Background. Dysbiosis of gut microbiota could promote autoimmune disorders including systemic lupus erythematosus (SLE). Clarifying this point would be of great importance in understanding the pathogenesis and hence the development of new strategies for SLE treatment. Aim. This study aimed to determine the fecal microbiota profile in newly diagnosed SLE patients compared to healthy subjects and to investigate the correlation of this profile with disease activity. Methods. Newly diagnosed SLE patients who fulfilled at least four of the American College of Rheumatology (ACR) criteria were enrolled during the study period. Patients with lupus were matched to healthy subjects. SLE activity was evaluated using the Systemic Lupus Disease Activity Index (SLEDAI-2K). Fresh fecal samples were collected from each subject. Genomic DNA was extracted from fecal samples. Quantitative real-time PCR was applied for quantitation of Firmicutes phylum, Bacteroidetes phylum, and Lactobacillus genus in comparison to the total fecal microbiota. Results of patients’ samples were compared to those of healthy subjects and were correlated to patients’ SLEDAI-2K score. Results. Twenty SLE patients’ samples were compared with 20 control samples. There was a significant alteration in SLE patients’ gut microbiota. A significantly lower ( p ≤ 0.001 ) Firmicutes/Bacteroidetes (F/B) ratio in SLE patients (mean ratio: 0.66%) compared to healthy subjects (mean ratio: 1.79%) was found. Lactobacillus showed a significant decrease in SLE patients ( p = 0.006 ) in comparison to healthy controls. An inverse significant correlation between SLEDAI-2K scores for disease activity and F/B ratio (r = −0.451; p = 0.04 ) was found. However, an inverse nonsignificant correlation between SLEDAI-2K scores for disease activity and Lactobacillus (r = −0.155; p = 0.51 ) was detected. Conclusion. Compared to healthy controls, recently diagnosed SLE Egyptian patients have an altered fecal microbiota profile with significant lowering of both F/B ratio and Lactobacillus abundance, which is weakly correlated with disease activity.

Introduction: Resistance to fluoroquinolones (FQ) in uropathogenic Escherichia coli (UPEC) has emerged as a growing problem. Chromosomal mutations and plasmidmediated quinolone resistance (PMQR) determinants have been implicated. Data concerning the prevalence of these determinants in UPEC in our hospital are quite limited. Purpose: To investigate the occurrence and genetic determinants of FQ resistance in UPEC isolated from urinary tract infection (UTI) cases in Zagazig University Hospitals. Patients and Methods: Following their isolation, the identification and susceptibility of UPEC isolates were performed by matrix-assisted laser desorption/ionization-time-of-flight mass spectrometer (MALDI-TOF MS). FQ resistance was detected by the disc diffusion method. Ciprofloxacin minimal inhibitory concentration (MIC) was determined using E-test. Chromosomal mutations in the gyrA gene were detected using polymerase chain reactionrestriction fragment length polymorphism (PCR-RFLP), and for detection of PMQR, a couple of multiplex PCR reactions were used. Results: Among a total of 192 UPEC isolates, 46.9% (n=90) were FQ resistant. More than half of the isolates (57.8%) exhibited high-level ciprofloxacin resistance (MIC > 32 µg/mL). Mutations in gyrA were detected in 76.7% of isolates, with 34.4% having mutations at more than one site. PMQR determinants were detected in 80.1% of UPEC isolates, with aac(6ʹ)-Ibcr gene being the most frequent found in 61.1% of isolates. Conclusion: There is a high prevalence of both gyrA mutations and PMQR determinants among UPEC isolates in our hospital which contribute to high-level ciprofloxacin resistance, a finding that may require the revision of the antibiotics used for empirical treatment of UTI.

