Mupirocin resistance in Staphylococcus aureus: A systematic review and meta-analysis

Objectives: Staphylococcus aureus is one of the most common pathogens causing nosocomial and community-acquired infections associated with high morbidity and mortality. Mupirocin has been increasingly used for treatment of methicillin-susceptible S. aureus (MSSA) and methicillin-resistant S. aureus (MRSA) infections. The aim of this study was to determine the prevalence of mupirocin-resistant S. aureus (MuRSA), mupirocin-resistant MRSA (MuRMRSA), high-level MuRSA (HLMuRSA) and high-level MuRMRSA (HLMuRMRSA) worldwide. Methods: Online databases including Medline, Embase and Web of Science were searched (2000�2018) to identify studies addressing the prevalence of MuRSA, MuRMRSA, HLMuRSA and HLMuRMRSA. STATA v. software was used to interpret the data. Results: Of the 2243 records identified from the databases, 30 and 63 studies fulfilled the eligibility criteria for MuRSA and MuRMRSA, respectively. Finally, 27 and 60 studies were included separately for HLMuRSA and HLMuRMRSA, respectively. The analyses revealed pooled and averaged prevalences of MuRSA, MuRMRSA, HLMuRSA and HLMuRMRSA of 7.6 95% confidence interval (CI) 6.2�9.0%, 13.8% (95% CI 12.0�15.6%), 8.5% (95% CI 6.3�10.7%) and 8.1% (95% CI 6.8�9.4%), respectively. Conclusion: Overall, these results show a global increase in the prevalence of HLMuRSA and HLMuRMRSA among clinical S. aureus isolates over time. However, there was only a significant increase in the prevalence of MuRMRSA compared with the other categories, especially MuRSA. Since mupirocin remains the most effective antibiotic for MSSA and MRSA decolonisation both in patients and healthcare personnel, a reduction of its effectiveness presents a risk for invasive infection. Monitoring of mupirocin resistance development remains critical. © 2019 International Society for Antimicrobial Chemotherap

Global genotype distribution of human clinical isolates of New Delhi metallo-β-lactamase-producing Klebsiella pneumoniae; A systematic review

Background and Aim: The global rise of antimicrobial resistance among bacterial strains is a rapidly growing challenge and is becoming a major public health concern. This study documents the worldwide spread and genotype distribution of human clinical isolates of New Delhi metallo-β-lactamase-producing Klebsiella pneumoniae (NPKP). Methods: Several international databases, including Web of Science, Embase and Medline were searched (2010 - 2019) to identify studies addressing the frequency of NPKP regionally or worldwide. Results: Of 4779 articles identified, 202 studies fulfilled the eligibility criteria and were included in our analysis. The frequency of NPKP in Asia, Europe, America, Africa and Oceania was 64.6, 20.1, 9.0, 5.6 and 0.4, respectively. The most prevalent sequence types (STs) among NPKP were ST11, ST290, ST147, ST340, ST15, ST278 and ST14 based on published studies. Conclusion: The dissemination of blaNDM variants in different STs among NPKP in the various region of world is a serious concern to public health. The prevalence of NPKP should be controlled by comprehensive infection control measures and optimization of antibiotic therapy. © 202

Impact of IgE-mediated Food Allergy on Parental Quality of Life in Iranian Patients

Food allergy is a common disorder especially in the first years of life. Strict avoidance of the responsible food is the most effective therapeutic measure so far. But this continuous vigilance could be stressful for the patient and family and decreases their quality of life (QOL). This survey was designed to evaluate the impact of IgE-mediated food allergy on parental QOL in Iranian patients and to develop a valid Persian version of "Food Allergy Quality Of Life-Parental Burden (FAQL-PB) questionnaire". 90 patients (28 females, 62 males) and their parents who were referred to the clinic of Allergy in Children's Medical Center, Tehran University of Medical Sciences, Tehran, Iran were enrolled. The questionnaire was translated with scientific method and its reliability was approved in a pilot study (ICC=0.75, cronbach-alpha=0.90). Among all patients the most common allergens were wheat (60) and cow's milk (42). The patient's age (p=0.02), parent's gender (p=0.004), mother's age (p=0.02), duration of the disease (p=0.048), and allergen multiplicity (p=0.004) were found to have the most significant correlation with family and social activity (FSA) domain. The most meaningful associations were achieved between parent's gender (p<0.001) and emotional issues (EM); as well as meal preparation (MP) with patient's age (p=0.02), parent's gender (p<0.0001) and also allergen multiplicity (p=0.003); likewise nutrition and health concern (NH) domain with parent's gender (p<0.001). Anaphylaxis's history did not place any burden on each domain. It was concluded that presence of food allergic patients in families could considerably affect all domains of QOL

