The 26th

Conference of the Egyptian Society for Medical Microbiology

1

The 26th

Conference of the Egyptian Society for

Medical Microbiology (ESMM)

In Association with Medical Microbiology & Immunology Department

Faculty of Medicine, Cairo University

Superbugs Threat;

The Problem and its Solutions

7th

March, 2020

Mercure Cairo Le Sphinx Hotel

Program &

Abstract Book

Announcement

We have the pleasure to announce that the EJMM had been

published on the Google scholar link.

For Online Submission Use This Website:

www.ejmm-eg.com/e

The 26th

Conference of the Egyptian Society for Medical Microbiology

2

Welcome Message

On behalf of the Egyptian Society for Medical Microbiology (ESMM), we

have the pleasure to welcome you to share the activities of the 26th Annual

ESMM Conference.

The conference theme "Superbugs Threat; the Problem and its Solutions"

was selected to express the real need for updating our knowledge,

understanding and following up the enormous development and the latest

recent advances in treatment of some vital problems we are facing in our

microbiology practice.

Also we have the pleasure to meet several eminent guest speakers who will

focus on recent advances in infection control, and the problem of drug

resistance.

Many of the eminent scientists, both the leading generation and the young

promising researchers, are meeting to communicate and exchange ideas and

thoughts that will surely find the proper approaches for solving medical

problems and to celebrate our traditional annual meeting of almost all

microbiologists and immunologists in our beloved Egypt.

The scientific program covers about 20 topics including plenary lectures and

research oral presentations delivered by distinguished professors, in addition to

poster presentations.

We are looking forward to meeting you in the conference participating in

its activities to make it a successful and fruitful one.

President of ESSM President of the Conference Prof. Samira Shoeb Prof. Nadia Hafez

ESMM Vice President

Prof. Ashraf Wegdan

The 26th

Conference of the Egyptian Society for Medical Microbiology

3

ESMM BOARD

President Prof. Samira Shoeb

Treasurer Prof. Ahmed Ashraf Wegdan

Secretary General Prof. Ahmed Amer Mossaad

Members Prof. Ahmed Omar Shafeik

Prof. Ahmed Sadek

Prof. Ahmed Saeed Osman

Prof. Ayman Allam

Prof. Mohamed Sherif

Prof. Rasha Bassyouni

Head of Scientific Committee

Prof. Dr. Somaia A. Eissa

Scientific Committee

Prof. Dr. Ahmed Omar Shafeik

Prof. Dr. Ashraf Sorour

Prof. Dr. Azz Al-Sharkawy

Prof. Dr. Azza Badr

Prof. Dr. Eman Tolba

Prof. Dr. Enas Deif

Prof. Dr. Ensaf Alazzazy

Prof. Dr. Ismail Sedeik

Prof. Dr. Rawia Badr

Organizing Committee

Ass. Prof. Marwa Salah

Ass. Prof. Noha Gohar

Mr. Maher Mobarak

Mrs. Soad Abou Al Enain

Mrs. Rasha Gamal

The 26th

Conference of the Egyptian Society for Medical Microbiology

4

Program Overview

08:00-09:30 Registration

09:30-09:45 Opening Ceremony

Plenary Session 10:00-12:00

Chairmen: Prof. Said Hamed Al abbadi

Prof. Azza Al Sharkawy

Prof. Ensaf Al-Azzazy

Prof. Somaia Abd El-Latif

09:45-10:00 Prof. Ensaf Al-Azzazy

Rules of Promotion Committee in Session 13

10:00-10:20 Prof. Ahmed Morad Asaad

The Guidelines of the Egyptian Ministry of Health for surveillance

of antimicrobial resistance in hospitals: Are they sufficient in the

current epidemiological situation?

10:20-10:40 Prof. Abeer Ezzat El Sayed

COVID -19 or SARS CoV-2 in China: Prevention & Control 10:40-11:00 Prof. Rasha H. Bassyouni

Could plant oils combat healthcare associated infections? 11:00-11:20 Prof. Rehab El-Sokkary and Rehab M.Tash

Diagnostic stewardship; Who lead the ship!... Microbiologist get

ready

11:20-11:40 Prof. Ayman A Allam

The Human Microbiome: A Revolution in Microbial Community

Analysis and Understanding 11:40:12:00 Prof. Noha Tharwat Abou El-Khier

Measuring Your Impact: Impact Factor, Citation Analysis, and other

Metrics

12:00:12:30 Coffee Break

The 26th

Conference of the Egyptian Society for Medical Microbiology

5

Session I 12:30-02:00

Chairmen:

Prof. Ismail Sedeik

Prof. Mona Abdel Wahab

Prof. Rawia Badr

12:30-12:45 Antibacterial Activity of Some Medicinal Plant Extracts

Against Biofilm and Non-Biofilm Producer klebsiella

pneumoniae

El Degla H.E., Abdel-Fattah G.M., Mohamedin A.H, Gaballah,

H.Y

12:45-01:00 Nursing Knowledge Level, Are There Room For

Improvement In Hepatitis Prevention At Suez Canal Area?

Hesham El-Sayed, Sohair Mehanna, Adel Hassan, Mahmoud

Sheded, Somaya Elsayed Abu Abdou, Hanan Abbas, Samar

Elfiky, Nermine Elmaraghy, Zeinab Khedr

01:00-01:15 Molecular detection and Frequency of Fluoroquinolone-

Resistant Escherichia coli by Multiplex Allele Specific

Polymerase Chain Reaction (MAS-PCR)

Noha Tharwat Abou El-Khier

01:15-01:30 The effect of blocking m-TOR gene in cellular model of

human fetal midbrain neuron (LUHMES) cell line on cellular

autophagy

Amira El-housseiny El-zalouey, Waleed Eldars, Mohamed

Salama, Mahmoud Elhussiny, Aziza Alsayed, Mohamed Sobh,

Mohammed Mahmoud El-naggar

01:30-01:45 Superbugs from Evolution to Revolution Eman Ragab ElShehy

01:45-02:00 Break

The 26th

Conference of the Egyptian Society for Medical Microbiology

6

Session II 02:00-03:00

Chairmen:

Prof. Ahmed Omar Shafeik

Prof. Ahmed Amer Mossaad

Prof. Rasha Bassyouni

02:00-02:15 Hypervirulent Klebsiella pneumoniae as a hospital-acquired

pathogen in the intensive care unit in Mansoura, Egypt

Rasha EL-Mahdy, Ghada El-Kannishy, Hassan Salama

02:15-02:30 Screening for latent TB infection in patients recently diagnosed

with bronchogenic carcinoma

Heba Wagih Abdelwahab, Dalia Abdel Latief, Marwa Omar,

Mohammad Shehta,Fatma M F Akl, Mohamed Farouk Akl, Rasha

Mokhtar ELNagar, Nesrine Saad Farrag, Ahmed Ehab

02:30-02:45 Candida glabrata complex from patients with healthcare-

associated infections in Mansoura University Hospitals, Egypt:

distribution, antifungal susceptibility and effect of fluconazole

and polymyxin B combination

Ghada Mashaly, Raghdaa Shrief

02:45-03:00 Multidrug Resistant Shigella Associated with Class 1 Integrase

and Other Virulence Genes as a cause of Diarrhea in Pediatric

Patients.

