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Background Acinetobacter spp. are increasingly important microbes involved in late-onset ventilator-associated pneumonia (VAP). Purpose The aims of this study were to determine the prevalence of New Delhi metallo-β-lactamase (MβL) (blaNDM-1)-producing Acinetobacter spp. among late-onset VAP patients in different intensive care units (ICUs) of Menoufia and Kasr Al Ainy University Hospitals, to investigate the possible risk factors contributing to the acquisition of blaNDM-1-producing Acinetobacter infection, and to correlate between antimicrobial resistance pattern and therapeutic efficacy as well as clinical outcomes of these patients. Materials and methods Sixty-four Acinetobacter isolates were collected from mechanically ventilated patients with suspected late-onset VAP and subjected to antimicrobial susceptibility testing. The modified Hodge test (MHT) and combined disk tests (CDT) were applied for blaNDM-1 MβL detection. Acinetobacter isolates with phenotypically confirmed MβLs production were subjected to a PCR assay to verify the presence of blaNDM-1 gene. The most obvious risk factors for acquisition of carbapenem resistance in VAP patients and treatment outcomes were also analyzed. Results Out of 64 Acinetobacter isolates, 42 (65.6%) proved to be blaNDM-1 positive. The sensitivity and specificity of MHT were 52.38% and 41.67%, while for CDT they were 92.86% and 83.33%, respectively. Acinetobacter isolates showed high susceptibility to colistin (85.7%). The clinical response was better among VAP patients who received combined carbapenem plus colistin therapy than those who received colistin alone. Relapse of infection was detected in 12.5% (8/64) of VAP cases. The reported mortality reached 46.8% (30/64) of which 27 (64.3%) were infected with blaNDM-1-positive isolates. Prolonged duration of mechanical ventilation, longer hospital and ICU stays, and prior exposure to antibiotic therapy were by far the most important factors predisposing to carbapenem resistance among VAP patients. Conclusion A worldwide spread of Acinetobacter spp. expressing carbapenemases represents a significant threat to the medical community. The current study addressed the high prevalence of blaNDM-1-producing Acinetobacter isolates among late-onset VAP patients.

Azza Gaber Antar Farag,1 Azza Mohamed Kamel Abdu Allah,2 Hala Said El-Rebey,3 Kawthar Ibraheem Mohamed Ibraheem,4,5 Asmaa Shams El Dein Mohamed,3 Azza Zaghlol Labeeb,6 Ayman Elhussien Elgazzar,1 Magda Mostafa Haggag11Department of Dermatology, Andrology and STDs, Faculty of Medicine, Menoufia University, ShibÄ«n al Kawm, Egypt; 2Department of Biochemistry and Molecular biology, Faculty of Medicine, Menoufia University, ShibÄ«n al Kawm, Egypt; 3Department of Pathology, Faculty of Medicine, Menoufia University, ShibÄ«n al Kawm, Egypt; 4Department of Medical Microbiology and Immunology, Faculty of Medicine, Ain Shams University, Cairo, Egypt; 5Microbiology Department, Taibah University, Medina, Kingdom of Saudi Arabia; 6Department of Microbiology, Faculty of Medicine, Menoufia University, ShibÄ«n al Kawm, EgyptBackground: Skin tags (STs) are benign connective tissue neoplasms, in which insulin-like growth factor −1 (IGF-1) has a mitogenic and antiapoptotic activity.Purpose: We aimed to study for the first time, the possible role of IGF-1 (CA) 19 and rs6214 gene polymorphisms, and its tissue immunoreactivity in the pathogenesis of STs.Patients and methods: This case–control study included 40 ST patients and 20 controls. We searched for (CA) 19 single-nucleotide polymorphism (SNP) using conversional PCR and for rs6214 gene polymorphism using real-time PCR. IGF-1 tissue immunoreactivity was investigated using polyclonal IGF-1 antibody.Results: IGF-1 immunoreactivity showed significantly strong upregulation in epidermis (p=0.002) and dermal components (endothelial cells [p=0.038] and fibroblasts [p=0.004]) of excised STs than control skin. TT and CT rs6214 genotypes and its T allele were significantly associated with STs (p=0.006 and P=0.002, respectively). Also (p=0.013). These 4 genotypes were significantly associated with development of multiple STs and epidermal IGF-1 tissue immunoreactivity in studied patients.Conclusions: IGF-1 (CA) 19 and rs6214 gene polymorphisms may contribute to a predisposition of STs in Egyptian patients, the role of which could be mediated through local upregulation of IGF-1 in cutaneous tissues.Keywords: skin tags, insulin growth factor-1, gene polymorphism, immunohistochemistry