The Susceptibility Evaluation of Multiresistant Gram-Negative Bacilli to Meropenem and Imipenem

Introduction: Nosocomial infections are responsible for the much of the morbidity and mortality found in hospitals. The present study was conducted on 70 bacterial strains isolated from hospitalized patients in various medical units of Baqiyatallah Hospital in Tehran, Iran during a period of 12 months from; March to February 2009. Methods: The bacterial sensitivity for meropenem and imipenem was evaluated using the E-test and explanations of the MIC values. All patients were included in this study that had been hospitalized with no signs and symptoms of infection within the first 48 hours of hospitalization and began presenting signs and symptoms of infection after 48 hours of hospitalization. Results: Resistance to meropenem and imipenem was confirmed with E-test (AB Biodisk, Sweden) and disc diffusion methods. Meropenem and imipenem were active against 61 (64.2%) and 62(65.2%) strains, respectively, of the 95 ESBL positive strains. Conclusion: The activity of meropenem or imipenem against gram negative ESBL-positive bacilli is decreasing rapidly but even so these antibiotics are effective against nosocomial multiresistant organisms

Identification and molecular epidemiology of nosocomial outbreaks due to Burkholderia cepacia in cystic fibrosis patients of Masih Daneshvary Hospital, Iran

Introduction. B. cepacia complex have emerged as an important opportunistic pathogen in hospitalized and immunocompromised patients. Small hospital outbreaks are frequent and are usually due to a single contaminated environmental source. In this study we were going to investigate the role of B.cepacia complex in those patients suspected to involve with cystic fibrosis and evaluate responsible types in Masih Daneshvary Hospital. Methods. One hundred specimens were collected from all admitted patients who were suspected to cystic fibrosis to Masih Daneshvary hospital during one year April 2011 till end of March 2012. All were culture and identified standard procedure. All samples were checked by API system (API20NE) and by specific PCR method for genus Bulkhorderia and Bcc as well. Identified strains were finally tested by PFGE system to identifying specific involving pulse-types. Results. Isolation and identification methods revealed 5 specimens were B.cepasia, The frequency of the cystic fibrosis detected at this study was lower than other similar study previously reported. All these isolates showed similar pattern by PFGE standard protocol that may have spread from a single source and could not be attributed to cross infections from patient to patients. Discussion. Application of PFGE and identification of pulse-type is a potential tool to enhance the investigation of apparent nosocomial outbreaks of B.cepacia. However it needs to be adjusted with environmental findings. Implementation of educational programs and adherence to infection control policies are obviously the main element for complete elimination of an outbreak

Survey of epidemiology and bacteriology features of cholera in Iran

AbstractObjectiveTo determine epidemiology and antimicrobial susceptibility patterns of Vibrio (V.) cholerae O1 biotype EL Tor in summer outbreak of 2008 in Iran.MethodsStool samples were collected from patients suspected to have cholera admitted to hospitals and clinics. Specimens examined by conventional bacteriological methods. All isolates were sent to cholera reference laboratory for further confirmation, stereotyping and susceptibility testing.ResultsA total of 220 patients were diagnosed as cholera. All cases confirmed by Iranian reference health laboratory. One hundred ninety nine of 220 V. cholerae serotypes were Inaba and 21 serotypes were Ogawa. All cases were reported from thirteen provinces. The majorities of cases were from Tehran, Qum and Zahedan provinces with 56, 26 and 25 cases respectively. 24(11%) of patients were under 15 years old and 196 (89%) of patients were older than 15 years.149 (68%) of patients were male and 71 (32 %) were female. 129(59%) of patients had Iranian nationality,79 (36.5%) were from Afghanistan and, 12 (5%) were from Pakistan. All isolates were resistant to co-trimoxazole, nalidixic acid, furazolidone, and intermediate to chloramphenicol and were susceptible to tetracycline, ciprofloxacin, and erythromycin.ConclusionOur study reveals that in recent outbreak caused by V. cholerae EL Tor serotype Inaba is the predominant serotype. All isolates are resistant to cotrimoxazole, nalidix acid and furazolidon

The Challenges in Diagnosis of Brucellosis Serological Tests and Available Approaches

