Hepatitis C virus infection and risk factors in health-care workers at Ain Shams University Hospitals, Cairo, Egypt

The objectives of this study were to document the background prevalence and incidence of HCV infection among HCWs in Ain Shams University Hospitals in Cairo and analyse the risk factors for HCV infection. A cross-sectional survey was conducted in 2008 among 1770 HCWs. Anti-HCV prevalence was age-standardized using the Cairo population. A prospective cohort was followed for a period of 18 months to estimate HCV incidence. The crude anti-HCV prevalence was 8.0% and the age-standardized seroprevalence was 8.1%. Risk factors independently associated with HCV seropositivity were: age, manual worker, history of blood transfusions and history of parenteral anti-schistosomiasis treatment. The estimated incidence of HCV infection was 7.3 per 1000 person-years. HCWs in this setting had a similar high HCV seroprevalence as the general population of greater Cairo

Determinants of hand hygiene compliance in Egypt: building blocks for a communication strategy

Hand hygiene of health-care staff is one of the most important interventions in reducing transmission of nosocomial infections. This qualitative study aimed to understand the behavioural determinants of hand hygiene in order to develop sustainable interventions to promote hand hygiene in hospitals. Fourteen focus group discussions were conducted with nurses in 2 university hospitals in Egypt. The interviews were tape recorded and transcribed. Thematic analysis was conducted by 2 independent investigators. The findings highlighted that nurses did not perceive the benefits of hand hygiene, and that they linked the need to wash hands to a sense of dirtiness. Knowledge of hand hygiene and related products was limited and preference for water and soap was obvious. Environmental constraints, lack of role models and social control were identified as barriers for compliance with hand hygiene. A multi-faceted hand hygiene strategy was developed based on existing cultural concepts valued by the hospital staff

Yersinia enterocolitica infection and pseudo-appendicular syndrome

Fifty patients with symptoms and signs suggestive of acute appendicitis were investigated for Yersinia enterocolitica infection by both direct cultural technique of the removed appendicular tissues for isolation of the organism and serological methods for detection of specific antibodies. Yersinia enterocolitica specific antibodies were estimated by both microagglutination technique and ELISA for detection of IgM and IgG antibodies. In addition, 25 apparently healthy adults were investigated as control group. In this work isolation of Yersinia enterocolitica from the appendix was not successful. The results of microagglutination technique revealed that 9 [18%] out of the 50 patients were positive for Y. enterocolitica. Moreover, 10 [20%] out of the 50 patients were positive by ELISA IgM compared to 1 out of the 25 controls [4%], which indicates recent infection of Y. enterocolitica. This difference found to be significant [P<0.01]. However, no significant difference was found between patients and control groups by ELISA IgG. In conclusion, recent infection with Yersinia enterocolitica must be taken into consideration in the diagnosis of acute abdominal pain suggestive of acute appendicitis to avoid unnecessary appendicectomies

Post antibiotic effect and its efficacy on enhanced microbial susceptibility to phagocytosis

In the present work the in vitro post antibiotic effects of Amoxycillin/ Clavulanic acid [Augmentin] on Staphylococcus aureus and of Amikacin and Cefotaxime on Pseudomonas aeruginosa were determined by the broth technique. These organisms were hospital strains isolated from two patients in Ain Shams University Hospitals. The exposure of Staph. aureus to 5X minimum inhibitory concentration [MIC] of Augmentin for 2 hours produced a significant post-antibiotic effect [PAE] of 1.7 hour. As well as, exposure of Pseudomonas aeruginosa to 5X MIC of Amikacin and Cefotaxime for 1 hour produced a significant PAE of 2.4 hours and 1.8 hour respectively. Amikacin had a longer PAE than Cefotaxime under the same conditions. Moreover, post-antibiotic leucocyte enhancement [PALE] or the effect of previous exposure to antibiotics on the susceptibility of bacteria to the phagocytic and bactericidal activities of polymorphonuclear leucocytes [PMNL] had been tested. The PAE of Augmentin on S. aureus and of Amikacin or Cefotaxime on Ps. aeruginosa caused a significant increase in their susceptibility to the antibacterial activities of human PMNL, compared with the untreated control cells under the same test conditions. We concluded that, the PAE has many biological significances, this effect may justify the use of PAE inducing antimicrobial agents with longer dosing interval than those currently employed without loss of efficacy. Also, PAE induces the post-antibiotic leucocyte enhancement, organisms in the PAE phase are more susceptible to the antibacterial activity of human PMNL. Further studies are necessary to determine the full PAE clinical significances

