الفهرس 
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Abstract
This work aimed to study the susceptibility and prevalence of multidrug resistant (MDR) E. coli isolates and the possible role of quinolone and carpabenem genes in E. coli resistance. Fifty clinical E. coli isolates were collected from different diagnostic centers of Mansoura University Hospitals from January 2012 to December 2014. The laboratory procedures were carried out at the Clinical Microbiology Laboratories in Mansoura University, Faculty of Medicine and in Genetics & Cytology Laboratory, Mansoura University Faculty of Science. The isolation and identification of the isolates were carried out by Primary identification, colony morphology, gram stained film, manual biochemical tests and the antibiotic sensitivity tests were carried out by disc diffusion methods. Out of 50 isolates, 10 MDR E. coli candidates were selected for the detection of the plasmid-bearing antibiotic resistant genes by PCR and protein profile in the presence of quinolone and carbapenem using SDS-PAGE. The results of antimicrobial susceptibility pattern of 50 clinical E. coli isolated from urine, wound swab, blood and sputum of patients from Mansoura University Hospitals, showed that urinary samples were the commonest samples giving positive bacterial growth (58%) from from the Department of Emergeny. The multidrug resistant E. coli isolates showed high resistance to cefuroxim (96%), cefotriaxone (92%), cefaclor (90%), trimethoprim (88%), cefotaxime (84%), augmentin (82%), ciprofloxacin &norfloxacin (76%), gentamicin (74%), nalidixic acid (72%), ceftazidume (66%), levofloxacin (64%), azteronam (60%), ampcillin/sulbactam (56%). On the other hand, some multidrug resistant E. coli isolates recorded low resistance to amikacin (16%), imipenem (30%) and meropenem (40%). Plasmid profile showed that all MDR strains harbored plasmids of different sizes. Some isolates possess single sized plasmid while other had multiple plasmids with different sizes. The distribution of antibiotic resistant genes in E. coli candidates included qnrA (0%), qnrB (50%), qnrS (70%), qnrB&qnrS (20%) and blaKPC (10%). All isolates were harbored one of quinolone resistant genes. The protein pattern of the MDR E. coli with ciprofloxacin was showed 19 bands distributed as; 16 monomorphic and 3 polymorphic. Meropenem case indicated 20 bands distributed as 14 monomorphic, 5 polymorphic and 1 unique. The antimicrobial resistance is a clinical and public health problem; there is a need for monitoring the microbial trends and antimicrobial resistance patterns.