Evaluating the Genetic Diversity of Helicobacter pylori Isolates in Patients Suffering from Gastritis

Backgrounds: Helicobacter pylori infections vary in severity and virulence in different populations for various reasons. There are different H. pylori strains with varying degrees of virulence. The genetic diversity of H. pylori strains in gastritis patients in different areas has not been well understood. This study aimed to evaluate the prevalence rate and different genotypes of H. pylori strains in clinical specimens of patients with gastritis in Ilam, Iran. Materials & Methods: Saliva and gastric biopsy samples were collected from 81 patients (55 males and 26 females in the age range of 20 to 90 years) referring to Ilam medical centers. After DNA extraction, the prevalence of H. pylori as well as vacA, cagA, and ureC genes was evaluated using PCR, and then each vacA-positive sample was further evaluated for m1m2 and s1s2 variants. Findings: The cagA and vacA genes were found in 27 (71) and 36 (94.7) H. pylori-positive samples, respectively. The cagA gene was detected in patients with gastric pain (44.4) and anorexia (18.51). Also, the results showed that the vacA s2m2 genotype and m2 allele were present in 32.9 of H. pylori isolates. Moreover, s2m2 and s1m2 genotypes were detected in 42.1 and 26.3 of vacA-positive samples, respectively. The lowest frequency was related to the m1 allele (17.18). Conclusion: This study results indicate a plausible relationship between the presence of some genotypes of H. pylori and the progression of gastritis, suggesting these markers as promising biomarkers to predict the disease severity. © 2022, TMU Press

CHARACTERIZATION OF STAPHYLOCOCCUS AUREUS ISOLATED FROM BURN WOUND; STRONG ANTIBACTERIAL ACTIVITY OF PHAGE COCKTAIL AGAINST VANCOMYCIN INTERMEDIATE-RESISTANT STAPHYLOCOCCUS AUREUS

A universal problem is about spread of Staphylococcus aureus infections in burn patients. The present study aimed to learn about the molecular characteristics and the resistance pattern of S. aureus strains isolated from burn patients. In this cross-sectional study, we investigated 100 unique S. aureus isolated from burn patients by antimicrobial activity and biofilm formation and evaluated the effect of Complex Pyobacteriophage, a commercial bacteriophage cocktail, against the isolates mentioned above. Methicillin-resistant Staphylococcus aureus (MRSA) comprised 76, and methicillin-susceptible Staphylococcus aureus (MSSA) comprised 24 of 100 S. aureus strains. The resistance rate among MRSA isolates was higher than compared of MSSA. Mupirocin resistance was found in 30 of isolates, with 28 (93.3) and 2 (6.7) strains of MRSA and MSSA, respectively, found. Vancomycin intermediate resistance in S. aureus (VISA) was 13 of MRSA strains. Two isolates were confirmed as vancomycin-resistant S. aureus (VRSA) strains and carried vanA. 31 and 62 of the total isolates showed inducible and constitutive resistance phenotypes. The rate of inducible and constitutive clindamycin resistance among MRSA strains was higher than MSSA strains. Biofilm production was detected in 66 of isolates. Strong, moderate, and weak producers accounted for 25, 17, and 24 of isolates. Phage analysis showed that 81 were susceptible to the phage cocktail, and only 19 were resistant to the phage cocktail. Our data indicated that VISA strains prevalence in the burn unit was mainly from S. aureus infections. Present work recommended that vancomycin treatment be closely monitored to prevent the spread of VISA and VRSA strains. Observations also highlighted the role of bacteriophage cocktails in eradicating S. aureus-related infections

Prevalence and Mechanisms of Carbapenem Resistance in Acinetobacter baumannii: A Comprehensive Systematic Review of Cross-Sectional Studies from Iran

