Vol. 31, January, 2012.

frequence de prise du cialis 1/31 IDENTIFICATION OF CTX-M GENE AMONG STRAINS OF EXTENDED SPECTRUM BETA-LACTAMASES PRODUCING KLEBSIELLAPNEUMONIAEIN CANCER PATIENTS WITH FEBRILE NEUTROPENIA

Rasha Abd El-Hamid Alm El-Din and Mohamed A. Alm El-Din*

Department of Medical Microbiology and Immunology, Tanta Faculty of Medicine, Tanta, Egypt

*Department of Clinical Oncology, Tanta University Hospitals, Tanta Faculty of Medicine, Tanta, Egypt

To identify the prevalence of CTX-M gene among strains of extended spectrum beta-lactamases (ESBLs) producing cialis et fertilité Klebsiellapneumoniae ( pourquoi prendre le cialis K.pneumoniae) isolated from cancer patients with febrile neutropenia.Ninety nine (99) isolates of repousse avec propecia K. pneumoniae were collected from 200 cancer patients with febrile neutropenia. ESBLs production of the collected isolates was detected and antibiotic susceptibility testing of ESBLs producing strain weredone. All ESBL-producing isolates were screened for comment acheter du viagra en france blaCTX-M genes using conventional polymerase chain reaction (PCR) with universal primer.Of 99 danger viagra homme K. pneumoniae clinical isolates, 55 isolates revealed ESBLs - phenotype. Among ESBLs producing strains, the highest resistance was to ampicillin and cefotaxime (100%), followed by gentamicin (90.90%), ciprofloxacin and cotrimoxazole (80%), amikacin (60%), and lastly imepenem (1.81%). Using PCR assay les contres indications du viagra blaCTX-M gene was detected in 39 of ESBLs-producing isolates (70.90%), and16 isolates (29.09%) did not produce any amplicons. All CTX-M containing isolates were resistant to cefotaxime, aztreonam, and ceftriaxone, while 35isolates (89.74%) were resistant to ceftazidime.High prevalence of cialis boite de 12 blaCTX-M genes among strains of ESBLs producing vente viagra casablanca K.pneumoniae isolated from cancer patients with febrile neutropenia may lead to the spread of resistance to antimicrobial drugs. New strategies are warranted for prevention and control of these strains.

cialis avec ordonnance ou pas  

2/31 PERFORMANCE OF COWPEA AND PEANUT PLANTS AS AFFECTED BY BACTERIZATION WITH PINK PIGMENTED FACULTATIVE METHYLOTROPHIC BACTERIAAND FOLIAR APPLICATION OF METHANOL

Mohamed E. El-Haddad, Mohamed E. El-Demerdash, Enas A. Hassan

and Selem S. Ashoor

Agricultural Microbiology Dept., Fac. Agric., Ain Shams Univ., Shoubra El- Kheima, Cairo, Egypt

Two strains of pink-pigmented facultative methylotrophic bacteria (PPFMs), namely Methylobacterium zatmanii CP3 & Methylobacterium extorquens M2 were evaluated for their effects, in the presence of methanol(5%), on growth and yield of cowpea (Vigna unguiculata, (L.) Walp) and peanut (Arachis hypogaea, L.) plants, under greenhouse conditions. Pot experiments were performed using 9 different treatments of PPFMs inoculation with or without foliar application of methanol. Results indicated that seed and foliar inoculation with mixed strains of PPFMs gave the highest significant effect in presence of methanol spray (5%) during all stages for the measured parameters of both plants. Results recorded, at 70 days of planting, proved that applying methanol (5%) in both plants secured increases in plant dry weight (g/plant), leaf area (cm2), indole acetic acid and cytokinin content (µg/g fresh weight) being, for cowpea plants 33.07, 14.82 ,25.58 and 17.58 %, respectively, over the same treatment without methanol application. The corresponding increases in peanut plants reached 29.05, 11.13, 16.84 and 17.72% in respective order. Moreover at the same period maximum values of PPFMs populations and N, P, K percentages were also recorded. In addition, the yield parameters, after 120 days of planting, were also reached to their maximum values. These effects might be mediated by the production or synthesis of plant hormones.

