الفهرس 
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Abstract
Non fermenting Gram-negative rods are increasingly recognized as an emerging opportunistic pathogens of clinical relevance, as they cause a variety of nosocomial infections including bacteremia, UTI, meningitis and VAP.
This study was carried out to determine the prevalence of NFGNRs, to assess the burdens of infections they cause and to identify their antibiotic resistance patterns.
The study was carried out during a one year period from January 2013 to January 2014. Clinical isolates of NFGNRs were identified after screening 370 patients with various infections who were admitted to different wards in SCUH in Ismailia. Specimens included urine, sputum, blood and pus. The collected specimens were processed in the Microbiology Department, Faculty of Medicine, SCU for the isolation and identification of NFGNRs. Each specimen was subjected to the following:
(1) Subculture on blood and MAC agar plates. Any growth appearing after appropriate incubation was identified according to: gross colony characteristics, Gram staining and motility test.
(2) Oxidase reaction and OF media test.
A total of 46 clinical isolates of NFGNRs were isolated representing 15% of all positive culture specimens (total=305). Then they were differentiated to species level by subculturing on Pseudomonas P agar and byAPI20 NE. It was found that P. aeruginosa represented the most common isolate, accounting for 45.6%of total isolates of NFGNRs; followed by A.baumannii17.4 %; P. fluorescens 13%; S.maltophilia10.9 %, then B.cepacia8.7 %. Only one isolate of Achromobacter and P. stutzeri were found and accounted for 2.2 %, each. Pus samples had the highest percentage of isolates representing 58.7 % followed by sputum samples representing 19.6%.
The association between NFGNRs infection and the immune status of the patients were cleared out in this study as it was found that most patients infected by NFGNRs had one or more underlying diseases.
Antimicrobial susceptibility pattern of isolates was performed and it was found that most of them were MDR. The resistance rates against ceftazidime, cefepime, pipracillin-tazobactam and azetronam were significantly higher in P. aeruginosa while colistin was found to be the most effective drug. Most of A. baumannii isolates showed high resistance to cefepime, ceftazidime, pipracillin-tazobactam and ciprofloxacin while doxycycline and amikacin were the most effective. The resistance rates against trimethoprim-sulfamethoxazole and doxycycline were higher in S. maltophilia. All B. cepacia isolates were resistant to ceftazidime. Levofloxacin and meropenem were the most effective antibiotics against S. maltophilia and B. cepacia, respectively.
Finally we conclude that non fermenting Gram-negative rods (NFGNRs) infections represent a considerable health problem in Suez Canal University Hospitals (SCUH). Since these organisms have great potential to survive in hospital environment, effective methods of sterilization and infection control measures should be implemented to control the horizontal spread of NFGNRs isolates. Also, the identification of multi-drug resistance (MDR) in these isolates is essential, since they are associated with a high level of mortality especially in immunocompromised patients.