Reduced vancomycin susceptibility in Staphylococcus aureus; laboratory detection and genomic characterization

Background: The emergence of resistance to methicillin resistant Staphylococcus aureus [S.aurus] [MRSA], followed by Vancomycin resistant S.aurus has turned the therapy of staphylococcal infections into a worldwide challenge. Three classes of vancomycin-resistance have emerged that differ in vancomycin susceptibility; vancomycin resistant S.aureus [VRSA], Vancomycin intermediate S.aureus [VISA] and heterogenous vancomycin-Intermediate S.aureus [hVISA]

Objectives: The present study aimed to detect S.aureus with reduced susceptibility to vancomycin in different types of clinical samples and their genomic characterizations

Methodology: The study was carried out on 250 S.aureus isolates from different types of clinical samples collected from patients admitted to various departments in the Alexandria University Hospitals, Egypt from May 2014 to April 2015

Results: We detected 22 S.aureus isolates with reduced sensitivity to vancomycin out of the 250 S.aureus test isolates by PAP-AUC and agar dilution methods. Three of them were VISA and 19 were hVISA; mainly isolated from pyogenic infections. Molecular typing of VISA and hVISA exhibited dominance of agr group Type I

Conclusion: Strict infection control measures and antibiotic policy should be adopted to control the problem of VISA and hVISA

Necrotizing fasciitis: study of 20 cases in Shifa hospital

Necrotizing Fasciitis [NF], although uncommon soft tissue infection but it is a diagnostic and therapeutic challenge to the surgeons due to their higher associated morbidity and mortality. This aggressive infection caused by aerobic and anaerobic infections mainly affects the subcutaneous fat and fascia, and later on the overlying skin, while the underlying muscles are almost always spared. Our objective is to put a plan for optimal care of such patients. The current study reviews our experience with 20 patients of NF admitted and treated at Surgery Department in Shifa Hospital in Gaza during the period from February 1995 to February 2003. They were 12 males and 8 females with a mean of age 53.5 years. After establishment of the diagnosis of NF by clinical examination and intra-operative findings, all the necrotic tissues were debrided under general anesthesia followed by minor debridement as frequent as needed under analgesia, while reconstructive procedures e.g. skin grafting and secondary suturing performed according to the condition. The mean time between the beginning of the disease and the operation was 4.4 days.Among the 20 patients with NF, 13 patients [65%] had diabetes mellitus [D.M.]; the mortality rate between the diabetics was 61.5%. The perineum was the most frequent site for primary infection, eight cases [40%] followed by the valvar region, four cases [20%]. Seven patients died out of the twenty giving a mortality rate of 35% in this study. Recognition of the need for early diagnosis and surgical treatment of this rapidly progressive surgical infection [NF] is necessary for successful management, especially for patients with perianal or valvar infections

Necrotizing fasciitis: study of 20 cases in Shifa hospital

Necrotizing Fasciitis [NF], although uncommon soft tissue infection but it is a diagnostic and therapeutic challenge to the surgeons due to their higher associated morbidity and mortality. This aggressive infection caused by aerobic and anaerobic infections mainly affects the subcutaneous fat and fascia, and later on the overlying skin, while the underlying muscles are almost always spared. Our objective is to put a plan for optimal care of such patients. The current study reviews our experience with 20 patients of NF admitted and treated at Surgery Department in Shifa Hospital in Gaza during the period from February 1995 to February 2003. They were 12 males and 8 females with a mean of age 53.5 years. After establishment of the diagnosis of NF by clinical examination and intra-operative findings, all the necrotic tissues were debrided under general anesthesia followed by minor debridement as frequent as needed under analgesia, while reconstructive procedures e.g. skin grafting and secondary suturing performed according to the condition. The mean time between the beginning of the disease and the operation was 4.4 days.Among the 20 patients with NF, 13 patients [65%] had diabetes mellitus [D.M.]; the mortality rate between the diabetics was 61.5%. The perineum was the most frequent site for primary infection, eight cases [40%] followed by the valvar region, four cases [20%]. Seven patients died out of the twenty giving a mortality rate of 35% in this study. In Recognition of the need for early diagnosis and surgical treatment of this rapidly progressive surgical infection [NF] is necessary for successful management, especially for patients with perianal or valvar infections

Gunshot wounds of the abdomen: Experience in Shifa hospital

Gunshot wounds of the abdomen [GSWA] still a subject of considerable disagreement and controversy regarding the indications of laparotomy and the appropriate methods of management. To declare our experience in GSWA and to identify the important factors that affects the morbidity and mortality. This is a retrospective study of 264 patients admitted at the surgery department in Shifa Hospital due to GSWA during the period from September 2000 to April 2003. All patients were males with a median age 20.4 years, ranged between 10 and 70 years. The patients were classified according to the severity of their injuries. The midline incision used in almost all cases and perioperative antibiotics used routinely. Among 264 patients sustained GSWA, 230 of them were explored and 34 patients were observed and discharged without operations. The commonly injured organs were the small intestine in 112 [48.7%] patients, the colon 73[31.7%] patients and the stomach 44[19.1%] patients. The lungs were the most common extra abdominal injured organs which occurred in 39 [16.9%] patients. Eighty six complications related to GSWA occurred; the most common were wound infection 39[17.0%] patients followed by chest complications 19[8.3%] patients. The number of injured organs and the penetrating abdominal trauma index [PATI] correlated with the mortality [p<0.001]. There were 17 [7.4%] deaths directly related to GSWA. Abdominal exploration for patients with peritoneal penetration due to GSWA is mandatory, while further evaluation and observation are necessary for those patients with equivocal abdominal signs of penetration in order to reduce the number of negative explorations. The increased number of intra-abdominal injured organs and the high PATI score increase the mortality