Renal Actinomycosis in Presence of Renal Stones in a Patient with End Stage Renal Disease

Renal actinomycosis is a rare infection, and actinomycosis mostly acts as a normal flora in mouth, colon and vagina. We present a case of 56 years old man, who referred to our center for renal transplantation with kidney stone and diagnosed  with renal actinomycosis.  This case has risen possibility of rare infection that can be considered in the setting of renal transplantation

Prevalence and contributing factors of methicillin-resistant staph. aureus and microbiological profile in diabetic foot infection

Background: Diabetic foot infections a common complication of diabetes. Staphylococcus aureus is most common pathogen associated with diabetic foot infection. Frequency of methicillin-resistant Staphylococcus aureus (MRSA) associated with diabetic foot infection at other country is 15-30% and important cause at hospital acquired infection. The aim of this study was to evaluate the prevalence of pathogenic organisms and the prevalence and contributing factors of MRSA in patients with diabetic foot infection. Methods: A cross-sectional study from 70 diabetic foot infection at Imam Khomeini Hospital, Tehran, Iran from March 2013 to September 2014. A retrospective analysis of wound swabs taken from infected foot ulcers in diabetic patient, selected from an outpatient diabetic foot. Swabs were used to obtain tissue fluid from the base after debriding the ulcer with a sterile scalpel. Sixty patients with positive wound swabs were included. Size of ulcer and ulcer grade were measured in all patients. Results: A total of 61 microorganisms were isolated. The mean number of isolate was 0/87. Corynebacterium spp were the sole pathogen in three cases than taked into normal flora. There wasn’t significant P-value between demographic subjects and MRSA frequency. In this study, P= 0/05, CI:95% were considered statistically significant. Gram-positive aerobic bacteria were the most common micro-organism isolated (52.54%) followed by gram-negative aerobic bacteria (44.26%). among the gram-positive aerobic organisms, Staphylococcus aureus was found most frequently and 10% were MRSA that confirmed by E-test. There wasn’t significantly different in measurement of the MRSA positive patients compared to MRSA negative patients (P> 0.05). Conclusion: In this study, MRSA prevalence was similar to other Asian studies and different from west countries study. There wasn't significant difference between gram-positive and gram-negative microorganisms that look out to change of microbiological profile in diabetic foot infections and creation multi-drug resistant bacteria. MRSA infections and other multi drug resistant organisms is a serious problem and increasing problem in diabetic foot infections. Further studies are required to assess the need for antibiotics in treating foot ulcers in diabetes and to assess the optimal therapeutic management

Incidence of Recurrent Urinary Tract Infection after Renal Transplantation

Background: The pathologies classified as urinary tract infections (UTI) can have a deleterious effect on patients who have undergone a renal transplantation.  Often recurrent UTIs will occur, leading to high morbidity, failure of the grafting process overall and even death.  The study presented here seeks to expand the knowledge of recurrent UTIs in the context of renal transplantation, what risks recurrent UTIs pose to transplant patients and evaluate possible treatments. Methods: Renal transplantations were performed on 94 patients.   For six months post-surgery the patients were evaluated for the presence of recurrent UTIs.  The criteria for determining a patient as having a UTI was given as finding   more than 103    and 105  pure colonies within one ml of urine for asymptomatic and symptomatic patients, respectively.   The criteria of recurrent UTI was defined as two or more conclusive UTIs within the first six months after the surgery or three more within a year after renal transplantation. Results: Of the 94 hospitalized patients, 29 UTIs were diagnosed (30.8%). The majority of diagnosed UTIs were in female patients (11.15, 73.3% vs.4.15, 26.7%; p-value = 0.003).   Those patients with diabetes mellitus correlated with a better chance of having a UTI (p-value = 0.019; CI = 1.2-12.2). The incidence rate of UTI was 51.7%, female predominant 73.3%. No  other  pathologies  were  shown  to  affect  the  chance  of  developing recurrent UTIs.   Typically Escherichia coli was the bacterium isolated from urine  cultures  (48.3%)  from  those  who  developed  recurrent  UTI.    The isolates tended to possess resistance to TMP / SMX and piperacillin but were susceptible to imipenem. Conclusion:   Recurrent UTIs in renal transplant patients can be mitigated with proper identification of risk factors

Posttransplant Infectious Complications: A Prospective Study on 142 Kidney Allograft Recipients