Imipenem-resistant Acinetobacter baumannii (A. baumannii) (IRAB) has emerged as a challenging nosocomial pathogen particularly in intensive care units (ICUs). Studying the risk factors associated with IRAB infection is of paramount importance for appropriate control of IRAB spread. The aim of this study was to assess the incidence rate and possible risk factors associated with nosocomial IRAB infections in ICUs. A prospective cohort study was carried out in surgical and emergency ICUs of a tertiary care hospital in Egypt. All patients who developed nosocomial A. baumannii infection from the start of January 2014 to the end of December 2015 were included. Isolates were identified as A. baumannii using API 20NE and E-test was used to define IRAB. Out of 146 A. baumannii isolates, 11 were found to be IRAB (7.5% incidence rate), of them 72.7% (8/11) were found to be multidrug resistant (MDR). Univariate analysis demonstrated that hospital stay before ICU admission [Relative risk (RR) 3.51, 95% confidence interval (CI) 1.0-12.7, P= 0.04)], longer ICU stay (P= 0.005), exposure to emergent surgery (RR 17.5, CI 7.39-41.4, P= 0.000), the presence of central venous catheter (RR 3.26, CI 1.0-10.6, P= 0.04) and previous carbapenem use (RR 4.05, CI 1.12-14.6, P =0.02) were significant risk factors for IRAB infection. In conclusion, a relatively high IRAB incidence was recorded in ICUs of our hospital. Hospital stay before ICU admission, longer ICU stay, exposure to emergent surgery, the presence of central venous catheter and previous carbapenem use were significant risk factors for IRAB infection. Rationale use of carbapenems in ICUs should be considered. LES INFECTIONS ACINETOBACTER BAUMANNIINOSOCOMIALES RESISTANTS A L'IMIPENEME DANS LES UNITES DE SOINS INTENSIFS: L'INCIDENCE ET LES FACTEURS DE RISQUE EVALUATION.Hend E Sharaf (1) et Marian A Gerges (1) (1) Département de microbiologie médicale et d'immunologie, Faculté de médicine, université de Zagazig, Egypte. 146 isolats d'A. baumannii, 11 ont été trouvés d'être IRAB (7,5% taux d'incidence), d'entre eux, 72,7% (8/11) ont été trouvés multi résistantes (MDR). Analyse univariée a montré que l'hospitalisation avant l'admission USI [Risque relative (RR)3,51, 95% intervalle de confiance (CI) 1,0-12,7, P=0.04)], long séjour à USI (P=0.0005), l'exposition à la chirurgie d'urgence (RR 17,5 CI 7,39-41.4, P= 0,000), la présence d'un cathéter veineux central (RR 3,26, CI 1,0-10,6 P=0.04) et l'usage de carbapenemprécédente (RR 4,05 CI 1,12-14.6 P=0,02) étaient des facteurs de risque importants d'infection IRAB. En conclusion, un incident relativement élevé d'IRAB a été enregistréà USI de notre hôpital. Séjour à l'hôpital avant l'admission à l'unité de soins intensifs, long séjour à USI, l'exposition à la chirurgie d'urgence, la présence d'un cathéter veineux central, et l'utilisation de carbapenemprécédenteétaient des facteurs de risque important pour l'infection d'IRAB. L'utilisation rationnelle des carbapanemes en USI devrait êtreconsidéré. Mots clés : Résistant àImipenème, Acineb...

Introduction The level of expression of the immunoregulatory human leukocyte antigen-G (HLA-G) has been suggested to play a role in the immunopathogenesis of systemic lupus erythematosus (SLE). A 14 bp insertion/deletion (ins/del) polymorphism in the 3ˊuntranslated region of HLA-G gene may influence the level of expression. The role of Toll-like receptor 9 (TLR9) in the pathogenesis of SLE has been highlighted. Data among Egyptian patients are quite limited. Purpose To detect the association of HLA-G 14 bp ins/del gene polymorphism with the susceptibility to SLE and to correlate TLR9 serum level with disease activity among Egyptian patients. Patients and Methods A case-control study that included 102 SLE female patients and 102 healthy matched volunteers as controls was carried out. Disease activity in patients was determined using the modified Systemic Lupus Erythematosus Disease Activity Index (SLEDAI). HLA-G 14 bp ins/del genotype was detected by polymerase chain reaction (PCR). TLR9 serum level was estimated using enzyme-linked immunosorbent assay (ELISA) technique. Results The ins/ins genotype was significantly increased among SLE patients compared to healthy subjects (58.8% vs 9.8%; odds ratio [OR] = 11.79, P < 0.001). The 14 bp ins allele was significantly more frequent in SLE patients than in healthy subjects (65.7% vs 27.9%, respectively) and significantly associated with an increased risk of SLE (OR 4.94, P < 0.001). The mean TLR9 serum level showed a significant increase in SLE patients compared to healthy subjects (397.04±137.86 vs 195.22±45.14 ng/L, p < 0.001) and was significantly associated with disease activity as well as to patients’ HLA-G genotypes (p < 0.001). Conclusion Among Egyptian population, HLA-G 14 bp ins/ins homozygous genotype and ins allele may constitute a potential risk for SLE susceptibility, while TLR9 serum level is significantly associated with disease activity.

Background: The growing incidence of multidrug resistant (MDR) bacterial infections has become a public health crisis. This work aims to evaluate the in-vitro activity of silver nanoparticles (AgNPs), alone and in combination with the antimicrobials amikacin and ceftazidime, against MDR Gram-negative bacilli (GNB) isolated from clinical cases in Zagazig University Hospitals. Methods: In a cross sectional study, MDR GNB were isolated from different clinical specimens and were tested to determine the minimal inhibitory concentration (MIC), minimal bactericidal concentration (MBC) and bactericidal activity of AgNPs using broth microdilution method. The effect of combining subMIC levels of AgNPs (MIC/2 and MIC/4) with amikacin and ceftazidime, was also determined by broth microdilution. Results: A total of 63 MDR GNB was obtained during the study period (22 E. coli, 17 Klebsiella, 15 Pseudomonas aeruginosa and 9 Acinetobacter isolates). AgNPs demonstrated a bactericidal effect on all tested isolates with an MBC/MIC ratio of less than 4. When combined with amikacin, a synergistic effect was demonstrated on all tested E.coli and Klebsiella isolates at AgNPs MIC/2 and on 45.4%, 40% and 77.8% of E.coli, P.aeruginosa and Acinetobacter isolates, respectively at MIC/4. In combination with ceftazidime, AgNPs exhibited a synergistic effect on 100% of E. coli and 88.2% Klebsiella at both MIC/2 and MIC/4 and on 40% of P. aeruginosa isolates at AgNPs MIC/4. Conclusions: AgNPs exert a bactericidal activity on MDR GNB as well as a synergistic effect when combined with amikacin and ceftazidime suggesting them as a new weapon in the war against MDR GNB.