Hypervirulent Klebsiella pneumoniae: Epidemiology, virulence factors, and antibiotic resistance

Human infections induced by Klebsiella pneumoniae (K. pneumoniae) include pneumonia; urinary tract infections, liver abscesses, bacteremia, and others. The introduction and spread of the hypervirulent K. pneumoniae (hvKp) strains have raised the number of persons who are already susceptible to infections, including those who are healthy or immune-compromised. Infections can occur worldwide; however, they are particularly prevalent in the Asia-Pacific area. Virulence plasmids as well as other conjugal components contain the genetic material that gives hvKp its hypervirulence phenotype. Although the vast majority of hvKp isolates are antibiotic-susceptible, the incidence of virulent as well as resistant isolates, such as carbapenem-resistant hvKp isolates, is continuously growing. Multidrug resistance (MDR) and increased virulence of these strains may be the cause of the subsequent clinical crisis. This study aimed to review and analyse the epidemiology, the factors associated with hypervirulence, and the mechanisms of antibiotic resistance of the hvKp strains in order to provide a better understanding of the basic biology of these strains

The relationship between antisperm antibodies prevalence and genital Chlamydia trachomatis infection in women with unexplained infertility

Background: Chlamydia trachomatis infection is one of the most common sexually transmitted diseases. Sperm-associated antibody could impair fertility through various mechanisms; both factors could be correlated to affect the fertility status of women. Design: A retrospective case-control study was performed enrolling ninety (n = 90) patients with primary or secondary infertility as the case group, in addition to another eighty (n = 80) healthy women attending the family planning clinic to investigate the correlation between C. trachomatis past and current infections and antisperm antibodies (ASA) in women with unexplained infertility. Results: The PCR prevalence of C. trachomatis did not differ significantly among both groups (2.4% versus 1.6%, p value = 0.66). In contrast, significantly higher prevalence of anti-C. trachomatis specific IgG (39% versus 19%, p value = 0.87) antibodies was found among infertile women. ASA prevalence was significantly higher in infertile group (20% versus 5%, p = 0.04). The final study results have failed to find a positive correlation between current or past C. trachomatis infection and the level of antisperm antibodies level in women suffering of un-explained infertility. Conclusion: Antisperm antibodies were significantly higher in infertile women, but without a significant difference between the incidences of ASA in infertile women with past or current C. trachomatis current infection

The relationship between antisperm antibodies prevalence and genital Chlamydia trachomatis infection in women with unexplained infertility

Chlamydia trachomatis infection is one of the most common sexually transmitted diseases. Sperm-associated antibody could impair fertility through various mechanisms; both factors could be correlated to affect the fertility status of women. Design: A retrospective case-control study was performed enrolling ninety (n=90) patients with primary or secondary infertility as the case group, in addition to another eighty (n=80) healthy women attending the family planning clinic to investigate the correlation between C. trachomatis past and current infections and antisperm antibodies (ASA) in women with unexplained infertility. Results: The PCR prevalence of C. trachomatis didn't differ significantly among both groups (2.4 versus 1.6%, P value=0.66). In contrast, significantly higher prevalence of anti- C. trachomatis specific IgG (39% versus 19%, P value=0.87) antibodies were found among infertile women. ASA prevalence was significantly higher in infertile group ( 20 % versus 5%, P=0.04 ). The final study results have failed to find a positive correlation between current or past C. trachomatis infection and the level of antisperm antibodies level in women suffering of unexplained infertility. Conclusion: Anti-sperm antibodies were significantly higher in infertile women, but without a significant difference between the incidences of ASA in infertile women with past or current C. trachomatis current infection. (Afr J Reprod Health 2011; 15[3]: 101-112).L'infection de chlamydia trachomatis est une des maladies sexuellement transmissibles les plus communes et l'anticorps li é au sperme peut abimer la fertilité à travers divers mécanismes. Les deux facteurs peuvent être corrélés pour affecter l'état de fertilité des femmes. Une étude rétrospective basée sur l'étude de cas a été menée auprès des quatre-vingt –dix (n=90) patientes atteintes de la stérilité primaire et secondaire comme constituant le groupe de cas, y compris quatre-vingts (n=80) d'autres femmes en bonne santé qui fréquentaient la clinique de planification familiale afin d'étudier la corrélation entre l'ancien C. trachomatis et les infections actuelles et les anticorps antisperme (AAS) chez les femmes atteintes de la stérilité inexplicable. La prévalence de PCR par rapport à C. trachomatis n'a pas indiqué des différences remarquables parmi les deux groupes (2,4 contre 1,6%, Valeur de P= 0,06). Par contre, on a découvert des différences très remarquables par rapport aux anti-C. trachomatis de la spécificité 1gG (39% par opposition à 19%, valeur de P= 0,87) ont été trouvé chez les femmes stériles (20% par opposition à 5% P=0,04). Les résultats définitifs de l'étude n'a pas réussi à montrer une corrélation positive entre l'infection de C. trachomatis et le niveau d'anticorps d'antisperme chez les femmes stériles, mais sans une différence remarquable entre les incidences d'AAS chez les femmes stériles de C. trachomatis passé ou actuel

