Phenotypic detection of efflux pumps in drug resistant Pseudomonas aeurginosa isolated from Suez Canal University Hospitals

Background: Pseudomonas aeruginosa is considered as one of the top five pathogens of nosocomial diseases worldwide. Infections caused by P. aeruginosa are often severe and life threatening and are difficult to treat because of the limited susceptibility to antimicrobial agents and the high frequency of emergence of antibiotic resistance during therapy. What adds to the problem of P. aeruginosa nosocomial infections is the emergence of multi-drug resistant [MDR] strains that develop resistance by various mechanisms like multi drug resistance efflux pumps, production of beta-lactamases, aminoglycoside modifying enzymes and decrease outer membrane permeability. Efflux pumps contribute to multidrug resistance as they expel different types of antibiotics and chemicals

Objectives: Detection of the role of the efflux pump in multidrug resistant P. aeurginosa isolates from Suez Canal university hospital [SCUH] in Ismailia

Methodology: This study included 307 hospitalized patients of both sexes and from all age groups. A forty nine P. aeruginosa strains were isolated from blood, urine, sputum and pus. Antibiotic susceptibility tests were done by using disc diffusion method. For detection of the role of efflux pump in MDR, strains proved to be MDR were further tested by MIC [agar dilution susceptibility method] before and after addition of efflux pump inhibitor carbonyl cyanide m-chlorophenylhydrazone [CCCP]

Results: The isolation rate of P. aeruginosa was 15.9% out of a total number of 307cases. The isolation rate was highest from cases in the ICU [26.5%], while it was lowest from internal medicine department [8.2%]. 57.1% of the isolates were multidrug resistant; the efflux pump mediated resistance was proved for ciprofloxacin and meropenem

Conclusion: Our study proved the role of efflux pump mechanism in mullti-drug resistance by P.aeruginosa isolates to ciprofloxacin and meropenem. Other studies proved the role of this mechanism in resistance to carbapenem, levofloxacin, ciprofloxacina and meropenem. Understanding the mechanisms by which these pumps act and how to overcome its activity opens the door for restoring the antibiotic activity and constitute a promising target for novel antibacterial agents

Species identification and pattern of antibiotic resistance of enterococci isolated from cases of nosocomial infections in Suez Canal university hospital

Enterococci which are part of the normal intestinal flora are opportunistic human pathogens. The two most important species, E.faecalis and E.faecium are among the leading causes of nosocomial infections that may cause severe infections including endocarditis, urinary tract infection, septicemia and wound infections which are often difficult to treat. The aim of the present study was Isolation and characterization of enterococci from patients with nosocomial infections were performed to determine the most common species responsible for nosocomial infections and to study the patterns of resistance of the isolated strains

Methods: This study is a twelve-month prospective study in which different clinical samples including urine, pus, blood and ascetic fluids were collected from patients with evidence of nosocomial infection at the period from December 2005 to December 2006. These specimens were subjected to a culture on blood and Mac Conkey agar, gram staining, catalase test, bile aesculin hydrolysis and salt tolerance test for isolation of enterococci. Enterococcal strains were further identified to the species level by using biochemical tests which are based on sugar fermentation, pyruvate utilization and arginine decarboxylation. Antimicrobial susceptibility was done for the isolates by disc diffusion method and agar dilution for vancomycin MIC determination

Results: The enterococci infection rate in our hospital was 3.3% isolated from urine [65%], pus [30%] and from ascetic fluid [5%] [p>0.005]. The majority of the isolates were E.faecalis [55%] followed by E. faecium [30%], E. durans [10%] and E. avium [5%]. The most common source of isolation was the internal medicine departments and ICUs [p>0.05]. By disc diffusion method, E.faecalis was more resistant than E.faecium to tertracyclines [P<0.05] and aminoglycosides [P<0.01]. Otherwise, E.faecium was more resistant than E.faecalis to penicillins [P<0.01] and quinolones [P<0.001]. All the strains were sensitive to vancomycin by disc diffusion method. The 20 isolates were further tested by agar dilution method to determine their vancomycin MICs. All the strains were vancomycin susceptible with MICs ranged from 1 micro g/ml to 4 micro g/ml

Hepatitis B virus [HBV] genotypes in Egyptian pediatric cancer patients with acute and chronic active HBV infection

Background: There are eight genotypes of hepatitis B virus [A-H] and subgenotypes are recognized. Genotyping can be accomplished based on a partial sequence of HBV genome such as the pre-S or S gene. Several methods have been developed and used for HBV genotyping. This study was undertaken to determine the HBV genotypes in Egyptian pediatric cancer patients with acute and chronic liver disease

Methods: HBV genotypes were determined in 22 patients who had acute forms of liver disease [AH] and in 48 patients with chronic active hepatitis [CAH]. A type-specific primer based on the nested-PCR method was employed in the HBV genotyping

Results: This study showed that HBV infections in pediatric cancer patients are attributed predominantly to viral genotypes D and B that constituted 37.1% and 25.7%, respectively of the total infections. In addition, there was a relatively high prevalence of mixed infections of 15.7% among the studied group especially mixed A/D genotype infections. Genotype D was found significantly more often in patients with CAH than in patients with AH [P<0.05]

Conclusion: These findings show the distribution of HBV A-D genotypes in pediatric cancer Egyptian patients. Furthermore, our results indicate a markedly high prevalence of mixed A/D genotype infections in subjects with CAH and a possible association of mixed infections with the severity of liver diseases

Species identification and pattern of antibiotic resistance of enterococci isolated from cases of nosocomial infections in Suez Canal university hospital

