Staphylococcus aureus nasal carriage among outpatients attending primary health care centers: a comparative study of two cities in Saudi Arabia and Egypt

Epidemiological and molecular data on community acquired methicillin resistant Staphylococcus aureus (CA-MRSA) are still scarce in both Egypt and Saudi Arabia. There is almost no data regarding methicillin resistant Staphylococcus aureus (MRSA) prevalence in both countries. This study was conducted to investigate the prevalence and molecular epidemiology of S. aureus and MRSA nasal carriage among outpatients attending primary health care centers in two big cities in both countries. A total of 206 nasal swabs were obtained, 103 swabs from each country. S. aureus isolates were characterized by antibiotic susceptibility, presence of mecA and PVL genes, SCCmec-typing and spa typing, the corresponding Multi locus sequence typing clonal complex was assigned for each spa type based on Ridom StaphType database. MRSA was detected in 32% of the Egyptian outpatients while it was found in 25% of the Saudi Arabian outpatients. All MRSA isolates belonged to SCCmec type V and IVa, where some isolates in Saudi Arabia remained nontypeable. Surprisingly PVL+ isolates were low in frequency: 15% of MRSA Egyptian isolates and 12% of MRSA isolates in Saudi Arabia. Two novel spa types were detected t11839 in Egypt, and t11841 in Saudi Arabia. We found 8 spa types among 20 isolates from Egypt, and 12 spa types out of 15 isolates from Saudi Arabia. Only two spa types t008 and t223 coexisted in both countries. Four clonal complexes (CC5, CC8, CC22, and CC80) were identified in both Egypt and Saudi Arabia. However, the data collected lacked a representation of isolates from different parts of each country as only one health center from each country was included, it still partially illustrates the CA-MRSA situation in both countries. In conclusion a set of control measures is required to prevent further increase in MRSA prevalence.

Expressional Evaluation of Androgen Receptor in Transitional Cell Carcinoma of Urinary Bladder Patients.

The study was undertaken to evaluate the possible role of Androgen Receptor (AR) in relation to tumor grade, age, sex and urinary bladder cancer risk. Expression of AR detected by immunohistochemistry in 125 Transitional Cell Carcinoma and 100 control cases. Expression of AR was noticed in 28.8% cases. AR increased with increasing tumor grade. Expression of AR was seen to be significantly higher in male in the age group ≥ 50 years (p < 0.05). AR expression was found to be associated significantly with the tumor grades, age and sex suggesting that AR may be used as prognostic markers in the treatment of urinary bladder carcinomas.

Paraffin Sections of Sputum Block: Description of a New Method for Pathological and Molecular Study.

Aim: This study was designed to enhance the scope of sputum analysis by using it as a clinical tool in gene/protein expression, by making the paraffin embedded blocks. Methodology: The specimens were prepared as smear and cell blocks for cytopathologic examination. The preparation of paraffin-embedded block from sputum samples employs fixation and dehydration of the cell specimens. The sputum specimen is first exposed to a suitable fixating agent, Formalin, and graded acetone was employed to dehydrate the samples and saved as pellet. Paraffin blocks containing embedded pellet were taken out gently from the tube. The solidified paraffin-embedded tissue blocks through this novel approach were found to be easy to process for immunohistochemistry and molecular analysis. Results: Immunohistochemistry staining was performed on paraffin section of sputum block for Cytokeratin (CK) and was found to be easy to process for immunohistochemistry. Conclusion: The sputum block preparation is feasible and non-invasive, can be useful to identify new biomarkers of exposure or susceptibility in patients with lung pathology to enhance the understanding of airways changes due to different etiological factors and may be useful to find new biomarkers in order to assess and monitor early lung damage.

Frequency and Antibiotic Susceptibility Pattern of Uro-Pathogens Isolated from Community and Hospital-Acquired Infections in Saudi Arabia – A Prospective Case Study.

Objective: Urinary tract infection (UTI) remains a worldwide therapeutic problem, not only as a nosocomial disease but also as a community-acquired infection. Antibiotic resistance of urinary tract pathogens has increased worldwide. Infectious Diseases Society of America (IDSA) recently recommended that each hospital should determine the locally establish mechanisms to resistance rates among uropathogens. The aim of this study was to determine the frequency of the bacterial agents that cause urinary tract infection both in outpatients as well as in hospitalized patients and to assess the antimicrobial sensitivity pattern against various types of antimicrobial agents used for treating urinary tract infections. Materials and Methods: We carried out a prospective study of urine culture and antibiotic sensitivity testing from symptomatic outpatients and inpatients. Results: A total 150 cases were positive for significant bacteria, out of which 83 (55.4%) were from out patients and 67 (44.6%) were from hospitalized patients. The majority of the bacteria were isolated from female (78.7%) while the remaining was from male (21.3%). In the present study Escherichia coli was the predominant pathogen for UTI in both the groups. Klebsiella sps was the second common organism in hospital acquired infection followed by Pseudomonas. sps. Analysis of the frequency of bacterial isolates according to the age of the patients revealed that Escherichia coli and Klebsiella infections were more prevalent in the age groups (>20-49 years) and Pseudomonas infections were more prevalent in children and the elderly (<20 years and >50 years, respectively) and Salmonella typhi were isolated from elderly (>60 years age) patient from community–acquired infection. The mean susceptibility was high for Imipenem (98.8%), Amikacin (53.2%), Gentamicin (52.3%) and Ciprofloxacin (50.5%) but low for Ampicillin (34.2%), Norfloxacin (40.4%), Nitrofurantoin (44.5%), and Cotrimoxazole (46.7%). High prevalence of Multi-drug resistance (MDR) isolates were recovered (53%) which showed 3 or more antibiotics resistance. Conclusion: Current knowledge of the antibiotic resistance patterns of uro-pathogens in specific geographical locations is an important factor for choosing an appropriate empirical antimicrobial treatment rather than on universal guidelines.