Prevalence of Multi-Drug resistant pseudomonas Spp. and acinetobacter Spp. causing nosocomial infection in intensive care unit [ICU] of national liver institute

Non-fermenting gram negative bacilli including Pseudomonas aernginosa, Stenotrophomonas maltophilia and Acinetobacter spp. have been implicated in a variety of nosocomial infection particularly in Intensive Car Units [ICUs]. This study aimed to overview the problem of multidrug resistant Pseudomonas spp an Acinetobacter spp causing nosocomial infections in ICUs in National Liver Institute and to determine the risk factors predisposing to these infections, also to assess the occurrence of ES beta ls and M beta Ls among these isolates. The study included 160 nosocomially infected patients [97 males and 63 females]. Also,20 hospital staff who were in close contact to ICU patients and 40 environment and equipment samples from the ICU. Bacterial culture and identification were carried out using standard microbiological methods. The antibiotic susceptibility was tested using the disc diffusion methods, also gram negative isolates were tested for ES beta Ls and M beta L production by disk diffusion method, double disk synergy test and E test [for MBL]. Our results revealed that NF gram negative isolates represented 18.75% of nosocomial isolates. Pseudomonas spp was 15.6%, Acinetobacter spp was 2.1% and Stenotrophomonas maltophilia was 1.04%. They were frequently isolated from cases with ventilator associated pneumonia [VAP]. All isolates were resistant to ampicillin and augmentin, They were highly sensitive to gentamycin [Pseudomonas spp 80.6%, Acinetobacter spp 80% and S. maltophilia 100%]. They were highly resistant to ceftriaxone [Pseudomonas spp 77.8%, Acinetobacter spp 80% and S.maltophilia 50%], ceftazidime[Pseudomonas spp 80.6%, Acinetobacter spp 100% and S.maltophilia 100%], Rates of resistant to Imipenem were[Pseudomonas spp 61.1%, Acinetobacter spp 80% and S.maltophilia 50%]. ES beta L +ve Pseudomonas spp. and Acinetobacter spp. detected by disk diffusion method were 38.9% and 40% respectively, and confirmed by double disk synergy tests were 25% and 40% respectively. M beta L was produced by 61.1% of Pseudomonas isolates and 80% of Acinetobacter isolates detected by disk diffusion and DDT, while E test detected the presence of M beta L in 52.8% of Pseudomonas isolates and 60% of Acinetobacter isolates. In conclusion non-fermenting Gram-negative bacilli including Pseudomonas spp, Acinetobacter spp and Stenotrophamoneas maltophilia were important causes of nosocomial infections in ICUs,particularly VAP. Most of these isolates were multidrug resistant and producers of ES beta L and M beta L

Cytomegalovirus frequency in neonates with biliary atresia

Biliary atresia [BA] is the most severe hepatic disorder in newborns and its etiopathogenesis remains unknown. Viral involvement has been proposed, including the human cytomegalovirus [HCMV]. The aims of the study were to use the polymerase chain reaction [PCR] to screen the liver tissue of neonates with biliary atresia or cholestasis due to non atretic causes for HCMV-DNA and to correlate the results with serological antibodies to CMV and plasma PCR for CMV-DNA. This study was carried on sixty patients suffered from cholestasis, thirty patients suffered from BA [BA group] and thirty patients suffered from cholstasis without BA [Non Atretic cholestasis group]. Patients with BA were divided according to the result of the tissue PCR for CMV-DNA in the liver biopsies into two groups, group I, BA patients with positive tissue PCR and group II, BA patients with negative tissue PCR. All groups were subjected to complete history take, clinical biopsy, CMV [IgG and IgM] antibodies [ELIZA], Plasma-PCR for CMVDNA by Cobas Amplicator Analyzer and tissue PCR for CMV-DNA. Results showed that liver tissues PCR for CMV in BA patients was positive in 43.3%, however its incidence was very low in patients with non Atretic cholestaesis [3.3%], we found also that CMV IgG was positive in [73.3%], CMV IgM was positive in [16.7%], plasma PCR-CMV was positive in [13.3%] in BA group. On other hand IgG was positive in 33.3%, IgM was positive in 10%, plasma PCR was positive in 3.3% in non atretic group with significant differnces p< 0.05. So these results indicate an elevated frequency of CMV in neonates with BA which was more prevalent in females. No significant correlation between groups I and II of BA group as regard clinical picture, laboratory results and pathological changes p>0.05. The accuracy of plasma PCR was 45.9%, CMV IgM was 47.9%and CMV IgG was 46.1% when consider tissue PCR as golden test. In Conclusions, there was high frequency of CMV in neonates with BA which was more prevalent in females. The accuracy of serological testing for CMV using ELISA techniques and plasma CMV-DNA PCR are not reliable and indicate that virological assessment by tissue PCR should be carried out to prove the role of the CMV infection in etiology BA cases

