Introduction With the increased occurrence of methicillin resistant S. aureus (MRSA), the consumption of vancomycin, the drug of choice, has also increased. As a consequence, strains of S. aureus resistant to vancomycin have started to emerge. This study aimed to evaluate the level of vancomycin resistance among clinical and nasal S. aureus isolates in a rural town in Egypt. MethodsThis cross-sectional study was held in the general hospital at the rural town of Kafr Eldawar in Egypt, during the period from January 2013 to January 2014. S. aureus isolates were collected from clinical samples and from nasal swabs. Results Two hundred S. aureus isolates were collected, 80 (40%) from clinical samples and 120 (60%) from nasal carriage samples. Vancomycin resistant S. aureus (VRSA) was only detected in clinical samples, all collected from the outpatient clinic. Eleven VRSA isolates (13.8% of total S. aureus clinical isolates) and one strain of vancomycin-intermediate S. aureus (from nasal carriage) were detected. VRSA isolates were most resistant to ciprofloxacin (90.9%) and erythromycin (81.8%). Five isolates were resistant to all tested antibiotics: ciprofloxacin, clindamycin, erythromycin, linezolid, oxacillin, penicillin and trimethoprim-sulfamethoxazole. MRSA was found to constitute 43.8% of clinical S. aureus isolates. The MRSA colonization rate among community individuals was 43.6%, 42.9% among healthcare workers and 51.4% among patients. Conclusion The prevalence of VRSA was high in clinical samples suggesting that there is a high level of VRSA strains in Egypt that goes undetected since most laboratories only use disk diffusion for detection of vancomycin resistance. Keywords Antibiotic resistance, methicillin resistant S. aureus, vancomycin resistant S. aureus

BackgroundSerodiagnosis of typhoid fever by Widal test based on demonstrating the presence of agglutinins (antibodies) in the serum of an infected patient, against the H (flagellar) and O (somatic) antigens of Salmonella enterica serotype Typhi has been associated with many debates. This is why the aim of this study was to: (i) Compare the diagnostic accuracy of four different commercial kits used to perform Widal test (Remel, BioSystems, Dialab and Biotec). (ii) Compare the sensitivity and specificity of both anti-O and anti-H antibodies. (iii) Compare the validity of single versus paired serum samples with a rising titer for the diagnosis of typhoid fever.MethodsDuplicate serum samples were obtained from150 patients clinically diagnosed as typhoid fever patients. Moreover, single serum samples were obtained from 25 patients with febrile diseases other than typhoid fever. All samples were tested using the four different Widal brands and Salmonella Typhi IgM anti-LPS ELISAResults-The results of Widal tests differed markedly using the four Widal brands in terms of sensitivity and specificity at three cut-off values of 1/80, 1/160 and 1/320. Remel brand gave the highest sensitivities and the lowest specificities and Dialab brand gave the highest specificities and the lowest sensitivities for both anti-O and anti-H antibodies at the three cut-off values.-Four fold rise in the antibodies titer was not demonstrable among clinically diagnosed typhoid fever patients-H agglutinins were less sensitive and less specific than O agglutininsConclusions-Widal test results showed marked discrepancies using different Widal brands. None of the serum samples of the typhoid fever patients showed four fold rise in the antibody titers. Raised O agglutinins were of slightly greater diagnostic value than raised H agglutinins.Significance and impact of studyWidal test done sequentially using two brands could be of value in typhoid fever diagnosis. Single serum sample could be used for typhoid fever diagnosis relying on anti O titer.

Background: T2DM patients are more likely to have UTIs caused by resistant organisms such as ESBLs producing bacteria. Challenging reliable identification and prompt characterization of in-vitro susceptibilities of these bacteria are the first steps of deciding the appropriate antimicrobial therapy for UTIs caused by them. Objectives: To isolate and identify E. coli and K. pneumoniae from urine of T2DM patients with UTIs, to determine antibiotic resistance pattern among isolates, and to identify ESBLs production phenotypically and genotypically. Material and method: All samples were cultured on Cystine-Lactose-Electrolyte-Deficient Agar medium (CLED) by using calibrated loop. Growth of 100 colonies or more, i.e. 105 colony forming units (CFU)/mL urine was considered as signifi- cant bacteriuria. Isolation and identification were done according to standard method. All isolates were tested for antibiotic susceptibility testing by the disc diffusion method according to CLSI guidelines. Phenotypic detection of ESBLs was done by double-disk synergy test. Genotypic detection of blaTEM, blaSHV and blaCTX-M genes by using PCR. Results: Results of this study showed that E. coli and K. pneumoniae were the dominant bacterial isolates, they constituted 103 (91.2%) out of 113 urine isolates. E. coli (58. 4%) K. pneumoniae (32.7%), Enterococcus spp. (4.4%), Proteus spp. (2.7%) and Pseu- domonas spp. (1.8%). About 25 (24.3%) out of 103 E. coli and K. pneumoniae isolates were ESBLs positive by DDST, and 22 (88.0%) out of them had ESBLs encoding genes by conventional PCR. The most common gene detected was blaTEM (59.1%), followed by blaSHV (27.3%). CTX-M had not been detected in any of testes isolates. Conclusion: blaTEM and blaSHV genes were detected in 22 out of 25 ESBLs producing E. coli and K. pneumoniae isolates phenotypically detected by DDST. blaTEM was found to be the predominant gene (59.1%), while blaCTX-Mene was not detected in any of tested isolates. Keywords: Extended Spectrum β-Lactamases; Type 2 diabetes mellitus; Urinary tract infections; Phenotypic; genotypic methods.

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Background: Carbapenemase-producing Enterobacterales are increasingly spreading in healthcare facilities. Identifying the type of carbapenemase can help epidemiologic surveillance and proper selection of antimicrobials. Objective: This study assessed the sensitivity and specificity of carbapenem inactivation method (mCIM with eCIM) for identification of carbapenemase-production. Methodology: The study involved 150 isolates of Enterobacterales. Carbapenem-resistant isolates by Kirby Bauer method were further tested for carbapenemase production phenotypically by mCIM with eCIM, and genotypically by multiplex PCR using specific primers for bla KPC , bla OXA-48 , bla NDM-1 , bla VIM , and bla IMP. Results: Resistance to carbapenem was observed in 53/150 isolates. Phenotypically, 28/53 isolates produced metallo-β-lactamase, 16/53 produced serine carbapenemase, 5/53 isolates gave inconclusive results, and 4/53 were negative by mCIM with eCIM test. Genotypically, 30 isolates carried bla NDM-1 , and 41 isolates carried bla . Both genes co-existed in 18 Metallo-β-lactamase producers. The 9 isolates with negative or inconclusive results carried carbapenemase-encoding genes. For mCIM with eCIM test the sensitivity and specificity of detecting Metallo-β-lactamase production were higher (87% and 91%) than for serine carbapenemase detection (34% and 83%), respectively. Conclusion: It was concluded that the mCIM with eCIM test does not always lead to true conclusions about the existence and the type of carbapenemase produced by Enterobacterales.