Background: Candidemia is a widespread threat that can lead to significant complications in healthcare settings. Objectives: Our study aimed to identify isolates of Candida isolated from blood culture bottles of patients with candidemia and assess their antifungal susceptibility profiles. Methods: We conducted a cross-sectional study at Cairo University tertiary care hospitals over 16 months including 90 patients. Candida isolates were collected from blood culture bottles, and identified using MALDI-TOF MS technology of VITEK MS PRIME (bioMérieux) with the corresponding database VITEK IVD Database 3.2. followed by antifungal susceptibility testing using VITEK 2 Compact system. Results: Candida albicans was the most common species isolated from both pediatric and adult patients with percentages of 47.3% and 36.4% respectively, followed by Candida parapsilosis with percentages of 32.6% and 25.0% respectively. Voriconazole showed the highest antifungal activity at 90.9% of isolates in adults and 95.7% in pediatrics, followed by caspofungin and micafungin. The mean hospital stays for adults ranged from 8 to 30 days and from 10 to 42 days in the pediatric group. Conclusions: C. albicans remains the predominant species isolated from both pediatric and adult candidemia patients, despite a notable increase in other species. C. tropicalis and C. parapsilosis are considered the most common non-albicans Candida (NAC) species. The rise in Candida species other than albicans highlights the urgent need for effective antifungal stewardship programs. Voriconazole exhibited the higher antifungal activity followed by caspofungin and micafungin.

A dangerous infection contracted in hospitals, ventilator-associated pneumonia is frequently caused by bacteria that are resistant to several drugs. It is one of the main reasons why patients in intensive care units become ill or die. This research aimed to determine the most effective empirical therapy of antibiotics for better ventilator-associated pneumonia control and to improve patient outcomes by using the minimal inhibitory concentration method and the Ameri–Ziaei double antibiotic synergism test and by observing the clinical responses to both single and combination therapies. Patients between the ages of one month and twelve who had been diagnosed with ventilator-associated pneumonia and had been on mechanical ventilation for more than 48 h were included in the study, which was carried out in the Pediatric Intensive Care Unit at Cairo University’s Hospital. When ventilator-associated pneumonia is suspected, it is critical to start appropriate antibiotic therapy as soon as possible. This is especially important in cases where multidrug-resistant Gram-negative infections may develop. Although using Polymyxins alone or in combination is effective, it is important to closely monitor their administration to prevent resistance from increasing. The combination therapy that showed the greatest improvement was a mix of aminoglycosides, quinolones, and β-lactams. A combination of aminoglycosides and dual β-lactams came next. Although the optimal duration of antibiotic treatment for ventilator-associated pneumonia is still unknown, treatments longer than seven days are usually required to eradicate MDR P. aeruginosa or A. baumannii completely.

Background: Acinetobacter baumannii (A. baumannii) is a life-threatening and challenging pathogen. In addition, it accounts for numerous serious infections, particularly among immunocompromised patients. Resistance to nearly all clinically used antibiotics and their ability to spread this resistance is one of the most important concerns related to this bacterium. Objectives: This study describes different molecular mechanisms of two multidrug-resistant A. baumannii isolates obtained from endotracheal aspirates collected from the neonatal intensive care unit (NICU), Ain Shams University Hospital, Egypt. Methods: Following the identification of two isolates, they were examined for susceptibility to antimicrobial agents. This was followed by multilocus sequence typing as well as whole-genome sequence (WGS). Additionally, a Pathosystems Resources Integration Center (PATRIC) analysis was performed. Results: Two isolates, Ab119 and Ab123, exhibited resistance to all tested antibiotics except for tigecycline and colistin. The WGS analysis of antimicrobial resistance genes (AMR) indicated that both isolates shared beta-lactam, aminoglycoside, macrolides, and sulfonamide resistance genes. Furthermore, each strain revealed different resistance genes such as blaNDM-1, blaNDM-10, OXA-64, aph (3')-VI, Tet-B in Ab119 strain and blaOXA-68, blaPER-1, blaPER-7, Tet-39 in Ab123 strain. Multiple efflux pump genes were detected. Multilocus sequence typing indicated that both isolates belong to the same sequence type (ST931), which belongs to international clone (IC3). Both isolates exhibited the presence of multiple mobile genetic elements (MGEs), but no plasmid was detected in either of them. Conclusions: A low prevalence of the IC3 sequence type was identified among two A. baumannii isolates obtained from the NICU in Egypt, exhibiting a high resistance level. Healthcare workers must have knowledge regarding the prevalence of A. baumannii among different populations in order to administer suitable treatment, improve patient outcomes, and apply effective infection control practices.