Early infections after living donor liver transplantation in Egyptian children [single center experience]

Liver transplantation [LT] has become an established therapeutic option for a large variety of fulminant and chronic liver diseases. Postoperative infections are the major cause of morbidity and the leading cause of mortality. The aim of this work was to investigate the incidence, types and possible predisposing factors for infection after living donor liver transplantation [LDLT] in children occurring early in the post operative period. We enrolled 22 children [10 boys [45.5%] and 12 girls[54.5%]] who underwent LDLT from 2003 to 2010 at National Liver Institute, Menofiya University, Egypt, the mean age +/- SD was 5.59 +/- 4.45 years [range, 7 months to 17yr] . We retrospectively investigated the proven episodes of bacterial, viral, and fungal infections. There were 62 infections episodes in 18 [81.2%] of 22 patients [2.8 infections/patient], two or more infections occurred in 14 out of 22 transplanted children [63.6%], bacterial infections accounted for 41 episodes of infection [66.1%], Viral infections accounted for 10 episodes of infection [16.1%] while fungal infections accounted for 11 episodes of infection [17.8%].The most common sites of bacterial infection were chest [24.4%], bile ducts [cholangitis] [17.1%] the blood stream [bacteremia] [12.2%] ,and abdomen either peritonitis or intra abdominal abscess [9.8%]. Most of the bacterial infections were polymicrobial mainly with gram negative bacilli occurred within the first month after LDLT. The most common causes of viral infection were cytomegalovirus in 4 patients, Epstein-Barr virus in 2 patients, Herpes Simplex virus types I and II presented in 4 patients. The mortality rate due to infection was 18.2% mainly caused by bacterial infection. This study found that infection is one of the important causes of morbidity and mortality after LDLT, so careful monitoring and management of infections is crucial for improving the outcome of LDLT in children

Value of PCR in the detection of occult hepatitis B virus infection in chronic end stage liver disease

Persistence of Hepatitis B virus [HBV] DNA in HBV surface antigen [HBsAg] negative individuals is termed occult HBV infection. Occult HBV infection has frequently been identified in patients with chronic HCV infection. This study aimed to evaluate the prevalence of occult HBV infection among late stage liver diseased patients and apparently healthy household contacts who may be used as potential donors for their liver transplantation. Also, prevalence of occult l-TBV infection in HCV-Ab and HBcAb seropositive subjects was evaluated. The study included 500 individuals distributed as 100 patients from National Liver Institute, 300 household contacts, and 100 apparently healthy subjects as a control group. All studied individuals were subjected to: full history taking, complete clinical examination, abdominal ultrasonography, liver biopsy if possible and laboratory investigations including: liver function tests, anti- HCV and HBV serological markers, as well as HBV- DNA detection using nested PCR. HBV-DNA was detected in 54% of patients, 18% of household contacts and 6% of control group. The prevalence of occult HBV infection in HBcAb seropositive subjects was; 75% in patients, 31.6% in household contacts, 46.2% in control group. The prevalence of occult HBV infection in HCV-Ab seropositive subjects was 55.8% in patients, 8.2% in contacts and 10% in control group. In conclusion, there is a high prevalence of occult HBV infection in patients with end stage liver disease, particularly those who are HCV-Ab and or HBcAb seropositive. The results of the current study indicate the need for a sensitive investigation for potentially infected relatives among family members of HBsAg carriers. On the other hand, apparently recovered people, are considered to be at risk for disease complications or for transmission of the infection till proved HBV-DNA negative