Samah Sabry El-Kazzaz, Ghada El-Saeed Mashaly, Mayada S.

Zeid

03:00-04:00 Lunch

04:00 Workshop

The 26th

Conference of the Egyptian Society for Medical Microbiology

7

Poster 1. Effect of Ceftaroline, Vancomycin, Gentamicin, Macrolides, and

Ciprofloxacin against Methicillin-Resistant Staphylococcus aureus

Isolates: An in Vitro Study

Dalia Saad ElFeky, Alaa Reda Awad, Mustafa Ali Elshobaky, Basma Ahmed

Elawady

2. Phenotypic Virulence Traits of Escherichia coli Isolates from Patients

with Orthotopic Ileal Neobladder and Their Correlation with Multidrug

Resistant Phenotype

Ragy Nader Shenouda, Noha Tharwat Abou El-Khier, Medhat A. El-Daker,

Yasser Osman, Rawia Badr

3. Serum CD64 and Ascetic Fluid Calprotectin & MicroRNA-155 as

Potential Biomarkers of Spontaneous Bacterial Peritonitis Yasmin Nabiel, Ghada Barakat, Sally Abed

4. Maternal Serum sEndoglin and Cell-Free Fetal DNA as Probable

Markers of Preeclampsia: a Case Control Study in a Single Health Care

Center, Egypt

Yasmin Nabiel

5. Sonication to improve the yield in culture-negative peri-prosthetic joint

infection

Noha Tharwat Abou El-Khier, Samah Sabry El-Kazzaz, Adham Elgeidi and

Abd El Rhman Elganainy

6. Prevalence and Prognosis of Thrombocytopenia in Blood Culture Proven

Neonatal Sepsis

Iman H. Draz, Reham A Dwedar, Suzan Hagag, Niveen Salama

The 26th

Conference of the Egyptian Society for Medical Microbiology

8

Plenary Session

The 26th

Conference of the Egyptian Society for Medical Microbiology

9

The Guidelines of the Egyptian Ministry of Health for

surveillance of antimicrobial resistance in hospitals: Are

they sufficient in the current epidemiological situation?

Ahmed Morad Asaad Professor of Medical Microbiology and Immunology

ZUMJ Editor-In-Chief, Faculty of Medicine, Zagazig University

For several decades, antimicrobial agents have been regarded as the magic key to cure

infections. However, use of antibiotics has become widespread, and these drugs have been

extensively misused in ways that favour the selection and spread of resistant bacteria. The

scenario is more dramatic as the pipeline for the development of new antibacterial drugs is

now virtually empty. According to WHO reports, it is estimated that 300 million people will

die prematurely because of infections as a result of multidrug-resistant (MDR) organisms

over the next 35 years. Besides, the world can expect to lose 60-100 trillion Dollars in

economic output if antimicrobial drug resistance is not effectively tackled. Despite several

strategies have been designed to control the spread of antimicrobial resistance, no single or

simple strategy will suffice to fully contain the emergence and spread of MDR organisms.

The collection of reliable information about the antimicrobial resistance situation inside

hospitals through well-conducted surveillance system is essential to inform strategies and

prioritize interventions to tackle the problem. Surveillance activities could provide the

necessary information to develop and monitor therapy guidelines, antibiotic formularies,

antibiotic stewardship programs, public health interventions, infection control policies, and

novel antimicrobials and vaccines. According to the Egyptian Ministry of Health and

Population (MHP), the National guide for infection prevention and control has included

useful information and protocols for healthcare-associated infections (HAIs) considering

definitions, standards and protocols for surveillance activities. Besides, The MHP has

efficiently provided healthcare Professionals with useful forms to define different types of

HAIs as well as the form for combining denominators of equations for calculating the

monthly rates of infections. Unfortunately, the National guide has summarized a brief list of

MDR nosocomial pathogen and only one form for antibiotics consumption rates. Meanwhile,

the MHP recommends that hospitals should prepare frequency tables of nosocomial

pathogens with their antibiogram at a monthly rate. Indeed, such tables will never suffice the

increasing need to optimize values for active surveillance activities of AMR in hospitals. This

could be due to several reasons. First, the manual preparation of these tables will be

cumbersome and time-consuming. Second, such tables will never provide us with practical

data which could help infection control staff improve empiric protocols or therapeutic

regimens. Finally, these tables will miss the practical relation of each individual antibiotic

with organism group (Antibiotic/organism group) or specimen type (Antibiotic/ organism/

specimen type). Therefore, the WHO has recently recommended the use of WHONET

program for surveillance activities in hospitals which could support many powerful tools for

data analysis including: Isolate listings, % resistance, % susceptibility, scatter plots and

isolate-alerts for predicting any possible outbreaks. In conclusion, more effective standards,

protocols and practically useful forms are urgently required in the new National Guide for

infection control to promote and enhance the AMR surveillance activities.

The 26th

Conference of the Egyptian Society for Medical Microbiology

10

COVID -19 or SARS CoV-2 in China: Prevention & Control

Prof. Dr. Abeer Ezzat El Sayed Professor of Medical Microbiology & Immunology, Department of Medical

Microbiology & Immunology, Faculty of Medicine, IPC Director, Consultant IPC,

Suez Canal University

Background: Novel coronavirus 2019 or COVID 19 named now SARS CoV-2.

Coronaviruses are enveloped viruses with positive sense single stranded RNA genome

that has protein spikes look like crown. There are seven strains:

1. Human coronavirus 229 E (HcoV-229E)

2. Human coronavirus OC43 (HCOV-OC43)

3. SARS-COV 2002

4. Human coronavirus NL 63( HCOV- NL63)

5. Human coronavirus HKU1

6. Middle East respiratory syndrome coronavirus (MERS-COV), known as novel

coronavirus 2012

7. Novel coronavirus (2019-n COV) also known as Wuhan pneumonia or Wuhan

coronavirus (COVID 19) or SARS COV-2.

