ABSTRACT
Background:Late-onset sepsis [LOS] is well-defined as onset of sepsis more than 72 hours of age. Late onset thrombocytopenia occurs frequently due to sepsis
Objective: The aim of our study was to learn the incidence of thrombocytopenia in neonates with late onset nosocomial sepsis and to study the effects of different infectious organisms on platelet counts and thrombopiotin [Tpo] Level in Neonates with LOS
Methodology:This study was performed prospectively on 60 neonates from Neonatal Intensive Care Unit [NICU]. The sample eligibility criterion was the presence of documented nosocomial late onset sepsis [LOS]. Sixty non septicemic neonates from the same NICU were included in the study as a control group. All neonates were subjected to the following: Complete blood cell count, C-reactive protein assessment, blood culture and assesment of thrombopoietin level
Results: Our study showed that platelet counts were significantly lower among case group compared with control group [p<0.01]. This study showed that more than half of the cases had severe thrombocytopenia [53.13%] and the majority of them had bacteria culture test positive [83.3%] with high mortality among them [53.13%]. The most common isolated organism was klebsiellapneumoniae followed by Staph. aureus then Coagulase Negative Staphylococcus [CONS]. In our study, there was statistically significant association between platelet count in thrombocytopenic neonates and blood culture resultes among studied cases. There was significant inverse correlation between platelet count and Tpo level in thrombocytopenic group
Conclusion: Thrombocytopenia is an early marker of sepsis and can be used as a screening procedure for early detection of sepsis, especially in NICU. Type of organism in blood culture results affect both platlet count and Tpo level
ABSTRACT
Coagulase negative staphylococci are normal skin commensals and are frequently isolated from clinical specimens. CoNS are a major cause of sepsis in the neonatal intensive care unit. The virulence of these bacteria is mainly due to their ability to form biofilms on indwelling medical devices. One important element in this process is the ica operon [intercellular adhesion operon], a gene cluster encoding the production of polysaccharide intercellular adhesion [PIA], which mediates the intercellular adherence of bacteria and the accumulation of multilayer biofilm . This work aimed to evaluate that pathogenic CoNS isolates are more likely to be positive for the ica operon and to produce biofilm than isolates isolated randomly from healthy individuals. Also to compare between antibiotic sensitivity of biofilm producing CoNS isolates and non-biofilm producing CoNS isolates. Finally to detect source of infection in neonatal intensive care unit using biotyping, antibiogram and plasmid profile as epidemiological markers. This study was conducted from April 2010 to April 2011, at Medical Microbiology and Immunology Department, Faculty of Medicine Zagazig University. The study included 40 neonates admitted to NICU, with picture of bacteremia with the mean age 17.43+/- 7.2 days. From them 40 blood samples were taken from peripheral sites and 40 skin swabs were taken from axilla for culture on blood culture bottles and blood agar respectively. 40 age matched healthy neonates as control group and 25 health care workers from NICU to detect source of infection were enrolled in the study. The biofilm production was examined using congo red agar and the presence of genes icaA, icaD were determined by PCR. Biotyping, antibiogram and plasmid profiles were used as epidemiological markers to detect source of infection in NICU. The isolated CoNS were [32.5%, 37.5%, 20% and 24 from blood samples, skin swabs, control and health care workers respectively and the most common isolated organism was S. epidermidis followed by S. haemolyticus then S. hominis. Also the results of qualitative detection of biofilm formation were 69.2%, 33.3% and 33.3% from the studied specimens respectively but all control were non-biofilm forming. The icaA and icaD genes were 76.9%, 40% and 33.3% from studied specimens respectively but both genes were not found in any control isolates. We conclude that the isolates of CONS infections are more likely to be positive for ica operon and health care workers play a role in dissemination of CONS infection in hospital
ABSTRACT
Purpose: The objectives of this study were to determine the magnitude of antibiotic resistance problem among Klebsiella pneumoniae isolates from patients with ventilator associated pneumonia and to investigate the association between multidrug resistance [MDR] strains and DNA, elements called "integrons, ". Also study aimed to test the effect of combined drugs therapy as alternative strategy for these MDR strains
Materials and methods: A total of 32 Klebsiella pneumoniae isolates were isolated from 130 endotracheal samples, randomly collected from suspected cases of ventilator associated pneumonia admitted to the ICU ofzagazig University hospitals and their resistance to different groups of antibiotics were analyzed. All MDR K. pneumoniae strains were tested against Combined antibiotics including Polymyxin B in combination with gentamicin, and rifampin. Also combined ciprofloxacin plus amikacin were tested to identify new treatment strategy. These isolates were further characterized by molecular studies to identify the Class I integr on-encoded intll integrase conferring the antibiotic resistance
Results: Although 22 of the 32 K. pneumoniae strains were MDR [i.e. resistant to three or more classes of antibiotics], all the strains were sensitive to imipenem. PCR detection using resistance gene-specific primers showed that 86.3% of MDR K. pneumoniae strains harboured Class I integr on-encoded intll integrase . Synergy was observed with the combination ofpolymyxin B and rifampin as well as with ciprofloxacin and amikacin
Conclusion: There was an increase in the spread of the MDR clinical isolates of Klebsiella pneumoniae among ventilator associated pneumonic patients. The results suggest that rifampin, may be useful additions to polymyxin B and ciprofloxacin plus amikacin in the treatment of infections caused by MDR K. pneumoniae. The study concluded high prevalence of Class 1 integr on-encoded intll integrase in MDR Klebsiella pneumoniae isolates?
