الفهرس 
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Abstract
Cirrhotic patient is considered one of the immunocompromised patients which in need for hospital admissions for many reasons as endoscopy, control of ascites, jaundice, hepatic encephalopathy and many other reasons. These repeated admissions can lead to exposure to noscomialinfection.
Our study was hospital based study in Tropical Medicine and Gastroenterology department, Assiut University Hospital .The study included follow up of 366 cirrhotic patients, 254 patients in the department wards and 112 patients in ICU.
This study was done to evaluate the incidence and risk factors of noscomial respiratory and urinary tract infections during the period of one year (from February 2013 to January 2014).
In this study we discovered that the incidence of noscomial respiratory tract infection was 6.3% in ICU and 13% in the department wards. The incidence of noscomial urinary tract infection in ICU was 10.7% and 5.5 % in the department wards.
In case of noscomial respiratory tract infection, the most important risk factor was artificial respiration and there were manyimportant risk factors in noscomial urinary tract infection as urinary catheter, malnutrition and diabetes meliteus.
Our study determined the main causative bacteria and fungi for noscomial respiratory and urinary tract infection and also the proper antibiotics and antifungal for each type of infection.
The most common bacteria in nosocomial respiratory tract infection were Staphylococci, Klebsiella and E.coli and the most important causative fungi were candida.
In nosocomial urinary tract infection the main causative bacteria were E.coli, Enterococci, Staphylococci and Pseudomonas.
Imipenem, meropenem and gatifloxacin were considered very important sensitive antibiotics to gram negative bacilli causing noscomial respiratory tract infections.
Levofloxacin was the most important sensitive antibiotic for gram positive cocci causing noscomial respiratory tract infection.also they were sensitive to ceftriaxone ,cefazoline, ciprofloxacin and gatifloxacin.
Gatifloxacinwas considered the most sensitive antibiotic for both gram positive cocci and gram negative bacilli in noscomial urinary tract infection.
from these results we observed that the most important antibiotics used in noscomial respiratory or urinary tract infections in cirrhotic patients were quinolones.
Our results revealed that the most common fungus appears in fungal isolates in noscomialrespiratory and urinary tract infection was candida albicans.
Sensitivity results determined that the most sensitive antifungal group for noscomial respiratory or urinary tract infections was azole group especially fluconazole.
Many types of resistant bacteria present in department wards and ICU like methicillin resistant staph aureus(MRSA), vancomycin resistant enterococci (VRE) and extended spectrum beta lactamase producing bacteria(ESBL).
The mortality rate in nosocomial respiratory tract infection was 15% and in case of nosocomial urinary tract infection was 31%.