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

Abstract-Waste water is a reservoir of resistant bacteria and an excellent location to describe the pattern of fecal carriage of extended-spectrum β lactamases (ESBLs) producing bacteria in the community. In this study, the aim was to determine the proportion of ESBL producing Gram-negative bacteria in waste water. Also to describe the antimicrobial susceptibility and types of beta-lactamases (TEM, SHV and CTX-M) among E. coli and K. pneumoniae isolates from waste water in the city of Alexandria, Egypt. The ESBLs compromised 69.8% in influent sewage and 57.7% in effluent sewage of the total Gram negative bacteria. The most frequently detected gene among E. coliisolates while bla TEM , while the most common among K. pneumonia isolates was bla SHV.

Background Injudicious dispensing of antibiotics in subtherapeutic doses is common in many developing countries. In Egypt, as in many developing countries, a few pills of common cold products are offered under the name cold group (CG). A cold group may contain one or more pills of antibiotics. A pharmacy client may obtain subtherapeutic doses of antibiotics upon direct request or as part of a CG. Objective To examine factors associated with the unwarranted dispensing of subtherapeutic doses of antibiotics in community pharmacies as part of a CG or upon direct request from patients among community pharmacy staff. Setting Community pharmacy staff in Alexandria, Egypt. Methods Semi-structured interviews were conducted with a purposeful sample of community pharmacy staff. An interview guide was developed based on the theory of planned behavior. Constructs related to attitudes, subjective norm, perceived behavioral control and perceived moral obligation were explored. Directed content analysis was conducted using interview data which were recorded and transcribed verbatim. Main outcome measures Community pharmacy staff's views on factors associated with the unwarranted dispensing of subtherapeutic doses of antibiotics. Results Nine Pharmacists and six pharmacy assistants were purposively sampled to assure variance in age, gender, time in practice and socioeconomic status of patients served by their corresponding pharmacies. Factors contributing to dispensing antibiotics injudiciously included incorrect beliefs about potential benefit of antibiotics, profit, client pressure, ease of obtaining antibiotics from other pharmacies, inadequate enforcement of the law, pharmacist absenteeism, and assuming that the 'nonmalfeasance' principle is not violated. Reasons for lying to clients about the actual content of CGs included protecting the patient from harm resulting from antibiotic resistance and avoiding a possible argument. Conclusions Examining constructs related to pharmacy staff's attitude, subjective norm, perceived behavioral control as well as perceived moral obligation provided insight into community pharmacy staff's behavior related to dispensing subtherapeutic doses of antibiotics. Multi-tiered interventions are urgently needed to tackle different factors contributing to this dangerous practice.

Background and AimDespite being in remission, functional gastrointestinal disease (FGID) in Crohn's disease (CD) patients can reduce their quality of life. The Egyptian daily diet contains a high amount of FODMAP (Fermentable Oligosaccharides, Disaccharides, Monosaccharides, And Polyols). As the low FODMAP diet has been proven to be effective in irritable bowel syndrome worldwide, it was reasonable to take a step further and begin to study the effect of low FODMAP in Egyptian CD patients with FGID. The outcomes were assessed in terms of improvement in symptoms and hence the quality of life, and the factors that led to this improvement were also recorded.MethodsIn total, 100 CD patients with FGID in the remission stage who were already on a low‐fiber diet (± lactose‐free diet) were selected to follow the low FODMAP diet. A structured interview was performed after 3 months with a number of scored‐scale questionnaires comparing symptoms before and after the diet and the impact on quality of life. Evaluation of the adherence, satisfaction, palatability, and affordability of the diet was performed. Different demographic data were also evaluated in correspondence with improvements in the quality of life.ResultsThe mean score of FGID improvement was 38.45 ± 21.56%. The quality of life was significantly improved; 90% of female patients versus 49.4% males had a better quality of life. The households (not working) as well as those with morning jobs (6 hours) reported an increase in quality of life. Although the Egyptian low FODMAP diet was expensive (in terms of gluten‐free wheat), 67% were adherent to it (18.16 ± 6.85).ConclusionAs a first step in Egypt, the low FODMAP diet was effective in improving the quality of life of CD patients with FGID.

Gabbett's stain was more accurate in the diagnosis of PTB compared with both ZN and MCS, even though the results were not statistically significant. It can replace ZN for initial diagnosis and follow up of cases. It is also easier, faster, and does not require a heating step.

CASP was more accurate than xylose lysine desoxycholate and Salmonella-Shigella in the detection of Salmonella from seafood samples. We recommend that CASP medium should be tested against more Salmonella-positive samples before it is used as a screening plating medium for Salmonella in seafood.

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