It has an animal reservoir as bats and intermediate host animal pangolin then genetic

mutation that lead to transmission to human. The symptoms range from fever, sore

throat, dyspnea, cough, running nose to severe pneumonia, diarrhea, vomiting , septic

shock and death. Prevention of the disease by avoiding travelling to China or any area

with ongoing community transmission of the disease, quarantine to suspected persons

from the airport. Avoid close contact with people suffering from acute respiratory

infections , frequent hand washing with soap and water especially after direct contact

with ill people or their environment. Avoid touching the eyes, nose and mouth by

contaminated hands. In the hospital follow all infection control standards wearing

personal protective equipment as in droplet and contact isolation precautions. Wear

n95 mask to HCWs when performing aerosol generating procedures with suspected

cases as intubation, suction, CPR or taking respiratory speciemens. Treatment based

on supportive therapy, management of the symptoms and combination of antiviral

agents as Oseltamivir, lopinavir, Ritonavir, Favilavir and Remdsivir. Antimalarial

agent as chloroquine also had been used in China. No vaccine is available up till now.

dr.abeer.ezzat@gmail.com

The 26th

Conference of the Egyptian Society for Medical Microbiology

11

Could plant oils combat healthcare associated infections?

Rasha H. Bassyouni Medical Microbiology and Immunology Department,

Faculty of Medicine, Fayoum University

Antibiotic resistance is exponentially rising to a dangerously high level worldwide.

Emerging of new resistance mechanisms threatening the ability to treat common

infectious diseases which becomes harder and sometimes impossible to treat.

Annually in the United State, 2.8 million people are infected with resistant organisms,

with more than 35,000 death as a result. Antibiotic resistance leads to longer hospital

stays, higher costs and increased mortality. Also resistance make the achievements of

modern medicine at risk. Chemotherapy, organ transplantations, and some surgeries

as joint replacements become much more dangerous without effective antibiotics used

for prophylactic and/or treatment of infections. The 1950s to 1970s represented the

golden period of antibiotic discovery, where numerous new classes of antibiotics were

discovered to treat previously incurable diseases. However, since that time the

discovery of new antibiotics has been decreased and almost nonexistent. The

pharmaceutical industry has poor incentive to invest in antibiotics because of the high

risk as well as the potential financial returns are less likely to cover the cost

of development of a new antibiotic than for other pharmaceuticals. In recent years,

much effort has been focused on identifying alternative medicines to treat infections

caused by drug resistant organisms. Health and Human Services as well as Public

Health Services had recognized plant oils as safe substances including compounds

extracted from some essential oils that can be used as antibacterial additives to food.

Previous researches showed that numerous plant oils have variable degrees of

antimicrobial activities against wide ranges of bacteria and fungi. Many advantages

were reported with natural products such as low adverse effects, better patient

tolerance, low cost and wide acceptance due to the traditional applications,

renewability and good biodegradability. This review will highlight the possible role of

plant oils as antimicrobials, antiseptics and disinfectants

rhb00@fayoum.edu.eg

The 26th

Conference of the Egyptian Society for Medical Microbiology

12

Diagnostic stewardship; Who lead the ship!...

Microbiologist get ready

Rehab El-Sokkary and Rehab M.Tash Medical Microbiology and Immunology, Infection Prevention and Control

Consultants, Zagazig University

Background: Recent advances in microbial diagnostics are providing clinicians with

information about microbes causing infections and their resistance to antimicrobial

agents more rapidly than ever before. Diagnostic stewardship refers to the appropriate

use of laboratory testing to guide patient management, including treatment, in order to

optimize clinical outcomes and limit the spread of antimicrobial resistance.

Diagnostic stewardship embraces all stages of the diagnostic process in clinical

microbiology and laboratory management: Pre-analytic (test-related decision making

and specimen collection), analytic (relating to laboratory practices), and post-analytic

(e.g., selective reporting of antimicrobial susceptibility data to encourage the use of

narrower spectrum agents). The success of each stage in this process is dependent

upon the quality and effective use of available resources.

Objectives:

Identify the concept and requirements of diagnostic stewardship

Reveals the difference between diagnostic and antimicrobial stewardship)

Apply diagnostic stewardship strategies.

Disclose the challenges for implementation of diagnostic stewardship

Conclusion: Diagnostic stewardship has emerged to formulate the role of the

microbiologist and microbiology laboratory in clinical practice, with a great emphasis

to get their experience paving the way for the global antimicrobial resistance

prevention.

The 26th

Conference of the Egyptian Society for Medical Microbiology

13

The Human Microbiome: A Revolution in Microbial

Community Analysis and Understanding

Ayman A Allam Department of Microbiology and Immunology,

Faculty of Medicine, Zagazig University

The human microbiome is the full array of microorganisms (the microbiota; bacteria,

archaea, lower and higher eurkaryotes, and viruses) that live on and in humans and the

collection of their genomes that contribute to the broader genetic portrait, or

metagenome, of a human. The Human Microbiome Project (HMP) was launched in

2007 by a United States National Institutes of Health (NIH) research initiative to

improve understanding of the microbial flora involved in human health and disease.

Its first phase (HMP1) focused on identifying and characterizing human microbial

flora. In 2014, its second phase was launched. The second phase was known as the

Integrative Human Microbiome Project (iHMP). The aim of iHMP was to generate

resources to characterize the microbiome and elucidating the roles of microbes in

health and disease states. Scientists use none culture techniques as metagenomics and

whole genome sequencing in the study of human microbiome. Microbe communities

can be very different from one healthy person to another, and they’re even different

from one location to another on the same individual so every human being carry his

own, largely individual, suite of microbial strains, which are acquired early in life,

differs between environments and populations, and can persist for years. The

microbiota are important for human health. An example is the gut michrobiota that

weigh as much as 2–5 pounds (1–2 kg), together, they function as an extra organ in

the body and play a huge role in health. The dynamics and function of the indigenous

microbiota play role in maintaining homeostasis, restoring missing functions or

eliminating harmful functions, may lead to novel methods to prevent or treat a variety

of diseases. Disturbances of the human microbiome is related to development of many

health problems as acne, antibiotic-associated diarrhea, asthma/allergies, autism,

autoimmune diseases, cancer, dental cavities, depression and anxiety, diabetes,

eczema, gastric ulcers, hardening of the arteries, inflammatory bowel diseases, and

obesity

The 26th

Conference of the Egyptian Society for Medical Microbiology

14

Measuring Your Impact: Impact Factor, Citation Analysis,

and other Metrics

Noha Tharwat Abou El-Khier Medical Microbiology & Immunology, Faculty of Medicine,

Mansoura University, Egypt

How does the scientific community measure how "good" or "great" a journal or

an author is? How do you determine the "impact" of an author's work? Should it

be purely based on the number of times the article is cited? If not, how can we

measure the "quality" of the research?

Several methods to calculate the impact of an article, journal, or author have

been developed answer these questions.