3/31 INCRIMINATION OF A SINGLE PFGE TYPE OF ACINETOBACTER BAUMANII IN THE ETIOLOGY OF VENTILATOR ASSOCIATED PNEUMONIA IN THE NEONATAL INTENSIVE CARE UNIT OF ALEXANDRIA UNIVERSITY HOSPITAL

Soad Farid and Sarah M. Abdelhamid*

Department of Medical Microbiology and Immunology, Faculty of Medicine, Alexandria University, Egypt.

*Department of Medical Microbiology and Immunology, Students’ University Hospital, Alexandria University, Egypt.

Acinetobacter, a Gram negative, oxidase negative, non fermenter hospital pathogen marred by its multi-drug resistance (MDR) and its ability to persist on environmental surfaces, has emerged as the most common pathogen incriminated in the etiology of Ventilator Associated Pneumonia (VAP). The aim of this work was to investigate the genetic relatedness of isolates of Acinetobacter baumannii incriminated in the etiology of VAP in the neonatal ICU of Alexandria University Hospital. All neonates receiving mechanical ventilation from October 2008 to February 2009 were enrolled in the present study. Microbiological investigations included: 1) Samples to identify potential sources of bacterial colonization of the aero-digestive tract 2) Samples to monitor aero-digestive colonization, and 3) Non-bronchoscopic bronchoalveolar lavage. Twenty nine A. baumannii isolates were typed using pulse field gel electrophoreisis (PFGE) since they were the predominant isolates in both bronchoalveolar lavage samples and patient-related samples. This showed that all isolates belonged to the same PFGE type. Nevertheless they were separated to two clusters with 100% identity within each cluster and > 96.7% similarity between the two clusters. Also, different antibiotic resistance patterns were observed within the same PFGE cluster and similar patterns were common between isolates belonging to a different PFGE cluster. Consequently, antibiograms alone are not useful in identifying outbreaks, unless used with molecular epidemiological techniques, and in which case they might improve the discriminatory power. Also, the persistence of a single PFGE type of A.baumanii throughout the study period dictates the need for instituting strict compliance with environmental decontamination and infection control measures to confront the imminent threat of untreatable infections caused by A.baumannii.

 

 

4/31 CHARACTERIZATION OF BACILLUS CEREUS AND STAPHYLOCOCCUS AUREUS STRAINS ISOLATED FROM FOOD AND FOOD PRODUCTSRETAILED IN THE EGYPTIAN MARKET

Tamer M. Elhabibi, Ahmed. S. Attia*, Abd El-Gwad M. Hashem*

and Mohamed Seif E. Ashour

Department of Microbiology and Immunology, Faculty of Pharmacy, October University for Modern Sciences and Arts.

*Department of Microbiology and Immunology, Faculty of Pharmacy,

Cairo University.

