Are Pneumococci resistant to microlides?

Background: Streptococcus pneumoniae is the most common cause of acute community - acquired pneumonia and accounts for 30-40% of lower respiratory tract infections. It accounts also for about 50% of hospital-acquired pneumonia. Macrolides remain the primary antibiotic of choice for physicians treating such infections. Macrolide resistance in Strept. pneumoniae is primarily due to two mechanisms; target site modification [encoded by the erm [B] gene] and efflux pump expulsion [encoded by the mef gene]

Objectives: The aim of this study was to identify the incidence of Strept. pneumoniae among acute and chronic otitis media cases; to perform the antimicrobial sensitivity tests for such isolates, to determine the percentage of Strept. pneumoniae resistant to erythromycin, clarithromycin and azithromycin, to assess the antibiotic susceptibility profile of macrolide-resistant Strept. pneumoniae and lastly to detect the frequency of common macrolide resistant genes [The mefE and ermB genes] among erythromycin resistant Strept. pneumoniae by PCR technique

Methodology: 317 patients suffering from acute or chronic otitis media, attended to pediatric and ENT- Outpatient Clinics at Al- Azhar University Hospital of Assiut, were isolated and tested for Strept. pneumoniae and for antibiotics sensitivity pattern. Resistant strains for erythromycin, clarithromycin and azithromycin were assayed for MIC using E test. PCR for erm[B] and mef[E] resistant determinant genes by multiplex PCR was applied

Results: 78 [24.6%] isolates of Strept. pneumoniae were isolated. Of them 66 and 12 isolates from acute and chronic otitis media respectively. Cefoperazone was the most sensitive drug, followed by Cefotaxime, Azithromycin and Amoxacillin-clavulanate. Tetracyclin was the most resistant drug followed by Clindamycin and Apramycin. The E- test confirmed the results of disc diffusion test. By PCR, 10 [41.7%] isolates have both erm B and mef E genes, while 8 [33.3%] isolates have mef E gene only and 2 [8.3%] isolates showed erm B gene only

Conclusion: There is a high prevalence of erythromycin resistant Strept. pneumoniae. So macrolides cannot be recommended for the treatment of pneumococcal infections without susceptibility testing. Results point to the importance of detection of erm B and mef E genes for epidemiological aspects and to track possible presence of macrolide resistance

Prevalence of extended-spectrum beta-lactamase producing klebsiella pneumoniae by phenotypic and genotypic methods in Assiut University Hospital

This study investigated the urinary tract infection in Assiut university hospitals to evaluate the rate of infection, and the prevalence of extended spectrum ?-lactamase producing Klebsiella pneumoniae to define the magnitude of the problem and may help to implement appropriate infection control measures. This study was conducted from January 2014 to June 2014. Urine samples were collected from urinary tract infected patients to detect the causative organisms. After antimicrobial susceptibility testing, resistant strains to ?-lactam antibiotics were selected for detection of ESBLs. In addition PCR was done to determine the most common group of beta-lactamase genes responsible for resistance. The study included 340 patients presented to urology department at Assiut University Hospitals. The rate of community and hospital acquired UTI were 41% [140/340] and 59% [200/340] respectively. For community patients the commonest isolate was E. coli [54.28%] followed by Klebsiella pneumonia [29.28%] then Staphylococcus aureus [7.14%], Pseudomonas aeruginosa [1.42%], Coagulase-negative Staphylococcus [3.57%], and Candida species [4.28%].While the pattern of nosocomial isolates was Klebsiella pneumoniae [51%] followed by E. coli [30%] whereas, Staphylococcus aureus [4%], Pseudomonas aeruginosa [11%], Coagulase-negative Staphylococcus [3%], Candida species [1%] Antibiotics sensitivity of K. pneumoniae isolates showed that these organisms were mostly sensitive to meropenem [100%]. Phenotypic confirmatory tests [combined disc method, double disc method and ESBL-E-Test] were done to test K. pneumoniae isolates for ESBL production. It was concluded that 60.97% [25/41] of community isolates and 81.37% [83/102] of nosocomial isolates were ESBLs producers. PCR was done to determine the responsible ESBL gene; it revealed that the common ESBL gene was CTX-M followed by TEM then SHV. Further analysis of CTX-M positive isolates showed that CTX-M-group-1 was the predominant type. ESBLs is a neglected healthcare crisis in Egypt that needs strategies to treat, prevent and control the rising rate. In addition, rapid and clinically relevant antibiotic testing service is always required to provide services. Besides, the controlled use of 3[rd] generation cephalosporin along with implementation of infection control measures are the most effective means of controlling and decreasing the spread of ESBL isolates

Detection and identification of staphylococcus aureus enterotoxins in some milk products and their handlers

Background: Staphylococus aureus may contain one or more genes that encode staphylococcal enterotoxins [SE] that cause food poisoning. The previously known toxins were the five major classical types; however, with the extensive analysis of the S. aureus genome, new genes encoding enterotoxin-like superantigens have been identified. Milk and dairy products are frequently contaminated with enterotoxigenic S. aureus, which is often involved in staphylococcal food poisoning; these contaminations are either from animal or human sources

