FimH adhesin among Enterobacter spp. isolates and its relation to biofilm formation and antimicrobial resistance pattern

Background: Enterobacter spp., which are able to carry a number of antibiotic-resistance genes, can cause a variety of infections especially in immune-compromised individuals and patients from intensive care units [ICUs]

Objectives: To assess the prevalence of Enterobacter spp. in Menoufia University Hospitals, and to investigate the relation between antimicrobial susceptibility patterns and biofilm production

Methodology:A total 296 clinical samples from patients admitted to Menoufia University Hospitals. Enterobacter spp. were identified by standard microbiological methods and Vitek-2 system. All Enterobacter isolates antibiogram was tested by the modified Kirby Bauer disk diffusion method, and for extended-spectrum beta-lactamases and metallo-beta-lactamase production. Biofilm production was detected by congo red agar, modified congo red agar methods and PCR

Results: Enterobacter spp. represented 17.3% of all the collected nosocomial isolates. Vitek-2 system showed that the predominant spp. was Enterobacter aerogenes [44%]. Enterobacter isolates were resistant to amoxicillin [100%], doxycycline [82%] and gentamycin [76%]. The rates of resistance to ceftriaxone, cefoxitin, cefepime, and amikacin were 64%, 72%, 60% and 70% respectively. Half of Enterobacter isolates were sensitive to piperacillin/tazobactam, meropenem, ciprofloxacin, ofloxacin and norfloxacin while 84% were sensitive to chloramphenicol. Production of ESbetaLs and MbetaL was found among 28% and 22% of isolates respectively. Biofilm production was found among50% by CRA method and 56% by MCRA method, while conventional PCR showed fimH gene among 58% of Enterobacter isolates

Conclusion: Enterobacter spp. are serious nosocomial pathogens as they can produce ESbetaLs and carbapenemase, and produce biofilm that is related to their antimicrobial resistance. Therefore, their adequate prevention and control is imperative

Enterococci in hospital associated infection in the national liver institute, Egypt

Enterococci have become important opportunistic pathogens in hospitalized patient's especially vancomycin resistant strains. This study was done to assess the prevalence of enterococci infection including vancomycin resistant enterococci [VRE] among patients admitted of National Liver Institute, to detect the possible risk factors involved in enterococci infection and to analyze the relationship between antimicrobial susceptibility pattern and plasmid profile. After identification of the isolated organisms, they tested the antibiotic susceptibility using the disc diffusion methods determine the MIC and E-test-strips, and plasmid profile analysis by agarose gel electrophoresis. The prevalence of enterococci was 20.5% , most of them were resistant to cefotaxime, ceftazidime and, cephalexin [93%], amikacin [88.4%], and vancomycin [20.91] by disc diffusion, but vancomycin resistant by E test was [23.3%] with 93.2% agreement between both methods. Six different resistance patterns [with minor 32 patterns] were found among enterococci isolates. Plasmid profile analysis showed that [44.2%] were plasmid less, while 55.8% contained plasmids with variable molecular weight ranging from 1.5 MDa to 42 MDa. Moreover, resistance to increasing numbers of antibiotics was associated with high molecular weight plasmids. In conclusion multi-resistant enterococci are important cause of Hospital associated infections. Most of these strains had plasmids, which may be responsible for resistance to antibiotics and its dissemination among the other strains

Role of interleukin-18 in allergic rhinitis

The role of IL-18 has not been well studied in allergic rhinitis. Few studies demonstrated up- regulation of IL-18 in nasal discharge of allergic rhinitis patients. The persistence of elevated IL-18 concentrations until after the season suggests a role for this cytokine in persistent allergic inflammation. In this study, we tried to through light on this role in patients with allergic rhinitis by investigating whether polymorphism is present in the coding regions of the IL-18 gene and, if so, to further analyze the association between polymorphism and allergic rhinitis in a case-control study. Blood samples were collected from 32 patients and 8 healthy controls matched by age and sex. Every patient was subjected to skin prick test [SPT] to confirm the clinical diagnosis and to detect the causative allergen[s]. Sera from the patients and controls were analyzed by using PCR single-nucleotide polymorphisms [SNPs]. There was a significant difference of IL-18 gene polymorphism at position -137 among allergic rhinitis patients and controls. The frequency of the -137C allele was significantly higher among allergic rhinitis patients as compared to the controls. We concluded that IL-18 gene polymorphism may represent an important susceptibility biomarker for the increased susceptibility to allergic rhinitis. This study reinforced the need for in-depth analysis of immune dysregulation of patients with allergic rhinitis arid point to the potential usefulness of cytokine-based therapy

Diagnosis of urinary tract infection in infants and children with protein energy malnutrition

This study was carried out to assess the prevalence of urinary tract infection [UTI] in infants and children with protein energy malnutrition [PEM], to evaluate the reliability of dipstick tests for its diagnosis and to show the most common causative organisms and their sensitivity to antibiotics. Urine samples were aseptically obtained from 60 patients of both sexes who were suffering from different types of PEM and from 40 healthy age- and sex- matched infants and children as controls. Patients were selected from the pediatric outpatient clinic, Faculty of Medicine, Menoufia University. Urine samples were examined for: 1]Dipstick [nitrite and leukocyte esterase] tests; 2] microscopic urine examination for leukocytes; 3] bacterial colony count and identification of the causative bacterial species; and 4] their antibiotic sensitivity were performed. Results showed increased prevalence of UTI among PEM patients [33.33%] than controls [7.5%]. Nitrite and leukocyte esterase tests had low sensitivity [35% and 55% respectively] and high specificity compared to urine analysis and culture. Enterobacteriaceae [E. coli, Klebsiella and Proteus] constituted 95% of the total isolates and they were highly sensitive to amikacin, tobramycin, gentamycin, and cefotaxime. In conclusion, it is important to look for UTI in PEM patients by demonstration of bacteriuria using culture which can not be replaced by screening dipstick tests