Random amplification polymorphic DNA is a good epidemiologic screening method of pseudomonas aeruginosa nosocomial isolates from menoufyia university hospital burn unit

Burned patients are at increased risk for hospital-acquired infections. Pseudomonas aeruginosa is the most common bacterial pathogen involved in these infections. Epidemiologic typing is needed to discover the source of infection. Phenotypic characteristics of Pseudomonas aeruginosa could be used for this purpose. However, the genomic fingerprinting methods are now regarded as more accurate typing methods. Random amplified polymorphic DNA is thought to be an efficient genetic typing method. In the Burn Unit of Menoufyia University Hospital this study was carried out in order to overview the problem of hospital acquired infections in this unit, to identify the most common pathogen and to find out probable sources of infections. Fifty-three cases of nosocomial burn wound infections, ten medical personnels and thirty-one environmental samples were screened, bacterial isolates were identified. Epidemiologic study for the most common isolate [Pseudomonas aeruginosa] was done using antibiogram and pyocin production in addition to some genetic studies as plasmid profile and random amplification polymorphic DNA [RAPD] typing. Total number of Pseudomonas aeurginosa strains isolated from burn wound infections, medical staff and Burn Unit environment and equipments was 36. These P. aeurginosa strains were mostly sensitive to imipinem [69.5%] followed by amikin [61.2%]. Antibiogram typing classified these isolates into 9 groups. beta lactamase prduction was proved in 58% of strains. Pyocin typing revealed 5 types. Sixteen strains had plasmids with 7 different profiles. According to RAPD 24 different patterns were distinguished. Identical clones of Pseudomonas aeurginosa were identified: two clones were related to environmental sources [Hydrotherapy tub and stretcher of hydrotherapy]. Horizontal acquisition through health care worker [finger tips] was proved.Endogenous colonization was also found in two cases. The RAPD method is simple, fast and has high discriminatory power suitable for application in epidemiologic studies. Stringent infection control policies and education campaign are urgently needed

Induced sputum versus fiberoptic bronchoscopy in the diagnosis of pulmonary tuberculosis

Tuberculosis still constitutes a major health problem despite advances in diagnosis and treatment. The diagnosis of TB is difficult in patients who cannot produce sputum spontaneously. This study aimed to compare between sputum induction using nebulized hypertonic saline, and fiberoptic bronchoscopy in the diagnosis of pulmonary TB, in clinically and radiologically suspected cases. Thirty suspected pulmonary tuberculosis cases were subjected to: 1-Tuberculin skin test. 2-Sample collection: a. Three successive spontaneous morning sputum samples, b. Sputum induction for 3 successive mornings c. Fiberoptic bronchoscopy with bronchial washing, brushing and Post-bronchoscopic sputum collection. All samples were stained with Ziehl-Neelsen stain. Induced sputum [SI] and bronchial wash were also cultured on Lowenstein-Jensen [L.J] medium. According to L J cultures there were 25[83.3%] positive bronchial wash samples VS 22[73.3%] induced sputum samples. The diagnostic yields of sputum induction and post-bronchoscopic sputum were similarly significant. Also, the yields of bronchial washing and bronchial brushing were similarly highly significant .The differences between all these procedures was non significant. The third SI sample was the most sensitive in the detection of AFB There was no significant difference between SI and Bronchial washing whether by using Z-N stain or L-J culture. Sensitivity, specificity and predictive values of different methods of specimen collection in diagnosing pulmonary TB gave non-significantly different results. Sputum induction is an easy, cheap and non invasive procedure that has a significantly high diagnostic yield for clinically and radiologically suspected cases of pulmonary tuberculosis who have dry cough or whose sputum for three successive days are negative. The third SI sample is the most significant one. There is no significant difference between SI and FOB using any of its procedures

Induced sputum versus fiberoptic bronchoscopy in the diagnosis of pulmonary tuberculosis

Tuberculosis still constitutes a major health problem despite advances in diagnosis and treatment. To compare between sputum induction using nebulized hypertonic saline, and fibreoptic bronchoscopy in the diagnosis of pulmonary TB, in clinically and radiologically suspected cases. 30 patients were subjected to: 1-Tuberculin skin test. 2-Microbiological examination of: a. Three successive spontaneous morning samples, b. Sputum induction for 3 successive mornings c. Fibreoptic bronchoscopy with Bronchial washing, brushing and post-bronchoscopic sputum collection. All samples were stained with Ziehl-Neelsen stain. Induced sputum [SI] and bronchial wash were also cultured on L.J medium. The diagnostic yields of sputum induction and post-bronchoscopic sputum were similarly significant. Also, the yields of bronchial washing and bronchial brushing were similarly highly significant. The differences between all these procedures was non significant. The third SI sample was the most sensitive in the detection of AFB. There was no significant difference between SI and Bronchial washing whether by using Z-N stain or L-J culture. Sensitivity, specificity and predictive values of different methods of specimen collection in diagnosing pulmonary TB gave non-significantly different results. Sputum induction is an easy, cheap and non invasive procedure that has a significantly high diagnostic yield for clinically and radiologically suspected cases of pulmonary tuberculosis who have dry cough or whose sputum for three successive days are negative. The third SI sample is the most significant one. There is no significant difference between SI and FOB using any of its procedures