Hospital outpatient clinics as a potential hazard for healthcare associated infections

Summary: Healthcare acquired infections are no longer confined to the hospital environment. Recently, many reported outbreaks have been linked to outpatient settings and attributed to non-adherence to recommended infection-prevention procedures. This study was divided into two parts: The first is a descriptive cross-sectional part, to assess the healthcare personnel's knowledge and compliance with Standard Precautions (SP). The second is an intervention part to assess the role of health education on reducing the level of environmental and reusable medical equipment bacterial contamination. Assessment of the doctors’ and nurses’ knowledge and compliance with SP was performed using a self-administered questionnaire. Assessment of environmental cleaning (EC) and reusable medical equipment disinfection has been performed using aseptic swabbing method. The extent of any growth was recorded according to the suggested standards: (A) Presence of indicator organisms, with the proposed standard being <1 cfu/cm2. These include Staphylococcus aureus (including methicillin-resistant Staphylococcus aureus, MRSA), Enterococci, including vancomycin-resistant Enterococci (VRE) and various multidrug-resistant Gram-negative bacilli. (B) Aerobic colony count, the suggested standard is <5 cfu/cm2. The effect of health education intervention on cleaning and disinfection had been analyzed by comparing the difference in cleaning level before and after interventional education. Good knowledge and compliance scores were found in more than 50% of participants. Primary screening found poor EC and equipment disinfection as 67% and 83.3% of stethoscopes and ultrasound transducers, respectively, were contaminated with indicator organisms. For all indicator organisms, a significant reduction was detected after intervention (p = 0.00). Prevalence of MRSA was 38.9% and 16.7%, of the total S. aureus isolates, before and after intervention, respectively. Although 27.8% of the total Enterococcus isolates were VRE before intervention, no VRE isolates were detected after intervention. These differences were significant. Development and monitoring of the implementation of infection prevention policies and training of HCP is recommended. Keywords: Standard Precautions, Multidrug resistant bacteria, Hospital environment, MRS

Utility of GeneXpert MTB/RIF assay for the diagnosis of pulmonary and extra-pulmonary tuberculosis, A report from Egypt

Early diagnosis of tuberculosis continues to be a challenge for clinicians. The World Health Organization (WHO) guidelines recommend the application of GeneXpert MTB/RIF in extra-pulmonary tuberculosis (EPTB) diagnosis. This study aimed to test and compare the accuracy of the GeneXpert MTB/RIF assay to diagnose pulmonary tuberculosis (PTB) and EPTB, compared to bacterial culture and to composite reference standard (CRS). The GeneXpert assay diagnosed tuberculosis (TB) in 19.5 % of patients. With reference to bacterial culture, the sensitivity of this assay for detection of the pulmonary and extra-pulmonary specimens was perfect. For pulmonary specimens, on using CRS; the detected sensitivity and specificity of the GeneXpert assay were 78.3 % and 99.1 %, respectively. However, for extra-pulmonary specimens, the sensitivity and specificity of the GeneXpert assay were 37.1 % and 99 %, respectively. In the current study, the GeneXpert assay showed almost perfect agreement with the bacterial culture for TB diagnosis. The diagnostic accuracy of the GeneXpert assay was high in ruling in, but not in ruling out of EPTB

Laparoscopic Management of Adhesions Developed after Peritoneal Nonclosure in Primary Cesarean Section Delivery