These calculations and statistical methods are called metrics. Be aware metrics

are highly debated. The most popular metrics include number of citations

(journal or author), journal impact factor, and author h-index.

The 26th

Conference of the Egyptian Society for Medical Microbiology

15

Session I

The 26th

Conference of the Egyptian Society for Medical Microbiology

16

Antibacterial Activity of Some Medicinal Plant Extracts

against Biofilm and Non-Biofilm Producer klebsiella

pneumoniae

El Degla H.E.2, Abdel-Fattah G.M.

1, Mohamedin A.H

1,

Gaballah H.Y1

1Department of Botany, Faculty of Science, Mansoura University, Egypt

2Department of Medical Microbiology and Immunology, Faculty of Medicine,

Mansoura University, Egypt

Background: The pathogenic success of K.pneumoniae in causing urinary and

respiratory tract infections may be attributed to its ability to form biofilms,

particularly on indwelling medical devices. Objective The main objective of this

study was to study the antibacterial activity of some medicinal plant extracts against

resistant planktonic and biofilm forming K.pneumoniae isolated from patients

admitted to Mansoura University Hospitals. Methodology: Clinical samples

(endotracheal tube and urinary catheter) were collected from patients admitted in

different intensive care units (ICU) of Mansoura University Hospitals. Isolation and

identification of K. pneumonia was performed using standard bacteriological

methods. Antibiotic susceptibilities of K.pneumoniae was tested by the disk diffusion

method against Ciprofloxacin, CIP (5 μg); Cefotaxime, CTX (30 μg); and

Gentamicin, CN (10 μg). K.pneumoniae strains were tested for their ability to form

biofilm by tissue culture plate method (TCP). Ethanolic plant extracts were tested

against biofilm and non-biofilm producer K. pneumoniae isolates by using agar well

diffusion method. Results: Forty K. pneumoniae isolates showed high resistance to

Cefotaxime (87.5%) followed by ciprofloxacin (82%) and Gentamicin (67.5%).

Tissue culture plate method showed strong (65%), moderate (22.5%) and weak /non

biofilm formation (12.5%). The ethanolic extract of Green tea was the most active

one with inhibition zones diameter ranged between 7mm-18mm and Clove caused

inhibition zones diameter ranged between 9mm-16mm, followed by Cinnamon and

without any effect of Garlic. Conclusion: High rate of antibiotic-resistance among

clinical K. pneumoniae isolates was detected and this necessitates monitoring the

microbial trends and resistance patterns. Plants may be used as natural antibiotics in

the treatments of antibiotic resistant K. pneumoniae infections.

heba_degla@yahoo.com

The 26th

Conference of the Egyptian Society for Medical Microbiology

17

Nursing Knowledge Level, Are There Room for

Improvement In Hepatitis Prevention At Suez Canal Area?

Hesham El-Sayed1, Sohair Mehanna

2, Adel Hassan

3,

Mahmoud Sheded4, Somaya Elsayed Abu Abdou

5, Hanan Abbas

6,

Samar Elfiky1, Nermine Elmaraghy

7 and Zeinab Khedr

2

1Department of Pediatrics, Faculty of Medicine Suez Canal University; Ismailia,

Egypt; 2Social Research Center, American University, Cairo, Egypt;

3Department of

Infectious and Endemic Diseases, Faculty of Medicine, Suez Canal University,

Ismailia, Egypt; 4Department of Infectious and Endemic Diseases, Faculty of

Medicine, Suez University, Suez, Egypt; 5Faculty of Nursing, Suez Canal

University, Ismailia, Egypt; 6Department of Family Medicine, Faculty of Medicine,

Suez Canal University, Ismailia, Egypt; 7Department of Medical Microbiology and

Immunology, Faculty of Medicine, Suez Canal University, Ismailia, Egypt

Background: Healthcare workers are at increased risk of contracting and spreading

hepatitis C virus (HCV) , and HBV to others. Objective: The aim of study is to

evaluate nursing staff and paramedics knowledge, concerning HCV, HBV and its

relationship to institutional infection control facilities, Methodology: A self-

administered questionnaire was distributed at fever hospital, infectious diseases

hospital, Suez canal university hospital, blood center, primary health care centers and

hospitals affiliated to ministry of health, with a convenient sample of 479 nursing

staff and paramedics in Suez canal region. A knowledge score was developed about

hepatitis B,C source of infections and different domains of infection control facilities

and procedures, with a maximum of 17. Results: The mean age of the participating

nursing staff and paramedics was 29.55± 8. 31. Knowledge score about mode of

transmission of hepatitis, reveals that the highest level was the student nurse which

was 17.07. Correct knowledge about mode of transmission of hepatitis the highly

mentioned item was used syringes 91.6 %. Concerning exposure including blood

contact, blood spoilage and needle stick, the nurse was 61 %, while mainly head nurse

to be 83% stated receiving training about infection control and care of sharp.

Conclusion: The infection transmission at occupational level can be prevented by

following standard precautions.

The 26th

Conference of the Egyptian Society for Medical Microbiology

18

Molecular detection and Frequency of Fluoroquinolone-

Resistant Escherichia coli by Multiplex Allele Specific

Polymerase Chain Reaction (MAS-PCR)

Noha Tharwat Abou El-Khier Medical Microbiology & Immunology, Faculty of Medicine, Mansoura University,

Egypt

Background: An increasing number of fluoroquinolone-resistant E. coli has been

observed recently. Objective: to detect the frequency of fluoroquinolone-resistant E.

coli clinical isolates from hospital acquired infections (HAI) compared to community

acquired infection (CAI) by multiplex allele specific polymerase chain reaction

(MAS-PCR) for gyrA (at Ser-83 and Asp-87) and parC (at Ser-80 and Glu-84)

mutations. Methodology: Two hundred non duplicate isolates of E. coli (100 from

HAIs, 100 from CAIs) were collected. Antibiotics susceptibility was performed by

MIC for ciprofloxacin. Mutations at gyrA and parC were determined by MAS-PCR.

Results: MICs of ciprofloxacin had significantly higher resistance pattern ≥ 4 μg/ml

in E. coli isolated from HAIs (40%) compared to CAIs (28%) and intermediate levels

of resistance in HAIs compared to CAIs (17% & 11%). The most frequent mutations

were in gyrA83 (29.5%), followed by gyrA87 (20.5%). ParC mutations were less

common with parC80 (17.5%) and parC84 (5%). Conclusion: The present study

highlights the rise of resistance to fluoroquinolones amongst clinical isolates of E. coli

that was significantly greater amongst isolates from HAIs than those isolates from

CAIs. The mutations of resistant E. coli strains were more frequent in gyrA gene than

parC gene. The study indicates the prominence of adherence to infection control

guidelines and antibiotics policy.

