Background: Candida species are among the most common fungal pathogens in ICU patients. Candida albicans was the predominant species, but a shift toward non-albicans Candida species has been recently observed. Objectives: To detect the prevalence of different Candida species and determine their antifungal susceptibility profile in ICU patients using phenotypic methods, the Vitek 2 system compared with CHROMagar Candida agar and a genotypic method; PCR-RFLP. Methodology: Various clinical samples were collected from 248 ICU patients in Sohag University Hospital from the period between September 2014 and May 2015. Samples were cultured on CHROMagar Candida agar. Results were compared with those of Vitek 2 system and confirmed by PCR-RFLP method and antifungal susceptibility profiles were analyzed by disc diffusion and Vitek 2 antifungal susceptibility tests. Results: The study revealed an overall isolation rate of Candida species among ICU patients was 29 % by PCR-RFLP. Candida albicans was the most frequent species isolated (40.3%). Non-albicans Candida species including Candida tropicalis (22.2%), Candida glabrata (18%), Candida krusei (12.5%), C. parapsilosis (4.2%), C. dubliniensis (1.4%) and Candida guilliermondii (1.4%) were also isolated. The sensitivity of vitek 2 with regard to correct identification of Candida species was 96%; the specificity was 100 % , also CHROMagar Candida agar enable the correct identification with sensitivity 89% , specificity 100 %. Vitek 2 antifungal susceptibility tests results were found to be an accurate method as it was compared with the disc diffusion method for fluconazole, voriconazole and amphotracin B. Conclusion: CHROMagar Candida agar supported by Vitek 2 system is a valuable method for identification of common Candida species, these methods are easy to interpret and give rapid results in comparison with the expensive PCR-RFLP method. Although amphotericin B and fluconazole are widely used in clinical practice, there was no evidence of enhanced resistance. Moreover, voriconazole could be used in treatment of fluconazoleresistant Candida species.
The spread of carbapenem resistance among Enterobacteriaceae have become a problem for healthcare facilities worldwide. Community and hospital-acquired infections caused by these bacteria have been associated with significant morbidity and mortality with limited treatment options. Rapid detection of carbapenem resistant Enterobacteriaceae (CRE) is important for infection control. Objectives: To detect the prevalence of carbapenem resistant Enterobacteriaceae (CRE) species and determine their antimicrobial susceptibility profile using the Vitek 2 system and the presence of carbapenemases genes using Multiplex PCR. Methodology: Various clinical samples were collected from 469 patients from Sohag University Hospitals in the period between August 2016 and April 2018, CRE isolates were identified by conventional methods and antimicrobial susceptibility testing using disc diffusion method and also performed by Vitek 2 automated system, Multiplex PCR was used for detection of carbapenemases genes as blaKPC, blaVIM, blaIMP, blaNDM-1 and blaOXA-48. Results: The prevalence of carbapenem resistant Enterobacteriaceae (CRE) species was 19.9%, Klebsiella pneumoniae was the most common species (51.4%), Escherichia coli (28.6%), Enterobacter aerogenes(8.6%) and Acinetobacter baumannii (5.7%). Vitek 2 system identified CRE isolates with 82.7% sensitivity, 98.6 % specificity and 90.6% diagnostic accuracy 25.7% of CRE strains were isolated from the internal ICU and 20 % from Chest Department, and mostly isolated from urine(40%) and from endotracheal tubes swabs(28.6 %) 77.1 % of CRE isolates contained carbapenemases genes, 62.1 % were blaKPC positive, 20.7 % were blaVIM-positive, 3.4 % were blaNDM-positive, 13.8 % were blaOXA-48-positive and none was blaIMP-positive. Conclusion: Conventional methods supported by Vitek 2 system is a valuable method for identification of CRE species, the detected carbapenemases genes in this study indicate that carbapenem resistance is spreading in Egypt and support the use of molecular methods for the rapid detection of CRE for successful implementation of infection control measures. We recommend routine testing to determine carbapenem resistance in Enterobacteriaceae in health facilities in Egypt.
Renal and hepatic functions are often mingled through both the existence of associated primary organ diseases and hemodynamic co-relationship. The primary objective of this study was to sum up the relationship between autoimmune hepatitis (AIH) on renal tubular acidosis (RTA) and the stages of the disease. A systematic review was performed for 24 trials. A total of 3687 patients were included. The incidence of RTA occurring and short-term mortality reduction was seen in two groups; for an overall effect: Z = 2.85 (P = 0.004) a total 95% CI of 0.53 [0.34, 0.82]. Only one patient with alcoholic liver cirrhosis was found to have an incomplete type of RTA. Test for overall effect: Z = 2.28 (P = 0.02) 95% CI of 2.83 [1.16, 6.95]. A reduction in fatal infections with dual therapy of corticosteroid plus N-acetylcysteine (NAC) test for overall effect: Z = 3.07 (P = 0.002) with 95% CI of 0.45 [0.27, 0.75]. Autoimmune diseases are the most frequent underlying cause of secondary RTA in adults. The primary renal disease must be actively excluded in all patients with hepatic failure by aggressive clinical and laboratory evaluations.
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