High rates of antimicrobial resistance (AMR) among Gram-negative pathogens (GNP) have been reported in Egypt. Antimicrobial surveillance and identifying the genetic basis of AMR provide important information to optimize patient care. In this study, we aimed to identify the beta-lactam resistance phenotypes and genotypes of multidrug-resistant (MDR) non-repetitive GNP from 3 tertiary hospitals in Egypt. WZe studied 495 non-repetitive MDR Gram-negative isolates from patients with complicated intra-abdominal infections (cIAI), complicated urinary tract infection (cUTI), and lower respiratory tract infection (LRTI), collected as part of the “Study for Monitoring Antimicrobial Resistance Trends” (SMART) conducted in 3 tertiary hospitals in Cairo, Egypt, from 2015 to 2016. Identification and susceptibility testing of GNP to antimicrobials were tested in each hospital laboratory and confirmed in a reference laboratory (International Health Management Associates (IHMA), Inc., Schaumburg, IL, USA). Molecular identification of extended-spectrum beta-lactamases (ESΒLs), AmpC, and carbapenem resistance genes was conducted in IHMA. Among the 495 MDR isolates, Klebsiella pneumoniae (K. pneumoniae) and Escherichia coli (E. coli) were the most common (52.7% and 44.2%). K. pneumoniae was most susceptible to colistin, amikacin, ertapenem, and imipenem (92.7%, 72.7%, 69.3%, and 64%, respectively). E. coli was most susceptible to colistin (100%), amikacin (94.1%), imipenem (90.4%), and ertapenem (83.6%). ESBL was detected in 96.2% and ESBL genotypes included blaCTX-M-15 (70.1%), blaTEM-OSBL (48.5%), blaSHV-OSBL (27.9%), and blaCTX-M-14 (10.7%). AmpC resistance genes were identified in 9.7% of the isolates, dominated by blaCMY-2 (5.7%). Carbapenem resistance genes were detected in 45.3% of the isolates. In K. pneumoniae, blaOXA-48 dominated (40.6%), followed by blaNDM-1 (23.7%) and blaOXA-232 (4.5%). In E. coli, the most frequent genes were blaNDM-5 (9.6%), blaOXA-181 (5.5%), blaOXA-244 (3.7%), and blaNDM-1 (3.7%). blaKPC-2 was identified in 0.4% of isolates. Notably, 32.3% of isolates carried more than one resistance gene. Our findings emphasize the continued need for molecular surveillance of MDR pathogens, implementation of strict infection control measures, and antimicrobial stewardship policies in our hospitals.

Helicobacter pylori (H. pylori): is a microbe with wide genetic diversity that infects the stomach of most people in developing countries, leading to several clinical outcomes among different individuals such as gastritis, ulcers, or gastric cancer. Outer inflammatory protein A (oipA) and duodenal ulcer promoting (dupA) genes are among the possible virulence factors which determine the patient outcome. Aim: To detect oipA and dupA genes of H. pylori among dyspeptic Egyptian patients, and to investigate their correlation with the varying degrees of the associated chronic gastritis. Methods: The study enrolled 50 patients with dyspepsia, attending the Gastrointestinal Endoscopy unit of the Gastroenterology and Tropical Departments at Ain Shams University Hospital for upper gastrointestinal endoscopy, in the period between, June and, December 2019. Four antral gastric biopsies were taken from each patient for polymerase chain reaction assay to detect the virulence genes oipA, dupA, and cagA and for histopathological assessment. Results: Forty patients were H. pylori positive by histopathology and PCR. cagA, oipA, and dupA were identified in 6 (15%), 13 (32.5%), 9 (22.5%) of biopsies, respectively. Both cagA and oipA genes were highly significantly associated with increasing the severity of gastritis. Only oipA virulence gene showed a highly significant association with gastroduodenitis. There was a highly significant moderate association between cagA and oipA genes. Conclusion: oipA could be a virulence biomarker that serves a great value in predicting the progress of gastric mucosal damage in patients with chronic gastritis, and targeting antimicrobial therapy in those patients to prevent severe gastroduodenal diseases.