Role of pro-inflammatory cytokines, and matrix metalloprotinases in the pathogenesis of heart failure

Extracellular matrix remodeling is thought to play an important role in the progression of heart failure [HF]. Matrix metalloproteinases [MMPs] and tissue inhibitors of metalloproteinases [TIMPs] are matrix-degrading enzymes that have been demonstrated to influence left ventricular properties and serve as targets of potential anti-remodeling agents. It has been reported that MMPs concentration and activity are upregulated in the failing human heart. However, there are few reports describing the role of elevated level of circulating MMPs in severe congestive heart failure [CHF] patients. This study examined whether circulating MMPs are also related to the pathogenesis of CHF. The study involved 50 patients with severe CHF and 20 apparently healthy subjects, with matched age and sex were selected as a control group. Two Dimensional echocardiography, Doppler and colour flow mapping were done for the patients. Left ventricular dimensions [LVD] and cardiac size were measured. LV mass [LVM] was calculated from Interventricular septum [IVS], Left ventricular end diastolic dimensions [LVEDd], Left ventricular wall thickness [LVWT] and Left ventricular end systolic dimension [LVESd]. The serum levels of MMP-2, MMP-9 and TIMP-l as well as IL-18, TNF-alpha as pro-inflammatory cytokines were measured in patients with CHF and control subjects. The serum levels of MMP-2, MMP-9, TIMP-1, IL-18 and TNF-alpha were significantly higher in the CHF patients than control group. Moreover, MMP-2, MMP-9 and TIMP-1 serum levels were positively correlated with the levels of IL-8, TNF-alpha, cholesterol, triglyceride and CRP. Furthermore, MMP-2, MMP-9 andTIMP-1 were positively coffelated with LVM, LVED[d] and LVWT. We conclude that, the increasing serum levels of MMP-2, MMP-9 and TIMP-l were associated with increased LV diastolic dimensions and increased wall thickness in patients with CHF. These observations indicate that MMPs and TIMP- I serum levels may be markers for cardiac extracellular matrix degradation, a process involved in LV remodelling. These findings may open a new avenue for therapy that ameliorating heart failure especially high risk patients

Helicobacter pylori in diabetes mellitus: value of different diagnostic methods

Helicobacter pylori is one of the most common chronic bacterial infections in diabetic patients due to alteration of glucose metabolism, abnormal emptying of the stomach and autonomic neuropathy. So, this study was done to determine H. pylori infection in diabetes, to evaluate the different diagnostic methods of its infection and to estimate the efficacy of he current antimicrobial therapy to eradicate H. pylori. The study involved 40 patients with diabetes mellitus [12 with type 1 and 28 with type 2], and 20 non-diabetic patients as control group. Their sera were used for the assay of H. pylori specific lgG and IgA by enzyme immunoassay [EIA]. Biopsy specimens were tested by rapid urease test [RUT], stained by Gram's stain and cultured to isolate H. pylori. Antimicrobial susceptibility testing was performed using Epsilometer test [E-test]. Results showed that there was a significant increase in the incidence of H. pylori in diabetic patients, 77.5% by RUT, 75% by culture, 70% by lgG, 50% by IgA and 20% by direct smear. There was a significant association between age and smoking and the presence of IgG and IgA. The specificity of the direct smear and IgA was 100%, the sensitivity of RUT was 100%, positive predictive value [PPV] of direct smear and IgA was 100%, negative predictive value [NPV] of RUT was 100%. H. pylori was highly sensitive to tetracycline [93.3%] and amoxicillin [73.3%] and relatively resistant to metronidazol [70%]. We concluded that H. pylon infection is more common among diabetic patients. Culture is the method of choice in diagnosis of H. pylori as it allows testing for antimicrobial therapy. EIA for anti-H. pylori lgG could be of value in screening population and in excluding H. pylori negative infections. Anti-microbial sensitivity must be performed for better eradication of H. pylori in diabetic patients