Enterococci which are part of the normal intestinal flora are opportunistic human pathogens. The two most important species, E.faecalis and E.faecium are among the leading causes of nosocomial infections that may cause severe infections including endocarditis, urinary tract infection, septicemia and wound infections which are often difficult to treat. The aim of the present study was Isolation and characterization of enterococci from patients with nosocomial infections were performed to determine the most common species responsible for nosocomial infections and to study the patterns of resistance of the isolated strains

Methods: this study is a twelve-month prospective study in which different clinical samples including urine, pus, blood and ascetic fluids were collected from patients with evidence of nosocomial infection at the period from December 2005 to December 2006. These specimens were subjected to a culture on blood and Mac Conkey agar, gram staining, catalase test, bile aesculin hydrolysis and salt tolerance test for isolation of enterococci. Enterococcal strains were further identified to the species level by using biochemical tests which are based on sugar fermentation, pyruvate utilization and arginine decarboxylation. Antimicrobial susceptibility was done for the isolates by disc diffusion method and agar dilution for vancomycin MIC determination

Results: The enterococci infection rate in our hospital was 3.3% isolated from urine [65%], pus [30%] and from ascetic fluid [5%] [p>0.005]. The majority of the isolates were E.faecalis [55%] followed by E. faecium [30%], E. durans [10%] and E. avium [5%]. The most common source of isolation was the internal medicine departments and ICUs [p>0.05]. By disc diffusion method, E.faecalis was more resistant than E.faecium to tertracyclines [P<0.05] and aminoglycosides [P<0.01]. Otherwise, E.faecium was more resistant than E.faecalis to penicillins [P<0.01] and quinolones [P<0.001]. All the strains were sensitive to vancomycin by disc diffusion method. The 20 isolates were further tested by agar dilution method to determine their vancomycin MICs. All the strains were vancomycin susceptible with MICs ranged from 1 micro g/ml to 4 micro g/ml

Direct molecular identification of Malassezia species from skin scales of patients with seborrheic dermatitis by nested terminal fragment length polymorphism analysis

Background: Malassezia yeasts are associated with several dermatological disorders. The conventional identification of Malassezia species by phenotypic conventional methods is complicated and time-consuming, and the results based on culture methods are difficult to interpret. This study aimed to perform a DNA-based procedure [nested terminal fragment length polymorphism analysis [tFLP]] directly applicable to pathological skin scales for the identification of seven Malassezia species. This technique involves nested PCR of the intergenic transcribed spacer [ITS] ITS I and ITS II region ribosomal gene clusters. All known Malassezia species can be differentiated by unique ITS fragment lengths

Subjects and methods: Specimens were taken from 14 patients with seborrheic dermatitis. Cultures were made in modified Dixon agar medium and the isolates were identified by the coventional methods: macroscopy, microscopy, catalase and Tween lipid assimilation tests. Skin scales were also directly analysed by nested terminal fragment length polymorphism analysis

Results: Malassezia species were detected in 9 [64.2%] of specimens. The most commonly isolated species were M. globosa [22.2%] and M. furfur [22.2%]. M. sympodialis, M. obtusa, M. pachydermatis, M. restricta and M. slooffiae were isolated in a rate of 11.1% each, by nested tFLP. Some discrepancies were noted when the molecular methods were compared with the phenotypic method of identification

Conclusion: From these findings it was suggested that this specific amplification may facilitate the rapid and direct identification of Malassezia species from skin scales

Evaluation of neutrophil apoptosis in patients with bacterial pneumonia and its relation to the severity of infection and types of isolated organisms

Inappropriate induction of neutrophil apoptosis during infection could deplete neutrophil numbers and function, impairing host defense and favoring bacterial persistence. The aim of this work was to determine whether infection could promote neutrophil apoptosis by evaluating the rate of neutrophil apoptosis in sera of patients with pneumonia and healthy control patients. It also aimed at examining the role of FasL in infection induced neutrophil apoptosis. This study included 25 patients diagnosed as having pneumonia and 15 healthy controls. Neutrophil apoptosis was quantified by flow cytometry using propidium iodide and Becton Dickinson FACScalibur. The rate of apoptosis was greater for neutrophils isolated from patients with pneumonia than for healthy controls [P value, 0.000]. Patients with gram negative and severe infections exerted a higher rate of neutrophil apoptosis than patients with gram positive infection. The rate of neutrophil apoptosis was greater when subjected to sera from patients with either gram-negative or gram-positive infection than when subjected to sera from controls [P value, 0.001]. Moreover, anti-FasL antibody-neutralized infected sera attenuated the infected-serum-induced neutrophil apoptosis [P value, 0.000]. These results suggest that infection enhances neutrophil apoptosis possibly through FasL but its source needs to be determined in further studies

Incidence of various types of taurodontism in a sample of Saudi population

A sample of 440 adults Saudi patients, attended the College of Dentistry, King Saud University in Riyadh, Saudi Arabia was reviewed of the presence of taurodontism. Thirty-eight patients of the sample had taurodontic molar teeth, a rather high percentage in comparison to other studies. The incidence of mesotaurodontism was 56%, hypotaurodontism 23.5% and hypertaurodontism was 20.5%. Fused- root teeth accompanied taurodontism in 42%. The incidence of other anomalies was also presented

Incidence of third molar impaction in a sample of Saudi patients from Riyadh

Four hundred and forty files of Saudi patients were treated. Only 2.3% werecomplaining of periocoronitis or operculitis. One hundred and eighteenpatients [26.8%] had third molar impaction. 53% of these patients were malesand 47% females. Impaction mandibular third molar predominated in malepatients, while maxillary third molars impaction prevailed in females. Agegroup between 20-29 years had the highest incidence, while older Saudi patientsshowed less incidence of impaction indicating a sign of tooth-jawdisproportions in the younger generation or a sign of civilization thateliminates the need for large and powerful jaws. Mesioangular inclination,especially in the mandible, class I and depth C predominated in this study