Nosocomial Infection by Multidrug Resistant Bacteria in Intensive Care Units of Assiut and Sohag University Hospitals

Nosocomial infections are the most common complications affecting hospitalized patients. The main purpose of this study was to determinate the frequency of nosocomial microorganisms obtained from intensive care unit patients admitted throughout 48 h and to detect the most common organisms and their susceptibility patterns to commercial antimicrobial agents and natural products [essential oils]. Resistance gene was determinate. During 18 months study, 894 bacterial isolates were recovered from 682 clinical samples[urine, blood, sputum, wound] in traumaandchest ICUs of Assuit University Hospital and trauma ICU of Sohag University Hospital. API 20E test was performed for Klebsiella pneumoniae isolates [as the commonest organisms]. In vitro susceptibility of Klebsiella pneumoniae isolates to 12 antimicrobial agents Ampicilin; Amikacin, Ciprofloxacin, Tetracycline, Bacitracin, Amoxclav, Gentamicin, Cefotaxime, Ceftazidime, Imipenem, Meropenem and Chloramphenicol [as commercial antimicrobial agents] and to Rosmarinus officinalis and Cymbopogen citrates essential oils was performed using the Kirby-Bauer's disk diffusion method. PCR Testing for resistance gene for Klebsiella pneumoniae to carbapenems [imipenem and meropenem]. Out of 894 bacterial isolates 210 Klebsiella pneumoniae isolates were detected and confirmed by API 20E. Lowest resistance of Klebsiella pneumoniae to imipenem and meropenem [1%, 1% in trauma ICU of Assiut university hospital] [17.6%, 11.8%in chest ICU of Assiut university hospital] [3.1%, 4.1% in trauma ICU of Sohag university hospital]. cymbopogen citrates essential oils had the positive effect on carbapenem resistant Klebsiella pneumoniae isolates rather than Rosmarinus officinalis essential oil. bla CTX-M gene, bla TEM gene and bla SHV gene were detected as resistance gene for imipenem and meropenem

The Enviromental Contamination in Some Intensive Care Units of Assiut and Sohag University Hospitals

The hospital environment may contribute with the dissemination of pathogens. There are no meaningful st and ards for permissible levels of microbial contamination of inanimate surfaces in hospital environment, but an increased microbial load on surfaces may imply the possibility of finding a pathogen. During a 18 months study, 1153 bacterial isolates were recovered from 1063 enviromental samples[beds, door h and le, trash basket, door surface, floors, and medial equipments] in traumaandchest ICUs of Assuit University Hospital and trauma ICU of Sohag university hospital. In vitro susceptibility of environmental bacterial isolates to 12 antimicrobial agents Ampicilin; Amikacin, Ciprofloxacin, Tetracycline, Bacitracin, Amoxclav, Gentamicin, Cefotaxime, Ceftazidime, Imipenem, Meropenem and Chloramphenicol [as commercial antimicrobial agents]. Proteus mirabilis, Escherichia coli, Klebsiella pneumoniae, Pseudomonas spp, Staphylococcus aureus, Streptococcus pneumoniae, Entercoccus spp, Acinetobacter baumannii, Serratia marcescens and Coagulase negative Staphylococcus were identified in three intensive care units. The most prevalent organism was Klebsiella pneumoniaandStaphylococcus aureus in traumaandchest ICUs of Assuit University Hospital, Escherichia coli in trauma ICU of Sohag University Hospital. Vancomycin, linezolid, gentamicin and ciperofloxcin were highly effective to gram positives while imipenem and meropenem to gram negatives

