Prevalence and risk factors of carbapenem-resistant gram negative bacilli in Assiut University Hospital

Carbapenem-resistant Gram negative bacilli [CRGNB] resulting from carbapenemase enzyme production have been reported to be an important cause of nosocomial infection and are a critical therapeutic problem worldwide. This study was conducted to determine the prevalence of carbapenem-resistant Gram negative bacilli in Asiut University Hospital and relevant risk factors associated with its occurrence. The study was conducted over a period of 12 month from January 2011 to January 2012 on 355 specimen of 134 nosocomialy infected patients, aged two month to 82 years, admitted to the ICUs at Assiut University Hospital. Patient demographics, comorbidities, antibiotics, invasive devices were determined to identify risk factors associated with CRGNB infections. Three hundred and fifty five Gram negative bacilli isolates [47.92%] were isolated from patients. Ninety seven [27.17%] of Gram negative bacilli isolates were carbapenem-resistant. Patients aged above 40 years, male sex, prior antibiotic treatment, the presence of a urinary catheter, mechanical ventilation and central line in ICU were the most prevalent risk factors associated with the accurence of nosocomial CRGNB infections. The prevalence of CRGNB was 27.17% among GNB isolates. Patients aged above 40 years, male sex, prior antibiotic treatment, the presence of a urinary catheter, mechanical ventilation and central line in ICU were the most prevalent risk factors Interventions aimed reducing initial broad spectrum antibiotics are clearly needed to help control the spread in of these difficult to treat infections

Prevalence of efflux mediated ciprofloxacin and levofloxacin resistance in pseudomonas aeruginosa urinary isolates

Pseudoinonas aeruginosa [P. aeruginosa] represents a phenomenon of antibiotic resistance, and demonstrates practically all known mechanisms of bacterial resistance. Active efflux is an important mechanism of resistance in P. aeruginosa. It contributes to the development of multiple resistances to all strategic antipseudonional antibiotics. More than five hundred urine samples were collected from patients in Assiut University Hospital. Fifty P. aeruginosa isolates were identified by conventional methods. The antibiotic susceptihity testing of isolates showed that 68% of isolates were resistant to ciprofloxacin and 62% were resistant to levofloxacin. A comparison between the effect of three efflux pump inhibitors [Reserpine, Pantoprazole and Carbonyl cyanide m-chlorophenylhydrazone [CCCP]] on the activity of ciprofloxacin and levofloxacin was done by measuring ability of these agents to potentiate effect of ciprofloxacin and levofloxacin against resistant P. aeruginosa isolates. Outer membrane profile of P. aeruginosa isolates was also done using sodium dodecyl sulfate polyacrylamide gel electrophoresis [SDS-PAGE]. Reserpine was able to potentiate effect of ciprofloxacin in 50% of isolates, and in 5.5% for levofloxacin. Pantoprazole results were 33.3% for ciprofloxacin, 16 7% for levofloxacin. Finally CCCP potentiate. Regarding the SDS-PAGE of P. aeruginosa isolates, all isolates produced proteins with apparent molecular masses in the range of 50-54kDa.Reserpine-ciprofloxacin proved to be the best combination against multidrug resistant P. aeruginosa. Over production of 50-54 KDa outer membrane proteins is responsible for emergence of P. aeruginosa strains highly resistant to fluoroquinolones in clinical settings