Nosocomial bncillus cereus infections in pediatric intensive care units of Mansaura university children's hospital

Backgrornzd: B. cereus, a well-known cause of food poisoning, is increasingly being identified as the cause of serious and life-threatening infections in immunosuppressed patients. We investigated B. cereus infections and possible outbreaks in ICUs of Mansoura University Children's Hospital, We also studied possible risk factors and virulence factors of clinical B. cereus isolates

Methods: this study was conducted from January, 2009 to June, 2010 on 313 patients admitted to ICUs [NICU, PICU, ans SICU] in Mansoura University Children's Hospital [MUCH]. B. cereus isolates were identified by the API 50 CH. Antimicrobial susceptibilities were determined using the disk diffusion method. Biofilm assay was done by the polyvinylchloride microtiter plate. During investigation of the outbreak typing of the isolates was done by biotyping, antibiotyping and molecular typing by RAPD patterns generated by AP-PCR

Results: nosoconzial B. cereus isoaltes accounted for 4.8% of all isolated pathogens. The significant risk factors were preterm, LBW, mechanical ventilation, PCVC utilization,and TPN administration. We found that, 38.9% of B. cereus isolates had the ability to form biofilm, prolonged endotracheal intubation, vascular catheterization, and hospital stay were significant risk factors,for biofilm formation. We present 3 antibiotypes, 2 biotypes, and 4 genotypes of the 9 B. cereus isolates collected during the outbreak

Conclusion: B. cereus can cause nosocomial infections and outbreaks in ICUs of MUCH. Biofilm production suggests its role in the pathogenesis of infections. AP-PCR technique is a highly discriminatory and reproducible method for the epideniiologicai investigation of B. cereus infections

Extended Spectrum and AmpC beta lactamases among nosocomial klebsiella pneumonia isolates: possible resistance mechanisms

Background: hospital acquired Klebsiella pneumoniae may produce Amp C Beta lactamases and/or extended spectrum Beta lactamases [ESBLs] as possible resistance mechanisms among others leading to therapeutic failures and global public health problem. Objectives: to investigate cephalosporin resistance mechanisms that may be referred to AmpC Beta lactamases production whether alone or among ESBLs

Methods: eighty two nosocomial Klebsiella pneumoniae isolates were included in the study. ESBLs production is diagnosed by positive double disk synergy test [DDST] and then PCR for bla CTX-M family was done. Both ESBLs and non ESBLs were tested for AmpC Beta lactamases production by resistance to cefoxitin and by positive three dimension enzyme test [I'DET]

Results: ESBLs were found in 76.7%, while non ESBLs were 23.3%. By PCR for bla CTX-M groups, 63.o4% and 36.7% were of CTX-M type and non CTX-M type respectively. Four cases [8. 7%] among ESBL producers were also AmpC Beta lactonases producers. While among non ESBLs, 5 cases [35. 7%] were harboring pure AmpC Beta lactamases and 9 cases [64.3%] were negative AmpC producers

Conclusion: resistance to beta lactam antimicrobial agents is quite frequent in Klebsiella pneumonia nosocomial isolates. Carbapenems is the first line of treatment followed by Piperacillin tazobactam

Nosocomial infections in living donor liver transplant recipients

Backgrounds: Infections continue to be a major problem, representing one of the leading causes of morbidity and mortality among liver transplant recipients

Objective: To detect the frequency of different bacterial and fungal pathogen causing nosocomial infections in living donor liver transplant recipients in Gastroenterology Center in Mansoura University

Patients and Methods: The current study conducted on 45 living donor liver transplant recipients. Patients with suspected bacterial or fungal infection cultures were performed. Susceptibility of the strains to the antibiotic and antifungal agents was tested

Results: Nosocomial infections occurred in 42% of liver transplant recipients. Surgical site infection was the commonest type of infection which represents 58% of the total bacterial infections. Multiple drug resistant bacteria occured in [67%] of isolates. Gram negative infections were predominant. Incidence of invasive fungal infection in early period after transplantation was 11.1%. Pretransplant ascites, low serum albumin, postoperative hospital stay and steroid intake were significantly associated with nosocomial infections among liver transplant recipients

Conclusions: Nosocomial bacterial infection is common in early period after liver transplantation. The commonest bacterial pathogens were Klebsiella pneumoniae and Staphylococcus aureus which represents 23.8% for each

Helicobacter pylori CagA genotype in patients with gastritis and peptic ulcer

H. pylori infection of the stomach is widespread and is considered to play a major role in the pathogenesis of gastric diseases such as peptic ulcer and adenocarcinoma. The virulence of this type of bacteria in gastroduodenal disease is related to virulence gene [cagA] present in some strains. The aim of this study was to investigate the presence of H. pylori cagA genotype and its association with clinical outcomes. H. pylori were isolated and rapid urease test was conducted from gastric biopsy specimens obtained from 93 patients [68 with gastritis and 25 with gastric ulcer]. The cagA genotype was detected by PCR. CagA genotype was present in 41% of the patients infected with H. pylori positive both by culture and rapid urease test. CagA genotype was correlated with the severity of gastritis [p=.017] and gastric ulcer [p=.047]. Dyspepsia patients should be tested for cagA status along with the tests for H. pylori status; and a positive cagA testing should be considered as an indication for eradication of treatment