الفهرس 
Intoduction and aim of this workOnly 14 pages are availabe for public view
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Abstract
The aim of this study was to detect the frequency of different Klebsiella species causing nosocomial infections in Mansoura University Hospitals with detection of different factors increase the risk of their acquisition. Besides study of some factors which implicated as factors involved in virulence of these organisms. Also detection of strains that produce ESβLase enzyme as a major cause of treatment failure in hospital infected patients. Moreover trial to correlate between studied virulence factors and the site of infection.
Clinical samples were collected, regardless the type of infection, the age or the sex of patients, during the period extending from July 2003 to January 2004. Out of 923 samples, 128 yielded positive culture results for Klebsiella, Klebsiella pneumoniae and Klebsiella oxytoca was identified in 122 and 6 cases respectively.
Screening for ESβLs was performed using double disk synergy test, their production was detected in 39 cases at a percentage of 30.5%. Specific risk factors identified in patients infected with an ESBL-producing, included prolonged hospital stay, intensive care unit admission, intubation, and empirical exposure to antibiotics.
PCR for Yersinia high pathogenicity island in isolated Klebsiella species was performed. It was detected in 13 (10.7%) isolates of Klebsiella pneumoniae and in 4 (66.7%) isolates of Klebsiella oxytoca. It was detected maximally in blood and urine specimens, indicating its important role in extraintestinal infection.
Adherence factors including type I and type III fimbriae were studied by detection of haemagglutination of guinea-pig and tanned ox erythrocytes respectively. Type one fimbriae was detected in 36 (29.5%) isolates of Klebsiella pneumoniae but not detected in Klebsiella oxytoca isolates. Type three fimbriae was detected in 27 (22.1%) and 1 isolates of Klebsiella pneumoniae and Klebsiella oxytoca respectively. Also it was observed that instrumentation is commonly associated with strains positive for type III fimbriae. Both types of fimbriae most commonly detected in urinary and respiratory tracts.
Resistance to serum killing in Klebsiella isolates was detected mainly in blood and urine specimens in 27(22.1) and 4 (66.7) isolates of Klebsiella pneumoniae and Klebsiella oxytoca respectively. Also it was noted that, there was significant association between strains that were resistant to serum and those produce ESβLase enzyme.