Prevalence of extended spectrum beta-lactamases production among resistant gram negative bacteria in samples of intensive care unit patients

The rapid emergence and dissemination of antimicrobial resistant microorganisms in hospitals worldwide is a problem of crisis dimensions. Although infections caused by drug resistant bacteria can strike anyone, they are especially grave for immune-compromised patients whose such as the hospitalized in Intensive Care Units [ICUs]. Extended Spectrum beta Lactamases [ESBLs] is a neglected health care crisis that is intended to provoke a debate. This study aimed to determine the prevalence of extended spectrum beta-lactamases multidrug resistant isolates of Enterobacteriacea in all samples [urine, respiratory, surgical and body fluid, blood] collected in ICU patients at El Damardash Hospital. Also, to study the antibiogram profiles of the ESBLs organisms isolated. A total of 1065 different samples collected from patients admitted to the surgical long term care nad ICUs were cultured. The antibiogram carried out for the possible ESBLs gram negative isolatles by screening preliminary method, thereafter confirmed for Klebsiella pneumonia [K.pneumoniae], Escherichia coli [E. coli] and Proteus mirabilis [P.mirabilis]. Out of the 1065 samples the total positive urine, respiratory, surgical and blood cultures were 434, 202, 352, and 77, respectively, where 670 gram negative organisms were isolated from the urine, respiratory, surgical and body fluid and the blood specimens were 299, 164, 187 and 20, respectively. The isolated Gram negative bacteria were 273 E. coli, 114 K. pneumoniae and 20 Proteus mirabilis isolates. The Gram negative organisms isolated from the urine culture was 68.9% [299/434], 64% [190/299] of the gram negative organisms were E. coli, 13.2% [25/190] were ESBL producers, 14% [41/299] the gram negative organism isolated from urine were K. penumoniae, 9.8% [4/41] were ESBL producers. About 4% [11/299] of the gram negative organisms were P. mirabilis and they were all non ESBLs producers. As regards, the gram negative organisms isolated from the respiratory specimens were 81.2% [164/202], 12% [20/164] of the gram negative organisms were E.coli, 15% [3/20] were ESBL producers, 19.5% [32/164] of gram negative organisms were K. penumoniae, 3% [1/32] of them were ESBL producers and 1.8% [3/164] of gram negative respiratory cultures were Proteus mirabilis, 33% [1/3] were ESBL producers. ESBLs is a neglected healthcare crisis in Egypt that needs strategies to treat, prevent and control the rising rate. In addition, clinical laboratories need to have adequate funding, equipment and expertise to provide a rapid and clinically relevant antibiotic testing service. Besides, the controlled use of 3[rd] generation cephalosporin along with implementation of infection control measures are the most effective means of controlling and decreasing the spread of ESBL isolates

rapid and accurate method for prevention and control of methicillin-resistant staphylococcus aureus in the ICU

Methicillin-resistant S. aureus [MRSA] oxacillin - resistant S. aureus [ORSA] is frequently encountered in health-care settings. Early screening for MRSA nasal colonization can identify patients requiring isolation and can be part of an effective infection control program. This study aimed to provide same-day results to facilitate rapid diagnosis and therapy MRSA to avoid hospital-acquired infections. A total of 80 patients from the medical intensive care units [ICUs] of El-Demerdash Hospital, Cairo Egypt, were screened for MRSA colonization. Two nasal swabs were collected from each patient, the first vortexed in the Liquid Stuart medium and two aliquots of 200 micro l were collected from the medium and tested. For direct culture, the 200 micro l aliquot was inoculated directly onto MRSA screening medium agar plate and incubated at 35[degree sign]C for 24-48h. The other 200 micro l aliquot was first cultured in a pre-enrichment broth medium for 24 hours at 35[degree sign]C, thereafter cultured onto MRSA screening medium agar for another 24-48 hr at 35[degree sign]C. The second swab was used to screen MRSA by a qualitative real-time PCR. Sixty six swabs [82.5%] were negative by culture and real time PCR for MRSA. Fourteen swab samples [17.5%] were positive by both methods. None was positive by culture only [0%], while the PCR assay detected additional four MRSA positive specimens [i.e 5%]. The sensitivity, specificity, positive-predictive value and negative-predictive value for PCR were 100%, 93.9%, 77.8% and 100%, respectively. Real-time PCR testing of nasal specimens can be used as a rapid and reliable technique for MRSA surveillance programs in the ICUs