Prevalence of constitutive and inducible resistance to clindamycin in staphylococci isolates from Hajar and Kashani hospitals in Shahrekord, 2014

چکیده مقدمه: مقاومت به کلیندامایسین در استافیلوکوکها به دو صورت بنیادی و القایی ایجاد می شود. درسویه هایی از این باکتریها که به اریترومایسین مقاوم هستند، ممکن است مقاومت القایی به کلیندامایسین نیز رخ دهد که با روش‌های معمول آنتی بیوگرام قابل تشخیص نیست. این مطالعه با هدف تعیین فنوتیپ های القایی مقاوم به کلیندامایسین در سویه‌های استافیلوکوک جدا شده ازبیماران بستری در بیمارستان‌های هاجر و کاشانی شهرکرد انجام شد. روش بررسی: این مطالعه توصیفی –تحلیلی برروی 200 ایزوله استافیلوکوکوس اورئوس و استافیلوکوک کواگولاز منفی مقاوم به متی سیلین که ازنمونه های بالینی بیماران جدا شده بودند با استفاده ازروش دیسک دیفیوژن انجام گرفت. مقاومت به کلیندامایسین درایزوله ها یی که به اریترومایسین مقاوم بودند، با ظهورهاله حساسیت به شکل D مشخص گردید. یافته‌ها: از بین 200 ایزوله استافیلوکوک مقاوم به متی سیلین، فنوتیپ D در ۶ ایزوله (3) (یک ایزوله استافیلوکوکوس اورئوس و ۵ ایزوله استافیلوکوک کواگولاز منفی) مشاهده شد. در چهار ایزوله فنوتیپ مثبت Dمشاهده شد. 13 ایزوله نیز فنوتیپ D منفی رانشان دادند. نتیجه گیری: تست تعیین مقاومتهای القایی روش مناسبی برای شناسایی الگوهای مقاومت در بین سویه های مختلف استافیلوکوک می باشد. به نظر می رسد انجام تست D درسویه های با فنوتیپ مقاوم به اریترومایسین ضروری بوده، وبا انجام این آزمایش می توان گزارش صحیح تری از حساسیت واقعی این سویه ها نسبت به کلیندامایسین ارائه داد. واژگان کلیدی: تست القا، کلیندامایسین، استافیلوکوکوس اورئوس، استافیلوکوکهای کوآگولازمنف

Detection of antiseptic resistance genes among Staphylococcus aureus colonising nurses and coagulase-negative staphylococci isolated from clinical specimens at teaching hospitals in southwest of Iran

Background: The wide application of antibiotics and antiseptics for patient therapy and medical equipment and surfaces disinfection has resulted in the emergence of resistant microorganisms. Staphylococcus aureus and coagulase-negative Staphylococci (CoNS) are found as a part of the normal resident flora in human so that up to two-thirds of the healthy populations are permanently or transiently colonized by S. aureus and CoNS. Chlorhexidine is an antiseptic agent particularly effective against Gram-positive bacteria. It is widely used for hygienic hand wash to prevent transmission of Staphylococci nosocomial infections. The plasmid-borne qacA/B, qacC, and smr genes confer resistance to cationic antiseptic agents in S. aureus and CoNS. Objectives: The objective of the current study was to characterize the antibiotic resistance and susceptibility to quaternary ammonium compounds (QACs) in methicillin-sensitive S. aureus (MSSA), methicillin-resistant S. aureus (MRSA), methicillin-sensitive coagulase-negative staphylococci (MSCoNS), and methicillin-resistant coagulase-negative Staphylococci (MRCoNS). Methods: In this study, the antibiotic susceptibility and resistance to Chlorhexidine in 120 Staphylococcal strains were evaluated by disc diffusion and Minimum inhibitory concentration (MIC) of Chlorhexidine gluconate (CHG) methods, respectively. The MICs of CHG were determined in triplicate by broth micro-dilution, and the presence of mecA, qacA/B, qacC, and smr genes was examined by PCR assay. Results: Of total 60 S. aureus isolates, 51 (85%) were MRSA, and of 60 CoNS, 7 (11.66%) were MRCoNS. The results showed that the MIC of Chlorhexidine for all 120 isolates was 1-16 _g/mL. 15 (12.5%) isolates carried qacA/B gene, 26 (21.7%) carried qacC gene, and 38 (31.7%) carried smr gene. Conclusions: Maintenance of MRSA isolates in the attendance of low amounts of antiseptics could result in the decreased susceptibility to antiseptics

FREQUENCY OF EXTENDED-SPECTRUM BETA-LACTAMASE-PRODUCING KLEBSIELLA PNEUMONIAE ISOLATES FROM URINARY TRACT INFECTIONS IN TEACHING HOSPITAL IN SHAHREKORD BY PCR METHOD

