KEYWORDSAmoxicillin, Clavulanate, Gallic acid, Vitamin C, Hemoxygenase gene.Amoxicillin/ Clavulanate (AC) combination has become one of the antibiotics most widely prescribed used in the treatment of several bacterial infections, associated with liver injury. This study aimed to investigate amoxicillin/clavulanic acid induced hepatotoxicity and the modulatory effect of gallic acid (GA)/ vitamin C (VTC) individually and in combination on oxidative stress-related liver damage. Sixty-four male albino rats were randomly separated into eight groups; negative control; GA group; VTC group; GA +VTC group; AC-treated group; AC + GA-treated group; AC + VTC treated group and AC+ GA + VTC treated group. A twice daily dose of AC (31.83 mg/kg) and a single daily dose of both GA (60 mg/kg) and VTC (200 mg/kg/day) were introduced to rats orally for 7 consecutive days. After sacrificed, blood was collected for biochemical analysis of aspartate aminotransferase (AST), alanine aminotransferase (ALT), serum tumor necrosis factor alpha (TNF-α), caspase-3, RNA of heme oxygenase-1 gene (HMOX-1) and liver sample for lipid peroxidation and histopathological study. The serum levels of AST, ALT and TNF-α were significantly increased and upregulation of caspase-3 protein in rats treated with AC. Hepatic contents of malondialdehyde (MDA) were markedly increased following AC administration but produced a significant decrease in the levels of reduced glutathione (GSH) and glutathione-S-transferase (GST) along with down regulated the expression of HMOX-1. These findings were in accordance with the histopathological findings. Co-administration of GA and/or VTC along with AC to rats reduced liver injury, oxidative stress, apoptosis and histopathological alterations. So, we concluded that GA and VTC pose a positive modulatory effect against AC induced hepatotoxicity.

Rapid identification of infection caused by Klebsiella pneumoniae carbapenemase producing bacteria, is critical for the beginning of appropriate antimicrobial treatment and ending their spread. Objectives: to study and evaluate RT-PCR technology as a rapid method to directly detect KPC-producing Enterobacteriaceae in positive blood culture bottles. Methodology was: cross sectional study, conducted at Benha University Hospital. 253 blood culture bottles were incubated in the BD BACTEC™ 9050 Blood Culture System for up to 5 days, and Gram staining was done when the bottles were identified as being positive by the Bactec system. All Gramnegative pathogens were subcultured and identified Antimicrobial susceptibilities to meropenem and imepinem were tested by disc diffusion and interpreted according to The Clinical and Laboratory Standards Institute guidelines 2014. Klebsiella pneumoniae carbapenemase producing enterobacteriaceae in positive blood culture bottles was identified by Real time PCR. Results: out of 253 specimens,235 were positive, 186 (79.1%) were Enterobacteriaceae, 57 isolates (30.6%) of all Enterobacteriaceae isolates were resistant by disc diffusion test, and real-time Polymerase chain reaction detected 55 isolates (29.6%) as positive for the presence of Klebsiella pneumoniae carbapenemase gene. The sensitivity of PCR was 96.5%, specificity was 100%, PPV=100%. NPV= 98.5%, and diagnostic accuracy was 98.9%, in comparison with disc diffusion as a gold standard test. Conclusion: real time Polymerase chain reaction is a useful, rapid, sensitive, and specific tool to detect Klebsiella pneumoniae carbapenemase directly in positive blood culture bottle.

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