Macrolide resistance of streptococcus pneumoniae in patients with otitis media

This study was performed on 317 patients attended to pediatric and ENT- Outpatient Clinics at Al-Azhar University Hospital of Assiut during 2 years from 2009-2011, samples were collected from middle ear fluid, 161 patients were males and 156 were females, patients were of different ages ranges from 6 months to 75 years old, children under 10 years represented 53.3% [169] of total patients in this study. The objectives were to determine the macrolide resistance of isolated Strept. pneumoniae. Out of the 317 cases of otitis media, 78 isolates of Strept. pneumoniae were obtained [24.6%]. Out of them 66 isolates were from 196 cases of acute otitis media [33.7%] and 12 isolates were from 121 cases of chronic otitis media [9.9%]. There were 45 isolates from males, while 33 were from females. Most isolates were taken from patients under 10 years old [51 isolates]. Sensitivity pattern of Streptococcus pneumonia showed that 30.7%, 26.9% and 24.4% were resistant to erythromycin, clarithromycin and azithromycin respectively. As previous findings proved that pneumnococci resistant to erythromycin have mainly one or both distinct resistance determinants either erm[B] or mef[E]. PCR was done to detect these genes in isolates [24] erythromycin resistance, it was observed that 33.3% harbored mef genes, 8.3% erm genes and 41.6% both mef and erm genes. erm B and mef E genes were detected using agarose gel electrophoresis at 224 and 347 bp respectively

Is there microbial health hazard from plain and flavored UHT milk ?

This study was conducted to answer the question about the probability of incidence of microbial public health hazard that may arise from consumption of UHT milk either plain or flavored types. To answer this question, we examined microbiologically UHT milk samples in 3 lines: aerobically, anaerobically and fungal. Therefore, 100 UHT milk samples were collected randomly from different supermarkets and retails distributed in Assuit city during summer season of 2011. Plain type was represented by 14 samples, while chocolate flavored by 31 samples, strawberry flavored by 30 samples and banana flavored by 25 samples. All samples were examined for the incidence of aerobic, anaerobic and fungal contamination. The revealed results showed that neither anaerobes nor fungi could be detected, while the aerobic microorganisms were detected in 11 samples [11%], in which Staphylococci species were isolated from 7 samples and Gram-negative bacilli werw isolated from 4 samples. It was also noticed that none of the contaminated samples was from the plain type, but they were from flavored types as 8 chocolate and 3 strawberry. Moreover, 6 samples out of the 11 contaminated were of the same production date [29/5/2011], indicating that the line of production in such day may be faced to unhygienic conditions. Latex agglutination test, SDS-PAGE and PCR were used for identification and toxigenicity detection of Staph. aureus strains, in which, 4 samples out of the 7 with Staphylococci species had enterotoxigenic Staph. aureus as 3 samples contaminated with strains harboring classical superantigen genes [2 with SEA + 1 with SED gene] and 4th sample contaminated with strain harboring new superantigen gene [SEG gene]. The Gram-negative bacilli were E. coli, Klebsiella species and Proteus species. Because of the isolated microorganisms were heat-sensitive, their presence in UHT milk means the sterilization temperature was inefficient and/or post-sterilization contamination that are referring to the answer of the present study

Catheter-associated urinary tract infections: uropathogens and fluoroquinolones resistance of gram negative bacilli in assiut

Background: Catheter-associated urinary tract infections [CAUTI] are commonly caused by Gram-negative bacteria which have a steady increase in their resistance to commonly used antimicrobial drugs, including fluoroquinolones

Objectives: The aim of this study was to identify the causative bacteria of CAUTIs, to assess resistance of Gram-negative bacilli to common fluoroquinolones, and to detect mutant gyrA gene responsible for fluoroquinolone resistance

Methods: 100 catheterized male patients, admitted to the Urology Department of Assiut University Hospital, were investigated for the causative organisms of CAUTI. Antimicrobial susceptibility testing of 123 isolates was performed by agar disc diffusion and minimum inhibitory concentration [MIC] test to ciprofloxaciri was performed to ftuoroquinolone-resistant Gram-negative isolates. Fluoroquinolone-resistant strains of E.coli, Klebsiella spp and Pseudomonas spp were investigated to detect the presence of quinolone resistance gyrA gene by PCR method

Results and conclusions: The isolates were E. coll [45.5%], Pseudomonas aeruginosa [19.6%] and Klebsiella spp [17.9%]. 28% of patients had quinolone-resistant isolates. Fluroquinolones resistance was detected in 36.6% of the total isolates [45/123] and in 37.5% of Gram negative isolates [39/104]. The highest quinolone resistance rate of the Gram negative isolates was observed to norfloxacin [33.7%]followed by levofloxacin [32.7%], and ofloxacin and lomefloxacin [30.8%]. The highest resistance rates were observed by Klebsiella spp to norfloxacin [45.4%, P<0.001], by Ps. aeruginosa to norfloxacin and levofloxacin [41.7% P<0.04], and by E. coll to lomefioxacin and levofloxacin [30.4%, P<0.04]. MIC values >32 microg/ml "were obtained by 66.7 % of Klebsiella spp, 72.7% of E. coli and 100% of Ps. aeruginosa resistant isolates. The high rate of quinolone resistance and the high MICs are alarming and the wide use of quinolones on empirical basis needs to be restricted. Twenty eight strains [85%] were positive for mutant gyrA gene by PCR. Not all quinolone-resistant isolates tested by PCR were positive for mutant gyrA gene suggesting that other causes for quinolone resistance may be involved?

