Fungal infection in Egyptian patients with diabetic foot ulcer [prevalence, spectrum, and antifungal susceptibility]

Foot ulcers are a very common complication of Type 1 and Type 2 diabetes. Patients having diabetic foot ulcer infection face serious problems including gangrene and amputations. The aim of this study was to determine the prevalence, spectrum of fungal infections in diabetic foot ulcer and to assess in vitro the antifungal susceptibility. This study was conducted on108 diabetic patients with foot ulcer attending the out-patient clinic of the National Institute of Diabetes and Endocrinology, from May to July 2014. Wound swabs were inoculated to slants of Sabouraud dextrose agar [SDA]. Yeast like growth on SDA was identified by Gram stain, germ tube formation, culture on Chrom agar Candida. The susceptibility of the isolated fungi was evaluated by disk diffusion method on Mueller- Hinton agar, using Amphotericin B, ketoconazole, fluconazole and itraconazole, posaconazole and caspofungin disks. Among the 108 patients 51% were females. Fungal foot infection were highest among the age group 51-60 years. 31.5% of patients were having fungal infection, Candida spp. was the most predominant isolated fungus [94.2%]; C. albicans [61.8%], C. glabrata [11.8%], other Candia spp. [8.8%], C. tropicalis and C. krusei each [5.9%]. In vitro susceptibility was highest to ketoconazole [78.1%], the highest resistance was for amphotericin B [87.5%]. Candida spp. is a predominant pathogen causing fungal infection in diabetic foot ulcer. High resistance to antifungal drugs is an emerging major problem

Effectiveness of Adjunctive Inhaled Colistin in Treatment of Ventilator Associated Pneumonia

Ventilator-Associated pneumonia [VAP] represents a major health problem in mechanically ventilated patients in intensive care units [ICUs]. Aerosolized colistin could represent an adjunctive treatment to intravenous antibiotics in VAP. To evaluate the safety and efficacy of adjunctive inhaled colistin in treatment of patients with Gram-negative VAP compared to the conventional intravenous antibiotic regimen alone. This prospective r and omized controlled study was conducted from July 2013 to August 2014 at Kasr El-Aini Medical ICU. Our study included a total number of 50 cases with VAP r and omly assigned into two equal groups; a study group [who received the conventional systemic IV antibiotic regimen plus adjunctive inhaled colistin] and a control group [who received the conventional systemic IV antibiotic regimen alone]. 76% of the patients were men with severe underlying co-morbidities. The main causative organisms of VAP were Klebsiella spp. [32%], Acinetobacter spp. [26%] and Pseudomonas spp. [24%]. Patients in the study group had significantly more favourable microbiological outcome when compared with patients in the control group [80% versus 52%, P=0.03]. No adverse effects related to inhaled colistin [nephrotoxicity, neurotoxicity, bronchoconstriction, cough, apnea or chest tightness] were recorded. Inhaled colistin seems to be safe and efficient as an adjunctive treatment for patients with Gram-negative VAP