4.1. Study Design

A prospective study was conducted at the International Medical Center (IMC) from July 2017 to June 2019 to screen carriers or patients infected with ESBL-producing Gram-negative pathogens and CRE. The IMC is an acute care, tertiary hospital with around 800 beds, 10 different ICUs and 3 different wards (oncology, surgical and medical). Authorized members of an infection control team were assigned to collect the microbiological records including the identified culture with its sensitivity pattern from different clinical specimens, including blood, sputum, urine and wound swabs among all ICUs and wards of IMC. The study protocol was reviewed and approved by the institutional ethics committee, Faculty of Pharmacy, Ain Shams University (ENREC-ASU-2018-72). This study was conducted in accordance with the ethical principles stated in the Declaration of Helsinki.