Aim of the work: To detect the presence and prevalence of coagulase positive S. aureus in milk, kariesh cheese and ice-cream samples and in nasal swabs and stool samples from milk handlers, and to detect types of S. aureus enterotoxins by sodium dodecyl sulphate-polyacrylamide gel electrophoresis [SDS-PAGE], and to detect the type of enterotoxins genes by PCR

Material and Methods: 250 samples of Milk, ice-cream, kariesh cheese, nasal swabs and stool samples from milk handlers were examined for the presence of Coagulase positive Staph aureus, using Mannitol salt agar, Baird-Parker agar, tube coagulase test, and latex agglutination test for protein A and capsular polysaccharides. Confirmed S. aureus isolates were examined for the production of SEs using sodium dodecyl sulphate-polyacrylamide gel electrophoresis [SDS-PAGE], and the type of SE genes by polymerase chain reaction [PCR]

Results: Coagulase positive S. aureus isolates were detected in 82% of Staph colonized raw milk, 80% of Staph colonized ice-cream and 82.3% of Staph colonized kariesh cheese samples and 86.6% of Staph colonized nasal swabs, and 60% of Staph colonized stool samples; with 70.9% of total samples staph colonization exceeds the Egyptian standards. Collectively, 44.3% of coagulase positive S. aureus isolates were enterotoxigenic and the highest percentages were detected in raw milk taken directly from animals [75%] and kariesh cheese from street distributors [66.6%]. In all samples, the major classical enterotoxin genotype was SEA which was detected in 44.4% of toxigenic isolates. SEC was detected in 22.2% of isolates and SED in 18.5% of isolates. SEB could not be detected. For the newly described genes, SEG was detected in 7.4% of isolates and SEH in 7.4% of isolates

Conclusions: Raw milk and some dairy products in the markets in Assuit Governorate rural areas-Egypt, are contaminated with enterotoxigenic S. aureus. The most common type in both milk and dairy products as well as in nasal swabs and stool samples was SEA which is known to be less common among strains from animal origin than from human. Nasal and fecal carriage in human milk handlers is considered a primary source of contamination of milk and dairy products

Selective IgA deficiency among children with recurrent infection

Aim of the study: to evaluate the incidence of IgA deficiency among children suffering from recurrent infections that were suspected to have a primary immunodeficiency disorder from the Assiut Pediatrics University Hospitals, in a hope that this would be the first step to establish a wider epidemiological study including the whole suspected primary immunodeficiency [PID] patients in the country

Methods: This study included 80 cases suffering from recurrent infections that were suspected to have a PID disorder from the Assiut Pediatrics University Hospitals. And eight apparently normal infants and children, age and sex matched that were enrolled as control in the period from July 2011 to May 2012. All children included in the study were subjected to the initial evaluation of immunocompetence which includes a clinical history and physical examination, and investigated for complete blood picture, ESR, Plain chest X-ray when indicated, Screening for serum level of IgA by Enzyme Linked Immuno-sorbent Assay [ELISA] and Radial Immuno-Diffusion [RID]. Patients with proved IgA deficiency were assayed for IgG and IgM

Results: Out of the 80 patients studied, 4 [5%] patients [group I] had laboratory evidence of IgA deficiency; three of them had IgG and IgM within normal level so they were diagnosed as selective IgA deficiency and one [25%] patient had low IgG and normal IgM level so that was diagnosed as common variable immunodeficiency disorder [CVID]. The mean values of age at onset of symptoms, age at diagnosis and the diagnosis lag were 10, 37.25 and 27.25 respectively

The diagnosis delay ranges from 2 months to 7 years. Parents' consanguinity was evident in our study, since 3/4 [75%] patients of group I were the products of consanguineous parents while the ratio was lesser in group II18/76 [23.7%] patients. The current study showed that patients with severe infections had significantly lower IgA levels, younger age and had earlier onset of recurrent infections than patients with less severe infections. There was no specific sex predilection in patients with IgA deficiency. There were no significant differences in both the total leucocytic, absolute lymphocyte and neutrophil counts or hemoglobin level in patients with selective IgA deficiency when compared to patients with normal IgA levels. The duration of infections was significantly longer in patients with selective IgA deficiency [mean: 11.5 days] when compared to patients with normal IgA levels [mean: 9.18 days]

Role of fluconazole prophylaxis in decreasing Candida infection and colonization among severely neutropenic children with hematological malignancies

To Assess the role of antifungal prophylaxis in decreasing Candida infection and colonization in severely neutropenic children with hematological malignancies. Sixty four patients with severe neutropenia are randomized equally into 2 groups on 1:1 basis either to receive fluconazole prophylaxis [study group], or to receive placebo [control group]. Fluconazole antifungal prophylaxis/ placebo It was continued for 6 weeks, and follow up of the patient done until either Prophylaxis success by recovery from severe neutropenia [ANC