Background The nightmare of the rising numbers of multidrug-resistant organisms (MDROs) requires the implementation of effective stewardship programs. However, this should be preceeded by making available  evidence-based knowledge regarding the local antimicrobial resistance pattern, which is fundamental. The aim of the current study is to determine the prevalence of MDRO among different Ain Shams University Hospitals (ASUHs) intensive care units (ICUs) and detect the resistance profile of the common pathogens. Results The 1-year records of a total of 1280 pathogens were studied. The highest number of pathogens were isolated from blood cultures (44.84%), followed by urine (41.41%) then wound swabs (13.75%). Gram-negative isolates (57.5%) were more prevalent than gram-positive ones (31.1%). The most frequently isolated pathogens were Klebsiella spp. (22.5%), Escherichia coli (13.4%), and Coagulase-negative Staphylococci (12.5%). The highest percentage of resistance among gram-positive organisms was exhibited by penicillin (89.5%) followed by erythromycin (83.98%) and then cefoxitin (76.52%). None of the isolates showed resistance to linezolid and resistance to vancomycin was minimal (2.62%). Gram-negative isolates exhibited high overall resistance to all used antibiotic classes. The least frequency of resistance was recorded against nitrofurantoin (52.5%), amikacin (58.01%), followed by imipenem (59.78%) and meropenem (61.82%). All isolates of Pseudomonas and Acinetobacter showed 100% susceptibility to colistin. Conclusions The prevalence of antibiotic resistance in Ain Shams University Hospitals (ASUHs) was high among both gram-negative and gram-positive organisms. This high resistance pattern foreshadows an inevitable catastrophe that requires continuous monitoring and implementation of effective antibiotic stewardship.

Aim: Assess performance of broth microdilution (BMD) as well as agar dilution methods for antimicrobial susceptibility testing of Staphylococci using tetrazolium salt. Methods and Results: Minimum inhibitory concentration (MIC) of eight antimicrobials; vancomycin (VA), linezolid, oxacillin, gentamicin (CN), tetracycline, ciprofloxacin, erythromycin and clindamycin was investigated for 80 isolates of Staphylococci by BMD with the addition of dimethyl thiazole diphenyl tetrazolium bromide (MTT), agar dilution with the addition of MTT and triphenyl tetrazolium chloride at the standard bacterial concentration together with addition of MTT at an experimental bacterial concentration. BMD (MTT) showed the highest agreement in comparison with the standard BMD. Conclusions: Colorimetric BMD was rapid and easy to interpret. Colorimetric agar dilution (MTT) was less tedious than BMD. Significance and Impact of the Study: Colorimetric antibiotic susceptibility is a good option to provide rapid reliable results for critically ill patients. In addition, agar dilution (MTT) helps to investigate outbreaks of methicillinresistant Staphylococcus aureus (MRSA), VISA or VRSA. BMD (MTT) can be performed routinely to detect VA MIC in MRSA blood stream infections and hospital acquired pneumonia, where, high VA MIC is associated with a higher mortality rate.

Colistin is considered the last option for treatment of infections caused by Multidrug Resistant (MDR) Gram negative pathogens. The mcr-1 gene could transfer the resistance to colistin between different species. Therefore, screening of this resistance mechanism will help greatly in the control of further spread of colistin resistance and enhancing the outcomes of patients. The current work aimed to study the frequency of colistin resistance among MDR Gram negative pathogens isolated from clinical samples at Ain Shams University Hospitals and to explore if the mcr-1 gene was the responsible mechanism for this resistance. These pathogens were isolated from various samples including; blood, pleural fluid, sputum, urine, swabs from surgical and burn wounds, that were submitted from wards and intensive care units to the central microbiology laboratory at Ain Shams University Hospital, Cairo, Egypt, during the period from June to December 2019. Culture and bacterial identification were done by conventional microbiologic techniques. Eighty Gram negative bacterial pathogens were assayed for antimicrobial susceptibility by disc diffusion test. Sixty MDR Gram negative isolates were identified and further studied for colistin susceptibility by E-test, as well as real-time PCR to detect mcr-1 gene. Totally four isolates (6.7%) were phenotypically resistant to colistin. We found mcr-1 gene in three of the obtained isolates (5%); 1 Pseudomonas aeruginosa (5.3%) and 2 Acinetobacter baumannii (14.3%). In conclusion, although we detected a low prevalence of mcr-1 positive isolates from human clinical samples, continuous monitoring and implementation of infection control precautions are greatly required, to interfere with the further occurrence and transfer of bacterial species carrying the mcr-1 gene.

Background: Patients with end stage renal disease (ESRD) have elevated levels of inflammatory mediators including Creactive protein (CRP), tumor necrosis factor-α (TNF-α), and interleukin-6 (IL-6). Neutrophil to lymphocyte ratio was introduced as a novel inexpensive indicator that reflects the severity and extension of systemic inflammation and atherosclerosis, and predicts adverse clinical outcomes in cardiac and non-cardiac disorders including ESRD.The aim of this study is to evaluate the frequency of subclinical inflammation using neutrophil to lymphocyte ratio (NLR) and its relation to other biochemical parameters in ESRD patients on maintenance haemodialysis (HD) in comparison to high-sensitivity C-reactive protein (hsCRP). Methods:A cross sectional observational study including 100 clinically stable ESRD patients on regular haemodialysis (mean age 48.25 ± 13.67, 57% were males), NLR was calculated from complete blood count and hsCRP was recorded for all patients where 8.2 mg/L indicated inflammation.Results: NLR was positively correlated to hsCRP, using ROC curve (AUC=0.647) and the best cut off point to detect subclinical inflammation in HD patients was calculated with NLR greater than or equal 1.54, with sensitivity 68.25% and specificity 54%. By using univariate and multiple variate analysis in our work to test for independent predictors of hsCRP levels as an indicator for inflammation, it was found that NLR can be used as an independent predictor of hsCRP as an inflammatory marker, with statistically significant correlation (p=0.015). Spearman coefficient (rs=0.220) shows statistically significant (p=0.028) positive correlation between NLR and hsCRP. Conclusion:NLR is an easy, simple and non-expensive method that can be used as a marker of inflammation in HD patients when compared to hsCRP.

Currently, the sole global concern is recurring waves of the COVID-19 virus that began in 2020 and is ongoing. This study aimed to compare the trends of COVID-19 infections in Egypt during the different waves. We calculated the COVID-19 positivity rate between March 2020 and the fourth week of April 2021 among those tested at the Reference Laboratory of the Egyptian University Hospitals. We then compared our results with those obtained from the WHO and the Egyptian Ministry of Health and Population websites. A dramatic increase in the positivity rate was observed during May and June 2020 (26.35% and 33.11%, respectively). This was followed by an abrupt reduction in July (11.7%), and flattening until a second increase was noted during November (9.6%), which reached its peak during December (17.8%). However, after the figures declined during January 2021, they began to rise again in February 2021 and continued to increase until the end of April 2021, simulating the first wave data. The analysis of the COVID-19 growth rate from April 1st to the 25th, 2021 revealed a slight downward trend in new cases. Data from both the WHO and the Egyptian Ministry of Health and Population websites showed similar patterns to our results. The third wave of COVID-19 started in Egypt. Analyzing future data can aid in forecasting the COVID-19 epidemic and allow us to use foresight to enact effective measures and strategies to keep this virus under control.