Background: Candidemia is a pervasive problem associated with significant morbidity and mortality in health care settings. This study aimed to determine the changing distribution of Candida species and the emergence of uncommon species. Methods: This was a cross-sectional study performed in two Cairo University hospitals between 2019 and 2020. All Candida species isolates recovered from blood cultures of adults and pediatrics patients admitted to the hospitals were included. Candida isolates were identified by chromogenic Candida agar and Vitek2 YST identification card. Candida kefyr was confirmed by chip array. Results: Candida species were responsible for 1.6% of bloodstream infections in adults and 10.8% in pediatric patients. C. albicans was the most prevalent species representing 27.8% in adults and 48.3% in pediatrics. Non-albicans species (NAC) represented the most isolated Candida species among adults and pediatrics (72.2% and 51.6%, respectively) with the predominance of C. tropicalis (27.8% and 22.5%, respectively) followed by C. parapsilosis (16.7% and 10.8%, respectively). The uncommon Candida, which is Candida species other than C. albicans, C. parapsilosis, C. tropicalis, C. glabrata, and C. krusei, represents 16.6% and 14% of all candidemia in adults and pediatrics, respectively. Only one of each of C. lusitaniae, C. utilis, and C. kefyr were detected in adults. C. lusitaniae was the most frequently recovered uncommon Candida among pediatrics resulting in 6.4% of candidemia followed by C. famata (4.3%), C. utilis (2.2%), and C. kefyr (1.1%). Conclusions: C. albicans is still the primary species isolated from pediatrics and adults with candidemia despite the considerable shift to the non-albicans species. C. tropicalis and C. parapsilosis are the most prevalent NAC. The increased prevalence of uncommon Candida species is alarming and necessitates a prompt stewardship program.

Of great concern is the increased frequency of carbapenem-resistant Acinetobacter baumannii (CRAB) causing healthcare-associated infections. Different classes of β-lactamases are involved in this resistance through hydrolyzing carbapenems. Multilocus sequence typing (MLST) has been applied successfully for characterizing different varieties of bacterial pathogens epidemiologically. In the present study, we aimed to type and characterize the resistance profile of clinical isolates of CRAB causing healthcare-associated infections in patients admitted to Kasr Al-Aini hospital, using MLST, and compare with sequence types (STs) from other countries. A total of 50 isolates were collected from clinical samples (predominantly wound and blood), then identified by bla OXA-51-like gene PCR, and subjected to Oxford MLST scheme. The ST was designated according to PubMLST database, and e-BURST algorithm was used to assign clonal complexes. Four sets of multiplex PCR were performed to detect common carbapenem resistance genes. ST391 was the predominant ST detected in 17 cases, 70.5% of which harbored bla OXA-23 alone, both bla OXA-23 and bla KPC in 11.8%. Newly recognized 13 STs were submitted to the PubMLST database. Carbapenem resistance due to bla OXA-23 carbapenemase was detected in 36/50 (72%), followed by bla OXA-23 concomitant with bla KPC in 7/50 (14%), while bla NDM with bla OXA-58 in 3/50 (6%) and bla NDM alone in 1 case (2%). To conclude, this study demonstrates the propagation of highly resistant clone of STs 391 and 1151, carrying bla OXA-23 genes, with the first report of bla KPC in bla OXA carrying CRAB and the presence of new STs by performing the MLST technique in an Egyptian laboratory facility.

Methicillin-resistant Staphylococcus aureus (MRSA) is a significant healthcare-associated (HA-MRSA) pathogen due to its increased morbidity and mortality rates. There is a paucity of data regarding MRSA clones circulating in the Middle East in the literature, especially from Egypt. We aimed to identify the pattern of resistance and virulence in the propagating clones using NGS technologies for the whole genome sequence. From an 18-month surveillance program for MRSA-positive patients, 18 MRSA isolates from surgical healthcare associated infections were selected. The Vitek2 system was used to assess antimicrobial susceptibility. The whole genome sequencing was performed using the NovaSeq6000. The reads were mapped to the reference genome (Staphylococcus_aureus_ATCC_BAA_1680), used for variant calling, screened for virulence/resistance genes, and typed using multi-locus sequence typing and spa typing. Correlation between demographic and clinical data and molecular findings were performed. All the MRSA isolates were highly resistant to tetracycline followed by gentamicin (61%) and highly susceptible to trimethoprim/sulfamethoxazole. Most of the isolates showed a high virulence profile. ST239 was the predominant sequence type (6/18), while t037 was the predominant spa type (7/18). Five isolates shared the same ST239 and spa t037. ST1535, an emerging MRSA strain, was the second most prevalent in our study. One isolate showed a unique pattern of a high abundance of resistance and virulence genes. WGS elucidated the resistance and virulence profiles of MRSA isolated from clinical samples of HAI patients with high-resolution tracking of clones predominant in our healthcare facility.

