Fatty liver in children

Mandana Rafeey1, Fakhrossadat Mortazavi2, Nafiseh Mogaddasi2, Ghergherehchi Robabeh2, Shamsi Ghaffari2, Alka Hasani31Liver and gastrointestinal Research Center; 2Tabriz University (Medical Science) Tabriz, Iran; 3Research Center of Infectious Diseases and Tropical MedicineAims: The aim of this study is to investigate the clinical and laboratory characteristics of nonalcoholic fatty liver disease (NAFLD) in a referral center of pediatrics in the northwest of Iran.Methods: In this cross-sectional study all subjects aged between six months to 15 years that were referred to the sonography unit, were investigated for fatty liver from March 2005 to August 2006. Patients with fatty liver change underwent detailed clinical and laboratory evaluation.Results: From 1500 children who were investigated, 34 subjects with sonographic evidence of fatty liver were enrolled in this study (2.3%). The mean age was 6.53 ± 3.07 years. Elevated aspartate aminotransferase and alanine aminotransferase was detected in 38.2% and 47.1% of patients, respectively. The mean level of cholesterol was 461 ± 182.23 mg/dl and 94.1% of patients had hypercholesterolemia. Total cholesterol level and serum aminotransferase levels had a significant positive correlation with severity of fatty liver (p < 0.05). Mean body mass index was significantly higher in patients with severe fatty liver (p < 0.05).Conclusion: The epidemiology of pediatric NAFLD should inform future attempts to develop evaluated screening protocols. Moreover, these data should guide efforts to delineate the pathophysiology of fatty liver in children.Keywords: nonalcoholic fatty liver disease, steatohepatitis, obesity, childre

Virulence and Antimicrobial Resistance in Enterococci Isolated from Urinary Tract Infections

Purpose: Urinary tract infection (UTI) is the most common nosocomial infection among hospitalized patients. Meanwhile, most frequent infections involving enterococci affect the urinary tract. The aims of this study were to investigate the susceptibility pattern of isolated enterococci from UTI and the prevalence of virulence genes. Methods: The study used enterococci isolated from urinary tract infections obtained from 3 university teaching hospitals in Northwest Iran. The antimicrobial susceptibility of the strains was determined using the disc diffusion method. Multiplex PCR was performed for the detection of genus- species specific targets, and potential virulence genes. Results: Of 188 enterococcal isolates, 138 (73.4%) and 50 (26.6%) were Enterococcus faecalis and E. faecium, respectively. Antibiotic susceptibility testing showed high resistance to amikacin (86.2%), rifampicin (86.2%) and erythromycin (73.9%), irrespective of species. In total, 68.1% were positive for gelE, and 57.4%, 53.2%, 56.4%, and 52.1% of isolates were positive for cpd, asa1, ace, and esp, respectively. Conclusion: The study revealed that most of UTI isolates were multidrug resistance against the antibiotics tested and antibiotic resistance was more common among E. faecium isolates than E. faecalis. A significant correlation was found between UTI and the presence of gelE among E. faecalis strains (p < 0.001)

Frequency of bap and cpaA virulence genes in drug resistant clinical isolates of Acinetobacter baumannii and their role in biofilm formation

Objective(s): Acinetobacter baumannii has a high propensity to form biofilm and frequently causes medical device-related infections with multiple-drug-resistance in hospitals. The aim of this work is to study antimicrobial resistance and the role of bap and cpaA genes in biofilm formation by A. baumannii to understand how this pathogen persists in the hospital environment. Materials and Methods: Theantibiotic resistance profile and in vitro biofilm-forming ability of one hundred clinical isolates of A. baumannii was evaluated by disc diffusion and crystal-violet staining methods, respectively. Isolates were tested for the presence of bap and cpaA genes. Results: The isolates were highly resistant to cefepime, third-generation cephalosporins, ciprofloxacin, cotrimoxazole, aminoglycosides and carbapenems. Moreover, four isolates were resistant to colistin. Quantification of biofilm showed that 43% of the isolates were strong biofilm-producer. Furthermore, 32% of the isolates exhibited moderate biofilm-formation and showed initial binding activity. Frequency of bap and cpaA were determined 92% and 36%, respectively. Conclusion: There was strong association between the presence of bap gene and biofilm formation by A. baumannii isolates (P=0.003). In addition, multidrug resistant isolates produced stronger biofilm than other isolates (P=0.0001). These results indicate importance of biofilm in resistance of isolates and effect of presence of bap gene in biofilm formation by A. baumannii strains

Detection of integrons among multi-drug resistant (MDR) Escherichia coli strains isolated from clinical specimens in northern west of Iran

