Prevalence of erm Gene among Clinical Isolates of Staphylococcus aureus in Shahrekord, Iran

Background: Development of drug resistance to Staphylococcus aureus (S. aureus) has led to the use of older antibiotics such as macrolide-lincosamide-streptogramin B (MLSB) for the treatment of infections. MLSB resistance can be caused by several mechanisms, however, one of the predominant reasons is target modification mediated by erm genes. The objective of this study is to determine the prevalence of erm genes and the frequency of constitutive MLSB (cMLSB), inducible MLSB (iMLSB), and MS phenotypes using D-test and polymerase chain reaction (PCR) methods. Methods: D-test was performed on 110 clinical specimens of S. aureus collected from Kashani and Hajar Hospitals in Shahrkord from October 2014 to May 2015. After sampling, DNA extraction was performed by simple boiling method and, in order to detect erm genes, multiplex PCR was carried out on erythromycin resistant isolates using specific primers. Results: The result of this study revealed that among 110 S. aureus isolates examined, 35 (31.8%) were MRSA and frequency of cMLSB, iMLSB, and MS resistant phenotypes were 22 (20%), 9 (8.2%), and 2 (1.8%), respectively. The genes ermA, ermB, and ermC were detected in 27 (24.5%), 28 (25.4%), and 26 (23.6%) isolates. Conclusion: This study demonstrated that cMLSB was the most common phenotype among isolated S. aureus. Moreover, another interesting point to notice in our study was the high frequency of the ermB gene in iMLSB resistant phenotypes

Drug Resistance Patterns and Genotyping of Acinetobacter baumannii Strains Isolated from Patients Admitted to Shahrekord Teaching Hospitals Using REP-PCR

Background & objectives In recent years, Acinetobacter baumannii has been shown to be associated with several nosocomial infections, including pneumonia, bacteraemia, urinary tract infections, wound infection and meningitis. This organism can survive in the hospital environment and rapidly develops resistance to many antibiotics. The molecular genotyping can increase our knowledge about the spread of A. baumannii strains from one hospital to another and their drug resistance. Therefore, this study aimed to determine the prevalence of antibiotic resistance profile as well as phylogenetic relationships of A. baumannii strains in Shahrekord teaching hospitals. Methods In this study, antibacterial susceptibility patterns of A. baumannii strains isolated from different clinical specimens (urine, blood, sputum) to amikacin, ampicillin/sulbactam, aztreonam, cefepime, ceftazidime, ciprofloxacin, gentamycin, imipenem, meropenem, norfloxacin, ofloxacin, piperacillin/tazobactam, tobramycin were tested using disk diffusion )Kirby-Bauer( method. Finally, genotyping of A. baumannii strains was performed using REP-PCR method. Results During this study, 50 samples of patients were identified as A. baumannii) 71%(, and their drug resistance rates were assessed. All A. baumannii strains were resistant to ceftazidime and cefepime and also a high rate of resistance to aztreonam, norfloxacin, ciprofloxacin, amikacin, imipenem, gentamycin, and ampicillin-sulbactam were observed. On the other hand, our results demonstrated nine genotype groups among A. baumannii strains based on REP-PCR method. Conclusion Due to the high prevalence of antibiotic resistance among isolated A. baumannii strains, similarities between different genotypes and the dispersion of these genotypes in different parts of Shahrekord hospitals, the implementation of infection control programs in different parts of the hospital is necessary. Keywords: Acinetobacter baumannii , Antibiotic Resistance , Genotyping , REP-PC

Development and psychometric properties of health care workers’ concerns in infectious outbreaks scale

