P = 0.018], antibiotic treatment [P = 0.002] specifically Carbapenems [P = 0.035] and fluoroquinolones [P < 0.001] and duration of antibiotic treatment. All TMPISMX resistant S. malt philia isolates were positive for sull gene. None of the isolates carried sul2
Conclusion: the isolation of TMP/SMX resistant S. malt philia at our geographic location is alarming. Strategies to prevent S. malt philia infection should be encouraged. The resistance of S. malt philia isolates to TMP/SMX is due to sull rather than to sul2
ABSTRACT
Background: implementation of MRSA decolonization programs is increasing and the emergence of mupirocin resistance among MRSA isolates has been a well-defined phenomenon in many parts of the world two mupirocin resistance phenotypes; low-level [LR-Mup] and high-level [HR-Mup] mupirocin resistance. Are defined in staphylococci. High-level mupirocin resistance cannot be eradicated with mupirocin
Aim of the Work: to assess the prevalence of the Mup A [ileS-2] gene encoding high-level mupirocin resistance among MRSA isolates and to study risk factors and predictors of mupirocin resistance in Mansoura University Hospitals [MUHs] supporting an efficient control of MRSA colonization
Materials and Methods: This study was carried out on 1200 nasal swab, MRSA isolates were detected by growth on Mueller-Hinton agar supplemented with 4% NaCl and oxacillin [6mglml] and confirmed by cefoxitin disc 'diffusion test [DDT]. Mupirocin resistance was detected by DDT and agar dilution test [ADT]. The presence of mup A [ileS-2] gene was tested by PCR for all mupirocin resistant MRSA isolates
Results: out of the 396 MRSA isolates, 76 mupirocin resistant strains were detected. Of them 59 [77.6%] were LR-Mup and 17 isolates [22.4%] were HR-Mup Significant risk factors included; previous ICU stay, previous treatment with mupirocin, other antibiotics and previous pseudomonas infection
Conclusion: mupirocin resistance is an emerging problem in MUHs. In our study HR- Mup mupirocin resistance was detected in 22.4% of MRSA isolates. The finding that the ileS2 gene was detected in all HR-Mup MRSA represents an alarming sign as this gene allow the fast spread of resistance among both MRSA, methicillin sensitive S. aureus [MSSA] and coagulase negative staphylococci [CoNS]. Thus we recommend a strict policy on mupirocin use. in MUHs including proper dose and duratio:1 as prolonged use has led to the development of a rapidly transmissible resistance
ABSTRACT
Background: Infections by multidrug-resistant [MDR] and pan-resistant A.baumanii have become a challenging problem. Resistance to carbapenems is a rising problem. Tigecycline provided a new hope for the treatment of MDR- A. baumannii infections. Our aim was to assess the incidence of MDRA. baumanii in various nosocomial infections in our institution, detecting the carbapenemase activity in those strains and finally in vitro evaluation of tigecycline against sensitive and MDR-A.baumanii strains
Methods: A.baumanii strains were isolated from different nosocomial infections in Specialized Medical Hospital, identified by API 20E,antibiotic sensitivity by disc diffusion method was done. Carbapenemase activity was tested in IMP- resistant strains by Imipenem EDTA double disc synergy test[DDST], Modified Hodge test, and finally detecting metallo-beta lactamase gene blaIMP by PCR. In vitro susceptibility to tigycycline by broth microdilution test was done for all isolated A.baumanii strains
Results: Thirty MDR -A.baumanii strains were isolated which represents 8% of all nosocomial infections. The most significant associated risk factor was: previous antibiotic intake, presence in intensive care units [ICUs], mechanical ventilation, indwelling catheter, urinary catheter, and peripheral vascular disease. Carbapenemase activity was detected in 44.4% by DDST, in 33.3% by the Modified Hodge test and blaIMP gene was detected in 50% by PCR. The DDST had 89% sensitivity and 100% specificity. Tigecycline showed MIC50 value of 1mg/L and MIC90 of 2mg/L with a unimodal susceptibility in carbapenem sensitive and resistant strains