Transference of resistance determinants by integrons is one of the important factors that can contribute to the increase in multi-resistant bacteria. We determined the prevalence and class of integrons among multi-drug resistant (MDR) Escherichia coli strains isolated from clinical specimens in Tabriz teaching hospitals. Firstly, susceptibility of 140 isolates to 13 antibiotics was determined using the disc diffusion method. Then, prevalence and class of integrons was detected in MDR strains by PCR-RFLP. One hundred five (75%) of total 140 isolates were uropathogenic Escherichia coli (UPEC). Other pathotypes included were: diarrheagenic Escherichia coli (13; 9.3%), sepsis-associated E. coli (5; 3.6%) and newborn meningitis-associated E. coli (2; 1.4%). Antibiotic resistance patterns were as follows: amoxicillin 99.3%, gentamicin 33.6%, tetracycline 72.8%, ceftazidime 46.4%, co-trimoxazole 75%, imipenem 1.4%, ciprofloxacin 47.6%, norfloxacin 50.7%, cephalothin 77.8%, amikacin 12.1%, nitrofurantoin 12.9%, chloramphenicol 20.7% and nalidixic acid 60.7%. One hundred eighteen (84.2%) of tested isolates were multi-drug resistant. Prevalence of integrons was confirmed in 27.1% of MDR isolates. intI1 and intI2 were detected respectively in 22.05% and 5.08% of MDR strains. No intI3 was detected. Resistance to gentamicin, amikacin and chloramphenicol was significantly associated with the presence of integrons. These results showed high resistance of E. coli to routine antibiotics, however, in consideration of low prevalence of integrons among these strains, we can conclude that antibiotic resistance genes in these strains presumably carried on elements other than integrons

An Alliance of Carbapenem-Resistant Klebsiella pneumoniae with Precise Capsular Serotypes and Clinical Determinants: A Disquietude in Hospital Setting

Carbapenemase-resistant Klebsiella pneumoniae (CRKP) is a genuine burden for physicians and researchers. We aimed at carbapenemase resistance and its relation with capsular serotyping in K. pneumoniae and studied some clinical determinants, which may influence the clinical infections. Initially, 61 K. pneumoniae isolates obtained from various clinical specimens were confirmed at the molecular level and then antimicrobial susceptibility test was performed followed by capsular serotyping performed by multiplex PCR. All isolates were subjected to the detection of carbapenemase genes including blaKPC, blaNDM-1, blaOXA-48, blaVIM, and blaIMP. Clinical and demographic data of all patients were reviewed including age, gender, underlying diseases, and the treatment obtained. Multidrug-resistance was a predominant feature in 77% K. pneumoniae strains. Presence of extended-spectrum beta-lactamase was detected phenotypically in 59% K. pneumoniae strains. Carbapenem resistance was noticed phenotypically in 24.6% isolates. blaOXA-48 and blaNDM-1 were the most frequent carbapenemase genes. blaNDM-1 positive isolates correlated with gentamicin, amikacin, imipenem, and meropenem resistance (p<0.05). The nosocomial isolates mostly harbored blaOXA-48 gene (p<0.02). Amongst all the K. pneumoniae isolates, 59% isolates could be typed and serotype K54 had the highest prevalence followed by K20 and K5. Correlation between the carbapenemase genes, serotype and type of infection showed that blaOXA-48 positive strains had a significant association with K20 serotype and urinary tract infections (p=0.2) while, K20 serotype and blaKPC positive strains were significantly associated with wound infections (K20, p=0.3 and blaKPC, and p=0.4). Mucoid phenotype was not found related to presence of specific carbapenemase genes or serotypes except serotype K20 (p<0.001). Patients with monotherapy had treatment failure in comparison to the combination therapy for blaKPC-associated infections. In conclusion, the present investigation exhibited the significant association between K20 serotype with blaOXA-48. The predominance of K54 reveals the possibility of endemicity in our hospital setting. K. pneumoniae isolated from wound specimens significantly harbors K20 serotype and blaKPC gene. Comprehensive clinical information and the distribution of antibiotic resistance genes, and serotypes may play important roles in the treatment process

Genetic characterization of extensive drug resistant Acinetobacter baumannii: an appalling impediment

Introduction: Acinetobacter baumannii infections are a growing public-health concern. The bacterium’s potentiality to acquire resistance to a number of commonly used antibiotics has turned it into a formidable pathogen.Aims: Molecular characterization of extensive drug resistant (XDR) typing of A. baumannii clinical isolates by polymerase chain reaction.Materials and methods: Thirty XDR A. baumannii were investigated for the presence of genes encoding carbapenemase resistance, biofilm capacity, autoinducer synthase, virulence and surface motility by polymerase chain reaction (PCR). Later, the isolates were typed by plasmid-based replicon (Rep) (PBRT) and trilocus sequence typing.Results: All 30 XDR A. baumannii strains displayed genes related to surface motility, autoinducer synthase, virulence determinant, biofilm related genes except PER, and bap, the frequency of which was 83.3% and 76.6%, respectively. Analysis of rep genes showed highest frequency of rep6 and rep2 genes, with frequency of 75% and 65%, respectively. All XDR A. baumannii strains belonged to SG I (European clone II) group.Conclusions: Our results show the extraordinary plasticity of XDR A. baumannii and suggest that the strains have gained endemicity in our hospital, which could be a great concern in the near future