Prevalence of extended spectrum beta lactamase producers in an Egyptian critical care center

To determine the existence of extended spectrum beta lactamase [ESBL] producing Gram negative bacilli [GNB], in an Egyptian critical care center [CCC], we conducted a study over a period of 14 months at Kasr El Aini hospital, Cairo University. We collected 340 samples from health care workers [HCWs], and from 50 patients who acquired infections during hospitalization. Susceptibility of all isolated GNB was done to cephalosporin's [e.g. ceftazidime, cefotaxime], aztreonam, aminoglycosides [e.g. amikacin, gentamycin, and tobramycin], ciprofloxacin, imipenem, piperacillin and other beta lactamase inhibitors. Out of 176 isolated GNB, 106 isolates [60.2%] were confirmed as ESBL producers, mostly Escherichia coli [E. coli, 34%] followed by Klebsiella species [spp.] [30.2%] and Pseudomonas spp. [24.5%]. The predominant hospital acquired infection was respiratory tract infection [RTI] [60.2%] followed by urinary tract infection [UTI] [15.9%]. ESBL producing E. coli were responsible for 23.6% of hospital acquired RTI followed by ESBL producing Pseudomonas spp. [21.7%] and ESBL producing Klebsiella spp. [15.1%]. On the other hand, ESBL producing E. coli and Klebsiella spp. were equally responsible for hospital acquired UTI. 80-90% of these ESBL producing GNB were sensitive to imipenem and 70-90% was sensitive to piperacillin/tazobactam. ESBL producing GNB were isolated from hands of HCWs. Plasmid profile analysis demonstrated that hands of HCWs play an important role in spread of ESBL producing GNB among patients. In conclusion, ESBL producing GNB exist in this Egyptian CCC [106/340, 31.2%]; and rational antibiotic guidelines are mandatory to minimize the problem along with infection control practices. Incorporating microbial genetic typing in infection control program is recommended

Study of campylobacter pylori in diabetic patients

Gastric antral biopsies were obtained from 40 insulin-dependent diabetics [IDDM] and non-insulin dependent diabetics [NIDDD] in Kasr El-Aini Hospital [13 males and 27 females]. Endoscopy showed that 47.5% of the patients have normal endoscopic appearance. Antral gastritis was present in 47.5%, esophagitis in 15% and duodenitis in 12.5% of patients. Campylobacter pylori were isolated from the antral mucosa of 22.5% of the patients. 15.8% of these patients have normal endoscopic findings, 31.6% of patients have gastritis. No Campylobacter pylori were isolated from biopsies obtained from patients having only duodenitis. No significant difference in prevalence of Campylobacter pylori was found between the two groups of diabetes. Candida albicans were isolated more frequently from antral gastric biopsies than Campylobacter pylori

Nosocomial infection due to instrumentations in critical care center

Clinical samples were collected from 120 patients admitted in the Critical Care Center of Kasr El-Aini Hospital, Cairo University. All patients under study were subjected to different types of invasive procedures. Nosocomial infection in CCC developed in 15.8% patients. Respiratory tract infections developed in 40% of the patients after the use of ventilators. Catheter associated urinary tract infection developed in 30% of the patients. 10% of patients developed infections after cardiac catheterization. Central venous line catheterization was followed by infection in 4% of the patients. The predominant organisms isolated were Staphylococcus pyogenes and epidermitis followed by Gram negative bacilli mainly Klebsiella and Pseudomonas. The duration of subjection to different procedures was found to influence the incidence of infection. Sex and age factors did not play any role in changing the incidence of nosocomial infections

Catheter associated coagulase-negative staphylococcal infection

In the past 6 years, the coagulase-negative staphylococci have emerged as a major source of nosocomial sepsis, usually in the setting of an intravenous catheter. In this work samples and swabs were taken from 30 patients receiving infusion therapy in intensive care unit. Isolation and identification of coagulase-negative staphlococci from nose, skin around the catheter, therapeutic fluid, surface of the catheter and blood were carried out by culture and biochemical reactions. Seventeen catheters out of 30 were positive for coagulase-negative staphylococci, and no organisms could be isolated from the blood of these patients. Coagulase-negative staphylococci can colonize the catheter without causing sepsis. Antibiotic sensitivity tests for isolated organisms showed sensitivity to amikacin and vancomycin and resistance to penicillins