Food-borne diseases are of major interest worldwide. To date, around 250 distinct food-borne diseases have been described, and bacteria are the causative agents of two thirds of food-borne disease outbreaks. Staphylococcus aureus and Bacillus cereus are among the predominant bacteria involved in these diseases. A total of 265 retail food samples were examined for B. cereus and S. aureus including 125 koshary samples, 20 fatta samples, 20 fava beans samples, 20 tamea samples, 20 pizza samples, 20 kofta samples, 20 kabab samples and 20 sobia and sugar cane samples collected from different areas in Cairo and Giza. A total of 76 (28.7%) isolates were identified as B. cereus. Sixty six (52.8%), four (20%), three (15%), two (10%) and one (5%) of the B. cereus strains were isolated from the koshari, fatta, fava beans, tamea and pizza samples, respectively. On the other hand, B. cereus was not detected in kofta, kabab sobia and sugar cane juice samples. While only 24 (9.1%) isolates were identified as S. aureus. Sixteen (12.8%), two (10%), two (10%), two (10%), one (5%) and one (5%) of S. aureus strains were isolated from the koshari, fava beans, tamea, pizza, kofta and fatta samples, respectively. On the other hand, S. aureus was not detected in kabab, sobia and sugar cane juice samples. In this study, we also evaluated the isolated B. cereus strains for the presence of the ces enterotoxin gene. We observed that only three strains out of seventy six (3.9 %) were positive to the cereulide gene ces. Also we evaluated the isolated S. aureus strains for the presence of sea ad see enterotoxin genes. We observed that 9 samples (37.5%) were shown to be positive for bothsea and see genes. While 11 samples (45.8%) were shown to be positive to “sea” gene alone and only 4 samples (16.7%) were shown to be positive to “see” gene alone.  

 

 

5/31 ASSOCIATION OF HELICOBACTER PYLORI AND CELL-FREE FETAL DNA WITH HYPEREMESIS GRAVIDARUM

Makram Attalah, Manal DarwishandAhmed Ibrahim*

Medical Microbiology and Immunology Department, *Gynecology and Obstetrics Department, Faculty of Medicine, Ain Shams University

Hyperemesis gravidarum (HG) is a common problem for an obstetrician. Though nausea and vomiting are quite common in pregnancy, hyperemesis is found in 1-20 patients per 1000.There are numerous theories regarding the etiology of hyperemesis gravidarum, though it is not fully understood and conclusive research on its potential cause is rare. It is a multifaceted disease that should be approached with a broad view of possible etiologies and complications. The objective of this study was to investigate any possible association between each of Helicobacter pylori (H. pylori) infection and cell free fetal DNA with the pathogenesis of hyperemesis gravidarum. This study was performed on 50 pregnant women, thirty with HG and twenty were asymptomatic pregnant controls matched for age, parity, gravidity and gestational age with patients in HG group. All the pregnant females were examined for Helicobacter pylori using H. pylori stool antigen test and detection of cell-free fetal nucleic acid in the maternal plasma by real time PCR. The present study reported that positive H. pylori stool antigen test (HpSA) was positive in 21 out of 30 patients with HG (70%) and 3 out of 20 women in the control group (15%) with statistically significant difference between the two groups. Also the study showed that the median concentration of fetal DNA in plasma of HG patients were 67.8% genome-equivalents/ml (range 25.9-315.4) and in control (35.6%) genome-equivalents/ml with statistical significant difference (range 4.8-62.7). The study concludes that there is an association between hyperemesis gravidarum and exposure to H. pylori in which exposure to the bacteria appears to be associated with increased risk of HG. In addition, the fetal DNA in maternal plasma is increased in patients with HG thus it is suggested that the pathogenesis of HG could be related to an abnormality of the immune interaction between the mother and the fetus. So, we recommend that screening for H. pylori stool antigens and analysis of cell free fetal DNA in the maternal plasma in early pregnancy may form important predictors for HG in the future.

 

 

6/31 PREVALENCE AND CHARACTERIZATION OF EXTENDED-SPECTRUM ß-LACTAMASE-PRODUCING PROTEUS MIRABILIS ISOLATES

Tarek El-Banna, Fatma Sonbol, Ahmed Abd El-Aziz and Fatma Mahmoud

Department of Pharmaceutical Microbiology, Faculty of Pharmacy, Tanta University.

