Detection and Identification of Gonococci Resistance to Cephalosporin and Determination the Most Effective Empirical Treatment for Gonococcal Urethritis in Male Human in Egypt

Introduction: Gonorrhoeae and antimicrobial resistance AMR of gonococci is a major health problem today, because emerged resistance to last line empirical treatment for gonorrhoeae cephalosporins in many countries is predictable to be untreatable disease in near future. WHO GASP, WHO GLASS and WHO’s global action plan on AMR recommends to expand nationally and internationally to collect data to monitor AMR of gonococci for public health policies. Objective: Our aim is to detect resistance of gonococci to Cepha- losporins and determine the most effective empirical treatment for un-com- plicated gonococcal urethritis in males in Egypt. Methods: We depended in our methodology on selected gonococci from male urethral discharge specimens on Thyer Martien medium;collected 33 isolates during three years from 2017 to 2020;used antibiotics with MIC according to international standards and measuring IZD according to antimicrobial susceptibility testing reference ranges in international standards. Results: By statistical studies, resistance to cephalosporins was as follows: Cephradine 97%, Cefaclor 87.9%, Cefoxitin 97%, Ceftriaxone 90.9% and 42.4% to Cefepime, that shows hetero-genecity in resistance inside cephalosporin group;while resistance to Macrolides group represented by Azithromycin and Tetracyclins group represented by Doxycycline was as follows: Azithromycin 39.4%, Doxycycilne 27.3%;finally fluoroquinolones, the most effective group, resistance, was as: Levofloxacin 15.2%, Ciprofloxacin 15.2% and Ofloxacin 24.2%. Conclusion: The most effective empirical treatment for uncomplicated gonococcal urethritis in males in EGYPT is Fluoroquinolone;especially Levofloxacin ranks first susceptibility as 78.8% and 15.2% resistance followed by Ciprofloxacin susceptibility as 69.7% and 15.2% resistance, finally Ofloxacin susceptibility as 66.7% and 24.2% resistance;for Ceftriaxone not more recommended in EGYPT as empirical treatment for uncomplicated gonococcal urethritis, it is susceptibility as 6.1% and 90.9% resistance;in addition, we can use combination therapy of Fluoroquinolones with Azithromycin or Doxycycline, whose susceptibility is 30.3% for Azithromycin and 42.4% for Doxycycycline, while resistance is 39.4% for Azithromycin and 27.3% for Doxycycline. It is worth noting that only Cefepime in Cephalosporins group represents 42.4% susceptibility and 42.4% resistance;in addition to the Carbapenems group, it represents as 42.4% susceptibility for Imipenem and 45.5% resistance, then 42.2% susceptibility for Meropenem and 48.5% resistance, which can play role in combination therapy.

心理治疗中的循证实践及其哲学思考

心理治疗中的循证实践是指治疗者根据个体已有的临床技能与经验,利用最佳的研究证据,在考虑病人人格、文化及偏好等因素的情况下进行的心理治疗实践。通过描述心理治疗中循证实践运动发展的两个阶段,考察其哲学基础及存在的问题,对其发展趋势及对整个心理学发展的意义进行了展望。

DIAGNOSTIC BEHAVIOR OF COMMUNITY-ACQUIRED PNEUMONIA:SURVEY CONDUCTED IN SOME REGIONS OF CHINA

Objective To analyze the spectrum of microbiological agents causing community-acquired pneumonia （CAP） in recent years. We also investigated the procedure of diagnosis us well as the empirical treatment for this disease in OPD （ outpatient department） of pulmonary disease. Methods A total of 7097 patients from 150 hospitals in 24 provinces in China were enrolled in the study from Nov. 2002 to Mar. 2003. Every patient was diagnosed, treated and registered at the same time. Diagnostic behavior for doctors include chest radiograph and/or CT examination of the lung, as well as collecting sputum samples at the time of diagnosis for bacteria culture to identify the pathogen. Appointed staff fulfiUed the questionnaires and information sheets in each center. After that, data were computerized and analyzed. Results There were 7404 valid information sheets and 7097 questionnaires taken into count. The majority CAP patients were from cities （ 77. 3% ）, most of those who had medical insurance. Most CAP patients had productive cough （81.1% ）, and 76. 7% and 18. 2 % CAP patients received chest film and CT examination respectively for diagnosis. Only 24% patients received sputum sample tested and with 36% got positive results. Streptococcus pneumoniae remained the main pathogen of CAP （43. 2% ）. Most doctors used to prescribe β-lactam antibiotics as the first line of empirical therapy of CAP （ 51.1% ） with oral taken as the main method for drug using （66. 3% ）. Conclusion This survey provides a key point of empirical therapy in China. The procedure for diagnosing us well as the empirical treatment of CAP in OPD of pulmonary disease in China still to be improved, especially in accessing the pathogen. Guidelines developed to recognize and evaluate CAP should base on epidemiological information of the pathogen prevalence, then could offer a rational approach to the initial management of the CAP patients.

Antibiotic resistance patterns of urinary tract pathogens in Turkish children

Background:Knowledge of local antimicrobial resistance patterns is essential for evidence-based empirical antibiotic prescribing.We aimed to investigate the distribution and changes in causative agents of urinary tract infections in children and the resistance rates,and to recommend the most appropriate antibiotics.Methods:In this retrospective study,we evaluated causative agents and antimicrobial resistance in urine isolates from the positive community from September 2014 to April 2016 in a single hospital in Ankara,Turkey.Results:A total of 850 positive urine cultures were identified,of which 588(69.2%)were from girls and 262(30.8%)were from boys.Their mean age was 36.5±45.0 months.The most common causative agent was Escherichia coli(64.2%of cases)followed by Klebsiella pneumoniae(14.9%).The overall resistance to ampicillin(62.6%),cephalothin(44.2%),co-trimoxazole(29.8%)and cefuroxime(28.7%)was significant.No resistance to imipenem was detected in the isolates.The least resistance was for amikacin,ceftriaxone,ciprofloxacin and cefepime(0.1,2.4,7.5 and 8.3%,respectively).Imipenem was the most active agent against E.coli followed by amikacin(0.2%),ceftriaxone(2.7%)and nitrofurantoin(5.1%).High resistance rates to nitrofurantoin were detected in K.pneumoniae,Proteus and Enterobacteriae.Conclusions:E.coli was the most common causative agent of urinary tract infection in children.Ampicillin,trimethoprim-sulfometaxazole,cephalothin and cefuroxim had the highest resistance rates against urinary tract pathogens in our center.For oral empirical antibiotherapy,cefixime is the most appropriate choice so as to include Klebsiella strains.