RESUMO
Background: The frequency of severe systemic fungal diseases has increased in the last few decades. Aims: This study was done to speciate the candida isolates, to determine their antifungal susceptibility pattern and to detect biofilm formation and exoenzymes (phospholipase and proteinase) production. Place and Duration of Study: This is a Six-months Cross sectional study conducted in ICU and Microbiology & Immunology departments, Benha University, Egypt Methodology: The study was conducted on 75 Candida spp. isolated from various clinical samples of patients admitted in ICU. The Candida isolates were identified upto species level. Antifungal susceptibility testing was done by disc diffusion method. The biofilm formation was assessed by inoculating the isolates in conical polystyrene test tube containing Sabouraud’s dextrose broth supplemented with glucose. Proteinase activity was detected by using plates containing bovine serum albumin (BSA) agar. Phospholipase activity was detected by using egg yolk agar. Results: Seventy five Candida spp. were isolated from different clinical samples. C. albicans was isolated from 39(52%) samples. Non-albicans Candida (NAC) spp. were isolated from 36 (48%) clinical specimens. Forty one (54.7%) out of 75 Candida species isolates obtained from the clinical isolates produced biofilm. Out of 39 C. albicans isolates 20 (51.3%) produced biofilm, while out of 36 NAC species isolates 21 (58.3%) produced biofilm. The number of total proteinase positive isolates were 50 (66.7%). C. albicans was higher than that of the NAC isolates (29 [66.7%] versus 21 [58.3%]). Phospholipase positive isolates of C. albicans was higher than that of the NAC isolates (32[82.1%] versus 37[49.3%]). All isolates were susceptible to amphotericin B and ketoconazole. Resistance to fluconazole was found in 8 isolates (22.2%) of NAC spp. and 2 isolates (5.1%) of C. albicans isolates. Conclusion: The isolation of C. albicans were 39 (52%) in different clinical samples and isolation of NAC spp. were 36(48%). So NAC spp. is no longer overlooked as these organisms are emerging pathogens. The number of NAC producing proteinase, phospholipase and biofilm are more than the number of C. albicans producing these virulence factors. The C. albicans and NAC showed 100% susceptiblity to amphotericin B and ketokonazole while fluconazole showed resistance in 22.2% of NAC spp. and 5.1% of C. albicans isolates. All resistant Candida species to fluconazole were biofilm producers.
RESUMO
Background: An increase in extended spectrum β-lactamase (ESBL)-producing Escherichia coli (E. coli) has been observed. Aims: Of this study was done to detect the prevelance of ESBL, AmpC producing and ESBL and AmpC co-producing strains of Escherichia coli (E. coli) in urinary tract infections patients in Benha University Hospital and to evaluate the performance of CHROMagar™ ESBL media for rapid screening of ESBL producing E. coli. Place and Duration of Study: This is a Six-months Cross sectional study conducted in Urology and Microbiology & Immunology departments, Benha University, Egypt. Methodology: All patients under study were subjected to: Full history taking and clinical examination. Bacteriological study included; urine sample collection from each patient and subjected to urine analysis, urine culture on cysteine lactose electrolyte deficient agar (CLED) agar, CHROMagar™ ESBL media and MacConkey agar supplemented with 2 mg/liter ceftazidime (MCKC). ESBL detection in E. coli isolated on CLED agar by phenotypic screening by clinical and laboratory standards institute (CLSI) method then phenotypic confirmation by E. test. The presence AmpC beta-lactamase ESBL was detected by AmpC disc test and detection of AmpC beta-lactamase and ESBL coproducers by cefepime and Cefepime + Clavulanate E test. Results: In this study out of 45 E. coli strains 24 (53.3%) ESBL producers were detected by E. test (golden method for confirmation of ESBL according to CLSI) and 21(46.7%) strains were non ESBL producers. There was no significant difference between ESBL isolation from community acquired and health care associated UTI patients; out of the 24 isolated ESBL producing E.coli strains 9 (37.5%) were detected in community acquired UTI patients while 15 (62.5%) were detected in health care associated UTI patients. The sensitivity of both MCKC and CHROMagar™ ESBL media were 100% (95%CL: 85.6% to 100%).While specificity were 87.5% (95%CL:67.6% to 97.2%) and 80.8% (95%CL: 60.6% to 93.4%) respectively. In our study out of 45 isolated E. coli strains 14 (31.1%) were AmpC producers by AmpC test, 4 (8.9%) were AmpC and ESBL co-producers by cefepime/ cefepime clavulanic E.test. Conclusion: It is important to know the prevalence of ESBL, AmpC producing and ESBL&AmpC co-producing organisms so that judicious use of antibiotics could be done and increase awareness about the need for routine detection of AmpC and ESBL in clinical isolates. CHROMagar™ ESBL media detect ESBL producers from clinical specimen and give rapid presumptive identification by means of colony colour after 24h with good sensitivity and specificity.