Brucellelosis has been almost eradicated in developed countries while in under developed areas from Mediterranean regions to Arabic countries and even in Indian subcontinental can cause serious health problems. This point can be found out easily in released reports. It is over a century that various serological methods have been introduced and applied for diagnosis of brucella infection, but all were not able to provide satisfactory results. Therefore, clinicians treat the patients with various unspecific treatment protocols based on clinical signs and symptoms, consequently causing treatment failure or possible relapse later on. This article aimed to have short survey on serological diagnosis of brucellosis and proposed an approach at present situation of brucellosis diagnostic specifically for local laboratories

Original Article A five-year study on the epidemiological approaches to cholera in Iran

Abstract Background: Cholera is considered a key indicator of social development but still is reported in various cities of Iran. The present study aimed to analyze the available information regarding cholera outbreaks since 2010 in Iran. Methods: All cases reported to the Center for Disease Control and Prevention of Ministry of Health and Education who had been confirmed as cholera cases by the Health Reference Laboratory, were entered into this study since 2010. A specific spreadsheet was designed to ensure the safe keeping of the patient records. Results: A total of 1522 patients were clinically diagnosed as cholera with laboratory confirmation over the study period. Cholera was detected in 26 Provinces and 115 cities during this period. Mean age of the patients was 35.1±17, both the Inaba and Ogawa strains were isolated. The highest mortality and the morbidity rate was 1.98% in 2013. The most cholera prevalent provinces in order of frequency were Baluchistan, Alborz, Gilan, Golestan and Qom, as well as Tehran. Inaba serotype was the most common cause of mortality and morbidity in 2013. Conclusion: These findings indicate significant outbreaks of cholera in some of the provinces of Iran and warrant appropriate treatment and preventive measures

Looking Again at the Diagnosis of Brucellosis Difficulties in Iran

Based on the frequently reports, final diagnosis of brucellosis is facing delay problem.  Significant percentage of hospitalized patients has been under unspecified and mostly single treatment. Therefore laboratory evidence and use of highly sensitive methods have an important role in final diagnosis. The increasing of brucellosis in recent years is due to increasing livestock infections and insufficient coverage of vaccination; we should also consider absence of active supervision on the distribution of livestock products specifically in local manufacturers and inefficient diagnostic procedures. Lack of coordination between responsible and decision-making centers such as subsidiaries of Ministry of Health and Agriculture has an important role. Unfortunately, despite the publication of numerous scientific papers, especially in the field of epidemiology, no clear picture of the status of brucellosis has been presented by the responsible authorities in Iran. In this study, we tried to look at the situation of brucellosis in Iran and to find out more about the limitations and advantages of each method by describing the diagnostic properties of each method. The aim of this study is to provide routine diagnosis limitations and errors to undertake necessary revision in diagnostic measures, in particular at the health labs level

A novel method “CHROMagar” for screening vancomycin-resistant enterococci (VRE) isolates

Infection with vancomycin-resistant enterococci (VRE) is reported to be increasing and becoming a problem especially in health care systems with prolonged survival in the environment. In this study, we compared the performance characteristics of CHROMagar with conventional methods for detection of VRE in clinical urine specimens. A total of 7404 urine samples were entered in the study. All specimens were cultured by routine microbiological method and were simultaneously cultured in prepared CHROMagar plate for growth characteristics with positive and negative controls. Susceptibility tests were performed by disk diffusion method as recommended by Clinical Laboratory Standards Institute. We also used E-test minimum inhibitory concentration (MIC) for confirmation of VRE isolates. Total isolation rate was 22.19% of the tested specimens. Enterococcus faecium and Enterococcus faecalis were isolated in 10 (0.13%) and 72 (0.92%) cases, respectively while six were VRE belonging to admitted patients. Analyzed data of VRE cases revealed the results of all three applied methods. The antimicrobial susceptibility testing, E-test and CHROMagar were in agreement in all the six identified VRE cases. The obtained results in the present study indicate that CHROMagar method is easy to use, and is a cost- and time-effective procedure for the isolation of VRE especially in urine specimens.Key words: Vancomycin-resistant enterococci (VRE), CHROMagar, admitted patients