Role of coxsackie-B4 virus in newly diagnosed type I diabetic cases in children

Background: Coxsackie B4 virus [CVB4] is one of the enteroviruses that play a major role in type I Diabetes Mellitus. It has been found that the virus has a selective tropism to ? cells of islets of Langerhans, causing selective autoimmune destruction of pancreatic islet cells. However many factors contribute to the pathogenesis of this disease, so this work tried to approve the role of CVB4 in the newly diagnosed type one Diabetes Mellitus cases in Pediatric Department in Assiut University Hospitals

Methodology: Fifty three cases with recent onset type I Diabetes Mellitus and 25 matched controls were enrolled in this study to detect the role of CVB4. Tissue Culture confirmed by micro-neutralization technique, semi nested RT-PCR and ELISA to detect IgM to CVB4 virus in sera of patients and controls were used to detect the presence or absence of CVB4

Results: It was found that 58.49% of cases were positive for CVB4 by tissue culture, while 67.92% and 54.7% were positive by microneutralization technique and semi nested RT-PCR respectively, corresponding to only 15.09% positive cases only by ELISA. While, in controls there were 44% positive for CVB4 by tissue culture and only 23% by microneutralization and 4% by PCR and ELISA

Conclusion: Coxsackie B4 virus is one of the major causes of newly diagnosed cases of type I Diabetes Mellitus and should be searched for during management of these cases

Pattern of hepatitis B and C virus infection among pregnant women and their newborns in women's health center - Assiut University, Egypt

Aims: To determine the prevalence, risk factors of HBV and HCV infection among pregnant women, rate of vertical transmission to newborns and to assess the preventive role of HBIG and HBV vaccine on the carrier state of newborns

Methods: Five hundred pregnant women were screened for HCV and HBV seromarkers by ELISA, positive cases were confirmed by PCR and evaluated for liver enzymes and INF-gamma. Newborns of HBV positive mothers received HBV vaccine and immunoglobulins and followed up to assess the vertical transmission and carrier rates

Results: Out of the five hundred pregnant women, 7.0% were HCV positive, 4.0% were HBV positive and 1.0% was both HCV and HBV positive. The vertical transmission rate to the newborns was 2.9% for HCV, 30.0% for HBV and 20.0% for combined HBV and HCV infection. The carrier rate of HCV and HBV positive newborns at the end of eight months was10.8% and 8% respectively

Conclusions: HBV and HCV are highly prevalent among pregnant women in Upper Egypt. The rate of vertical transmission was also high. HBV vaccine and immunoglobulin resulted in satisfactory reduction [92%] in the carrier state of HBV infection among the newborns

Any role for chlamydia pneumoniae in ischemic stroke?