Bacterial multiresistance in clinical practice

Over a period of one year, 202 isolates with antibiotic multiresistant pattern [> 5 antibiotics] were selected from different samples received at Ain Shams University Hospitals laboratories. Pure cultures of isolates were identified by cultural characters and biochemical reactions using conventional methods, modified micro well plates and the new technique of agar plates incorportated with chemical substrate. Susceptibility tests were performed by disk diffusion method and by minimum inhibitory concentration using microdilution broth technique. Multiresistant strains were isolated mainly from wound specimens [46.5%] and urine [45.5%]. They were mostly Ps. pyocyaneus [36.6%] followed by Klebsiella [22.7%] and Staph. aureus [17.8%]. Gram negative organisms showed high resistance [> 90%] towards ampicillin / sulbactam [unasyn], cephalexin and nalidixic acid. Also they shared Staph. aureus in their resistance [> 90%] towards amoxycillin and ampicillin. Such results indicate that an alarming increase in antibiotic resistance has taken place among both gr -ve and gr +ve isolates

Latex agglutination test versus blood culture technique in diagnosis of neonatal sepsis

This study was done on 50 neonates diagnosed clinically and hematologically as suspetted sephis in to evaluate the diagnostic accuracy of latex particle agglutination test [LPA] for rapid detection of bacterial antigen in sera in relation to blood culture technique. The most common hematological abnormality detected was the H.S.S. > 3.0 in 90% of cases. Microbiological results revealed that E. coli and Klebsiella were the most common organisms. E. coli accounted for [28%] of the cases, Klebsiella accounted for [24%] of cases and mixed infection by both organisms in [12%] of cases. The LPA test of E. coli gave positive reactions in 95% of patients with E. coli positive cultures while it gave positive reaction in 2 cases with negative blood cuItures and this elevate the sensitivity of the test up to 99%. The LPA tests of Streptococcus group B [SGB], Haemophilus influenzae, Streptococcus pneumoniae and Neisseria meningitidis gave negative reactions

Impaired hepatic function tests after streptokinase for acute myocardial infarction

Comparing the results of livers function tests for 50 patients with acute myocardial infarction, of which 25 patients received strepto- kinase and the other 25 patients matched in age, sex, and clinical presentation did not receive streptokinase, on admission and after one week. There was a significant increment in the serum total bilirubin, alkaline phosphotase and GGT in both groups after one week. While SGPT was no significantly elevated in the control group while it was very highly significantly elevated at one week in SK group. Both group had comparable results after one week with not significant difference. So the results of this study concluded that hepatic dysfunction was more marked after SK administration. The exact mechanism of these dysfunction are not yet fully elucidated

prevalence of listeria monocytogenes in different groups of Egyptian population

Two hundred fecal samples were cultured for isolation of listeria monocytogenes to detect the prevalence of listeria among Egyptian population. These samples were collected from 50 pregnant women, 50 immunocompromised patients, and 100 apparently healthy individuals comprising the control group. In this work, Listeria monocytogenes was isolated from one pregnant woman [2%], two immunocompromised patients [4%], and also from one individual of the controls [1%]. These results indicate that Listeria infection should be considered in cases of repeated unexplained abortion in pregnant women and also in cases of pyrexia of unknown origin in immunocompromised patients

Infective endocarditis after open heart surgery

This work was done in Ain Shams University hospital during the period from December 1988 to July 1989. This included 20 patients subjected to open heart surgery and suffering from post operative non reactive fever clinically diagnosed as infection endocarditis. The frequency of positive blood culture endocarditis following open hear surgery was 2.5% and the most affected valve in our study was prosthetic aortic valve [60%].Pseudomonas aerugenosa represented 60% of the isolated organisms from blood cultures, followed by staph aureus [30%] streptpneumonea and Klebsiella [20%], and finally diphthroids in 10% of cases

Aspergillus species infection in respiratory diseases

This study had been carried on 100 patients with various broncho-pulmonary diseases, in addition to 40 apparently healthy controls. Direct microscopic examination of sputum and sputum culture for Aspergillus on sabouraud's dextrose agar and brain heart infusion agar were performed repeatedly. The mycological examination of sputum by direct microscopy showed that 10% of the studied cases were suggestive for pulmonary Aspergillosis. By culture, Aspergillus was isolated in 28% of cases The isolated Aspergillus species were in order of Frequency : A. niger [15%], A. fumigatus [7%], A. fumigatusus [2%] and a combination of A. niger and A. fumigatus in [4%] of the cases. It was found that males were more susceptible to Aspergillus infection than females. Thus, repeated demonstration of the same fungus in culture from successive sputum samples are in favour for the diagnosis of pulmonary A. spergillosis