IntroductionHealthcare workers are a crucial workforce; from a moral perspective, understanding their concerns and how to support them is crucial and makes it possible for health services to keep functioning. This study aimed to develop and validate Health Care Workers’ Concerns in Infectious Outbreaks Scale (HCWCIOS).MethodsThis exploratory sequential mix-method study was employed to design and validate the HCWCIOS. The initial tool was designed after searching similar studies and performing a qualitative phase under the semi-structured approach. Both qualitative and quantitative methods were used to evaluate the face and content validity. The content validity ratio, content validity index, and item-level content validity index were also calculated. Exploratory factor analysis was employed to evaluate the construct validity. Using a convenient sampling method, 354 Iranian healthcare workers participated in the study. Computing Cronbach’s alpha coefficient estimated the internal consistency for HCWCIOS and its subscales. Furthermore assessed was test–retest reliability.ResultsThe preliminary scale was designed with 57 items. By eliminating nine items in the content validity phase and 12 items during factor analysis, the final 36-item scale was developed on six factors: inadequate preparedness, lack of knowledge, risk perception, affected social relations, work pressure, and absenteeism. These six factors accounted for 46.507% of the total variance. The whole scale’s Cronbach’s alpha coefficient was 0.912, and the intra-class correlation coefficient was 0.88.ConclusionA 36-item HCWCIOS has good psychometric properties and is suitable for measuring healthcare workers’ concerns during a pandemic

Evaluation of Cause of Deaths' Validity Using Outcome Measures from a Prospective, Population Based Cohort Study in Tehran, Iran

OBJECTIVE: The aim of this study was to evaluate the validity of cause of death stated in death certificates in Tehran using outcome measures of the Tehran Lipid and Glucose Study (TLGS), an ongoing prospective cohort study. METHODS: The cohort was established in 1999 in a population of 15005 people, 3 years old and over, living in Tehran; 3551 individuals were added to this population three years later. As part of cohort's outcome measures, deaths occurring in the cohort are investigated by a panel of medical specialists (Cohort Outcome Panel--COP) and underlying cause of death is determined for each death. The cause of death assigned in a deceased's original death certificate was evaluated against the cause of death determined by COP and sensitivity and positive predictive values (PPV) were determined. In addition, determinants of assigning accurate underlying cause of death were determined using logistic regression model. RESULT: A total of 231 death certificates were evaluated. The original death certificates over reported deaths due to neoplasms and underreported death due to circulatory system and transport accidents. Neoplasms with sensitivity of 0.91 and PPV of 0.71 were the most valid category. The disease of circulatory system showed moderate degree of validity with sensitivity of 0.67 and PPV of 0.78. The result of logistic regression indicated if the death certificate is issued by a general practitioner, there is 2.3 (95% CI 1.1, 5.1) times chance of being misclassified compared with when it is issued by a specialist. If the deceased is more than 60 years, the chance of misclassification would be 2.5 times (95% CI of 1.1, 5.9) compared with when the deceased is less than 60 years

Prevalence of Fluoroquinolone-Resistant Campylobacter Species in Iran: A Systematic Review and Meta-Analysis

Background. Campylobacter species are one of the main causes of bacterial food poisoning worldwide. Recently, WHO reported that the emergence of fluoroquinolone-resistant Campylobacter species is becoming a public health issue around the world. The aim of the present systematic review and meta-analysis was to evaluate the prevalence of the antimicrobial susceptibility patterns of Campylobacter species, especially fluoroquinolone-resistant strains isolated from human and animal origins in Iran. Methods. Using related keywords and without date and language limitations, a comprehensive literature search was conducted in PubMed, Scopus, ISI Web of Knowledge, Google Scholar, and SID to identify relevant studies on the prevalence of the antimicrobial susceptibility patterns of Campylobacter species in Iran. Results. A total of 34 reports (9 in Persian and 25 in English) were selected based on inclusion and exclusion criteria. Disk diffusion, E-test, and agar dilution were common methods used for antimicrobial susceptibility testing. The antibiotic resistance profiles of Campylobacter species against fluoroquinolones were as follows: 53.6%, 41.8%, and 0% to ciprofloxacin for C. jejuni, C. coli, and C. lari, respectively, 24.3% and 25.1% to enrofloxacin for C. jejuni and C. coli, respectively, 59.6% and 49.2% to nalidixic acid for C. jejuni and C. coli, respectively, and 87.3% and 64.7% to ofloxacin for C. jejuni and C. coli, respectively. Conclusion. Our findings revealed a high prevalence of fluoroquinolone-resistant Campylobacter species in Iran. This calls for the use of more effective antibiotics with low resistance rates including aminoglycosides, chloramphenicol, and imipenem