Background and Objectives: The rising prevalence of drug-resistant organisms presents a significant challenge to healthcare, underscoring the importance of implementing effective antimicrobial stewardship programs. The success of these programs depends on access to accurate, evidence-based data reflecting local patterns of antibiotic resistance. This study aims to assess the antimicrobial susceptibility profiles of gram-positive bacteria isolated from pediatric patients in a tertiary care hospital in Egypt. Materials and Methods: We carried out a retrospective study over a five-year period, from January 2018 to December 2022, using microbiology laboratory records. Clinical samples included blood, urine, respiratory secretions, pus, wound, cerebrospinal fluid (CSF), and pleural fluid. The analysis focused on the resistance patterns of gram-positive pathogens identified through routine culture procedures. Antimicrobial susceptibility testing was performed using the Kirby–Bauer disc diffusion method, and vancomycin MIC was confirmed using the VITEK 2 system. Results: A total of 3223 gram-positive bacterial isolates were identified. Staphylococcus aureus, including 82.5% methicillin-resistant strains (MRSA), exhibited high resistance to erythromycin (47.3%) and gentamicin (low potency) (32.1%). Coagulase-negative staphylococci (CoNS) showed the highest erythromycin resistance (up to 88.3%), while Enterococcus spp. demonstrated declining susceptibility to vancomycin, levofloxacin, and erythromycin. Across all isolates, vancomycin and gentamicin (high potency) showed the highest overall susceptibility. Resistance to cotrimoxazole and doxycycline declined over the five-year period. Conclusions: While a decline in resistance was noted for some agents, persistent resistance to key antibiotics (particularly erythromycin and gentamicin) among MRSA and CoNS remains concerning. These findings underscore the importance of targeted antimicrobial stewardship interventions and continuous surveillance to inform empirical therapy in pediatric settings.

Blood stream infection (BSI) is a life-threatening condition that implies prompt diagnosis and management. With the time-consuming traditional microbiological culture and limited provision of molecular diagnostics, procalcitonin (PCT) has emerged as a rising rapid biomarker for prediction of BSI. We aimed to evaluate the diagnostic performance of PCT in predicting BSI as well as in tentative differentiation of the possible underlying microbial etiology. Blood samples were collected from total 328 patients suspected of having BSI and were measured for levels of procalcitonin, C-reactive protein (CRP) and total leucocyte count (TLC). Concomitant microbiological culture was done for detection and identification of microbial etiology. Microbial cultures were positive in 47.9% and negative in 52.1% of patients. Bacterial and fungal growth accounted for 87.8% and 12.1%, respectively, where bacterial growth was differentiated as Gram-positive and Gram-negative bacteria. Culture-positive group displayed significantly higher median values of PCT (2.69 ng/ml) and CRP (117.2 ng/ml) than culture-negative group. PCT levels were significantly higher among Gram-negative than Gram-positive cultures, however were non-significantly higher among bacterial than fungal positive-cultures. Compared to other biomarkers, PCT displayed the highest diagnostic accuracy in differentiating culture-positive and -negative BSI (ROC-AUC: 0.706, P < 0.001) at cut-off value of 0.675 ng/ml, as well as in discriminating Gram-negative and Gram-positive bacteria (ROC-AUC:0.636, P: 0.004) at cut-off value of 2.135 ng/ml. PCT exhibited higher diagnostic accuracy than other biomarkers in BSI and in differentiating Gram-negative and Gram-positive bacterial etiology, which may offer a modest guidance in sepsis management and optimization of antibiotic intake. Not applicable.

Background: Blood culture contamination is a safety and quality indicator in the pediatric population. False positive blood culture negatively impacts pediatric patients' proper management, microbiology laboratories, healthcare facilities where blood cultures are ordered, and pharmacies. The study aims to appraise the blood culture contamination rate in an intensive care unit of an emergency department at an Egyptian tertiary care pediatric hospital, and accordingly design a quality improvement program to reduce it. Methods: A plan-do-study-act model is implemented over 8 consecutive months. All nursing staff members who enrolled in the study; participated in an educational program, afterward, they were assigned to collect blood samples for culture, following the instructions implemented and listed for improvement of the blood culture sampling practice. Then, blood culture samples were sent to the microbiology laboratory of this Egyptian tertiary care pediatric hospital for microbiological processing. Results: Our average contamination rate declined from the baseline of 12.6% to an average of 5.8%. Conclusions: According to our study, blood culture contamination rates can be significantly reduced when blood culture sampling is standardized.