The 26th

Conference of the Egyptian Society for Medical Microbiology

19

The effect of blocking m-TOR gene in cellular model of

human fetal midbrain neuron (LUHMES) cell line on

cellular autophagy

Amira El-housseiny El-zalouey1, Waleed Eldars

1,

Mohamed Salama2,3

& Mahmoud Elhussiny3, Aziza Alsayed

3,

Mohamed Sobh4 & Mohammed Mahmoud El-naggar

1

Departments of 1Medical Microbiology and Immunology,

2Toxicology, Manoura

University, Mansoura, Egypt. 3Medical Experimental Research Center (MERC),

Faculty of Medicine, Mansoura University, El-Gomhourya Street, Mansoura 36551,

Egypt. 4Urology and Nephrology center, Mansoura University, Mansoura, Egypt

Background: autophagy, a method for maintaining cellular homeostasis, is

considered as a survival pathway as it allows recycling of cellular components during

starvation, and in response to hypoxia, endoplasmic reticulum stress, and many other

stresses. This process is regulated mainly via mTOR pathway. Autophagic

dysfunction was directly linked to a large number of neurodegenerative disorders.

Therefore, autophagy is believed to be crucial for neuronal homeostasis. Objective:

In this study we evaluate the effect of blocking of mTOR with siRNA sequence on

both autophagy and apoptosis on tauopathy cellular model (LUHMES cell line).

Methodology: Our study was done in the Medical Experimental Research Center

(MERC) of Mansoura University. Lund human mesencephalic (LUHMES) cell line

was cultured, intoxicated by addition of a complex I inhibitor (Fenazaquin) to induce

tauopathy, and then treated using siRNA mTOR. Then autophagy was evaluated by

both LC3 expression via immunocytochemistry and ATG-7 expression via flow

cytometry. Finally, apoptosis was detected by Annexin V kit. Results: post silencing

of mTOR resulted in inhibition of autophagy pathways presented by decrease of LC3

reaction and reduction of ATG7 positive cells by 42.6%. Surprisingly, the effect of

silencing lead to a decrease in the percentage of apoptotic cells by 25.8%.

Conclusion: mTOR silencing in LUHMES cell line leads to reduction of both

autophagy and apoptosis.

The 26th

Conference of the Egyptian Society for Medical Microbiology

20

Superbugs from Evolution to Revolution

Dr. Eman Ragab ElShehy MD Medical Microbiology and Immunology

Consultant of Medical Microbiology, Alexandria Fever Hospital

Superbugs are microorganisms that have become resistant to antimicrobial drugs

typically used to treat the infections they cause. Antibiotics have transformed the

practice of medicine, but the miracle seems to come to an end as bacterial populations

quickly modified themselves to: resist antimicrobials, propagate these resistances to

their progeny and share resistance genes with other bacteria within their environment.

Antimicrobial resistance (AMR) are estimated to cause 700,000 deaths every year,

this number is likely to be an underestimate due to poor reporting and surveillance.

World Health Organization (WHO) developed a global action plan to combat

antimicrobial resistance. In line with the global initiative to fight antimicrobial

resistance, the WHO Egypt country office is supporting the government of Egypt

in drafting an antimicrobial resistance national action plan.

eman_elshehy@yahoo.com

The 26th

Conference of the Egyptian Society for Medical Microbiology

21

Session II

The 26th

Conference of the Egyptian Society for Medical Microbiology

22

Hypervirulent Klebsiella pneumoniae as a hospital-acquired

pathogen in the intensive care unit in Mansoura, Egypt

Rasha EL-Mahdy1, Ghada El-Kannishy

2, Hassan Salama

3

1MD, Department of Medical Microbiology and Immunology, Faculty of Medicine,

Mansoura University, Mansoura, 35516, Egypt, 2MD, Department of Internal

Medicine, Faculty of Medicine, Mansoura University, Mansoura, 35516, Egypt, 3MD,

Department of Neurology, Faculty of Medicine Mansoura University, Mansoura,

35516, Egypt

Background: Hypervirulent Klebsiella pneumoniae (hvKP) are variants of K.

pneumoniae that come up worldwide. hvKP is known in community-acquired

infections but little is known about its role in hospital-acquired (HA) infections. The

aim of this study was to evaluate the frequency of hvKP among HA K. pneumoniae

infections in the intensive care unit (ICU) and to compare virulence and antibiotic

susceptibility between hvKP and classical K. pneumoniae (cKP). Methodology:

String test, biofilm formation, serum bactericidal assay, capsular polysaccharide

genes (K1, K2, K5, K20, K54, K57), virulence genes: rmpA, rmpA2, iucA, iroB and

antimicrobial susceptibility were assessed in HA K. pneumoniae strains isolated from

the ICU in Mansoura, Egypt. Results: Probable hvKP represented 4 out of 65 (6.2%)

K. pneumoniae. K1 and K2 genes were present in 2 and 1 isolate respectively in

probable hvKP. rmpA genes were significantly associated with hvKP; at the same

time biofilm production and serum resistance were not significantly associated with

the hypervirulent group. There was no significant difference between hvKP and cKP

strains in terms of resistance pattern. Conclusion: hvKP in critically ill patients from

the ICU may form a new threat especially in the presence of antibiotic resistance.

Although the validity of the string test in detecting metastatic Klebsiella is

questionable, it is a simple and easy test that can be done in any laboratory indicating

the presence of this organism. Serotypes and genomic background may provide

helpful and confirmatory tools to diagnose hvKP.

rhehassan@gmail.com

The 26th

Conference of the Egyptian Society for Medical Microbiology

23

Screening for latent TB infection in patients recently

diagnosed with bronchogenic carcinoma

HebaWagihAbdelwahab 1 *

, Dalia Abdel Latief 1, Marwa Omar

1,

Mohammad Shehta 1,Fatma M FAkl

2, Mohamed FaroukAkl

2,

Rasha Mokhtar ELNagar4, Nesrine Saad Farrag

3, Ahmed Ehab

1,5

1Chest medicine Department, Mansoura University, Egypt;

2Clinical Oncology &

Nuclear Medicine Department, Mansoura University, Egypt.; 3Community Medicine

Department, Mansoura University, Egypt.; 4Medical Microbiology and Immunology

Department, Faculty of Medicine, Mansoura University, Egypt.; 5Loewenstein Lung

Center, Germany

Background: Cancer and pulmonary tuberculosis (TB) are major global health

concerns. The association between active TB and subsequent cancer development has

been investigated, however, the relation between latent TB infection (LTBI) and

subsequent cancerdevelopment remains unclear. Aim of the Study: This study plans

to estimate the prevalence of latent TB infection in patients with recently diagnosed

bronchogenic carcinoma and to determine predictors of LTBI in lung cancer patients.