Introduction: Carbapenem-resistant Acinetobacter baumannii (CRAB) is recognized to be among the most difficult antimicrobial-resistant gram-negative bacilli to control and treat. An understanding of the epidemiology of CRAB and the mechanisms of resistance to carbapenems is necessary to develop strategies to curtail their spread. Methods: Electronic databases were searched from January 1995 to December 2017 for all studies, which: (1) provide data on the frequency and antibiotic resistance profile of the isolated A. baumannii and (2) describe the mechanisms of carbapenem resistance in detail. Results: Sixty-eight studies were found referring to mechanisms of carbapenem resistance in clinical isolates of A. baumannii, and 56 studies were found referring to the frequency of CRAB. The pooled frequency of carbapenem resistance was 85.1 (95 confidence interval CI: 82.2-88.1) in 8,067 clinical isolates of A. baumannii. Resistances due to blaOXA23 (55.3%), blaOXA24 (41.4%), and blaOXA58 (5.2%) genes were the most prevalent reported mechanisms of resistance to carbapenem, respectively. Conclusions: Our data warn that CRAB will rise if the current situation remains uncontrolled. Better control infection strategies and antibiotic managements, particularly in the health care systems, are needed to limit the spread of this pathogen. © Copyright 2020, Mary Ann Liebert, Inc., publishers 2020

CHARACTERIZATION OF STAPHYLOCOCCUS AUREUS ISOLATED FROM BURN WOUND; STRONG ANTIBACTERIAL ACTIVITY OF PHAGE COCKTAIL AGAINST VANCOMYCIN INTERMEDIATE-RESISTANT STAPHYLOCOCCUS AUREUS

A universal problem is about spread of Staphylococcus aureus infections in burn patients. The present study aimed to learn about the molecular characteristics and the resistance pattern of S. aureus strains isolated from burn patients. In this cross-sectional study, we investigated 100 unique S. aureus isolated from burn patients by antimicrobial activity and biofilm formation and evaluated the effect of Complex Pyobacteriophage, a commercial bacteriophage cocktail, against the isolates mentioned above. Methicillin-resistant Staphylococcus aureus (MRSA) comprised 76, and methicillin-susceptible Staphylococcus aureus (MSSA) comprised 24 of 100 S. aureus strains. The resistance rate among MRSA isolates was higher than compared of MSSA. Mupirocin resistance was found in 30 of isolates, with 28 (93.3) and 2 (6.7) strains of MRSA and MSSA, respectively, found. Vancomycin intermediate resistance in S. aureus (VISA) was 13 of MRSA strains. Two isolates were confirmed as vancomycin-resistant S. aureus (VRSA) strains and carried vanA. 31 and 62 of the total isolates showed inducible and constitutive resistance phenotypes. The rate of inducible and constitutive clindamycin resistance among MRSA strains was higher than MSSA strains. Biofilm production was detected in 66 of isolates. Strong, moderate, and weak producers accounted for 25, 17, and 24 of isolates. Phage analysis showed that 81 were susceptible to the phage cocktail, and only 19 were resistant to the phage cocktail. Our data indicated that VISA strains prevalence in the burn unit was mainly from S. aureus infections. Present work recommended that vancomycin treatment be closely monitored to prevent the spread of VISA and VRSA strains. Observations also highlighted the role of bacteriophage cocktails in eradicating S. aureus-related infections

Prevalence and Mechanisms of Carbapenem Resistance in Klebsiella pneumoniae and Escherichia coli: A Systematic Review and Meta-Analysis of Cross-Sectional Studies from Iran

Introduction: Carbapenem-resistant Enterobacteriaceae (CRE) represents an urgent threat worldwide. We aimed to investigate the frequency of carbapenem-resistant Klebsiella pneumoniae and Escherichia coli in Iran. Materials and Methods: PubMed/Medline, Embase, Scopus, Web of Sciences, and Iranian databases were searched to find potentially relevant articles. Statistical analyses were performed using STATA version 14. Results: Forty-nine studies fulfilled the inclusion criteria. The pooled rates of resistance to carbapenem in K. pneumoniae and E. coli were 24.0 (95 confidence interval CI 18.0-31.0) and 5.0% (95% CI 2.0-8.0), respectively. blaOXA-48 gene was the most common cause of carbapenem resistance in K. pneumoniae and E. coli. Conclusions: CRE is prevalent in Iran, which confers the importance of strength prevention and control measures. © 2020, Mary Ann Liebert, Inc., publishers 2020