Conclusion: MDR-A.baumanii is an emerging problem in our institution. DDST and M.Hodge test can be used for screening of cabapenemase. Tigecycline had a good activity against the MDR A. baumannii strains while maintaining the same MIC90 of 2 mg/L against the carbapenem-resistant and sensitive strains
ABSTRACT
Bloodstream infections [BSI] due to Candida species are important complications in immunocompromised patients. This study presents data on species distribution and antifungal susceptibility profiles of Candida bloodstream isolates obtained from Mansoura University Hospitals [MUH] over a 2-year period. All the bloodstream isolates were identified to species level by CHROMagar Candida cornmeal-Tween 80 agar, and API 20C [bioMerieux, France]. Susceptibility to triazole antifungal drugs were determined by M 27A2 [broth microdilution method] of the Clinical and Laboratory Standards Institute [CLSI]. C. albicans was the predominant species, followed by C. parapsilosis, C. tropicalis, C. glabrata, C. krusei and C. dubliensis . All C. dubliensis, C. tropicalis and C. glabrata isolates were susceptible to triazoles. Resistance to fluconazole was observed in 3.8% [1/13] of C. albicans isolates, 50% [2/4] of C. glabrata isolates and 100% [4/4] of C. krusei isolates. Resistance to voriconazole was observed in 4 isolates [12.1%]. Our findings show that C. albicans is the most common cause of Candida-related BSI, followed by C. parapsilosis, and that the rates of resistance to triazole antifungals are low among bloodstream Candida isolates in MUH
ABSTRACT
Background: Occult hepatitis C virus [HCV] infection is a type of recently identified chronic infections that is evidenced only by detection of HCV- RNA in patients' liver tissue with consistently negative serum tests for antibodies to HCV and HCV-RNA
Aim: To study the prevalence of occult HCV infection among Egyptian patients with abnormal liver function tests and compare the characteristics of those patients with other patients with overt chronic hepatitis C infection
Methods: The presence of HCV-RNA was tested by reverse-transcription polymerase chain reaction [RT-PCR] in both liver tissue and peripheralblood mononuclear cells [PBMCs] for forty five patients with abnormal liver function tests. Clinical features of 27 patients with occult HCV infection [ 27 out of 45 patients who were negative for anti-HCV and serum HCV-RNA] were compared to 50 untreated patients with chronic HCV [anti-HCV antibodies and serum HCV-RNA positive], matched for age, gender, duration of abnormal liver function tests and body mass index
Results: HCV-RNA was detected in liver tissue of 27 [59.4%] out of 45 patients with abnormal liver function tests who were negative for both anti-HCV antibodies and serum HCV-RNA with abnormal liver function tests [i.e., who had occult HCV infection]. Twenty patients out of the 27 [74%] having intrahepatic HCV-RNA, had also viral RNA in their PBMCs. Regarding the biochemical characteristics there was significant impairment in classic HCV infection; serum bilirubin [P < 0.001], ALT [P = 0.009], AST [P = 0.013], alpha fetoprotein [P < 0.001], and fasting blood glucose [P < 0.008], but serum albumin, cholesterol, triglycerides and prothrombin time were significantly higher in occult HCV than chronic HCV [P <0.001]. No significant difference regarding Gamma-glutamyl transpeptidase [P< 0.10] was found. Necroinflammatory reactions, fibrosis, [P<0.0001] and cirrhosis [P = 0.03] were significantly higher in chronic HCV than occult HCV, but there was no significant difference regarding steatosis [P = 0.41]
Conclusion: Patients with abnormal liver functions may have intrahepatic HCVRNA in the absence of anti-HCV antibodies and serum HCV-RNA. Occult HCV infection is a milder disease than chronic HCV. Screening of those patients with persistently abnormal liver function for occult HCV-RNA can be firstly done by examining PBMCs
ABSTRACT
Background and aim of work: stenotrophomonas maltophilia [S. maltophilia] is recognized as an important cause of nosocomial infection, especially in immunocompromised patient's .The treatment of S. maltophilia infection presents a therapeutic challenge because the organism is usually resistant to most of the commonly used antimicrobial agents. Enterobacterial repetitive intergenic consensus - polymerase chain reaction [ERIC-PCR] is a simple and rapid method to detect the genomic polymorphism at the strain level in nosocomial outbreaks due to S. maltophilia. This study investigated the isolation, risk factors, antimicrobial resistance and genotypic relationship of 22 S. maltophilia isolates from 22 patients in MUHs. During the period from March 2007 to April 2008