Objective. The aim of the current study was to laparoscopically investigate the effects of peritoneal nonclosure on the sites, types, and degrees of adhesions developed after primary caesarean section (CS) in women complaining of secondary infertility after first CS delivery. Study Design. This was a cross-sectional study, where 250 women suffering from secondary infertility after their first CS had been recruited. They had been classified into group I (n = 89), where both the visceral and parietal peritoneum had been left opened; group II (n = 75), where only the parietal peritoneum had been closed; and group III (n = 86), where both peritoneal layers had been closed. Laparoscopy had been used to classify those adhesions according to the location, severity, and their adverse impact on the reproductive capacity. Results. Both adnexal and nonadnexal adhesions had been found significantly higher in group I, while adnexal types of adhesions were significantly higher after nonclosure of the visceral peritoneum in group II. Laparoscopic tubal surgery performed included tubo-ovariolysis, fimbrioplasty, and neosalpingostomy. Pregnancy rate was found correlating with the adnexal adhesion location and score. Conclusion. Nonclosure of the peritoneum in CS is associated with more adhesion formation, which might adversely affect the future women reproduction

Tumor necrosis factor (TNF)-α- 308 G/A gene polymorphism (rs1800629) in Egyptian patients with alopecia areata and vitiligo, a laboratory and in silico analysis.

Purpose & methodsSeveral single-nucleotide polymorphisms (SNPs) in the promoter region of the TNF-α gene can cause variations in the gene regulatory sites and act as risk factors for some autoimmune disorders as alopecia areata (AA) and vitiligo. This study aimed to detect the serum TNF-α (sTNF) level (by ELISA) and the rs1800629 (by real-time PCR) among AA and vitiligo Egyptian patients and to determine their relation with disease duration and severity. In silico analysis of this SNP to study the molecular regulation of the mutant genotypes was also done.ResultsIn AA patients, no risk was associated with the mutant genotypes vs. the normal genotype, or with A allele vs. G allele. The risk of vitiligo was significantly higher with the G/A and A/A genotypes compared with HCs (p = 0.011). Similarly, a significantly increased risk was noted in patients with A allele vs. G allele (pConclusionAccording to results of the laboratory and the in silico study, the mutant TNF-α (308) genotypes were risk factors that conferred susceptibility to vitiligo among Egyptian patients but had no effect on the susceptibility to AA

Antiseptics and mupirocin resistance in clinical, environmental, and colonizing coagulase negative Staphylococcus isolates

Abstract Background Coagulase-Negative Staphylococci (CoNS) are opportunistic and nosocomial pathogens. The excessive use of antimicrobial agents, including antiseptics, represents one of the world’s major public health problems. This study aimed to test the susceptibility of CoNS to antiseptics. Methods Out of 250 specimens collected from different sections of the hospital, 55 samples were identified as CoNS, categorized into three groups based on their sources: environmental samples (n = 32), healthcare worker carriers samples (n = 14), and clinical infection samples (n = 9). Isolates were examined for susceptibility to antibiotics and antiseptics, such as benzalkonium chloride (BC), cetyltrimethylammonium bromide (CTAB), and chlorhexidine digluconate (CHDG). Mupirocin and antiseptic resistance genes, as well as the mecA gene, were detected using polymerase chain reaction. CoNS isolates with notable resistance to antiseptics and antibiotics were identified using the API-Staph system. Results A high frequency of multidrug resistance among CoNS clinical infection isolates was observed. Approximately half of the CoNS isolates from healthcare workers were susceptible to CHDG, but 93% were resistant to BC and CTAB. The frequency of antiseptics and antibiotics resistance genes in CoNS isolates was as follows: qacA/B (51/55; 92.7%), smr (22/55; 40.0%), qacG (1/55; 1.8%), qacH (6/55; 10.9%), qacJ (4/55; 7.3%), mecA (35/55; 63.6%), mupB (10/55; 18.2%), and mupA (7/55; 12.7%). A significant difference in the prevalence of smr gene and qacJ genes between CoNS isolates from healthcare workers and other isolates was reported (P value = 0.032 and ˂0.001, respectively). Four different CoNS species; S. epidermidis, S. chromogene, S. haemolyticus, and S. hominis, were identified by API. Conclusions CoNS isolates colonizing healthcare workers showed a high prevalence of antiseptic resistance genes, while clinical infection samples were more resistant to antibiotics. CHDG demonstrated greater efficacy than BC and CTAB in our hospital