Epidemiology of nosocomial infections in pediatric patients in an Iranian referral hospital

Nosocomial infections (NI) are important causes of morbid- ity and mortality in pediatric hospitals. Different surveillance methods for detecting hospital-acquired infection have been developed. The selection of which varies according to specific surveillance objectives and the resources are available. The aim of this study was to determine the epidemiology of noso- comial infections in medical wards of a tertiary-levels teaching pediatric hospital in Tehran, Iran. We performed a prospective cross-sectional study and NI was identified by daily review of medical charts of patients hospitalized for at least 48 hours. We evaluated 1497 patients. The overall patient NI rate was 3.34 per 100 patients and the infection rate per 1000 patient-days was 5.27. The most common site of infection was the respira- tory tract (36%) followed by the gastrointestinal tract (32%). S. aureus, P. aeruginosa and Salmonella species were the most frequent pathogen isolates. The lethality rate associated with NI was 10%. Describing the epidemiology of NI in this hospi- tal enable us to estimate infection occurrence, distribution and expected incidence, as well as recognizing trends and keeping track of possible outbreaks

Clonal spread of vancomycin resistance Enterococcus faecalis in an Iranian referral pediatrics center

Vancomycin-resistant enterococci (VRE) represent as an immediate threat to public health. Since few active compounds are available for VRE infections, rapid identification of these isolates are essential. In the absence of any report on the genetic relatedness of Enterococcus faecalis especially Vancomycin-resistant E. faecalis (VREF) isolates in Iran, we undertook this study to characterize these isolates using random amplification of polymorphic DNA (RAPD?PCR) genotyp- ing method. In this study, E. faecalis strains isolated from various samples collected from different wards of Children Medical Hospital (Tehran, Iran). These isolates were identified by standard laboratory procedures and tested for antimicrobial resistance to vancomycin and teicoplanin. The genetic similarity of the strains was investigated by amplification of the RAPD?PCR. In our study among 91 E. faecalis isolates, 15 (16%) were identified as VREF. The similarity pattern built for E. faeca- lis isolates by RAPD?PCR, demonstrated the presence of four distinct clusters (A, B, C, D). It is of interest to note that 100% of VREF isolates belonged to Clusters A, indicating that there may have occurred horizontal transmission of the same strain between patients. In conclusion, rapid spread of VREF from a clonal origin calls for implementation of careful isolation and infection control measures. Therefore, environmental control by routine disinfection of patient area as well as screening of high risk patients and isolation of colonized patients should be imposed in order to diminish risk of acquiring nosocomial VRE

Pseudomonas aeruginosa infection among cystic fibrosis and ICU patients in the referral Children Medical Hospital in Tehran, Iran

Introduction. Pseudomonas aeruginosa is one of the important causes of hospital-acquired infections in Intensive Care Unit (ICU) and considered as a major determinant of morbidity and mortality in patients affected by cystic fibrosis (CF). The aim of this study was to investigate clonal diversity among randomly picked P. aeruginosa isolates of CF and the other hospitalized patients in ICU. Methods. Cultivation, identification, and antimicrobial suscep- tibility testing of P. aeruginosa isolates were performed using standard techniques. The genetic similarity of the strains was investigated by amplification of the Enterobacterial Repetitive Intergenic Consensus-polymerase chain reaction (ERIC-PCR) sequence. Results and discussion. Among 49 isolates, sixteen were isolated from 11 patients affected by CF and 33 came from an epidemiologi- cal investigation of 25 P. aeruginosa infected patients of ICU. Five clusters were generated for all isolates analyzed through ERIC-PCR genotyping. Two major clusters (B and C) were discovered in P. aer- uginosa isolates of ICU and CF patients during the whole period of this study. Fifteen unique antibiogram patterns obtained from all iso- lates and multi-resistant P. aeruginosa (MRPA) were identified in 23 isolates (47%). MRPA isolates were detected in all clusters (except A) while pan-resistant isolates were recovered only in cluster C. The high prevalence of related or identical isolates in CF and non-CF patients can be due to transmission of particular domi- nant clones in ICU ward. Therefore, enhanced infection-control may become necessary to prevent further spread of clonal strains

Staphylococcus aureus infections in children in an Iranian referral pediatric Hospital

