In vitro antimicrobial combinations for pan-drug resistant acinetobacter species

Background: Pandrug resistant Gram-negative organisms [PDRGNs] have emerged, as a major threat to hospitalized patients. They have been associated with mortality rates ranging from 30 to 70%. Because of the high morbidity and mortality rates of severe pandrug resistant acinetobacter spp infections, combination therapies, as opposed to monotherapy, are suggested. A synergistic effect may be developed when antibiotics are used in combination. Through this synergistic effect, treatment efficacy can be improved and resistance can be prevented

Aim of the work: To investigate the use of in vitro antibiotic synergy test [checkerboard] for pandrug resistant acinetobacter species with a clinical feedback on the most synergistic antimicrobial combination

Materials and Methods: During this study, one hundred isolate of drug resistant acinetobacter species identified by routine culture and sensitivity using disc diffusion susceptibility test, were collected from critically ill patients admitted to Ain Shams University Internal Medicine Intensive Care Units. The isolates were subjected to: [i] Determination of MIC using Vitek 2 automated system to confirm resistance of acinetobacter species to all commercially available antibiotics, [ii] Broth micro-dilution method [BMD] for determination of tigecycline susceptibility, and [iii] Determination of antimicrobial synergy by broth micodilution [Checkerboard method]

Results: Vitek 2 system results showed that, all of the 100 isolates were resistant to all antibiotics included in the study. On the other hand, 100% of the isolates were sensitive [S] to Colistin. As regards the results by Broth microdilution antibiotic susceptibility method, all 100 isolates [100%] were resistant to ampicillin/sulbactam, meropenem and ciprofloxacin, whereas 95 isolates [95%] were resistant to amikacin, whereas all 100 isolates [100%] tested were sensitive to tigecycline. The results of the antibiotic combinations were as follows; the activity of ampicillin/sulbactam in combination with amikacin showed synergy in [48%], addition in [42%] and indifference in [10%]. The activity of ampicillin/sulbactam in combination with ciprofloxacin showed, synergy in [36%], addition in [52%] and indifference in [12%]. The activity of meropenem in combination with amikacin showed, synergy in [26%], addition in [53%] and indifference in [21%]. No antagonistic activity was detected between any of the antibiotic combinations used

Conclusion: The prevalence of XDR/PDR resistant Acinetobacter spp. was highest in blood samples [43%] followed by sputum samples [35%] recovered from critically ill patients admitted to Ain Shams University Internal Medicine Intensive Care Units. Vitek 2 system showed that, all of the 100 isolates were resistant to all antibiotics included in the study. On the other hand, 100% of the isolates were sensitive [S] to colistin. Broth microdilution antibiotic susceptibility method showed that, all 100 isolates [100%] were resistant to ampicillin/sulbactam, meropenem and ciprofloxacin, whereas 95 isolates [95%] were resistant to amikacin, whereas all 100 isolates [100%] tested were sensitive to tigecycline, indicating that acinetobacter spp. did not attain resistance to tigecycline yet. The broth microdilution antibiotic synergy test [Checkerboard method], being the reference method for assessing antimicrobial synergy, showed that the highest synergic activity belongs to ampicillin/sulbactam and amkacin [48%], and the lowest synergic activity belongs to meropenem and amikacin [26%]

Effect of honey supplementation on clostridium difficile infection in childhood cancer

Background: the treatment of cancer is associated with nausea and vomiting, oral mucositis, constipation, xerostomia and diarrhea and weight loss, additionally; chemotherapeutic agents promote inflammatory changes in the gut, intestinal necrosis, and anaerobic conditions, allowing proliferation of Clostridium Difficile. Honey, as a natural honeybee product, has antioxidant, antimicrobial, immunomodulatory and anticancer effects. Honey can fight microbial infection by its immuno-activating, anti-inflammatory and prebiotic activity

Objectives: the aim of this study was to evaluate the effect of honey supplementation on frequency of Clostridium Difficile infection [CDI] and gastrointestinal complications in pediatric patients undergoing chemotherapy

Design: a cross sectional study conducted on 40 patients with malignancy recruited from Children's Hospital, Ain Shams University, Oncology Unit and Clinic, Cairo, Egypt in the period from December 2015 to December 2016. Patients were divided into two groups; group I [25 patients] received honey in the dose of 2gm/kg 3 times dailyfor 1month] while group II [15 patients] did not receive honey. All the studied patients were subjected to medical history and clinical examination, with special emphasis on gastrointestinal complication including oral mucositis, vomiting, diarrhea, constipation, and abdominal pain. Follow up was done for weight, height z score, gastrointestinal complications and any adverse events. Stool analysis, culture, C difficle toxin A, B by ELISA was done to all patients at baseline and repeated to patients receiving honey at week 4 of supplementation. Main outcome measure frequency of CDI, gastrointestinal complication, febrile neutropenia

Results: the frequency of C difficle was 8% [2], the first case was 9 years old patient with ALL [50%] and the other 11 years old patient with Burkitts lymphoma both were diagnosed by positive stool culture and positive stool ELISA for toxin A, B. gastrointestinal complications were significantly less and improved in the supplemented group and mean of hemoglobin significant increase in group 1

Conclusion: the frequency of CDI in children with cancer 8% diagnosed by stool culture and toxin A, B study in stool. Honey improved the oral mucositis and different GIT complications associated with chemotherapy

Detection of fluoroquinolones resistance in enterobacteriaceae and pseudomonas species using molecular techniques

Background: quinolone resistance is traditionally mediated by chromosomal mutations mutation of DNA gyrase and/or topoisomerase IV or by the mutation of genes regulating the expression of efflux pumps, until PMQR was described in a clinical isolate of Klebsiella pneumoniae in 1998. PMQR genes generally confer low-level resistance, with their MICs falling below Clinical and Laboratory Standards Institute [CLSI] breakpoints for intermediate resistance; therefore, their contribution to quinolone resistance can be masked in strains also harboring QRDR mutations in gyrA and parC. However, their clinical significance stems from the fact that they greatly facilitate the selection of more highly quinolone-resistant strains. Although the PMQR mechanism only confers low-level resistance to FQs, its association with the occurrence of mutations in QRDR can lead to clinically relevant resistance levels. These PMQR determinants are increasingly being identified worldwide in clinical isolates of Enterobacteriaceae and Pseudomonas spp

Aim of the work: this study aimed to identify different mechanisms of fluoroquinolones resistance and determine fluoroquinolones resistance pattern among the studied isolates

Material and methods: this study was carried on 100 non duplicate clinically relevant Enterobacteriaceae and Pseudomonas spp. recovered from clinical specimens referred to Central Microbiology Laboratory, Ain Shams University Hospital for routine culture and sensitivity, aiming to 1] Determine the occurrence of plasmid-mediated fluoroquinolones resistance [PMQR] determinants by multiplex PCR and chromosomal mutations by PCR-RFLP among Enterobacteriaceae and Pseudomonas spp. in clinical specimens. 2] Identify different mechanisms of Fluoroquinolones resistance. 3] Determine Fluoroquinolones resistance pattern among the studied isolates

Results: in this study we found that 77% of FQs resistant isolates were positive to one or more plasmids, oqxAB was highest recovered PMQR among Klebsiella. 78% were positive for gyrA mutations, gyrA gene mutations were higher in Pseudomonas, Asp- 87mutation was 56/78[72%] higher than Ser-83 mutation 38/78 [49%] isolates