Introduction: Multi-Drug Resistance (MDR) is common in hospitalized geriatric patients. The study aims to investigate the pattern of antibiotic use and determine its association with MDR in hospitalized geriatric patients. Methodology: A retrospective cohort study including 193 geriatric patients admitted to a Geriatric Intensive Care Unit (GICU) in a tertiary care Geriatrics hospital in Egypt, throughout a consecutive 6 months duration. A review of medical records was done to extract clinical, socio-demographic, and prescribing data on antibiotics throughout admission. The presence of MDR organisms (MDROs) was determined by reviewing culture and sensitivity reports. Descriptive statistics and logistic regression analysis were performed. Results: 181 (93.8%) patients received at least 1 antibiotic. Cephalosporins were the most commonly consumed antibiotics (24%). MDROs were significantly associated with receiving ≥ 3 antibiotics. Longer hospital stay was a predictor of multiple antibiotics use (Odds Ratio of 1.075). MDROs were prevalent in 110 (57.0 %) patients. Klebsiella species were the most frequent MDROs (26%) with the highest susceptibility to amikacin. Conclusions: The study provides a detailed description of both antibiotics use and MDR among hospitalized geriatric patients in Egypt. It gives a novel insight into the ongoing drug-pathogen combinations in acute healthcare settings of the aged. This data has a potential role in applying antimicrobial stewardship programs for hospitalized geriatric patients to mitigate antimicrobial resistance in similar settings.

Background: quinolone resistance is traditionally mediated by chromosomal mutations mutation of DNA gyrase and/or topoisomerase IV or by the mutation of genes regulating the expression of efflux pumps, until PMQR was described in a clinical isolate of Klebsiella pneumoniae in 1998. PMQR genes generally confer low-level resistance, with their MICs falling below Clinical and Laboratory Standards Institute (CLSI) breakpoints for intermediate resistance; therefore, their contribution to quinolone resistance can be masked in strains also harboring QRDR mutations in gyrA and parC. However, their clinical significance stems from the fact that they greatly facilitate the selection of more highly quinolone-resistant strains. Although the PMQR mechanism only confers low-level resistance to FQs, its association with the occurrence of mutations in QRDR can lead to clinically relevant resistance levels. These PMQR determinants are increasingly being identified worldwide in clinical isolates of Enterobacteriaceae and Pseudomonas spp. Aim of the work: this study aimed to identify different mechanisms of fluoroquinolones resistance and determine fluoroquinolones resistance pattern among the studied isolates. Material and methods: this study was carried on 100 non duplicate clinically relevant Enterobacteriaceae and Pseudomonas spp. recovered from clinical specimens referred to Central Microbiology Laboratory, Ain Shams University Hospital for routine culture and sensitivity, aiming to 1) Determine the occurrence of plasmid-mediated fluoroquinolones resistance (PMQR) determinants by multiplex PCR and chromosomal mutations by PCR-RFLP among Enterobacteriaceae and Pseudomonas spp. in clinical specimens. 2) Identify different mechanisms of Fluoroquinolones resistance. 3) Determine Fluoroquinolones resistance pattern among the studied isolates. Results: in this study we found that 77% of FQs resistant isolates were positive to one or more plasmids, oqxAB was highest recovered PMQR among Klebsiella. 78% were positive for gyrA mutations, gyrA gene mutations were higher in Pseudomonas, Asp-87mutation was 56/78(72%) higher than Ser-83 mutation 38/78 (49%) isolates.

Fluconazole resistance by Candida albicans (C. albicans) is a growing medical issue which makes patient management more difficult. The development of new effective, safe and inexpensive alternatives becomes essential. Probiotics represent an intriguing strategy that can be applied for prevention or treatment of Candida infections. The aim of our study is to investigate the anti-fungal activity of different Lactobacillus species against fluconazole resistant C. albicans isolates and to evaluate the inhibitory effect of cell free supernatant of the most potent one. Sixty-nine C. albicans isolates were collected from different clinical specimens and subjected to antifungal susceptibility testing. Then, the anti-Candida activity of various Lactobacillus spp was investigated via different methods, spot overlay method, radial streak method and agar well diffusion method. Results showed that 33% of C. albicans isolates were resistant to fluconazole with MIC ≥ 64 μg/ml. L. rhamnosus demonstrated strong inhibitory activity against the majority of fluconazole resistant C. albicans isolates, followed by L. reuteri and L. salivarus respectively. Inhibitory activity of L. rhamnosus against C. albicans may be due to acid production. Our findings conclude that L. rhamnosus represent a promising candidate to be used in the treatment of candidiasis caused by fluconazole-resistant C. albicans strains.