Methodology: Newly diagnosed primary lung cancer patients were enrolled.

QuantiFERON-TB Gold In-Tube (QFT-GIT) assay was used for diagnosing of LTBI

in the enrolled patients. Active pulmonary and extrapulmonary TB were excluded.

Results: A total number of 64 newly diagnosed primary bronchogenic carcinoma

patients were included in the study. The mean age was 63 Y (10.6), 38 (59.4%) of the

patients were males. Most of the included patients had positive smoking

history(either current smoker: 19 (33.3%), passive smoker 2 (3.5%) and ex-smoker

was 17 (29.8%)).Non-smoker patients were 19 (33.3%).As regard the underlying lung

diseases, COPD was reported in 6 (9.4%), BA in 2 (3.1%) and interstitial lung disease

(ILD) was reported in one patient (1.6%).The right lower lobe was the most common

site of primary tumor in 23patients (35,9 %). Bronchoscopic intervention wasthe

method of diagnosis in nearly half of patients 19 (51.4%). The most common

histopathology was adenocarcinoma in21 (47.7%) patients. The prevalence of latent

TB among the patients was 16 (25%) of patients. Conclusion: There is a considerable

risk of coincidence of latent TB in newly diagnosed primary bronchogenic

carcinoma. The need of treatment of latent TB in those patients and its influence on

the outcome and prognosis are points of further investigations.

Wagihheba84@gmail.com

The 26th

Conference of the Egyptian Society for Medical Microbiology

24

Candida glabrata complex from patients with healthcare-

associated infections in Mansoura University Hospitals,

Egypt: distribution, antifungal susceptibility and effect of

fluconazole and polymyxin B combination

Ghada Mashaly, Raghdaa Shrief,* Department of Medical Microbiology & Immunology,

Mansoura Faculty of Medicine

Introduction: Candida glabrata complex is composed of three cryptic species,

Candida glabrata sensu stricto, C. bracarensis and C. nivariensis. Its reduced

susceptibility to fluconazole is responsible for treatment failure of its infections.

Combination therapy is recommended to treat these resistant strains. This study

assessed the distribution of C. glabrata complex collected from patients in Mansoura

University Hospitals and their antifungal susceptibility, with evaluation of

fluconazole and polymyxin B combination against them. Methodology: C. glabrata

complex was collected from patients with healthcare-associated infections. The

isolates were identified biochemically then the species were detected using multiplex

PCR. The susceptibility of isolates to antifungals and polymyxin B was tested by the

microdilution assay. The effect of fluconazole and polymyxin B combination was

assessed by checkerboard microdilution and time kill assays. Results: This study

included 45 isolates of Candida glabrata complex. The common isolate was Candida

glabrata sensu stricto (38 isolates). There were 4 isolates of C. bracarensis and three

isolates of C. nivariensis. All isolates were susceptible to amphotericin B, and 17.8%

were susceptible to itraconazole. Regarding fluconazole, 48.9% of isolates were

susceptible dose-dependent and 51.1% were resistant. Synergistic effect of the

combination was observed in 68.9% of isolates by the checkerboard method and in

66.7% of isolates using the time kill assay. Conclusions: Candida glabrata sensu

stricto is the main member of the complex. Combination of fluconazole and

polymyxin B can be considered a treatment option for fluconazole resistant C.

glabrata complex infections. In vivo studies are needed to validate these results.

r.shrief77@gmail.com

The 26th

Conference of the Egyptian Society for Medical Microbiology

25

Multidrug Resistant Shigella Associated with Class 1

Integrase and Other Virulence Genes as a cause of Diarrhea

in Pediatric Patients

Samah Sabry El-Kazzaz1, Ghada El-Saeed Mashaly

1 and

Mayada S. Zeid2

1Medical Microbiology and Immunology Department, Faculty of Medicine,

Mansoura University, Mansoura, Egypt, 2Pediatrics Department, Faculty of Medicine,

Mansoura University, Mansoura, Egypt

Background: Shigella is one of the most serious pathogens associated with bloody

diarrhea in children. The empiric antibiotic therapy of enteric illness with blood

streaked stool leads to emergence of multi drug resistant (MDR) Shigella. The

condition gets exacerbated by presence of integrons that facilitate the horizontal

spread. Virulence genes associated with MDR Shigella modulate the patient outcome

particularly in children. Objectives: The present study was aiming at isolation of

MDR Shigella from children with diarrheal sickness and characterization of those

isolates as regarding presence of class 1 integrase and other virulence genes.

Methods: Four hundred and ninety patients under the age of five suffering from

diarrheal illness were examined for presence of Shigella in their stool specimens.

MDR Shigella was determined using the antibiotic susceptibility testing by disc

diffusion method, those isolates were tested for presence of class 1 integrase by PCR.

Multiplex PCR assay was used to determine the presence of virulence genes, virA,

ial, sen, set1A, set1B, sat, ipaBCD, ipaH and stx in the MDR Shigella isolates.

Results: The isolation rate of Shigella from pediatric patients was 5.3%. Most of the

isolated Shigella (57.7%) were from infants between 12 and 23 month. 73.1% of the

identified Shigella were MDR. intI1 gene was present in 78.9% of MDR isolates.

Muliplex PCR revealed that ipaH and ipaBCD, virA, sat, ial, set1A and set1B, sen

were detected in 94.7%, 78.9%, 73.7%, 68.4%, 42.1%, 36.8% of the MDR Shigella

isolates respectively. Conclusion: The MDR isolates represented a considerable

percentage of Shigella detected in pediatric patients. Presence of intI1 gene in most of

MDR Shigella reflects the higher possibility of resistant strains spread. Existence of a

variety of virulence genes in those isolates is an important indicator of serious disease

outcome.