A total of 108 Proteus mirabilis isolates were recovered from different clinical specimens including urine, stool, pus and ear discharge. The specimens were collected from different departments in Tanta and Minoufia universities hospitals during the period from March 2006 to August 2007. The susceptibility of all 108 P.mirabilis isolates to each of 10 different commonly used ß-lactam antibiotics was studied. ß-lactamase production was detected in 67 out of 108 P. mirabilis isolates. ESßLs were identified in 13 isolates out of 67 ß-lactamase producers. Isoelectric focusing points experiment was performed on the ESBL producers, nine enzymes with different pI values were detected among the tested isolates. Dienes typing experiment was performed, where 11 different Dienes types were detected among the ESBL producers (n=13). Typing of the ESßLs producing P. mirabilis isolates using the outer membrane proteins profiles revealed six distinct OMP patterns were distinguished among the tested isolates. Moreover typing using plasmid was performed and nine patterns were detected among the ESBL producers. The increase in clinical prevalence of ESßL-producing P. mirabilis isolates has been noted in this study as well as other's, hence more precise methods should be used to detect these enzymes in laboratories. Dienes test should be the method of choice for the epidemiologicalcharacterization of P. mirabilis isolates.

 

 

7/31 GENOTOXIC EFFECTS OF ANTIRHEUMATOID DRUGSON LIVING CELLS

Fatma I. Sonbol, Thanaa F. El Shsikh*, Mohamed A. Elmorsi**, Ali E. El Deeb*** and Hoda Y. El Deeb*

Dept. of Microbiology, Faculty of Pharmacy, *Dept. of Biochemistry, Faculty of Medicine and **Faculty of Science, ***Dept. of Physical Medicine & Rehabilitation, Faculty of Medicine, Tanta University.

Among the drugs used in the treatment of rheumatoid arthritis paracetamol, salicylate, tetracycline, methotrexate and diclofenac are commonly used. The effects of these drugs on living cells either prokaryotic (bacteria) or eukaryotic (human) were investigated in this study. All the tested drugs slowed down the bacterial growth specially, diclofenac which exihibited the highest growth retardation effect. Significant changes on bacterial morphology was detected as revealed by light microscopy. Electrophoresis of the total proteins of Escherichia coli grown in the presence of sub MIC of any of the tested antirheumatoid drugs revealed the hypoproduction of the amount of proteins in three bands of apparent molecular weights 60, 45 and 40 KDa in drug treated bacteria. DNA analysis showed no detectable effect of the studied antirheumatoid drugs on the chromosomal DNA of the tested bacteria. Regarding the biochemical effects of these antirheumatoid drugs on human tissues, it was found that all the tested drugs resulted in significant elevation of liver enzymes. However, kidney function tests; blood urea and serum creatinine revealed no noticeable effect on the function of these organs. Enhanced DNA fragmentation effect of the tested drugs on human lymphocytes was detected in this study as compared to that of untreated rheumatoid arthritis patients. Accordingly, further studies are strongly recommended in this field in order to avoid a lot of side effects associated with the long term use of these drugs in treatment of rheumatoid arthritis.

 

 

8/31 DIAGNOSTIC VALUE OF LACTOFERRIN ASCITIC FLUID LEVELS IN SPONTANEOUS BACTERIAL PERITONITIS (SBP)

Faten M Ali, Iman H Shehata, *AbdElfatahAbdElsalam and **Mahmoud R El-Ansary

Departments ofMedical Microbiology &Immunology,* Internal Medicine, Faculty of Medicine, Ain Shams University and ** Department of Microbiology & Immunology. Misr University for Science and Technology, Cairo, Egypt

