الفهرس 
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Abstract
Acinetobacter isolates are challenging pathogens responsible for serious nosocomial infections. They can survive in the clinical environment with great resistance to disinfectants, antibiotics, moist and dry conditions as; they can use different metabolic sources and have the ability to form biofilms.
Acinetobacter has transformed from a monodrug-resistant to a multidrug-resistant or even pandrug-resistant organism. Numerous mechanisms may lead to this resistance, and the active efflux mechanism is an important factor for MDR in Acinetobacter. RND multidrug efflux system is most important. The AdeABC efflux system is the most important in RND pumps and its expression is regulated by AdeR and AdeS genes.
The aim of this work was to the Study the effect of mutation in Ade S gene in multidrug resistant Acinetobacter baumanni by studing the expression of AdeR and AdeS isolates from patients of Menoufia University Hospitals.
This study was performed in Clinical Pathology Department, Faculty of Medicine, Menoufia University. Clinical samples were collected and processed according to standard microbiological methods.
Antimicrobial susceptibility testing for Acinetobacter isolates was performed by disk diffusion method against to pipercillin-tazobactam (94%), ampicillin–sulbactam (90%), tobramycin (81%), doxycycline (80%), tetracycline (78%), gentamycin (72%), trimethoprim-sulphamethoxazole (69%), cefotaxime (67%), ceftazidime (66%), ciprofloxacin (64%), levofloxacin (55%), meropenem (53%), Imipenem (52%) and amikacin (50%).
All clinical isolates of Acinetobacter were tested for the expression of AdeR and AdeS genes by real time PCR.
A total of 100 Acinetobacter isolates were obtained from different clinical samples. Acinetobacter infections were more common among males (55 %), with average age 50.24 years. Patients used antibiotic (87%), exposed to invasive procedures (87%) and had associated co-morbidities (85%).
The highest rate of clinical Acinetobacter isolation was from respiratory secretions (67%).
About (86%) of all Acinetobacter isolates were MDR or XDR. In this study the distribution and expression of AdeR and AdeS genes increased significantly in more resistant groups in relation to less resistant cases.