Antibiotic resistance of Neisseria species in Iran: A systematic review and meta-analysis

Objective: To estimate the prevalence of antibiotic resistance of Neisseria species in Iran. Methods: A systematic and electronic search using relevant keywords in major national and international databases was performed until 6th July, 2018 in order to find studies reporting the prevalence of antibiotic resistance of Neisseria species in Iran. Results: A total of nine studies were found to be eligible based on predefined inclusion and exclusion criteria. Our analysis indicated that the prevalence of Neisseria gonorrhoeae resistance to different antibiotics was as follows: 66.9% to penicillin, 59.1% to ciprofloxacin, 11.1% to ceftriaxone, 21.6% to spectinomycin, 13.8% to cefixime, 82.4% to co-trimoxazole, 52.7% to tetracycline, 29.9% to gentamicin, 87.5% to ampicillin, 11.1% to azithromycin, 2.2% to chloramphenicol, 50.1% to cefepime and 50.0% to vancomycin. Antimicrobial resistance rates of Neisseria meningitidis was as follows: 30.0% to penicillin, 33.3% to amoxicillin, 33.3% to cephalexin, 55.6% to ampicillin and 0.0% to ciprofloxacin, ceftriaxone, cefotaxime, amikacin, co-trimoxazole, gentamicin, kanamycin, chloramphenicol and ceftizoxime. Conclusion: Neisseria gonorrhoeae and Neisseria meningitidis isolates of Iran show resistance to different types of antibiotics. Therefore, care should be exercised for the use of penicillin, ciprofloxacin, co-trimoxazole, tetracycline, gentamicin, ampicillin, cefepime and vancomycin for gonococcal infections, and also with respect to the use of penicillin, amoxicillin, ampicillin and cephalexin for meningococcal infections in Iran

Is Penicillin-Nonsusceptible Streptococcus pneumoniae a Significant Challenge to Healthcare System? A Systematic Review and Meta-Analysis

Background. In recent years, antibiotic-resistant pathogens including penicillin-nonsusceptible Streptococcus pneumoniae (PNSP) have posed serious threats against human health. The aim of this meta-analysis was to investigate the prevalence of Streptococcus pneumoniae drug resistance particularly the incidence of PNSP strains in Iran. Methods. A systematic search was done in national and international electronic databases using Persian and English keywords. Up until May 20, 2020, a total of 58 publications were detected as eligible articles based on the inclusion and exclusion criteria, and then the selected studies were enrolled for data extraction and meta-analysis according to the PRISMA guidelines. Results. A high rate of PNSP (46.9%) and multidrug-resistant (MDR) S. pneumoniae (45.3%) in our isolates were evident. Furthermore, total frequency resistance to other drugs in S. pneumoniae was as follows: erythromycin 41.1%, azithromycin 53.2%, tetracycline 39.9%, levofloxacin 1.7%, rifampin 1.2%, clindamycin 31.7%, vancomycin 1.7%, trimethoprim/sulfamethoxazole 63.9%, chloramphenicol 20%, ceftriaxone 10.9%, amoxicillin 30.5%, ciprofloxacin 8.3%, imipenem 6.1%, linezolid 0%, and cefotaxime 8.3%. Conclusion. Although the overall prevalence of cephalosporin- and carbapenem-resistant Streptococcus pneumoniae was low, penicillin-resistant strains, especially PNSP, could become a significant challenge to the healthcare system in Iran. Hence, the prescription of penicillin as the first-choice antibiotic in the treatment of S. pneumoniae infections should be avoided

The role of Toll-Like Receptor Gene Polymorphisms in Tuberculosis Susceptibility: A Systematic Review and Meta-Analysis