Spontaneous bacterial peritonitis (SBP) is one of the most frequent bacterial infections in patients with decompensated liver cirrhosis and ascites and is associated with high mortality. Diagnosis of SBP is established when the ascitic fluid polymorphonuclear leukocyte (PMN) counts is 250 or greater /mm3 .In clinical practice, a positive bacterial culture is obtained in a minority of the patients and results are delayed for several days. A very big problem is lysis of the PMNs during transport to the laboratory, which may lead to false negative results. Lactoferrin is one of the main immune proteins of the PMNs that is released on activation of these cells, and its presence in body fluids is proportional to the flux of neutrophils. Therefore, measurement of ascitic fluid lactoferrin could be clinically useful for detection of SBP in patients with cirrhosis. Patients with cirrhosis and ascites show a higher susceptibility to bacterial infections because of their inadequate defense mechanisms and resistant bacteria have started to emerge. The goal of this study was to evaluate the diagnostic value of ascitic fluid lactoferrin in SBP and identify a clinically useful cut-off level that could be used for future development of a rapid bed side test. This study also aimed to determine the etiological microorganisms causing SBP and their antibiotic susceptibility patterns. The study was conducted on 90 patients with end stage liver disease and ascites secondary to chronic hepatitis “C”. The patients were divided into two groups according to presence or absence of SBP. Diagnosis of SBP was based on: clinical examination, biochemical analysis of ascitic fluid, PMN cell count and culture of ascitic fluid. Isolation and identification of isolates and their antibiotic sensitivity patterns were done. Lactoferrin levels in ascitic fluid were estimated by ELISA. Ascitic fluid levels of lactoferrin were significantly higher in SBP patients (191.7 ± 37.5ng/ml) than controls (42.2 ± 24ng/ml). A cut off level of 88 ng/ml had highest combined sensitivity and specificity in discriminating SBP. Gram negative enteric bacilli were the most frequently isolated pathogens with E coli presenting the majority of the isolates .The majority of Gram negative enteric bacilli showed resistance against almost all antibiotics used except imipenem. In conclusion, Lactoferrin can serve as a sensitive and specific initial screening test for detection of SBP in cirrhotic patients with ascitis. The results of current study also indicate emergence of mutidrug resistant strains of bacteria among isolates of SBP

 

 

9/31 NOSOCOMIAL INFECTIONS CAUSED BY ESBL PRODUCING ENTERBACTERIACEAE IN SOHAG UNIVERSITY HOSPITAL

Ahmed H.Abdel-Aziz, Mona F. Mohamed, Nahed F. Fahmy

Medical Microbiology and Immunology Department, Sohag Faculty of medicine, Sohag University

The detection of extended spectrum β-lactamase-producing (ESBL) bacteria is important for infection control and epidemiological surveillance. ESBLs are enzymes capable of hydrolyzing penicillins, broad-spectrum cephalosporins and monobactams, and are generally derived from TEM and SHV-type enzymes. Different members of Enterobacteriaceae are able to produce extended spectrum β-lactamases (ESBLs) that cause high multi-drug resistance to the beta-lactam antibiotics. Therefore, determining the antibiotic susceptibility patterns in resistant organisms is necessary for suitable therapeutic approaches. The objective of this study was to detect the presence and antibiotic susceptibility patterns of extended – spectrum β - Lactamase (ESBL) producing Enterobacteriaceae causing different types of nosocomial infections in Sohag University Hospital. A total of 70 clinical isolates of different members of Enterobacteriaceae were collected from Sohag University Hospital during the period from June 2010 to June 2011. All isolates were screened for ESBL production by double disc synergy test (DDST) and double disc diffusion test (DDDT) & PCR for detection of ESBL genes including blaTEM and blaSHV genes. Forty isolates (57 %) were diagnosed as ESBL positive by DDDT, while 32 isolates (46 %) were ESBL positive by DDST. ESBL genes (blaTEM & blaSHV) were detected in 36 isolates (51%); TEM type ESBL genes were detected in 14 isolates (39 %). While SHV type ESBL genes were detected in 36% (13 isolates). Both blaTEM & blaSHV geneswere detected in 9 isolates (25 %). Results revealed high percentage of ESBL genes among different members of Enterobacteriaceae causing nosocomial infections in Sohag University Hospital.