Background: The aim of this study was to investigate the frequency of ESBL producing Klebsiella pneumonia at an educational hospital in shahrekord, Iran. Methods: This study was conducted at Shahrekord University of medical science. Totally, 150 isolates of Klebsiella pneumonia bacteria were selected from out-patient of Hajar and kashani university hospitals. Uropathogens were identified through culture, microscopy and biochemical tests. To detect possible ESBL production, combined double disc synergy test was performed by disc of ceftazidime (30 mg) alone and in the presence of clavulanate (30 mg/10 mg) at a distance of 25 mm, on a Mueller–Hinton agar plate. Detection of SHV gene was examined in ESBL positive strains by PCR. Results: Combined double disc synergy test was applied to detect ESBL in 75 Klebsiella pneumoniae isolates that are resistant to ceftazidime using ceftazidime. Among the 48 ESBL-producing K. pneumonia strains, 18 (37.5%) were identified as SHV producing strains. Conclusion: The spread of ESBL-producing bacteria has been strikingly rapid worldwide, indicating that continuous monitoring systems and effective infection control measures are required. Therapeutic options for infections due to ESBL producers become increasingly limited. Molecular detection and identification of beta lactamases would be essential for a reliable epidemiological investigation of antimicrobial resistance. Therefore, ESBL producing organisms should be identified quickly so that appropriate antibiotic usage and infection control measures can be implemented

Colloidal carriers of almond gum/gelatin coacervates for rosemary essential oil : characterization and in-vitro cytotoxicity

The potential of almond gum and gelatin complex coacervates as a colloidal carrier for rosemary essential oil (REO) was investigated along with in vitro gastrointestinal release and cytotoxicity. The optimum formulation (1 gelatin:2 almond gum and 7% (w/w) REO) was selected based on encapsulation efficiency (43.6%) and encapsulation yield (99.3%). The particle size was 6.9 mu m with a high negative zeta-potential (-37.3 mV). FTIR and XRD data revealed that REO was properly loaded within carriers and there were interactions between gelatin and almond gum. Thermal stability of REO was enhanced after complex coacervation according to TGA. REO released slowly from carriers under simulated gastrointestinal fluid. Cytotoxicity of pure REO and REO-loaded complexes was evaluated on 4 T1 cell lines. Encapsulation of REO caused a reduction in toxicity. Overall, coacervates of gelatin-almond gum could be a promising carrier to enhance the application of bioactives in the food and drug industry with low toxicity

Prevalence of cagA and babA2 genes in Helicobacter Pylori strains Isolated from Iranian gastrointestinal disorder patients and their gas-tritis classification

Helicobacter pylori is a spiral gram negative flagellate bacteria and localize in the stomach. H.p infection is a worldwide health problem and identified as an important cause of gastritis and gastric cancer and its ability to develop such disorders is related to its virulence factors and environment. cagA is the most important Hp virulence factor that directly penetrate into gastric epithelial cells by bacterial secretion system (T4SS) from pathogenicity island (PAI) and disrupts cell homeostasis. Adherence factors are significant for bacterial colonization and suitable function of other virulence factor. Blood group antigen binding adhesion (babA) is an outer membrane protein (OMP) that binds to ABO blood group antigen and can stimulate inflammatory response in gastric cells. Our main target was to determine the roles and prevalence of cagA and babA2 virulence factor in gastrointestinal disorders in Iranian patients. Existences of These factors were determined by PCR in 218 patients with gastrointestinal disorders. Semi-quantitative methods of scoring according to the Updated Sydney classification system were used for detection of H.pylori density, neutrophil and monocyte cells infiltration. A high prevalence of cagA positive (81.4%) and babA2 positive (35%) were found. The most combined genotype (cagA&babA2) prevalence was found in gastritis & ulcer (100%) (P < 0.001). High prevalence of cagA positive observed in active inflammation phase 76.9% and high prevalence of babA2 positive was in active phase 61.1% of H.pylori gastritis (P=0.001) . Results of this study showed information about the high prevalence of cagA genes in H.pylori infected patients and their rolls in active gastrointestinal disorder

Burden of disease scenarios for 204 countries and territories, 2022–2050: a forecasting analysis for the Global Burden of Disease Study 2021