Introduction: Susceptibility to tuberculosis (TB) infection varies in individuals and is linked to genetic variations in the toll-like receptors (TLRs) genes. The current study employed a systematic literature review and meta-analysis to describe the most prevalent single nucleotide polymorphisms (SNPs) from various TLRs and to assess the association between these polymorphisms and tuberculosis susceptibility. Methods: The PubMed, Google Scholar, Scopus, and ISI Web of Knowledge databases were searched for all articles published before May 25, 2015, that contained the target keywords. Following the application of the inclusion and exclusion criteria, a total of 37 relevant articles were identified that examined the association between the TLRs gene polymorphism and susceptibility to tuberculosis.Result: A meta-analyses approach to the research determined that there is a statistically significant association between TLR1 rs4833095, TLR6 rs5743810, and TLR8 rs3788935 in the allelic model and also TLR1 rs4833095, TLR1 rs5743018, TLR2 rs5743708, TLR6 rs5743810, and TLR8 rs3761624 in the co-dominant model with increased or decreased susceptibility to tuberculosis. No associations were observed between the other TLRs polymorphisms and tuberculosis risk.Discussion: Several studies have found that host genetic factors, such as SNPs in TLRs gene, may increase an individual’s susceptibility to tuberculosis. Therefore, the identification of these SNPs is important to investigate immune responses to TB.Conclusion: The present study concluded that there is an association between some polymorphisms of TLRs and tuberculosis risk. Thus, for a better understanding about the role of SNPs to TB susceptibility, additional studies on alternative TLRs SNPs are needed

The Effect and Persistency of 1% Aluminum Chloride Hexahydrate Iontophoresis in the Treatment of Primary Palmar Hyperhidrosis

Abstract Topical solutions containing aluminum chloride are known to be the first line of therapy for hyperhidrosis. Palmar hyperhidrosis however, is less responsive to aluminum chloride therapy and successful treatment may require 6-8 h application of high concentrations up to 30% that commonly leads to skin irritation. The purpose of this study is to investigate the effect of 30 min iontophoretic application of low concentration (1%) aluminum chloride solution in patients with palmar hyperhidrosis. Iontophoresis of 1% aluminum chloride was applied to one hand of twelve patients with palmar hyperhidrosis for four successive days. The subjects' other hand was treated topically with the same solution at the same time. Gravimetric and iodine-starch tests were performed at baseline, 3 days, 1, 2, 3 and 4 weeks after the last treatment. Experimental hand showed significant hypohidrosis from the 3 rd day until the 4 th week post-treatment (p < 0.04) which was lower than the control hand throughout the follow-up period. Iontophoresis of low concentration aluminum chloride hexahydrate can induce hypohidrosis that is more persistent than its topical application and with no side effects

Potential of polymeric particles as future vaccine delivery systems/adjuvants for parenteral and non-parenteral immunization against tuberculosis: A systematic review

Objective(s): Production of effective tuberculosis (TB) vaccine is necessity. However, the development of new subunit vaccines is faced with concerns about their weak immunogenicity. To overcome such problems, polymers-based vaccine delivery systems have been proposed to be used via various routes. The purpose of this study was to determine the potential of polymeric particles as future vaccine delivery systems/adjuvants for parenteral and non-parenteral immunization against TB. Materials and Methods: PubMed, Scopus, Science-Direct, and the ISI web of knowledge databases were searched for related keywords. A total of 420 articles, written up to June 25, 2016, were collected on the potential of polymeric particles as TB vaccine delivery systems after parenteral and non-parenteral immunization. Thirty-one relevant articles were selected by applying inclusion and exclusion criteria. Results: It was shown that the immunogenicity of TB vaccines had been improved by using biodegradable and non-biodegradable synthetic polymers as well as natural polymers and they are better able to enhance the humoral and cellular immune responses, compared to TB vaccines alone. The present study revealed that various polymeric particles, after M. tuberculosis challenge in animal models, provide long-lasting protection against TB. PLGA (poly (lactide-co-glycolide)) and chitosan polymers were widely used as TB vaccine delivery systems/adjuvants. Conclusion: It seems that PLGA and chitosan polymers are well-suited particles for the parenteral and non-parenteral administration of TB vaccines, respectively. Non-biodegradable synthetic polymers in comparison with biodegradable synthetic and natural polymers have been used less frequently. Therefore, further study on this category of polymers is required