 

10/31 EVALUATION OF THE MANUAL MYCOBACTERIA GROWTH INDICATOR TUBE (MGIT) FOR THE DETECTION OF ANTIMICROBIAL SUSCEPTIBILITY IN MYCOBACTERIUM TUBERCULOSIS ISOLATES

Lamiaa Abd El-Fattah Ahmed Madkour, Basma Hussein Gomaa, Zeinab Abd EL-Khalek Ibrahim, Reham Ali Fahmi Dwedar and Youssef Mohamed Amin Soliman*

Department of Medical Microbilogy and Immunology, Faculty of Medicine,

Cairo University.

*Deaprtment of Chest Diseases, Faculty of Medicine, Cairo University.

The performance of the manual Mycobacteria Growth Indicator Tube (MGIT) was compared to the proportion method (PM) for drug susceptibility testing of Mycobacterium tuberculosis. The study was carried on 50 smear-positive sputum samples. Sputum samples were subjected to culture on Lowenstein-Jensen's L-J medium. Hence, drug susceptibility testing was performed by the proportion method and the manual MGIT against isoniazid (INH), rifampicin (RIF), ofloxacin (OFX) and kanamycin (KAN). With the PM, the highest resistance rate was against INH (28%) followed by RIF (26%). Multi-drug resistance was 16%. The agreement between MGIT and the PM was 94.9%for INH and 84.8%for RIF, while the agreement between the 2 methods in the detection of MDR-TB was 92.9%. In conclusion, the manual MGIT offers a rapid and practical approach for susceptibility testing of M. tuberculosis in diagnostic laboratories with limited financial resources, but with competent technologists.

 

 

11/31 INFLUENCE OF CEFTAZIDIME ON THE MUTATION PREVENTION CONCENTRATION (MPC) OF CIPROFLOXACIN FOR CLINICAL ISOLATES OF PSEUDOMONAS AERUGINOSA

Shereen Fawzy, Wafaa K. Zaki and *Raghda H. Ibrahim

Departments of Medical Microbiology & Immunology, Ain Shams University and

*Misr University for Science and Technology

Pseudomonas aeruginosa infections are difficult to treat as they display high level of intrinsic antibiotic resistance. Mutation prevention concentration (MPC) is defined as the lowest drug concentration blocking the growth of the most resistance single step mutant and it can be a helpful mean to treat infections caused by this resistant bacteria. This study aimed to find out the difference between the Minimum Inhibitory concentration (MIC) and the MPC of ciprofloxacin for clinical isolates of P.aeruginosa and to test if the MPC of ciprofloxacin could be decreased if combined with ceftazidime. This study was conducted on 30 clinical Pseudomonas aeruginosa isolates sensitive for both ciprofloxacin and ceftazidime. These isolates were tested to determine the MIC and MPC of ciprofloxacin and ceftazidime each alone and combined together. The MIC of ciprofloxacin was decreased by addition of ceftazidime in 11 isolates (36.7%) while insignificant difference in the MIC was detected in 19 isolates (63.7%). Reduction in the MPC of ciprofloxacin was observed in 22 isolates (73.4%) while 8 isolates (26.6%) showed no chang of MPC after ceftazidime addition. In conclusion the MPC of ciprofloxacin and ceftazidime each alone was at high concentrations and significantly higher than the MIC. And Combination of ciprofloxacin with ceftazidime led to a significant reduction of the MPCs of both antibiotics.

 

12/31 EVALUATION OF DIFFERENT METHODS USED FOR DIAGNOSIS OF HELICOBACTER PYLORI

Gamal F.M. Gad, Ayman M. Hassanein*, Mohammed S. Mohammed**

and Nancy G. Waly

Microbiology Department, Faculty of Pharmacy, Minia University, Egypt

*General Surgery Department, Faculty of Medicine, Minia University, Egypt

**Microbiology Department, Faculty of Medicine, Minia University, Egypt

Helicobacter pylori (H. pylori) represent one of the most common and medically prominent infections worldwide. The problem is more complicated in Egypt as the prevalence of organism exceeds universal rates. Accurate diagnosis is essential for the effective treatment and management of infection. This study was carried out on 50 patients suffering from different GIT problems. Diagnosis of H. pylori was carried out using five different methods, Three of them were invasive (culture, rapid urease test & PCR) and two were non-invasive (serum antibodies detection and stool antigen detection). The aim of this study was to evaluate these different diagnostic techniques. Culture had the highest specificity (100%) followed by stool antigen test (93%) while highest sensitivity and accuracy were observed in PCR results (97% and 94% respectively) followed by rapid urease test (90% and 86% respectively) and stool antigen test (89% and 92% respectively). Serum antibody testing gave the lowest specificity and sensitivity (68% and77% respectively).

