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

Comparative study between two methods for detecting cytomegalovirus in chronic renal failure patients

This work was- designed to evaluate and compare Human Cytomegalovirus [HCMV] ELISA and Polymerase chain reaction PCR methods for the detection of HCMV in chronic renal failure patients. Also, it aims to correlate HCMV infection with positive clinical history, duration of dialysis, blood transfusion and renal transplantation. The present study was conducted on 66 patients with chronic renal failure, divided into two subgroups [50 non-transplanted on hemodialysis and 16 renal transplanted patients], and twenty apparently healthy volunteers as control group. Both the patients and the controls have been studied for detection of HCMV infection by CMV specific IgG and IgM ELISA assay, and qualitative leukocytes PCR assay. Regarding CMV IgG and IgM were detected in 66 [100%] and 10 [15.1%] patients respectively. The patients' group was found to be positive for CMV IgM and PCR assays in a percentage of 15.1% and 45.4% respectively with statistically significant difference compared to the control group. By PCR, HCMV positivity was significantly increased more frequent among non-transplanted patients with frequent blood transfusion. However, frequent blood transfusion had no influence on the positivity of HCMV in renal transplanted patients. Also, duration of dialysis In non-transplanted patients had insignificant role on the positivity of HCMV. Although the positivity for CMV IgM ELISA was [12%] and [25%] among non-transplanted and transplanted subgroups respectively, the difference was statistically insignificant. Comparing the positivity for PCR which was [42%] and [56.25%] among non-transplanted and transplanted subgroups respectively, the difference was also statistically insignificant. The relative sensitivity and specificity of CMV IgM ELISA assay compared to CMV PCR were 30% and 97.2% respectively. We concluded that leukocytes PCR is a reliable test in screening HCMV infection and it is more valuable than serology in diagnosis of HCMV infection. Also, the determination of IgM antibodies for HCMV is not helpful in identifying patients at risk or in following the course of HCMV disease because antibody response is too slow and it has low sensitivity