Clinical Predispositions, Features, and Outcomes of Infections with Carbapenem-resistant among Critical Care Patients., Shoala, Ahmed El-Karamany R., Nassar Yasser, El-Kholy Amani A., Soliman Noha S., El-Fattah Alia Abd, and El-Ghawaby Helmy , Indian journal of critical care medicine : peer-reviewed, official publication of Indian Society of Critical Care Medicine, 2025 Jan, Volume 29, Issue 1, p.36-44, (2025) Abstract

BACKGROUND: Carbapenem-resistant (CRE) infections pose a significant global public health threat. We aimed to assess the risk variables, clinical characteristics, and outcomes of CRE-caused infections in criticalcare patients.

PATIENTS AND METHODS: This prospective study enrolled 181 adult patients infected with in the intensive care unit (ICU). Patients underwent clinical assessment and monitoring throughout their ICU stay. Carbapenem resistance was identified through antibiotic susceptibility testing and multiplex molecular detection of carbapenemase-encoding genes.

RESULTS: The mean age of patients was 67.99 ± 12.89 years, with 71.3% being males. Of 181 patients, 111 (61.3%) were found to have CRE infections, including 39 and 31 isolates. The CRE isolates showed the predominance of the (74.8%), followed by the genes (20.7%). The risk factors associated with CRE infection included high sequential organ failure assessment (SOFA) score, prolonged length of stay (LOS) in ICU, prior use of broad-spectrum antimicrobials, hemodialysis, plasma exchange, and prolonged mechanical ventilation. Carbapenem-resistant infections significantly required longer LOS, more need for mechanical ventilation, and exhibited lower rates of bacterial elimination than carbapenem-susceptible (CSE) infections. The type of resistance gene did not significantly influence the mortality rate among CRE patients. The successful treatment of -positive CRE showed a strong correlation with tigecycline and colistin antibiotics.

CONCLUSION: Carbapenem-resistant infection in ICU patients was associated with adverse outcomes. Identification of high-risk patients is essential for early diagnosis and appropriate management. Therefore, it is crucial to improve infection control methods and implement antimicrobial stewardship to avoid spreading infections.

HOW TO CITE THIS ARTICLE: Shoala ARK, Nassar Y, El-Kholy AA, Soliman NS, Abdel-Fattah A, El-Ghawaby H. Clinical Predispositions, Features, and Outcomes of Infections with Carbapenem-resistant among Critical Care Patients. Indian J Crit Care Med 2025;29(1):36-44.

Resistome, mobilome, and virulome explored in clinical isolates derived from acne patients in Egypt: unveiling unique traits of an emerging coagulase-negative pathogen., Amer, Mai A., Darwish Manal M., Soliman Noha S., and Amin Heba M. , Frontiers in cellular and infection microbiology, 2024, Volume 14, p.1328390, (2024) Abstract

Coagulase-negative staphylococci (CoNS) are a group of gram-positive staphylococcal species that naturally inhabit the healthy human skin and mucosa. The clinical impact of CoNS-associated infections has recently been regarded as a challenge for diagnosis and therapeutic options. CoNS-associated infections are primarily caused by bacterial resistance to antibiotics and biofilm formation. As antibiotics are still the most used treatment, this problem will likely persist in the future. The present study aimed to investigate the resistance and virulence of CoNS recovered from various acne lesions and explore their genetic basis. Skin swab samples were collected from participants with acne and healthy skin. All samples underwent conventional culture for the isolation of CoNS, MALDI-TOF confirmation, antibiotic susceptibility, and biofilm formation testing. A total of 85 CoNS isolates were recovered from the samples and preliminarily identified as . Isolates from the acne group (n = 60) showed the highest rates of resistance to penicillin (73%), cefoxitin (63%), clindamycin (53.3%), and erythromycin (48%), followed by levofloxacin (36.7%) and gentamycin (31.7%). The lowest rates of resistance were observed against tetracycline (28.3%), doxycycline (11.7%), and minocycline (8.3%). CoNS isolated from mild, moderate acne and healthy isolates did not show strong biofilm formation, whereas the isolates from the severe cases of the acne group showed strong biofilm formation (76.6%). Four extensively drug-resistant and strong biofilm-forming staphylococcal isolates recovered from patients with severe acne were selected for whole-genome sequencing (WGS), and their genomes were investigated using bioinformatics tools. Three of the sequenced genomes were identified as ; however, isolate 29AM was identified as , which is a newly emerging pathogen that is not commonly associated with acne and was not detected by MALDI-TOF. All the sequenced strains were multidrug-resistant and carried multiple resistance genes, including , , , , , , , , , , and , which were found to be located on plasmids and chromosomes. Virulence features were detected in all genomes in the presence of genes involved in adherence and biofilm formation (, , , , , , , and ). Only the isolate 29AM contained immune evasion genes (, , , and ), an anti-phagocytosis gene (), and other unique features. As a result of their potential pathogenicity and antibiotic resistance, CoNS must be monitored as an emerging pathogen associated with acne infections. To the best of our knowledge, this is the first report to isolate, identify, and correlate with severe acne infections among Egyptian patients using WGS and bioinformatic analysis.

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