الفهرس 
Introduction And RationaleOnly 14 pages are availabe for public view
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Abstract
Health crisis of MDR seems overwhelming. Multi drug resistant GNB pose a serious threat to current medical practices. K. pneumoniae, E. coli, A.baumannii, P. aeruginosa, and Enterobacter spp. are the most common resistant hospital acquired gram negative pathogens causing infections around the world. It is necessary that the last remaining antimicrobial agents be protected against intellectual choice and ameliorated infection control.
Combined therapy, using combination between two or more drugs, may be the last resort for treatment of these MDR organisms especially with the paucity of new antibiotics production.
The main objective of this study was to in vitro assess the effect of carbapenem-colistin combination on MDR-Enterobacteriaceae, including resistance to carbapenem, isolated from cases of hospital acquired infections in SCUHs, aiming that this is followed by clinical trials for treatment of critically ill patients suffering from infections with MDR-organisms.
The study included 272 patients admitted to several wards in SCUHs and clinically diagnosed to have UTI, VAP, pneumonia, BSI, IAIs and SSI. A total of 219 (80.5%) Enterobacteriaceae strains were isolated; K. pneumoniae showed the highest rate of isolation (51.14%), followed by E. coli (36.07%), P. mirabilis (6.3%) , Enterobacter cloacae (1.82%) while Serratia marcescencs showed the least rate (0.91%).
A total number of 48 isolates (21.91%) were proved to be imipenem resistant. The two P. mirabilis strains were excluded due to intrinsic resistance to colistin. All the remaining 46 isolates were proved to be MDR by antibiotic susceptibility testing. These isolates were subjected to in vitro assessment of the effect of imipenem-colistin combination on the imipenem MIC using the checkerboard technique. Out of the 46 isolates, 29 (63.04%) showed synergistic effect with FICI ≤ 0.5, 11 isolates (23.9%) showed additive effect, 5