الفهرس 
Introduction & aim of the workOnly 14 pages are availabe for public view
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Abstract
Nosocomial infections (NIs) caused by pseudomona aeruginosa present a widespread problem in today’s healthcare environment with between 4% and 10% of hospitalized patients acquiring an infection annually. Also, NIs have a significant burden to patients, they affect the general health of patients, cause functional disability, emotional stress and may lead to conditions that reduce quality of life.
In addition, the widespread use of antibiotics has fostered the development of resistance in a variety of pathogenic bacteria. Unfortunately, the emergence of bacterial strains that exhibit resistance to a variety of antibiotics (multi-drug resistant strains) are becoming the major causes of treatment failure of infections worldwide.
Our study was carried out in Sohag university hospital in the period between June 2012 and June 2013. 202 samples were collected from different hospital wards to detect MBL producing pseudomonas aureginosa isolated from patients with wound infections from different surgery wards.
Pus samples were taken from infected wounds from different surgical wards,cultured on selective media(cetrimide agar).
60 pseudomonas aeruginosa were isolated from pus samples from infected wounds all were subjected to antibiotic sensitivity testing(disc diffusion method).
According to CLSI 2010 the antibiotics used are:
ceftriaxone, ceftazidime, gentamicin, piperacillin, ciprofloxacin, imipenem, meropenem, cefotaxime, aztreonam,cefepime, pipracillin/tazobactam.Imipenem, Meropenem, Pipracillin, Pipracillin/taz, Aztreonam, Cefotaxime, Ceftriaxone, Ceftazidime, Cefepime, Gentamycin, Ciprofloxacine.
combined disc test was done to detect MBL pseudomonas aeruginosa 6 isolates were positive MBL pseudomonas aeruginosa(phynotypic detection). It was detected by increasing in the zone of inhibition by ≥ 7 mm around the imipenem disc that contains EDTA.
The most important risk factor associated with MBL pseudomonas infection was malignancy the cause may be due to state of immunosuppression, getting care from
multiple health care worker who may be acause in transporting the organism from one person to anotherand moving from one place to another may be acause of transimiting the organism.
PCR was done to all samples to detect gene of resistance VIM2,IMP1.
14 samples were positive for VIM2,no IMP1 could be detected .
Using results of PCR sensitivity, specificity, positive, negative predictive values of CDT were calculated as follow: Sensitivity(28.57%), specificity(95.65%), positive predictive value(66.67%), negative predictive value(81.48%), diagnostic accuracy (80.00%).
Conclusion & Recommendations
This study has illustrated that MBL-producing P. aeruginosa is an important cause of imipenem resistance in P. aeruginosa strains isolated from patients with wound infection in surgery wards in Sohag university hospital. since out of 22 imipenem resistant strains, 6 strains were MBL positive by phenotypic method,14 by pcr. Detection and molecular characterization of MBL-producing P. aeruginosa strains is recommended for the purposes of infection prevention and control and, potentially, for defining the risks of development for severe diseases and adverse outcomes and unsuitable β-lactams antibiotic consumption
Rrecommendations to decrease nosocomial pseudomonas aeruginosa infections and decrease carbapenemase producing strains :
1- Strict implementation of infection control measures particularly hand hygiene practice and reliable cleaning techniques to decrease spread of nosocomial infection.
2- Proper cleaning, disinfection and sterilization of equipments and hospital environment to prevent cross transmission.
3- Active surveillance measures to identify patients colonized with pseudomonas aeruginosa especially carbapenemase producer .
4- Regular surveillance for carbapenemase producer pseudomonas aeruginosa Especially in high risk units e.g burn unit and isolation of infected patients to prevent further transmission.
5- Avoid the use of carbapenem antibiotics as a treatment for pseudomonas aeruginosa infection before doing antibiotic sensitivity to avoid treatment failure and development of resistance due to unnecessary use of this class of antibiotics.
Recommendation for accurate detection of carbapenemase producer pseudomonas aeruginosa:
1- The clinical and laboratory standards institute puplished a recommendation that pseudomonas aeruginosa with elevated carbapenem MICs or reduced disk diffusion inhibition zones be tested phenotipicaly for the production of carbapenemases by means of the CDT.
2- Further study to determine the carbapenemase classes: by berforming carbapenemases activity inhibition ALL strains resistant to imipenem and which were positive in the CDT with EDTA to determine phenotypically the carbapenemase class B.
3- More detailed study is necessary using both phenotypic and genotypic method to have better picture about carbapenemase producer pseudomonas aeruginosa, detection of different types of carbapenemases And to trace the source of the infection.