The 26th

Conference of the Egyptian Society for Medical Microbiology

26

Posters

The 26th

Conference of the Egyptian Society for Medical Microbiology

27

[1] Effect of Ceftaroline, Vancomycin, Gentamicin, Macrolides,

and Ciprofloxacin against Methicillin-Resistant

Staphylococcus aureus Isolates: An in Vitro Study

Dalia Saad ElFeky,1,2

Alaa Reda Awad,1 Mustafa Ali Elshobaky,

3 and

Basma Ahmed Elawady1

1Department of Medical Microbiology and Immunology, Faculty of Medicine, Cairo

University, Cairo, Egypt. 2Department of Basic Medical Sciences, College of

Medicine, Princess Nourah Bint AbdulRahman University, Riyadh, Saudi Arabia. 3Department of Biochemistry, Faculty of Pharmacy, Ahram Canadian University,

Cairo, Egypt

Background: Methicillin-resistant Staphylococcus aureus (MRSA) infection remains

a challenging threat because of limited treatment options. Ceftaroline was identified

as having potent anti-MRSA activity. Objective: To evaluate the susceptibility of

MRSA to gentamicin, macrolides, ciprofloxacin, vancomycin, and ceftaroline and to

perform molecular characterization of different resistance genes as aminoglycoside

modifying enzyme genes, ermA and ermC, and vanA and vanB genes. Methodology:

One hundred non-duplicate MRSA strains were isolated from different samples of

hospitalized patients in Cairo University teaching hospitals from November 2015 to

August 2016. Determination of antibiotic susceptibility was done using disk diffusion

test and minimum inhibitory concentration followed by detection of resistance genes

by multiplex polymerase chain reaction (PCR). Results: Of 100 MRSA isolates, 63

(63%) were resistant to gentamicin, erythromycin, clindamycin, and ciprofloxacin,

however, all were sensitive to ceftaroline. Fifteen isolates (15%) were vancomycin

intermediate resistant and were sensitive to ceftaroline as well. Conclusion:

Ceftaroline was potent against MRSA, which was found to be non-susceptible to

vancomycin, ciprofloxacin, erythromycin, clindamycin, and gentamicin and it may

represent a successful treatment for MRSA infections.

The 26th

Conference of the Egyptian Society for Medical Microbiology

28

[2] Phenotypic Virulence Traits of Escherichia coli Isolates

from Patients with Orthotopic Ileal Neobladder and Their

Correlation with Multidrug Resistant Phenotype

Ragy Nader Shenouda *, Noha Tharwat Abou El-Khier *,

Medhat A. El-Daker *, Yasser Osman **, Rawia Badr * *Medical Microbiology and Immunology Department, Faculty of Medicine, Mansoura

University, Egypt; ** Urology and Nephrology Center, Mansoura University, Egypt

Background & objectives: Phenotypic virulence traits and their correlation to antibiotic resistance pattern have been widely studied among uropathogenic E. coli (UPEC), and to a lesser extent among commensal fecal strains, but yet to be investigated in E. coli isolates from ileal neobladder. We aimed to characterize ileal neobladder E. coli strains as regard virulence phenotype and its correlation with antibiotic resistance. Methodology: 35 E. coli isolates from monobacterial urine cultures collected from 35 patients who underwent ileal orthotopic bladder reconstruction were compared to 35 uropathogenic E. coli (UPEC) isolates from 35 patients with native bladder complaining from urinary tract infections (UTIs) and 30 fecal E. coli isolates from apparently healthy adults. The isolates from these three groups were compared as regard the antibiotic resistance pattern and the prevalence of phenotypic virulence determinants (α-hemolysin production, biofilm formation and hemagglutination pattern). Results: Antibiotic resistance among the neobladder isolates occurred at a nearly similar rate as in the bladder isolates with the highest resistence occurred to amoxicillin/clavulanate (88.6% Vs 65.7%), followed cefotaxime (74.3% Vs 23 65.7%) and ceftriaxone (71.4% Vs 60%), while the least resistance occurred to amikacin 0% in each group, followed by meropenem 5.7% in each group, gentamicin (11.4% Vs 22.9%), pipracillin/tazobactam (14.3% Vs 22.95), and nitrofurantoin (22.9%) in each group. Only resistance to amoxicillin/clavulanate was significantly (p < 0.05) more common neobladder than in bladder isolates. On the other hand, a significant difference (p < 0.05) was noticed while comparing the neobladder isolates to the fecal isolates as regard resistance to amoxicillin/clavulanate (88.6% Vs 53.3%), cefotaxime (74.3% Vs 23.3%), ceftriaxone (71.4% Vs 16.7%), Trimethoprim/sulfamethoxazole (65.7% Vs 23.3%), norfloxacin (62.9% Vs 3.3%), levofloxacin (65.7% Vs 0%), cefipeme (51.4% Vs 10.0%), aztereonam (54.3% Vs 10.0%), and nitrofurantoin (22.9% Vs 3.3%), respectively. Multidrug resistance (MDR) was detected in 28 neobladder isolates (80%), 21 bladder isolates (60%), and 6 fecal isolates (20%), with statistically significant difference (p < 0.05) when comparing neobladder to fecal isolates. Among the 28 MDR neobladder isolates, 12 isolates (42.9%) were biofilm producers, 7 isolates (25%) were MSHA, 5 isolates (17.9%) were MRHA, and 3 isolates (10.7%) were α-hemolysin producers. Out of the 21 MDR bladder isolates, 9 isolates (42.9%) were also biofilm producers, 5 isolates (23.8%) were MRHA, 2 isolates (9.5%) were MSHA, and 2 isolates (9.5%) were α-hemolysin producers. From the 6 MDR fecal isolates, only one isolate (16.7%) was MSHA, while none of the 6 MDR fecal isolates was biofilm producer nor α-hemolysin producer. There was no significant relationship (p > 0.05) between MDR and any of the different phenotypic virulence markers among the studied E. coli isolates. Conclusion: MDR phenotype is evident among Neobladder E. coli isolates with least resistance was to amikacin, followed by meropenem, gentamicin, pipracillin/ tazobactam, and nitrofurantoin. These isolates are capable of production of multiple virulence factors such as α- hemolysin, biofilm, and fimbriae in a manner that is intermediary between UPEC and commensal fecal isolates, although it was more similar to UPEC. MDR phenotybe was found to be not significantly associated with any of the studied virulence traits.

The 26th

Conference of the Egyptian Society for Medical Microbiology

29

[3] Serum CD64 and Ascetic Fluid Calprotectin &

MicroRNA-155 as Potential Biomarkers of Spontaneous

Bacterial Peritonitis

Yasmin Nabiel, Ghada Barakat, Sally Abed Associate Professor of Medical Microbiology and Immunology,

Faculty of Medicine, Mansoura University

Background: Patients with ascites are at higher risk for development of on top

bacterial infections with subsequent life threatening complications. Objectives: We

aimed to evaluate CD64, calprotectin and miR-155 levels as diagnostic markers of

SBP and the effect of using more than one marker in dual over their diagnostic

efficiency. Methodology: An observational comparative study included 103 patients

with ascites admitted to Tropical Medicine Department, Mansoura University

Hospitals, Egypt divided into two groups; cases group (64 patients) having ascites

with SBP and control group (39 patients) with decompensated cirrhotic non-SBP

ascites. 20 milliliters ascetic fluid was obtained from all participants for bacterial

culture, assessing of calprotectin and miR-155, besides two ml blood for CD64

marker expression assay by flowcytometer. Results: Sensitivity and specificity of

CD64 expression assay were 95.3% & 92.3% respectively, AUC=0.93, whereas those

of ascetic fluid calprotectin and miR-155 were 87.5% and 82.1%, AUC=0.90 &

95.3% and 97.4% with AUC of 0.95. Combined blood CD64 and ascetic fluid

calprotectin had diagnostic accuracy of 0.988, for blood CD64 and ascetic fluid miR-

155, AUC=0.991, ascetic fluid calprotectin and miR-155 was 0.988. On using the

three studied markers collectively, the diagnostic accuracy was the best recorded, it

was 0.994. P values were <0.001*. Conclusions: CD64, calprotectin and miR-155

were good diagnostic markers of SBP and on using a combination of them; they

became more efficient in diagnosis.