Introduction. Staphylococcus aureus is associated with various infections ranging from skin and soft tissues such as surgical site infections and abscesses to lower respiratory tracts and blood- stream. The aim of this study was to evaluate underlying condi- tion of patients with S. aureus infections in an Iranian referral pediatric Hospital. Material and methods. Information was extracted retrospec- tively from the medical records of patients who were diagnosed with S. aureus infections. Data obtained about the study subjects included basic demographics, reason for admission, culture site, length of hospital stay, and methicillin susceptibility. Results. The underlyning condition of of patients with S.aureus infection during November 2011 and March 2013 were included in the study. The most frequent diagnosis in patients with S. aureus infection was jaundice (12%), abscess (10%), cellulitis (10%), wound infection (8%), septic arthritis (7%) and sezeire (5%). Wound was the most common infection sites among all subjects 34/98 (35%) following by blood (20/98, 20%) as well as skin and soft tissue (19/98, 19%). The proportion of MRSA infections among all S. aureus isolates was 79% (77/98) during the study period. In addition, 58/74 (78%) met the definition of Hospital-Associated Methicillin-Resistant S. aureus (HA- MRSA) infections and the rest; 20/24 patients (83%), were classified as Community-Associated Methicillin-Resistant S. aureus (CA- MRSA). Conclusion. In our study, the high frequency of MRSA was found not only in HA S. aureus but also in CA S. aureus isolates; there- fore, the strategic goals to optimize antimicrobial use includin

Effects of oral probiotic feeding on toll-like receptor gene expression of the chicken's cecal tonsil

Background: It was proposed that probiotics may influence immune system through direct or indirect exposure. Direct exposure is mostly mediated by surface receptors. Toll-like receptors (TLRs) are conserved molecular sensors which could be triggered via some pathogen associated structures, hence, modulate the immune responses. This study was conducted to elucidate the impact of lactobacillus acidophilus as a common probiotic on the expression level of TLRs in the chicken's cecal tonsil. Methods: Thirty one-day-old chicken were selected and separated into three groups as probiotic-fed, dairy-fed and control. In addition to commercial powder supply, each chicken in the probiotic-fed group received 109 CFU/Kg of L. acidophilus daily. While, chickens in the dairy-fed group were provided with commercial powder feed and sterile dairy milk. After 14 and 21 days of oral feeding the cecal tonsil was removed and the expression of TLR2, TLR4 and TLR5 were examined by real-time PCR. Results: At the age of 14-day, there was a slight upregulation in the expression levels of TLR2 (118.9), TLR4 (129.6) and TLR5 (123.7) of the cecal tonsil in the probiotic-fed group; however, these alterations were not statistically significant. At the age of 21-day, a non-significant downregulation was observed in TLR expression level of both dairy-fed (TLR2, 85; TLR4, 79.5; and TLR5, 86.5) and probiotic-fed (TLR2, 88.8; TLR4, 81; and TLR5, 87.2) groups in comparison to controls. Conclusions: The findings revealed that although the probiotic supplementation could be useful but it did not significantly affect innate immunity state through alteration of TLRs

Effects of oral probiotic feeding on toll-like receptor gene expression of the chicken's cecal tonsil

Background: It was proposed that probiotics may influence immune system through direct or indirect exposure. Direct exposure is mostly mediated by surface receptors. Toll-like receptors (TLRs) are conserved molecular sensors which could be triggered via some pathogen associated structures, hence, modulate the immune responses. This study was conducted to elucidate the impact of lactobacillus acidophilus as a common probiotic on the expression level of TLRs in the chicken's cecal tonsil. Methods: Thirty one-day-old chicken were selected and separated into three groups as probiotic-fed, dairy-fed and control. In addition to commercial powder supply, each chicken in the probiotic-fed group received 109 CFU/Kg of L. acidophilus daily. While, chickens in the dairy-fed group were provided with commercial powder feed and sterile dairy milk. After 14 and 21 days of oral feeding the cecal tonsil was removed and the expression of TLR2, TLR4 and TLR5 were examined by real-time PCR. Results: At the age of 14-day, there was a slight upregulation in the expression levels of TLR2 (118.9), TLR4 (129.6) and TLR5 (123.7) of the cecal tonsil in the probiotic-fed group; however, these alterations were not statistically significant. At the age of 21-day, a non-significant downregulation was observed in TLR expression level of both dairy-fed (TLR2, 85; TLR4, 79.5; and TLR5, 86.5) and probiotic-fed (TLR2, 88.8; TLR4, 81; and TLR5, 87.2) groups in comparison to controls. Conclusions: The findings revealed that although the probiotic supplementation could be useful but it did not significantly affect innate immunity state through alteration of TLRs

Wide distribution of carbapenem resistant Acinetobacter baumannii in burns patients in Iran