Introduction: We evaluated the posttransplant complications resulting from infections and their association with graft function, immunosuppressive drugs, and mortality.Materials and Methods: A total of 142 kidney allograft recipients were followed for 1 year after transplantation. The patients’ status was assessed during regular visits, and data including clinical characteristics, infections, serum creatinine level, acute rejection episodes, immunosuppressive regimen, graft function, and mortality were recorded and analyzed. Results: Infections occurred in 77 patients (54%). The lower urinary (42%) and respiratory (6.3%) tracts were the most common sites of infection. The most frequent causative organisms were Klebsiella in 34 (24%) and cytomegalovirus in 25 patients (18%). Wound infection occurred in 7 patients (5%). The mortality rate was 7.7% and infection-related death was seen in 5 patients (3.5%) who developed sepsis. Graft loss was seen in 16 patients (11%), of whom 2 developed cytomegalovirus infection, 2 experienced urinary tract infection, and 5 developed sepsis and died. Mycobacterial and hepatitis C infections were noticeably rare (0.7% and 2.8%, respectively). Conclusion: This study showed that infections are important causes of morbidity and mortality during the posttransplant period. We recommend that serologic tests be performed before and after transplantation to recognize and meticulously follow those who are at risk. In our study, high-risk patients were those with elevated serum creatinine levels who received high doses of immunosuppressive drugs. As the urinary tract is the most common site of infection, early removal of urethral catheter is recommended to reduce the risk of infection.</p

Presenting Effective Factors on Ecological Restoration of Cultural Landscapes

مناظر فرهنگی بخشی از میراث فرهنگی هر مرز و بومی است که در بستری طبیعی شکل گرفته اند و دارای تعامل پیوسته با طبیعت می باشند. امروزه با از بین رفتن بخشی از طبیعت که بستر شکل گیری این مناظر می باشند، حضور انسان در این مناظر محدود گردیده است. عدم انطباق پذیری گسستگی تعامل مطلوب انسان با این مناظر، پایداری مناظر فرهنگی را دچار اختلال نموده است. از این رو هدف اساسی در پژوهش حاضر دست یابی به اصول مرمت و بازیابی بستر طبیعی در مناظر فرهنگی و بسط این اصول در منظر تاریخی – فرهنگی بیستون در جهت بازیابی تعادل مطلوب انسان و طبیعت در این محدوده می باشد. به منظور تحقق پژوهش حاضر از روش تحقیق توصیفی – تحلیلی و موردی و از شیوه های مرور متون، اسناد کتابخانه ای و تحلیل اسناد تصویری استفاده شده است. در راستای دست یابی به هدف اصلی پژوهش، نخست به تحلیل و ارزیابی اکولوژیکی منظر طبیعی محدوده مطالعاتی از طریق تحلیل عناصر ساختاری موزاییک منظر بستر جهت شناسایی آشفتگی های به وجود آمده، پرداخته شده است. در نهایت با توجه به اصول اساسی مرمت اکولوژیکی منظر در گستره های فرهنگی، پیشنهادات مرمتی و توسعه ای ارائه گردیده است. نتایج حاصل از تحقیق حاکی از آن است که مرمت منظر طبیعی بستر مطالعاتی نیازمند حفاظت از آبراهه های موجود در بستر از دسترس گردشگران، حفاظت و ارتقا تنوع گونه های زیستی اعم از گیاهی و جانوری، حذف کاربری های صنعتی ناسازگار (کارخانه قند، اتوبان بین شهری) با محیط طبیعی، احیای ارتباط میان لکه های طبیعی بستر از طریق ایجاد دالان ها و لکه های جدید، احیای مرغزارهای بیستون با حذف زمین های کشاورزی از طریق کاشت درختان بومی می باشد

Universal Primers Used for Detection of Bacterial Meningitis

Background: Acute bacterial meningitis is among serious infections of the central nervous system (CNS). The early diagnosis and empiric antibiotic treatments have led to a reduction in morbidity and mortality rates. PCR and the enzymatic digestion of 16S rDNA fragment following the PCR by universal primers led up fast and sensitive determination. The aims of the present study was to improve our previous method for rapid and specific detection of common bacteria causing acute meningitis. Methods: According to the gene encoding 16S rDNA found in all bacteria, a set of primers was designed. Then the universal PCR was performed for bacterial agents of meningitis by employing broad-range DNA extraction method. The amplicons were digested with restriction enzymes to identify bacterial species. Results:  By the  enzymatic  digestion  of  the  amplicons  of  each  standard strain, specific patterns were achieved. These specific patterns may be used for comparison in CSF examination. The analytical sensitivity of the assay was  approximately 1.5×102   CFU/ml  of  CSF  even in  samples with  high amount of proteins. Conclusion: The universal PCR coupled with enzymatic digestion can be used to detect and identify bacterial pathogens in clinical specimens rapidly and accurately. Molecular diagnostic of bacterial meningitis, though expensive and labor-intensive, but is valuable and critical in patient management

