Candidemia among chronic HCV patients in intensive care unit: risk factors and antifungal susceptibility testing

Candida is one of the common causes of blood stream infection [BSI] especially in intensive care unit [ICU] and associated with high mortality rates. Due to low immunity, the patients with chronic hepatitis C virus [HCV] are prone to Candida infection. This study presents data on species distribution, clinical risk factors and antifungal susceptibility profiles of candidemia obtained from chronic HCV patients in hepatic ICU in specialized medical hospital of Mansoura University. All the bloodstream isolates were isolated by manual lysis centrifugation method and identified to species level by CHROMagar Candida and API 20C AUX. Also, multiplex PCR was done to detect candida spp. in blood samples. Antifungal susceptibility was done by M 27A2 [broth microdilution] and M 44 [disk diffusion] methods of the Clinical and Laboratory Standards Institute [CLSI] to fluconazole, voriconazole and amphotricin B. From 342 patients, 33 candida isolates were recovered by manual lysis centrifugation method, and 26 were detected by PCR. Candida albicans [C. albicans] was the predominant species [13/33], followed by Candida parapsilosis [C. parapsilosis] [6/33]. Resistance to fluconazole was observed in 15.38% [2/13] of C. albicans isolates, 50% [2/4] Candida glabrata [C. glabrata] isolates, and 100% [4/4] C. krusei isolates. Resistance to voriconazole and AMB were observed in 5 isolates [15.2%] and in 4 [12.1%] isolates, respectively. Neutropenia carries the highest risk factor with candidemia [Odds ratio 14.08 with confidence intervals 95% 6.05-32.8]. So, C. albicans is the most common cause of Candidemia among chronic HCV patients in ICU, followed by C. parapsilosis, and the rates of resistance to azoles antifungal and AMB are still low

Portal hypertensive colopathy and haematochezia in cirrhotic patients: an endoscopic study

In patients with liver cirrhosis, portal hypertensive colopathy [PHC] and anorectal varices [ARVs] are thought to cause lower gastrointestinal [GI] bleeding. In the present work, we studied we studied the diagnostic yield of colonoscopy in cirrhotic patients and haematochezia. The current study was conducted on 77 consecutive cirrhotic patients who underwent colonoscopy at Mansoura Emergency Hospital, Egypt, between May 2007 and May 2011. Following rapid evaluation and adequate resuscitation, a thorough history was obtained with complete physical examination including digital rectal examination and routine laboratory investigations. Colonoscopic evaluation was performed for the included patients by recording endoscopic abnormalities and obtaining biopsies from lesions. There was no significant difference between the PHC-positive group when compared with the PHC-negative group regarding patients' age, sex, severity of haematochezia, positive family history and the history of intake of non-steroidal anti-inflammatory drugs [NSAIDs]. Significant difference was noted regarding the Child-Pugh class [p < 0.05], history of splenectomy [p < 0.05], prior history of endoscopic sclerotherapy [EST] or endoscopic variceal ligation [EVL] [p < 0.05], prior history of upper gut bleeding [p < 0.05], the presence of gastric varices [GVs] [p < 0.05], presence of portal hypertensive gastropathy [PHG] [p < 0.05], presence of haemorrhoids [p < 0.05] and rectal varices [<0.05] and therapy with ?-blockers [p < 0.05]. Regarding the laboratory parameters, the platelet count only was markedly reduced in the PHC-positive group [p < 0.05]. All the PHC-related sources of bleeding [7/32 cases [21.87%]] were successfully managed with argon plasma coagulation. Regarding the laboratory parameters, the platelet count only was markedly reduced in the PHC-positive group [p < 0.05]. All the PHC-related sources of bleeding [7/32 cases [21.87%]] were successfully managed with argon plasma coagulation. Our data revealed that it is not only PHC which is involved in haematochezia in cirrhotic patients despite the significant association. Instead, a high prevalence of inflammatory lesions came on the top of the list. Complete colonoscopy is highly advocated to detect probable proximal neoplastic lesions

Screening for minimal hepatic encephalopathy in asymptomatic drivers with liver cirrhosis

Minimal hepatic encephalopathy [MHE] represents a part of the spectrum of hepatic encephalopathy [HE]. It can have a far-reaching impact on quality and ability to function in daily life and may progress to overt HE. This study was designed to screen for MHE in drivers with liver cirrhosis in Mansoura, a city in the Nile delta in Egypt. A total of 174 consecutive drivers with positive serology for viral markers and cirrhosis were screened for MHE. Questionnaires and standard psychometric tests and well-informed consent were performed at the same setting. The diagnosis of MHE was made when one or both symbol digit test [SDT] and number connection test [NCT] appeared abnormal. Beck's inventory and Mini Mental State Examination questionnaires were performed for those diagnosed as MHE. After overnight fasting, venous blood samples were taken for haematologic tests and routine liver function tests by conventional methods. Arterial ammonia was also measured. A total of 66 patients showed evidence for MHE out of 139 patients who fulfilled the inclusion criteria. No significant differences were present, apart from a significantly elevated arterial ammonia level [p-value <0.001] and a bad self-reported driving history [p < 0.05] in the MHE-positive group when compared with the MHE-negative group. Multivariate logistic regression revealed that advanced Child-Pugh grade [p < 0.001], hepatitis B virus [HBV]-related a etiology [p < 0.001] and smoking are significant risk factors for MHE. MHE is significantly commoner among Child-Pugh C patients [p < 0.05] when compared with the other Child-Pugh grades. Our data revealed a high prevalence of MHE [47%] among Egyptian drivers with liver cirrhosis. It is hence recommended to include the driving history as well as regular pencil-paper standard psychometric testing in evaluating those at risk, especially in the outpatient setting, for early detection and proper management

Characterization of methicillin resistant staphylococcal aureus [MRSA] isolates from mansoura university hospitals

Hospital-acquired infections due to MRSA are associated with considerable morbidity, mortality, and excess costs. Our work aimed to study the prevalence, risk factors and genotypic characteristics of MRSA isolates from patients admitted at Mansoura University Hospitals [muhs]. A total 184 of Staphylococcal aureus [SA] clinical specimens were collected from our in-patients between June 2009 to June 2010. Isolated colonies were identified in a systematic manner for selection of MRSA. Oxacillin and cefoxitin resistance tests identified MRSA that were subjected to antibiogram and resistogram. MRSA amplified genes, visualized by agarose gel electrophoresis, were analyzed by Sanger sequencing. Only 49 isolates out of the isolated strains of SA were identified as MRSA strains by cefoxitin disc diffusion test. All strains are resistant to cefoxitin, ceftriaxon, cloxacillin and ampicillin while most strains were susceptible to vancomycin. Sanger sequencing of meca gene showed 3 monographs. MRSA isolates were more from blood samples [F< 0.001] of patients above 60 years [P< 0.001], of low socioeconomic status [P< 0.001], and of >2wks duration hospital stay [P< 0.05], in icus [P< 0.001], with a previous history of hospital admission within the past year [P< 0.001] and a positive history of antibiotic use in the last 6 months [P< 0.001]. Positive family history of chronic disease [P< 0.001] or hospitalization within the last year [P< 0.05] and the presence of family member working in a clinic or a hospital [P< 0.05] were noted in MRSA-positive patients. Our data revealed an increased prevalence of multi-drug resistant MRSA isolates where PCR was of the best choice for their rapid and accurate detection. An effective infection control program should be implemented for appropriate MRSA management