Stroke is the third leading cause of death and is an important cause of long term disability. Inflammatory processes have fundamental roles in stroke in both the etiology of ischemic cerebrovascular disease [CVD] and the pathophysiology of cerebral ischemia. Chronic infection with Chlamydia pneumoniae [C. pneumoniae], a common respiratory pathogen capable of infecting endothelium, arterial smooth muscle, and monocytes, is a recently proposed risk factor for atherosclerosis and first ischemic stroke. In the present study we tried to provide evidence for the presence of C. pneumoniae in peripheral blood mononuclear cells [PBMCs] by tissue culture confirmed immunofluroscence [IF], polymerase chain reaction [PCR] on PBMCs and enzyme linked immunosorbent assay [ELISA] for detection of immunoglobulin A [IgA] to C. pneumoniae in patients with first ischemic stroke. The study included 157 cases with first ischemic stroke and 50 aged and gender matched healthy controls. The mean of age +/- SD of all patients was 61.68 +/- 11 years old. The patients were divided into two groups according to the age of onset: early onset group with age < 65 years old and late onset group with age >/= 65 years old. Using the multiple logistic regression analysis between patients and control, there was significant association between smoking [odds ratio= 7.8 and 95% confidence interval [C.I.] = 2.5 - 23.9, P=0.0001] and diabetes mellitus [odds ratio= 3.29 and 95% C.I. = 1.2 - 8.3, P= 0.013] as risk factors for ischemic stroke. There was statistical significant difference between patients and control groups for the presence of C. pneumoniae by tissue culture, IF, PCR on PBMCs and ELISA for IgA to C. pneumoniae. A statistical significant differences was found between both patients groups and control group for C. pneumoniae by all used laboratory measures. But there was no significant statistical difference between both patients groups in the frequency of C. pneumoniae by all used laboratory measures. On the other hand, there was no significant statistical relation between risk factors and C. pneumoniae presence in patients with first ischemic stroke. Measuring the sensitivity and specificity of each laboratory technique for C. pneumonia, we found that tissue culture is more sensitive [97%] but less specific than IF, and PCR is the most specific [100%], but also less sensitive than IF, and ELISA is more sensitive [93%], less specific than IF. There was statistical significant positive correlation between ELISA IgA for C. pneumoniae and both IF and PCR. Conclusions it is concluded that C. pneumoniae could be one of the important sharing factors in fist ischemic stroke occurrence, it should be searched fore in those patients admitted with first ischemic stroke. Tissue culture confirmed by IF could be used as routine measure for diagnosis of C. pneumoniae, and if needed it could be confirmed by PCR on PBMCs. ELISA IgA for C. pneumoniae could be used for screening of these patients for C. pneumoniae because of the time consumed to carryover tissue culture or PCR. Treatment of patients with ischemic stroke with C. pneumoniae antimicrobial therapy is needed to eliminate the infectious risk factor that may contribute in this disease especially in young patients which may not have other risk factors

Clinical and laboratory significance of endocervical Cysts

Aim of the work: To provide full assessment of cervical cysts clinically, and bacteriologically. To correlate the level of inflammatory cytokines [IL-8, IL-10 and MMP-9] with the nature of cervical cyst. To find out the impact of cervical cysts occurrence, type, site and number on the common female genital complaints such as vaginal discharge, deep pelvic pain and unexplained infertility

Study design: Prospective Cohort study

Setting: Women's Health Center of Assiut University Hospitals, tertiary care referral facility

Intervention: 75 cases were examined clinically, by transvaginal ultrasonography and diagnostic office hysteroscopy for the diagnosis of cervical cysts. Cyst aspiration was performed using interventional 2D ultrasonography and diagnostic office hysteroscopy. Cysts' aspirates were examined bacteriologically and cytologically. Sera of these patients were evaluated for IL8, IL10 and MMP-9

Main outcome measures: To estimate the relief of genital complaints as a result of cyst aspiration either as a single maneuvers or completed by administration of antibiotics guided by culture and sensitivity test of cyst aspirates, and pregnancy rate after one year in infertile women

Results: Cervical cysts were diagnosed in 75 patients. The mean size of the cervical cyst was 2.18 +/- 0.609 cm. It was found that 61.4% of cysts were infected, Chlamydia Trachomatis was detected in 13.33% of infected cysts, while Gardenella Vaginalis was detected in 24 %, GBS in 14.67% and Mycoplasma hominis in 14.67%. Patients with infected cysts had elevated IL-8 [P= 0.000], and had increased IL-10 [P= 0.000] in all groups in comparison with non infected cysts, but increased MMP-9 was detected in group III only [P=0.000], with significant correlation between size of the cysts and level of cytokines. Improved health related quality of life in the form of relief of deep dyspareunia and excessive vaginal discharge were reported in 42.8% and 59.3% of cases respectively. Pregnancy was achieved in 26.6% in the infertile females after 1 year of follow-up spontaneously or with the aid of controlled ovarian stimulation

Conclusion: Cervical cysts should not be ignored as a potential cause of common gynecological symptoms especially when it's large in size. Infected cysts account for reasonable ratio which may necessitate aspiration followed by culture and sensitivity test to the aspirate. Unexplained infertility shows some improvement after cyst aspiration and proper antibiotic administration