Toll- like receptor 2 polymorphism and IL-6 profile in relation to disease progression in chronic HBV infection: a case control study in Egyptian patients.

Chronic hepatitis B (CHB) has a wide range of outcomes depending on host immune responses mainly Toll-like receptors (TLRs) signaling and released cytokines. Toll-like receptor 2 (TLR2) single nucleotide polymorphisms (SNPs) and interleukin 6 (IL-6) may influence the course of CHB. We aimed to elucidate the relation between TLR-2 polymorphism, IL-6 profile, and CHB progression. We analyzed TLR-2 polymorphism (SNP; rs3804099) in 185 CHB patients and 60 controls using TaqMan allelic discrimination assay. Serum IL-6 levels were assessed by ELISA. IL-6 levels were considerably higher in active CHB and cirrhotic patients compared with inactive carriers and controls (P < 0.001). IL-6 showed positive correlation with ALT and advanced fibrosis in active CHB patients (r = 0.31, P = 0.02). A significant positive correlation was noticed between IL-6 and HBV DNA PCR in all CHB groups. TT genotype of rs3804099/TLR-2 was significantly more prevalent in inactive carriers compared to active hepatitis patients (P = 0.04, OR = 0.39 and 95% CI: 0.16-0.95). Both heterozygous CT and mutant TT genotypes were significantly more frequent among inactive carriers compared to cirrhotic patients (P = 0.01, OR = 0.33, 95% CI: 0.13-0.81 and P = 0.009, OR = 0.32, 95% CI: 0.13-0.77). TT genotype was significantly related to lower IL-6 levels in active hepatitis and cirrhotic groups (P = 0.005 and P = 0.001, respectively) showing that TLR mutations would be associated with milder hepatitis activity and lower possibility for disease progression. There may be a positive association between TLR2 rs3804099 polymorphism and hepatitis B activity. IL-6 is a good indicator of CHB disease progression.

Methicillin-Resistant Staphylococcus aureus Carriage in Hemodialysis Vicinity: Prevalence and Decolonization Approach.

Hemodialysis (HD) patients are at risk for developing serious infections. Methicillin- resistant Staphylococcus aureus (MRSA) is one of the most prevalent pathogens in healthcare facilities with a major threat to the medical community. We aimed to determine the prevalence of MRSA colonization among patients and medical staff members in a HD Unit and determine efficacy of mupirocin as a decolonizing agent. This cross-sectional study enrolled 250 patients and 35 health care providers of a HD unit. Nasal and hand swabs were collected to assess the prevalence of MRSA carriage. Those exhibiting MRSA phenotype were subjected to conventional Polymerase chain reaction (PCR) assay for detection of mecA gene. Colonized patients and medical personnel with MRSA were prescribed mupirocin ointment (2%) for decolonization. The screening approach identified 54/285 (18.9%) nasal MRSA carriers (41/250 of HD patients and 13/35 of the medical staff members). Concomitant extranasal MRSA colonization of the hands was observed in 10 (18.5%) of these 54 MRSA carriers. In relation to PCR results the sensitivity, specificity, and diagnostic accuracy of cefoxitin disk test were 98.2%, 75%, and 93.9% respectively and for MRSA Select II agar screening method, the sensitivity, specificity, and diagnostic accuracy were 92.6%, 66.7%, and 87.9% respectively. Decolonization approach using mupirocin ointment revealed an overall success rate up to 77.8% (42/54) and failure rate of 16.7% (9/54), while 5.6% (3/54) of decolonized carriers showed recolonization. There is still high prevalence of MRSA colonization in HD vicinity. Implementation of strict infection control measures is essential in dialysis units to avoid MRSA cross-transmission and invasive infections.

New Delhi metallo-ß-lactamase-producing Acinetobacter isolates among late-onset VAP patients: multidrug-resistant pathogen and poor outcome.

BACKGROUND: Acinetobacter spp. are increasingly important microbes involved in late-onset ventilator-associated pneumonia (VAP). PURPOSE: The aims of this study were to determine the prevalence of New Delhi metallo-ß-lactamase (MßL) (blaNDM-1)-producing Acinetobacter spp. among late-onset VAP patients in different intensive care units (ICUs) of Menoufia and Kasr Al Ainy University Hospitals, to investigate the possible risk factors contributing to the acquisition of blaNDM-1-producing Acinetobacter infection, and to correlate between antimicrobial resistance pattern and therapeutic efficacy as well as clinical outcomes of these patients. MATERIALS AND METHODS: Sixty-four Acinetobacter isolates were collected from mechanically ventilated patients with suspected late-onset VAP and subjected to antimicrobial susceptibility testing. The modified Hodge test (MHT) and combined disk tests (CDT) were applied for blaNDM-1 MßL detection. Acinetobacter isolates with phenotypically confirmed MßLs production were subjected to a PCR assay to verify the presence of blaNDM-1 gene. The most obvious risk factors for acquisition of carbapenem resistance in VAP patients and treatment outcomes were also analyzed. RESULTS: Out of 64 Acinetobacter isolates, 42 (65.6%) proved to be blaNDM-1 positive. The sensitivity and specificity of MHT were 52.38% and 41.67%, while for CDT they were 92.86% and 83.33%, respectively. Acinetobacter isolates showed high susceptibility to colistin (85.7%). The clinical response was better among VAP patients who received combined carbapenem plus colistin therapy than those who received colistin alone. Relapse of infection was detected in 12.5% (8/64) of VAP cases. The reported mortality reached 46.8% (30/64) of which 27 (64.3%) were infected with blaNDM-1-positive isolates. Prolonged duration of mechanical ventilation, longer hospital and ICU stays, and prior exposure to antibiotic therapy were by far the most important factors predisposing to carbapenem resistance among VAP patients. CONCLUSION: A worldwide spread of Acinetobacter spp. expressing carbapenemases represents a significant threat to the medical community. The current study addressed the high prevalence of blaNDM-1-producing Acinetobacter isolates among late-onset VAP patients.