Detection of Plasmid Mediated AmpC alpha-Lactamases in Nosocomial Isolates of Klebsiella pneumoniae at Mansoura University Hospitals

Plasmid-mediated AmpC alpha-lactamases [pAmpC] have been discovered most frequently in Klebsiella pneumoniae. At this time, there is no st and ardized phenotypic method for the screening and detection of AmpC enzymes. The aim of the present study was to evaluate three phenotypic methods [modified three dimensional test, AmpC test and Hodge test] to detect pAmpC, to determine the rate of pAmpC in nosocomial isolates of Klebsiella pneumoniae from six hospitals in Mansouraandstudy antibiotic sensitivity pattern for isolates carrying pAmpC. A total of 112 consecutive nosocomial isolates of Klebsiella pneumoniae were included in the study. The presence of pAmpC was evaluated by cefoxitin screening test, modified three dimensional test, Hodge test, AmpC disc and multiplex polymerase chain reaction. Antibiotic susceptibility test was done by disc diffusion method for Klebsiella pneumoniae isolates carrying pAmpC gene. Phenotypic tests showed that three dimensional test, was the best regarding sensitivity and specificity when compared to Hodge test, AmpC disc. The multiplex PCR detect pAmpC in 54 [48%] isolates, DHA family in 34 [63%] isolates, followed by gene family ACC family in 17 [31.5] and both DHAandACC in three [5.6%] isolates. All isolates were resistant to third generation cephalosporins, 57% of isolates were sensitive to imipenem and 100% of isolates were sensitive to tigycyclin. Conclusions: pAmp C was detected in 48% of the study isolates. The most common pAmp C was the DHA family. tigycyclin is the most effective antibiotics in all isolates carrying p AmpC

Persistent oxidative stress in patients with chronic active hepatitis-C infection after antiviral therapy Failure

Oxidative stress and hepatocellular pathological changes are common associations with chronic hepatitis C virus [CHC] disease. The aim of this study was to assess serum antioxidant-oxidant [Redox] balance in patients with CHC infection before and after intake of the traditional antiviral therapy [pegylated interferon alpha-2b and oral ribavirin]. Blood samples from 50 biopsy-proven CHC patients, with no prior anti-viral treatment and persistently elevated serum transaminase levels for 6 months, as well as 15 age- and sex-matched healthy subjects were used for determination of the antioxidants: reduced glutathione [GSH], superoxide dismutase [SOD], alpha tocopherol and ascorbic acid as well as lipid peroxidation [LPO] index [malondialdehyde [MDA]]. The measurements were repeated in the diseased group 25 weeks after pegylated interferon alpha-2b and ribavirin combination therapy. Serum levels of bilirubin, aspartate aminotransferase [AST], and alanine aminotransferase [ALT] were significantly higher in CHC patients than in the control group [P < 0.05]. Pretreatment serum MDA values were significantly higher in patients with CHC infection than the control group [P < 0.001], while serum antioxidant levels were significantly lower [P < 0.001]. Responders [10 patients] had lower pretreatment serum levels of MDA than non-responders [35 patients] [P < 0.001]. Both groups were comparable for the antioxidant serum levels. There was significant negative correlation between serum MDA and serum SOD, GSH, alpha tocopherol, and ascorbic acid concentrations in CHC patients. On the other hand, there was no correlation between the studied parameters and serum bilirubin, albumin, ALT, and AST. Redox imbalance was detected in patients with CHC. Responders had significantly lower levels of MDA than non-responders. Serum MDA may be used as a pretreatment predictor of response to antiviral treatment in patients with CHC

Nosocomial infections in living donor liver transplant recipients

Backgrounds: Infections continue to be a major problem, representing one of the leading causes of morbidity and mortality among liver transplant recipients

Objective: To detect the frequency of different bacterial and fungal pathogen causing nosocomial infections in living donor liver transplant recipients in Gastroenterology Center in Mansoura University

Patients and Methods: The current study conducted on 45 living donor liver transplant recipients. Patients with suspected bacterial or fungal infection cultures were performed. Susceptibility of the strains to the antibiotic and antifungal agents was tested

Results: Nosocomial infections occurred in 42% of liver transplant recipients. Surgical site infection was the commonest type of infection which represents 58% of the total bacterial infections. Multiple drug resistant bacteria occured in [67%] of isolates. Gram negative infections were predominant. Incidence of invasive fungal infection in early period after transplantation was 11.1%. Pretransplant ascites, low serum albumin, postoperative hospital stay and steroid intake were significantly associated with nosocomial infections among liver transplant recipients

Conclusions: Nosocomial bacterial infection is common in early period after liver transplantation. The commonest bacterial pathogens were Klebsiella pneumoniae and Staphylococcus aureus which represents 23.8% for each