Antimicrobial resistance in carbapenem non-susceptible Acinetobacter baumannii (CNSAb) is a major public health concern globally. This study determined the antibiotic resistance and molecular epidemiology of CNSAb isolates from a referral burn center in Tehran, Iran. Sixty-nine CNSAb isolates were tested for susceptibility to antimicrobial agents using the E test methodology. Multiple locus variable number tandem repeat analysis (MLVA), Multilocus sequence typing (MLST) and multiplex PCR were performed. PCR assays tested for ambler classes A, B, and D β-lactamases. Detection of ISAba1, characterization of integrons, and biofilm formation were investigated. Fifty-three (77) isolates revealed XDR phenotypes. High prevalence of blaOXA-23-like (88) and blaPER-1 (54) were detected. ISAba1 was detected upstream of blaADC, blaOXA-23-like and blaOXA51-like genes in, 97, 42, and 26 of isolates, respectively. Thirty-one (45) isolates were assigned to international clone (IC) variants. MLVA identified 56 distinct types with six clusters and 53 singleton genotypes. Forty previously known MLST sequence types forming 5 clonal complexes were identified. The Class 1 integron (class 1 integrons) gene was identified in 84 of the isolates. The most prevalent (33) cassette combination was aacA4-catB8-aadA1. The IC variants were predominant in the A. baumannii lineage with the ability to form strong biofilms. The XDR-CNSAb from burned patients in Iran is resistant to various antimicrobials, including tigecycline. This study shows wide genetic diversity in CNSAb. Integrating the new Iranian A. baumannii IC variants into the epidemiologic clonal and susceptibility profile databases can help effective global control measures against the XDR-CNSAb pandemic. � 2015 Farshadzadeh, Hashemi, Rahimi, Pourakbari, Esmaeili, Haghighi, Majidpour, Shojaa, Rahmani, Gharesi, Aziemzadeh and Bahador

Identification of Etiologic Agents of the Pertussis-like Syndrome in Children by Real-time PCR Method

The aim of this study was to recognize the identity and frequency of etiologic agents of the pertussis-like syndrome in children < 2 years of age. A cross-sectional hospital-based study conducted from August 2014 to August 2015. All children < 2 years of age (n=100) who were suspected as pertussis infected were enrolled in this study and tested for Bordetella pertussis, adenovirus (Adv), respiratory syncytial virus (RSV), human metapneumovirus (hMPV), and influenza virus A (INF-A) by real-time PCR technique. RSV was the most detected pathogen (20), followed by B. pertussis (18), Adv (16), INF-A (11), and hMPV (10). Co-infection was observed in 8 patients (11) and the combinations of RSV/INF-A (n=3, 4), and AdV/B. pertussis (n=3, 4) were more frequent. RSV, B. pertussis, and hMPV were more frequent pathogens among infants < 4 months of age. However, Adv and INF-A were more frequent pathogens among children > 6 months of age. In this study, RSV was the most frequent identified pathogen (n=20, 20), followed by B. pertussis (n=18, 18) and AdV (n=16, 16). Pertussis was more frequent in spring (8) and summer (6). In addition, clinical symptoms of pertussis were the same as some viral pathogens, which can lead to misdiagnosis of infection. Therefore, diagnosis of pertussis should be established on the bases of both the clinical symptoms and the laboratory methods

Wide distribution of carbapenem resistant Acinetobacter baumannii in burns patients in Iran

Antimicrobial resistance in carbapenem non-susceptible Acinetobacter baumannii (CNSAb) is a major public health concern globally. This study determined the antibiotic resistance and molecular epidemiology of CNSAb isolates from a referral burn center in Tehran, Iran. Sixty-nine CNSAb isolates were tested for susceptibility to antimicrobial agents using the E test methodology. Multiple locus variable number tandem repeat analysis (MLVA), Multilocus sequence typing (MLST) and multiplex PCR were performed. PCR assays tested for ambler classes A, B, and D β-lactamases. Detection of ISAba1, characterization of integrons, and biofilm formation were investigated. Fifty-three (77) isolates revealed XDR phenotypes. High prevalence of blaOXA-23-like (88) and blaPER-1 (54) were detected. ISAba1 was detected upstream of blaADC, blaOXA-23-like and blaOXA51-like genes in, 97, 42, and 26 of isolates, respectively. Thirty-one (45) isolates were assigned to international clone (IC) variants. MLVA identified 56 distinct types with six clusters and 53 singleton genotypes. Forty previously known MLST sequence types forming 5 clonal complexes were identified. The Class 1 integron (class 1 integrons) gene was identified in 84 of the isolates. The most prevalent (33) cassette combination was aacA4-catB8-aadA1. The IC variants were predominant in the A. baumannii lineage with the ability to form strong biofilms. The XDR-CNSAb from burned patients in Iran is resistant to various antimicrobials, including tigecycline. This study shows wide genetic diversity in CNSAb. Integrating the new Iranian A. baumannii IC variants into the epidemiologic clonal and susceptibility profile databases can help effective global control measures against the XDR-CNSAb pandemic. � 2015 Farshadzadeh, Hashemi, Rahimi, Pourakbari, Esmaeili, Haghighi, Majidpour, Shojaa, Rahmani, Gharesi, Aziemzadeh and Bahador