Objectives: Probiotics are live microorganisms consisting of many bacterial species that have immunoregulatory functions. The effectiveness of probiotic administration in conjunction with topical corticosteroid application in oral lichen planus (OLP) treatment was evaluated. Methods: Sixty OLP patients were enrolled in this study and divided into two groups. Group 1 (Probiotics’ group): probiotic capsules were administered twice daily, for 4 weeks in addition to topical clobetasol propionate application 0.05% four times daily. Group 2 (Control group): topical clobetasol propionate 0.05% was applied 4 times daily for 4 weeks. Thongprasom criteria, numerical rating scale and candidal load were evaluated. Results: Significant reduction in the numerical rating scale as well as Thongprasom scale in the probiotic group when compared to the control group, after 2 and 4 weeks, and more significant reduction was observed after 2 weeks. No difference in the reduction of the candidal load was observed between the two groups, nevertheless, no topical antifungal was used in the intervention group. Conclusions: Systemic administration of probiotics as a supplementary treatment with topical corticosteroid was effective regarding the reduction of; pain, Thongprasom scales, and candidal load. However, the effectiveness was more evident after 2 weeks when compared to 4 weeks resulting in: more rapid relief of symptoms, improving quality of life, in addition to their antifungal properties. Trial registration: The current study was registered in clinicaltrials.gov (ID: NCT04383236) 6-11-2023.

Aim: This study aimed to evaluate the efficacy of carboxymethyl cellulose (CMC)-based natural mixture of aloe vera gel and coconut oil as a salivary substitute in comparison to the conventional CMC for the management of xerostomia in a sample of patients with Sjogren’s syndrome (SS). Methods: This crossover randomized clinical trial included 24 patients diagnosed with SS. Half the patients started with the study treatment (A-Gel) for 2 weeks, then went through a 7-day washout period, then received the control treatment (B-Gel), while the other half had the order reversed. The measured outcomes were subjective oral dryness (Bother 1’ xerostomia index), modified xerostomia quality of life scale (XeQoLS), clinical oral dryness (CODs), and salivary candidal load. Results: With a mean age of 46.96 ± 11.86 years, all patients were female and suffered from mouth dryness for 16.58 ± 25.32 months. In light of our findings, both groups’ Bother 1’ xerostomia index values recorded at different intervals showed significant improvements. There was a p < 0.001 difference between the mean value for groups A and B at baseline (7.33 ± 2.39 and 7.29 ± 2.66), one week later (4.17 ± 2.24 and 4.25 ± 2.57), and two weeks later (2.83 ± 2.08 and 2.88 ± 2.07). However, there was no significant difference between the groups. Likewise, for CODs and modified XeQoLS, no significant difference was found between groups; however, both groups showed a statistically significant improvement (p < 0.001). Improvement in the modified XeQoLS was observed in all domains (physical functioning, pain & clinical acceptance). Regarding candidal load, there was no statistically significant difference between groups or even within groups (p > 0.05). Conclusions: As salivary substitutes, the CMC natural mixture (aloe vera, coconut oil) and the conventional CMC-based oral gel are equally efficient at minimizing xerostomia symptoms and enhancing SS patients’ quality of life with minimal side effects. Saliva’s natural effect might be substituted with a natural mixture of coconut oil, aloe vera gel, and CMC. The trial is registered on clinicaltrials.gov, identifier: NCT04252209.

Background: Antimicrobial resistance (AMR) poses a significant global threat to public health and safety. To address this challenge, antimicrobial stewardship programs (ASPs) play an important role in optimizing antimicrobial use, reducing adverse effects, and lowering healthcare costs. Integrating advanced diagnostics like MALDI-TOF MS enhances ASP effectiveness, potentially improving antimicrobial use, lowering AMR rates, and bettering patient outcomes. Objective: This study aimed to evaluate the clinical impact of implementing MALDI‐TOF MS alongside ASP on the outcomes of PICU patients with various infections at Cairo University Specialized Pediatric Hospital (CUSPH). Method: A prospective cohort study was conducted in the PICUs at CUSPH. The 13-month study was divided into three phases: pre-implementation (baseline assessment), implementation (establishing guidelines and ASP orientation), and post-implementation. Key ASP indicators, such as length of stay, cure rate, mortality rate, length of therapy, and days of therapy, were measured. Results: In the post-implementation phase, both the average length of stay and mortality rate showed a notable decrease, with p-values of 0.059 and 0.06, respectively, suggesting a trend toward significance. The cure rate increased (p = 0.06). Additionally, the use of amphotericin significantly decreased (p = 0.03), while the use of cefepime (p = 0.002), clindamycin (p = 0.01), and linezolid (p = 0.03) increased. Klebsiella pneumoniae was the most isolated organism, accounting for 21% of cases. Conclusion: Integrating MALDI-TOF MS with ASP significantly reduce time to organism identification, improving time to optimal antibiotics therapy, with positive outcome measures including shortening hospital stays, increasing cure rate, and lowering mortality rates.