 

 

13/31 MECHANISMS OF ANTIBIOTIC RESISTANCE IN KLEBSIELLA - CLINICAL ISOLATES

Fatma Sonbol, Tarek El-Banna, Ahmed Abd El-Aziz and Rasha El-Morsi

Department of Pharmaceutical Microbiology, Faculty of Pharmacy, Tanta University.

A total of 1002 clinical specimens including urine (292), tracheal aspirates (128), stool (217), sputum (77), blood (133) and wound (155) were obtained from different departments in Tanta University Hospital. Out of these samples 105 Klebsiella isolates were recovered. It was found that 88 out of 105 (83.8 %) were Klebsiella pneumoniae and the remaining 17 (16.19 %) isolates were Klebsiella oxytoca. The susceptibility of the 105 tested isolates to 23 different antimicrobial agents was carried out. All isolates were multiply (3-22) resistant to the tested drugs. It was found that 83 Klebsiella isolates out of the 105 (79.0%) produced β-lactamase enzymes. ESβLs production were detected in 31 (30%) out of these isolates. The plasmid profile of the selected Klebsiella isolates as well as the isoelectric focusing of the detected enzymes were performed. Five types of pI(s) values corresponding to five types of enzymes were detected among the tested isolates. The most common enzyme was of pI value 7.7 . All isolates were found to harbore large plasmids of molecular size 150 or 180 Kbp. Such plasmids were found to be transferable to the recipient E.coli UB5202 strain. Transfer of all β-lactam resistance markers were detected in all transconjugants. On the other hand, quinolone resistance was not detected in any of the resulting transconjugants. The outer membrane proteins (OMPs) analysis of the ESβLs producing Klebsiella isolates were also, performed. Heterogenus patterns were detected, however proteins with molecular weights of 45 and 36 KDa represent a major protein bands. Quinolone resistant Klebsiella isolates were selected to study the efflux mechanism of resistance by using the hydrophobic fluoresent probe NPN. Efflux mechanism were detected in two out of the tested isolates.This study shows that Klebsiella species develops resistance to antibacterial drugs through several ways indicating that different resistance mechanisms may interact to increase the level or spectrum of resistance of an organism. Inactivation of these drugs by β-lactamases was apparently the major mechanism of resistance.

 

 

14/31 PATTERN OF CANDIDA COLONIZATION IN PATIENTS IN NEONATAL INTENSIVE CARE UNIT AT AIN SHAMS UNIVERSITY HOSPITALS

Amany T. Abd El-Rahman, **Nayera I. Attia, Rasha A. Nasr and *Fatma M. Ismaeil

Departments of Medical Microbiology and Immunology, Faculty of Medicine, Ain Shams University, *Misr University for Science and Technology, **Institute of Postgraduate Childhood Studies and NICU of Obstetrics and Gynaecology Hospital, Ain Shams University, Cairo, Egypt

