Device-associated infection rates in adult and pediatric intensive care units of hospitals in Egypt. International nosocomial infection control consortium [INICC] findings

To determine the rate of device-associated healthcare-associated infections [DA-HAIs] at a respiratory intensive care unit [RICU] and in the pediatric intensive care units [PICUs] of member hospitals of the International Nosocomial Infection Control Consortium [INICC] in Egypt. A prospective cohort DA-HAI surveillance study was conducted from December 2008 to July 2010 by applying the methodology of the INICC and the definitions of the NHSN-CDC. In the RICU, 473 patients were hospitalized for 2930 d and acquired 155 DA-HAIs, with an overall rate of 32.8%. There were 52.9 DA-HAIs per 1000 ICU-days. In the PICUs, 143 patients were hospitalized for 1535 d and acquired 35 DA-HAIs, with an overall rate of 24.5%. There were 22.8 DA-HAIs per 1000 ICU-days. The central line-associated blood stream infection [CLABSI] rate was 22.5 per 1000 line-days in the RICU and 18.8 in the PICUs; the ventilator-associated pneumonia [VAP] rate was 73.4 per 1000 ventilator-days in the RICU and 31.8 in the PICUs; and the catheter-associated urinary tract infection [CAUTI] rate was 34.2 per 1000 catheter-days in the RICU. DA-HAIs in the ICUs in Egypt pose greater threats to patient safety than in industrialized countries, and infection control programs, including surveillance and guidelines, must become a priority

Comparison of culture, direct antigen detection and PCR for diagnosis of pneumococcal pneumonia

Pneumonia due to Streptococcus pneumoniae [S.pneumoniae] is a major cause of morbidity and mortality among children and adults worldwide. Comparison of Culture, Direct Polysaccharide Antigen Detection and Polymerase chain Reaction 'PCR' for diagnosis of Pneumococcal Pneumonia. This study was conducted on 80 nasopharyngeal aspirates from children patients with community acquired pneumonia [CAP], admitted to Cairo university specialized Pediatric hospital [CUSPH]. Only samples of good quality and Significant counts of alpha haemolytic streptococci were subjected to optochin sensitivity, bile solubility test, pneumococcal antigen detection by latex and PCR. Significant counts of alpha haemolytic streptococci were isolated from-35 patients out of the original 80 patients. Out of 35 samples, 11 [31%] were optochin sensitive and bil soluble. Considering the optochin disc sensitivity test as a reference method, both Latex agglutination test and PCR had excellent sensitivity [100%] and good specificity: 62.5% for latex agglutination test and 79% for PCR. Culture and optochin sensitivity remain to be the definitive diagnostic test for streptococcus pneumoniae. Pneumococcal antigen detection by latex is a rapid screening test but should be combined with culture to avoid false positive results. PCR had good sensitivity and specificity, but it is difficult to be used for routine clinical diagnosis because of its relatively high cost and its tedious work that needs skilled personnel

Catheter associated nosocomial urinary tract infections

Urinary catheters are placed in up to 25% of hospitalized patients and are a leading cause of hospital-acquired infection. Six hundred urine samples throughout 5 months were collected from Al-Kasr Al-Aini hospital. 450 samples were from catheterized patients for at least 72 hours before taking the sample and 150 samples were from non-catheterized patients and were studied by identification of the isolated pathogens. The aim of this study was to evaluate the role of catheterization in nosocomial urinary tract infection. The study revealed significant statistical difference p value <0.05 between catheterized and non-catheterized patients as regarding positive cultures, out of 450 catheterized patients 83% had positive culture results while out of 150 non-catheterized patients only 67% had positive culture results. Age and sex were found to be two main factors in the development of catheter associated UTI. Also results of this study revealed that E.Coli was the most commonly isolated organism in both catheterized and non-catheterized patients [35%] and [50%] respectively. Forty nine [13%] Candida isolates were isolated out of 375 positive culture from urine samples of catherized patients and only 1 Candida isolate [1%] out of 100 positive cultures from non catheterized. Isolated Candida species were identified by germ tube and subculture on CHROM and Biggy agar. Twenty two strains [44%] were identified as Candida-albicans on the basis of positive germ tube test while 28 strains [56%] were diagnosed as Candida non-albicans with germ tube test negative. In this study we found the sensitivity and the specificity of CHROM agar to identify isolated Candida species were 100% while the sensitivity and the specificity of Biggy agar were [86%] and [90%] respectively

Role of Chlamydia pneumoniae infection in Egyptian asthmatic patients

The role of respiratory infections in asthma is poorly understood. Chlamydia pneumoniae [C.pneumoniae] infection is claimed to be of importance for the development of asthma. This study was designed to investigate the role of Chlamydia pneumoniae infection in asthmatic patients in an attempt to understand its role in respiratory tract allergy. Forty adults and forty children with acute attack of asthma were included in our study in addition to ten healthy adults and ten healthy children as control group. Nasopharyngeal aspirates were taken from patients and controls and tested for the presence of Chlamydia pneumoniae by tissue culture and PCR. Six [15%] adult patients were positive by culture as well as PCR while two [5%] patients were positive by culture alone, in children, four [10%] patients were positive by both culture and PCR, only one [2.5%] patient was positive by culture alone. None of the control group gave positive result with culture or PCR. Taking chlamydia tissue culture as the reference method, the PCR sensitivity in adult group was 75% and in children 80% while the specificity in both groups was 100%. There is no statistically significant difference regarding the chlamydia positivity by culture and PCR between the patient group and the control group suggesting that C.pneumoniae may not play a significant role in the pathogenesis of asthma