Methods: 22 Isolates were collected from sputum, endotracheal aspirate [ETA], blood, urine and pus from ICUs, medical and surgical wards in [MUHs]. Susceptibility profiles for 12 antimicrobial agents were determined by the NCCLS agar dilution method for non-fermentative bacteria, while [ERIC-PCR] was used for genotyping of the isolates
Results: S. maltophilia was isolated mostly from respiratory tract [50%] followed by blood [27.3%]. The risk of S. maltophilia isolation was higher in intensive care units. Antibiotic exposure, mechanical ventilation and central venous catheter were considered as risk factors for S. maltophilia acquisition. Resistance levels were > 60% for all antimicrobial agents tested except co-trimoxazole [4.5%] and ticarcillin clavulinic acid [18.2%]. By ERIC-PCR 15 genotypes were detected which indicates high genetic diversity among S. maltophilia isolates and highlights the importance of ERIC-PCR in detecting the variability among these isolates
ABSTRACT
Background and aim of the work: in healthy adult women, the normal vaginal pH is < 4.5 which is mainly maintained by lactobacilli. Some species of lactobacilli are hydrogen peroxide [H2O2] producers. Lactobacilli, principally the strains that are hydrogen peroxide producing, may have a protective effect against vaginal colonization by pathogenic species such as those that cause bacterial vaginosis. The aim of this study was to investigate the lactobacillary flora in normal pregnant women and pregnant women with preterm labor, to compare vaginal flora by smear and score by Nugent criteria on Gram stain and to assess the distribution of lactobacilli generating hydrogen peroxide in both groups and its correlation to preterm labor
Methods: vaginal specimens were obtained from 60 normal pregnant women and 40 pregnant women with preterm labor with intact membranes. Leukocytic counts, pH detection and Gram stain for scoring by Nugent criteria were done. Isolation and semiquantification of vaginal lactobacilli on Man-Rogosa-Sharp media [MRS] and identification of lactobacilli by detection of 1,350 bp fragment of 16S rRNA gene by polymerase chain reaction [PCR] was done. Lactobacilli were then tested for their production of hydrogen peroxide on MRS media containing 0.25 mg/ml tetramethyl-benzidine and 0.1 mg/ml of horseradish peroxidase
Results: nugent score was significantly higher in women with preterm labor with intact membranes than normal pregnant women [P<0.001]. There was significant high isolation of lactobacilli in normal pregnant women as it was isolated from 47[78.3%] normal pregnant women and from 15[37.5%] pregnant women with preterm labor with intact membranes [P<0.001]. As regards hydrogen peroxide production from the isolated strains there was highly significant difference between both groups as after 30 min hydrogen peroxide producing lactobacilli were isolated from 59.6% of normal pregnant women isolates and 20% of preterm labor women isolates [P<0.001]. After 1h, the percentage of isolation had increased to 72.5% and 30% in both groups respectively. The number of hydrogen peroxide producing lactobacilli colonies in women with preterm labor with intact membrane after 30 min and 1h was significantly lower than the normal pregnant for the strong positive, weak positive and negative groups .With regard to the pregnancy outcomes in relation to strong positive and negative hydrogen peroxide producing groups there was significant difference for the gestational age at delivery as it was 37.34 w for the strong positive group and 32.31 w for the negative group [P<0.001]]. Also, the incidence of preterm delivery was significantly reduced in the strong positive group as it was 2 women [11%], while it was 8 women [40%] for the negative group
Conclusion: hydrogen peroxide production by vaginal lactobacilli may be used as a simple test for detection of women at high risk of preterm labor