ABSTRACT
Acinetobacter is frequently isolated in nosocomial infections and is especially prevalent in intensive care units, where sporadic cases as well as outbreaks and endemic occurrence are common. Acinetobacter infections are serious and difficult to treat owing to their ability to acquire resistance to many of the most commonly used drugs
Aim of work: to evaluate the role of Acinetobacter spp. as nosocomial pathogens in Zagazig University hospitals including methods of identification, the isolation rate from clinical and environmental samples and their antibiotic susceptibility patterns
Subjects and Methods: the study included 333 samples isolated from 273 hospitalized patients, 10 health care workers and 50 environmental samples. Identification of isolates by conventional methods as well as PCR detection of bla OXA-51-like Carbapenems gene was performed. Susceptibility patterns of Acinetobacter isolates to antibiotics were determined
Results: forty two [1 2.6%] Acinetobacter isolates were detected. Out of 273different clinical specimens and JO health- care staff examined 29 [10.6%] and 2 [20%] Acinetobacter baumannii were isolated respectively. Out of 50 different environmental specimens, 11 Acinetobacter strains [JO [90.5%] A. baumannii and I [9.5%] A. haemolyticus] were isolated. All isolates A. baumannii were positive for the of bla OXA 51-like gene. There was complete matching between conventional methods and PCR. Antimicrobial susceptibility testing of all 42 Acinetobacter isolates identified· a majority of multi-drug resistant isolates. Conclusion: PCR is recommended for identification of Acinetobacter baumannii in epidemiological studies and research work because conventional methods cannot differentiate between Acinetobacter baumannii an4 some strains of DNA group 13 phenotypically. The incidence of multidrug resistant Acinetobacter isolates is high. So, antibiotic policy for empirical administration of antibiotics is recommended depending upon the results of antimicrobial culture and sensitivity testing. Strict adherence to infection control measures should be practiced
ABSTRACT
Purpose: To demonstrate the prevalence and possible risk factors of retinal complications of pegylated interferon plus ribavirin treatment on patients involved in the national campaign for treatment of chronic hepatitis C in Sharkia governorate in Egypt
Methods: The study included 646 patients with chronic hepatitis C who were receiving treatment with pegylated interferon- alpha and ribavirin combination. Ophthalmologic examination was carried out on all patients of the study that were at different times of the treatment course. Ocular examination consisted of best corrected visual acuity measurement, anterior segment biomicroscopy and dilated fundoscopy. Patients with retinopathy had colored fundus photography. Statistical analysis was done to determine the prevalence of retinopathy and the possible correlation of several variables [age, sex, duration of treatment, dose of ribavirin, virus load, type of peginterferon [PEG-IFN alpha-2a or PEG-IFN alpha-2b], diabetes, hypertension etc] to the occurrence of retinopathy in this group of patients
Results: Out of 646 patients, 120 patients developed interferon induced retinopathy, so the prevalence of interferon induced retinopathy is 18.6%. 85% of the patients with retinopathy were asymptomatic; there were statistically significant correlations between patients' age, body mass index, dose of ribavirin, diabetes mellitus, hepatitis C virus load, general side effects of interferon treatment and the occurrence of retinopathy
Conclusions: Interferon induced retinopathy is not uncommon side effect of interferon plus ribavirin treatment and stress on regular ophthalmologic follow up is mandatory especially in patients with risk factors