Carpabenem resistant Enterobacteriacae (CRE) is an increasing worldwide health problem with excess morbidity and mortality. So the aim of this work to study the risk factors, phenotypic and genotypic characters of CRE in our institute. Seventy five patients with hospital acquired infection were enrolled in this study. Identification and susceptibility testing were performed. The differentiation of the types of carbapenemases was done by inhibitor-based tests. The bla genes were detected by using the multiplex PCR. Out of 75 cases of Enterobacteriaceae, 47 (62.7%) CRE were detected. Cases of septicaemia and ventilator associated pneumonia with previous history of carbapenam intake especially in neonatal ICU were more risky for CRE. The overall detection rate in the CRE by modified hodge test (MHT) was 82.9%. By synergy combined disc tests, 47%, 19.1% were positive respectively for Klebsiella pneumonia carbapenemase (KPC) and metallo-β-lactamases (MBLs). By multiplex PCR, the most prevalent gene was bla KPC (22 ,46.8%), followed by blaVIM (10 , 21.3%) , blaOXA-48 (6 , 12.7%), bla KPC + blaOXA-48 (5, 10.6%), bla KPC + blaVIM (3 , 6.4%) while blaIMP and blaNDM genes were not detected. As the burden of carbapenem resistance in Egypt is increasing with limited treatment options. We suggest to develop antimicrobial stewardship in Tanta University Hospital together with governmental supervision to prevent the unrestricted anti microbial sales without prescriptions.

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Background: The study aimed to compare the antimicrobial activity and cytotoxicity of saponin extracted from six sea-cucumber species, licorice, and ginseng to determine the most potent one. Methods: Antimicrobial activity assessed by well diffusion and agar dilution methods. The inhibitory effects of the tested extracts on cell growth of Liver (HePG-2) and breast (MCF-7) cell lines assessed by MTT [3- (4, 5- dimethyl thiazol-2yl) - 2, 5- diphenyl tetrazolium bromide] assay. Results: The results revealed that licorice extract presented higher antibacterial activity against Gram-positive bacterial strains than sea-cucumber extracts; but has comparable results for Gram-negative (Salmonella tyhimurium, Klebsiella spp, and Acinetobacter baumanii). Holothuria atra body wall and Bohadschia tubules have the highest antifungal effect against Candida albicans, Candida krusei, Candida famata, Candida glabrata, and Candida tropicalis. Sea-cucumbers are more potent against fungal strains than licorice and ginseng extract. Licorice and ginseng presented higher cytotoxicity against HePG2 and MCF-7 cell lines than sea-cucumbers. Conclusion: This study promotes the use of licorice extract as a better antibacterial substance than sea-cucumber extracts, however the use of sea-cucumber extracts as antifungal agents than herbal extracts. Also, we support the utilization of licorice and ginseng as a cytotoxic agent instead of sea-cucumbers to stop the fishing of animals and consequently save it from extinction.

Background In the era of the increase in carbapenem resistance, searching for alternative drugs becomes mandatory. In this study, an in vitro activity of β-lactam/β-lactamase inhibitors against extended-spectrum β-lactamase–producing Enterobacteriaceae (ESBL-PE) isolated from bloodstream infections was investigated. Methods Blood samples were collected from patients with bloodstream infections in both pediatric and internal medicine intensive care units of Tanta University Hospitals, Egypt. BacT/ALERT was used, and positive blood cultures were subcultured on MacConkey, blood, chocolate agar and then incubated at 5% to 10% CO2, 37°C for 24 hours. Identification of the bacterial isolates was performed by VITEK 2TM Compact 15. Susceptibility testing was performed for isolated Escherichia coli and Klebsiella species using Kirby-Bauer disk diffusion and minimum inhibitory concentration. E test strips were used for cefoperazone/sulbactam, ceftazidime/avibactam, and ceftolozane/tazobactam. All isolates that were resistant to third-generation cephalosporins as per Clinical and Laboratory Standards Institute recommendations were confirmed for ESBL detection by modified double-disk synergy test, VITEK2 system, and multiplex polymerase chain reaction. Results One hundred twenty-five Enterobacteriaceae were isolated; 100 of them (80%) were ESBL positive. The best used β-lactam/β-lactamase inhibitors were ceftazidime/avibactam and ceftolozane/tazobactam with lower minimum inhibitory concentration at which 50% of isolates are inhibited (≤0.016, 0.094 μg/mL, respectively) than that of meropenem (0.125 μg/mL), so they can be used as carbapenem sparers in the treatment of ESBL-PE to decrease the incidence of carbapenem resistance. Conclusions Ceftazidime/avibactam and ceftolozane/tazobactam can be used as carbapenem sparers in the treatment of ESBL-PE to decrease the incidence of carbapenem resistance.

Background: Multiplex PCR is a sensitive and rapid method compared with conventional methods. Therefore, we use multiplex PCR for the rapid detection of the four major intestinal pathogens causing gastroenteritis ( Shigella spp., Campylobacter spp., Aeromonas spp. and Enterohemorrhagic Escherichia coli [EHEC]) in stool specimens. Materials and methods: A prospective randomized study using 200 stool samples obtained from patients presented with acute gastroenteritis during the study period (between February 2019 and December 2021). Bacteria in stool samples were identified using conventional culture methods and multiplex PCR for stool samples Results: The identified organisms using conventional cultures; were Shigella (27%), Aeromonas species (10%) and EHEC (O157 ) (8%). Using multiplex PCR. Shigella spp. was the most commonly identified pathogen (detected in 40.5% of positive samples), followed by Aeromonas spp. (30%), EHEC (20%) and Campylobacter species was only detected in (1%) of positive samples. The diagnostic evaluation of multiplex PCR in relation to conventional method in diagnosis of Shigella, EHEC and Aeromonas showed, sensitivity of 100% (for each), specificity of 88.5%, 92.4%, 77.8% respectively. However, the diagnostic evaluation of multiplex PCR in relation to conventional method in diagnosis of Campylobacter showed specificity of 99% and NPV of 100%. Conclusions: Multiplex PCR is an accurate and rapid method for detection of common intestinal pathogens causing severe gastroenteritis. a rapid method that could be used in outbreaks for diagnosis of the common enteric pathogens causing fatal gastroenteritis.