BackgroundFuture trends in disease burden and drivers of health are of great interest to policy makers and the public at large. This information can be used for policy and long-term health investment, planning, and prioritisation. We have expanded and improved upon previous forecasts produced as part of the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) and provide a reference forecast (the most likely future), and alternative scenarios assessing disease burden trajectories if selected sets of risk factors were eliminated from current levels by 2050.MethodsUsing forecasts of major drivers of health such as the Socio-demographic Index (SDI; a composite measure of lag-distributed income per capita, mean years of education, and total fertility under 25 years of age) and the full set of risk factor exposures captured by GBD, we provide cause-specific forecasts of mortality, years of life lost (YLLs), years lived with disability (YLDs), and disability-adjusted life-years (DALYs) by age and sex from 2022 to 2050 for 204 countries and territories, 21 GBD regions, seven super-regions, and the world. All analyses were done at the cause-specific level so that only risk factors deemed causal by the GBD comparative risk assessment influenced future trajectories of mortality for each disease. Cause-specific mortality was modelled using mixed-effects models with SDI and time as the main covariates, and the combined impact of causal risk factors as an offset in the model. At the all-cause mortality level, we captured unexplained variation by modelling residuals with an autoregressive integrated moving average model with drift attenuation. These all-cause forecasts constrained the cause-specific forecasts at successively deeper levels of the GBD cause hierarchy using cascading mortality models, thus ensuring a robust estimate of cause-specific mortality. For non-fatal measures (eg, low back pain), incidence and prevalence were forecasted from mixed-effects models with SDI as the main covariate, and YLDs were computed from the resulting prevalence forecasts and average disability weights from GBD. Alternative future scenarios were constructed by replacing appropriate reference trajectories for risk factors with hypothetical trajectories of gradual elimination of risk factor exposure from current levels to 2050. The scenarios were constructed from various sets of risk factors: environmental risks (Safer Environment scenario), risks associated with communicable, maternal, neonatal, and nutritional diseases (CMNNs; Improved Childhood Nutrition and Vaccination scenario), risks associated with major non-communicable diseases (NCDs; Improved Behavioural and Metabolic Risks scenario), and the combined effects of these three scenarios. Using the Shared Socioeconomic Pathways climate scenarios SSP2-4.5 as reference and SSP1-1.9 as an optimistic alternative in the Safer Environment scenario, we accounted for climate change impact on health by using the most recent Intergovernmental Panel on Climate Change temperature forecasts and published trajectories of ambient air pollution for the same two scenarios. Life expectancy and healthy life expectancy were computed using standard methods. The forecasting framework includes computing the age-sex-specific future population for each location and separately for each scenario. 95% uncertainty intervals (UIs) for each individual future estimate were derived from the 2·5th and 97·5th percentiles of distributions generated from propagating 500 draws through the multistage computational pipeline.FindingsIn the reference scenario forecast, global and super-regional life expectancy increased from 2022 to 2050, but improvement was at a slower pace than in the three decades preceding the COVID-19 pandemic (beginning in 2020). Gains in future life expectancy were forecasted to be greatest in super-regions with comparatively low life expectancies (such as sub-Saharan Africa) compared with super-regions with higher life expectancies (such as the high-income super-region), leading to a trend towards convergence in life expectancy across locations between now and 2050. At the super-region level, forecasted healthy life expectancy patterns were similar to those of life expectancies. Forecasts for the reference scenario found that health will improve in the coming decades, with all-cause age-standardised DALY rates decreasing in every GBD super-region. The total DALY burden measured in counts, however, will increase in every super-region, largely a function of population ageing and growth. We also forecasted that both DALY counts and age-standardised DALY rates will continue to shift from CMNNs to NCDs, with the most pronounced shifts occurring in sub-Saharan Africa (60·1% [95% UI 56·8–63·1] of DALYs were from CMNNs in 2022 compared with 35·8% [31·0–45·0] in 2050) and south Asia (31·7% [29·2–34·1] to 15·5% [13·7–17·5]). This shift is reflected in the leading global causes of DALYs, with the top four causes in 2050 being ischaemic heart disease, stroke, diabetes, and chronic obstructive pulmonary disease, compared with 2022, with ischaemic heart disease, neonatal disorders, stroke, and lower respiratory infections at the top. The global proportion of DALYs due to YLDs likewise increased from 33·8% (27·4–40·3) to 41·1% (33·9–48·1) from 2022 to 2050, demonstrating an important shift in overall disease burden towards morbidity and away from premature death. The largest shift of this kind was forecasted for sub-Saharan Africa, from 20·1% (15·6–25·3) of DALYs due to YLDs in 2022 to 35·6% (26·5–43·0) in 2050. In the assessment of alternative future scenarios, the combined effects of the scenarios (Safer Environment, Improved Childhood Nutrition and Vaccination, and Improved Behavioural and Metabolic Risks scenarios) demonstrated an important decrease in the global burden of DALYs in 2050 of 15·4% (13·5–17·5) compared with the reference scenario, with decreases across super-regions ranging from 10·4% (9·7–11·3) in the high-income super-region to 23·9% (20·7–27·3) in north Africa and the Middle East. The Safer Environment scenario had its largest decrease in sub-Saharan Africa (5·2% [3·5–6·8]), the Improved Behavioural and Metabolic Risks scenario in north Africa and the Middle East (23·2% [20·2–26·5]), and the Improved Nutrition and Vaccination scenario in sub-Saharan Africa (2·0% [–0·6 to 3·6]).InterpretationGlobally, life expectancy and age-standardised disease burden were forecasted to improve between 2022 and 2050, with the majority of the burden continuing to shift from CMNNs to NCDs. That said, continued progress on reducing the CMNN disease burden will be dependent on maintaining investment in and policy emphasis on CMNN disease prevention and treatment. Mostly due to growth and ageing of populations, the number of deaths and DALYs due to all causes combined will generally increase. By constructing alternative future scenarios wherein certain risk exposures are eliminated by 2050, we have shown that opportunities exist to substantially improve health outcomes in the future through concerted efforts to prevent exposure to well established risk factors and to expand access to key health interventions.FundingBill & Melinda Gates Foundation.</p