Spontaneous bacterial empyema in cirrhotic patients: complements 3 and 4, opsonic power and C-reactive protein as pathogenic mechanisms and diagnostic tools

Hepatic hydrothorax occurs in approximately 5-12% of patients with cirrhosis and portal hypertension and may be complicated by spontaneous bacterial empyema [SBE]. Pathogenic mechanisms of SBE still need to be investigated. The present work assesses the role of complement components [C3, C4], opsonizing power and C-reactive protein in the pathogenesis of SBE in cirrhotic patients. Twenty five cirrhotic patients with hepatic hydrothorax were randomly selected and 10 patients with hydrothorax secondary to heart failure were included as controls in the study. Pleural fluid [PF] and serum samples were analyzed for: total protein [TP], albumin, lactic dehydrogenase [LDH], glucose, polymorph nuclear leukocytic count [PMNL], complement components [C3, C4], opsonic activity [on the basis of log-kill] and high sensitive C-reactive protein [CRP]. SBE was diagnosed when pleural fluid PMNL was > 250 cells/mm[3] with a positive culture or >500 cells/ mm[3] with a negative culture after exclusion of pulmonary infections. Thirteen patients [52%] [Group I] were diagnosed as SBE and 12 patients [48%] had no SBE [Group II]. There was no significant difference between patients and controls [GIII] as regards age, gender, serum proteins, serum C3, serum WBC and effusion CRP. Levels of serum albumin, total pleural effusion proteins, PT% and opsonic activity of groups I and II were significantly lower than in GIII with no significant difference between groups I and II. Levels of serum bilirubin and C4 of groups I and II were significantly higher than group III with no significant difference between groups I and II. Level of pleural effusion C3 in group I was significantly lower than in groups II and III and level of C3 in group II was significantly lower than in group III. Level of pleural effusion C4 in group I was significantly lower than group III, but there was no significant difference between groups I and II. In hepatic patients, 7 patients [28%] belonged to Child's class B and 18 [72%] to class C. Spontaneous bacterial empyema was detected in 56% of hepatic patients with Child's class C and in 43% of Child's class B. There was no significant difference between hepatic patients with and without SBE with regard to Child-Pugh's score. In patients with SBE, levels of C3 and C4 were significantly less in pleural fluid than in serum but there was no significant difference with regard to opsonic activity. Local complement defects [especially C3] and opsonic activity in cirrhotic patients predispose to SBE. Serum CRP increases, but effusion CRP level should be reassessed as a cheap diagnostic tool

Comparative study of peripheral intravenous cannulae versus peripherally inserted central venous catheters in newborn infants

Newborn infants especially the high-risk groups require venous access for total or partial parenteral nutrition, intravenous fluids and medications for prolonged periods of time. The aim of this study was to compare between the complications of peripheral intravenous cannulae [nosocomial infection, local complications and mechanical complications] versus peripherally inserted centrally placed catheters in neonates. The present study was carried out on 50 neonates admitted to the Neonatal Intensive Care Unit [NICU] of Minoufiya University Hospital from June 2002 to June 2003 and expected to require venous access for at least 7 days for intravenous [IV] fluids, IV antibiotics, IV medications or parenteral nutrition. All infants were assigned randomly on admission to use either peripheral intravenous [PIV] cannula [n=25] referred to as [PIV group] or peripherally inserted central [PICC] catheters [n=25] referred to as [PICC group]. We found that there was a significant difference between both groups as regard number of attempts of insertion required for total IV therapy [2.36 +/- 1.07 in PICC group versus 11.48 +/- 5.72 in PIV group P<0.001]. The mean number of catheters used was significantly lower with PICC group than PIV group [1.08 +/- 0.27 in PICC group versus 6.52 +/- 3.77 in PIV group P<0.001]. Episodes of proven sepsis in PICC group were found to be significantly lower than in PIV group [5 cases [20%] in PICC group versus 12 cases [48%] in P/V group P<0.05]. The average time to develop sepsis [infection free catheter days] in PICC group was significantly higher than that in Ply group [5.67 +/- 3.13 in PICC group versus 2.83 +/- 1.03 in PIV group P<0.001]. The mechanical complication was statistically significantly lower in the PICC group than that in the PIV group. The rates of phlebitis and catheter associated infection are lower in the PICC group than the PIV group. Apart from the high cost, PICC is a desirable intravascular device in newborn with difficult venous access and in those requiring prolonged antibiotics or fluid therapy