The 26th

Conference of the Egyptian Society for Medical Microbiology

30

[4] Maternal Serum sEndoglin and Cell-Free Fetal DNA

as Probable Markers of Preeclampsia: a Case Control

Study in a Single Health Care Center, Egypt

Yasmin Nabiel Associate Professor of Medical Microbiology and Immunology,

Faculty of Medicine, Mansoura University

Objective: This study was conducted to compare the levels of maternal serum sEng

and cffDNA in pregnant females with PE to normotensive pregnant ones, together

with correlating these levels to PE severity and onset. Methodology: It was a

comparative case control study in Mansoura University Hospital, Egypt to detect the

levels of serum sEng by ELISA besides the levels of cffDNA by qRT PCR in 80

pregnant females suffering from PE in addition to 80 normotensive pregnant ones

with matching age and body mass index that were included as control.

Results: Levels of serum sEng and cffDNA were higher in PE cases than control (P

value <0.0001 both٭) and significantly correlates with the severity of the

disease. Levels were also higher in early than late onset PE (P value <0.003٭ and

respectively). Sensitivities and specificities of serum sEng and cffDNA were ٭0.002>

97.5% and 82.5% & 88.0% and 100% respectively. Conclusion: Maternal serum

sEng and cffDNA can be good markers for prediction and early diagnosis of PE in

Egyptian patients. They positively correlate with the disease severity.

The 26th

Conference of the Egyptian Society for Medical Microbiology

31

[5] Sonication to improve the yield in culture-negative peri-

prosthetic joint infection

Noha Tharwat Abou El-Khiera, Samah Sabry El-Kazzaz

a,

Adham Elgeidib and Abd El Rhman Elganainy

b

aMedical Microbiology & Immunology Department, Faculty of Medicine, Mansoura

University, Al Mansurah, Egypt, bOrthopaedics and Traumatology Department,

Faculty of Medicine, Mansoura University, Al Mansurah, Egypt.

Peri-prosthetic joint infection (PJI) is a catastrophic complication, after joint

arthroplasty. Culture-negative PJI presented 7–39% of PJI cases at most health-care

centers.We aimed to investigate the diagnostic accuracy of sonication fluid culture

(SFC) with the respective peri-prosthetic tissue cultures (PTC). Also, to evaluate the

efficacy of sonication in PTC-negative PJI. Peri-prosthetic tissue specimens were

subjected tomicrobiological culture and histo-pathological examination. Retrieved

prosthesis components were sonicated. SFC was examined. One hundred and seventy

patients had PJI and 95 were aseptic failures. SFC was positive in 120 patients

(70.5%). For PTC, 80 of 170 samples (47.1%) were positive; all reveal the same

bacterial species with the corresponding SFC. In 50 patients, both PTC and SFC

cultures of the prosthesis were negative. There were 40 negative PTC samples proved

to be positive by SFC, 39 displayed Staphylococcus epidermidis, and only one

sample yielded Propionibacterium acne. Biofilm formation was detected in 22

(56.4%) out of the 39 S. epidermidis isolates. The overall sensitivity of SFC

compared to PTC was (70.6% versus 47.1%). SFC represents a sensitive, accurate,

easy diagnostic strategy representing increased sensitivity contrasted with PTC. S.

epidermidis, although an important commensal, is considered the most significant

pathogen in the context of PJI.

The 26th

Conference of the Egyptian Society for Medical Microbiology

32

[6] Prevalence and Prognosis of Thrombocytopenia in Blood

Culture Proven Neonatal Sepsis

1Iman H. Draz,

2Reham A Dwedar*,

3Suzan Hagag,

4Niveen Salama

1Assistant Professor of Pediatrics, Faculty of Medicine, Cairo University

2Assistant Professor of Medical Microbiology & Immunology, Faculty of Medicine,

Cairo University; 3Lecturer of Public Health and Community Medicine, Faculty of

Medicine, Cairo University; 4Assistant professor of Pediatrics, Faculty of Medicine,

Cairo University

Background: Neonatal sepsis is a major health problem. Thrombocytopenia in

neonates is a serious disorder affecting 1%-5% of neonates at birth and up to 50% of

the neonates receiving intensive care. Neonates with this disease are at risk for

hemorrhage, particularly intraventricular hemorrhage, negative neurodevelopmental

outcomes and increased mortality. One of the chief reasons of neonatal

thrombocytopenia is sepsis. Objectives: We aimed to explore the different grades of

severity thrombocytopenia and their relationship with diverse types of organisms in

blood cultures from neonatal sepsis patients highlighting their prognostic role.

Methodology: This is a retrospective study of one year duration including data of

culture proven neonatal sepsis patients admitted at the neonatal intensive care unit

(NICU), in Cairo University Pediatric Hospital. Results: We studied 314 neonates

diagnosed with sepsis grounded on clinical signs and/or microbiological laboratory

results. 171 had positive blood culture; 124 of them were Gram negative bacteria

(72.5%) and 47 were gram positive ones (24.4%). Klebsiella spp. was the most

repeatedly encountered organism among all positive blood cultures (n=74) (43.3%)

and coagulase negative staphylococci was the most frequently isolated Gram positive

bacteria (n=22) (12.9%). A total of 134 patients had thrombocytopenia; its degree of

severity was ranging from mild, moderate, to severe in 101, 25, and 8 neonates,

respectively. We found no association between the severity of thrombocytopenia and

the type of organism in blood culture; however, thrombocytopenia was significantly

higher among neonates with Gram negative blood cultures (p 0.001). Poor outcome

has a statistically remarkable correlation with gestational age and reduced platelet

count (p value <0.001). There is a 2.131 increased probability of developing

thrombocytopenia in patients with neonatal sepsis. Conclusion: The percentage of

thrombocytopenia reported in the blood culture proven sepsis episodes highlights the

extent of the problem. The present study found a greater percentage of

thrombocytopenia among neonates with Gram negative sepsis compared to those with

Gram positive sepsis. Sepsis with Klebsiella spp. needs superior consideration

regarding platelet monitoring.

rehamdwedar@gmail.com