A prospective cohort study was conducted in the neonatal intensive care unit (NICU) of Gynaecology and Obstetric Hospitals of Ain Shams University to analyze patterns of neonatal candida colonization as well as to determine the potential risk factors, the possible source of colonization and the antifungal susceptibility of the candida isolates. Weekly surveillance fungal cultures of the perianal area, oral cavity, umbilicus and ear canal of 100 neonates were performed from birth until discharge. Colonization was analyzed for timing, site, species, birth weight and gestational age. Potential environmental reservoirs and hands of health care workers )HCWs) were also cultured monthly for fungi. Antifungal susceptibility of the identified isolates was also determined by disk diffusion method. The overall colonization rate was 51%. Early colonization was found in 27 (27%) neonates whereas 24 (24%) neonates were lately colonized during their stay in NICU. Colonization was more in preterm neonates than in full and post term. Perianal area and oral cavity were the most frequent colonized sites. C. albicans was the main spp. (58.8%) isolated from the neonates followed by C.tropicalis (17.6%), C.glabrata (15.6%) and C. krusei (2%). Although C. albicans was the most common early colonizing spp., the non-albicans candida spp. were the predominant in late colonization. By univariate analysis, birth weight <1.5 kg and total parenteral nutrition were risk factors for late colonization. No candida was isolated from the environmental samples while 3 candida spp. (2 C. glabrata and 1 C. tropicalis) were isolated from the hands of 3 nurses on different occasions. These isolates had the same susceptibility pattern of the spp. lately colonizing the neonates at the same week of sampling suggesting a possible source. Of the 51 isolated candida spp., 68.6% were sensitive to fluconazole, 80% to itraconazole and 64.7% to ketoconazole, while only 33% were sensitive to amphotericin B. C. albicans and C. tropicalis were found to be highly susceptible to azoles, especially to itraconazole, while only 40% of C. albicans and 22% of C. tropicalis of were sensitive to amphotericin B. None of C. glabrata and C. krusei isolates was sensitive to azoles or amphotericin B. In conclusion, the preponderance of non-albicans candida colonization of neonates during their stay in NICU and the possibility that HCWs might be a source of colonization together with the decreased antifungal susceptibility of these isolates emphasize the importance of continuous surveillance, antifungal susceptibility testing, and compliance to infection control standards to establish an effective preventive strategy.

 

15/31 DETECTION OF KLEBSIELLA PNEUMONIAE CARBAPENEMASE PRODUCING BLAKPC GENE IN ASYMPTOMATIC ICUS' PATIENTS:

A NEW THREAT TO OUR ANTIBIOTIC ARMAMENTARIUM

Shereen E. Taha and Makram F. Attalah

Medical Microbiology and Immunology Department, Faculty of Medicine,

Ain Sham University

Carbapenem-resistant Klebsiella pneumonia (K. pneumoniae) is resistant to almost all available antimicrobial agents and infections with it have been associated with high rates of morbidity and mortality, particularly among patients with prolonged hospitalization and those who are critically ill and exposed to invasive devices. To detect gastrointestinal colonization by carbapenem-resistant Klebsiella pneumoniae in intensive care units' patients and study the presence of blaKPC gene in these isolates. Prospective randomized study.The study was performed on 67 patients admitted at three intensive care units (ICUs) at El Zaitoun Specialized Hospital which is a tertiary medical center in Cairo, Egypt. Surveillance perianal/rectal swabs were collected randomly from all patients. Carbapenem-resistant K. pneumoniae were conventionally identified and they were confirmed by Kirby-Bauer disk diffusion method. They were also tested for susceptibility to multiple antimicrobials.blaKPC gene was detected by real time PCR in carbapenem-resistant K. pneumoniae isolates.Carbapenem resistant gram negative bacilli were detected in 23 patients out of 67 (34.33%). Among them K. pneumoniae isolates were detected in 14 patients out of 67 (20.9%). Real time PCR for detection of blaKPC gene among carbapenem-resistant K. pneumoniae isolates showed that the gene was detected in 11 isolates (78.57%). Gastrointestinal colonization with carbapenem-resistant Enterobacteriaceae, especially K. pneumoniae, is of great importance in ICUs. Their transmission characteristics and pathogenesis resemble those of the more sensitive Enterobacteriaceae, but the infections are much more difficult to treat. For this reason, it is vital that a containment action plan need to be prepared to prevent their spread.

 

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