Identification of Class-1 Integron and Various Β-Lactamase Classes among Clinical Isolates of Pseudomonas aeruginosa at Children's Medical Center Hospital

Background: Pseudomonas aeruginosa is one of the most important oppor- tunistic pathogens responsible for various types of infections. Children suffer significant morbidity and mortality due to nosocomial infections. The aim of this study was to investigate the presence of Class1 integron, blaBEL, blaPER, blaKPC, blaVIM, blaIMP and blaOXAgroup-1  genes among P. aeruginosa isolates at Children's Medical Center Hospital in Iran and to determine phenotypic evi- dence of ESBL and MBL production. Methods: Antibiotic susceptibility tests were analyzed for 72 P. aeruginosa clinical isolates. Isolates were identified by using biochemical tests and con- firmed by PCR assay for oprL gene. ESBL and MBL producer isolates were identified  by phenotypic  tests (double disc synergy tests). Detection of β- lactamase genes and class-1 integron were performed by PCR method. Results: All of the isolates were susceptible to ceftazidime / clavulanate, me- ropenem, imipenem and ciprofloxacin. About 83.3% and 16.7% of isolates were  resistant  to  ceftazidime  and  amikacin  respectively.  Approximately,83.3% of isolates were considered as potential ESBL producers. None of the clinical isolates showed above β-lactamase genes. It seems that, the reason is the absence of class-1 integron in all of isolates. About 16.7% of strains were identified  as multidrug  resistant.  Fortunately,  all of the isolates were sus- ceptible to meropenem and imipenem which are effective against ESBL pro- ducing strains. Conclusion:  The absences of class-1 integron decreases the probability of acquired β-lactamase especially MBL. Thus, absolute susceptibility to carba- penems and ciprofloxacin among P. aeruginosa isolates in pediatric hospital has important implications for empirical antimicrobial therapy. It seems that these properties help to decrease mortality of nosocomial infections within children

Frequency and Antimicrobial Resistance Patterns of Methicillin-Resistant Staphylococcus aureus in Tehran

Background: Methicillin-Resistant Staphylococcus aureus (MRSA) is the one of most commonly isolated organisms from clinical samples which can cause life- threatening infections. The emergence and spread of antibiotic resistance makes the treatment of these infections more complicated. In this study, we aimed to determine  the  patterns  of  antibiotic  resistance  among  MRSA  isolates  from Tehran, Iran. Methods: From December 2012 to April 2014, 120 clinical samples were collected. MRSA was identified by cefoxitin disc diffusion. Antimicrobial susceptibility testing was performed on MRSA isolates for eight other antibiotics by disc diffusion method according to CLSI (2013) recommendations. Also, the minimum inhibitory concentration (MIC) was determined for vancomycin by MIC test strips. Results: According to disc diffusion, 60 (50%) isolates showed resistance to cefoxitin. Among these isolates, the rate of resistance to nitrofurantoin, vancomycin, teicoplanin, doxycycline, trimethoprim, erythromycin, clindamycin, and ciprofloxacin were 0%, 0%, 0%, 28.3%, 28.3%, 58.3%, 63.3%, and 70%, respectively. All isolates were susceptible to vancomycin according to disc diffusion and MIC. Conclusion: Compared to other reports from Iran, our study indicated a moderate rate  for  MRSA.  However,  the  rates  of  resistance  to  generally  prescribed antibiotics in these isolates were high. In this situation, it is recommended to monitor the antibiotic resistance in these hospitals

Phenotypic Changes of Oxacillin Resistance in Methicillin-resistant Staphylococcus aureus Strains by Successive Passaging

Background and purpose: Rotational use of antibiotics can decrease antibiotic resistance in Staphylococcus aureus strains. The present study aimed to evaluate the alteration of oxacillin resistance in methicillin-resistant Staphylococcus aureus (MRSA) strain carrying SCCmec III cassette in long-term evolutionary experiments in an antibiotic-free medium. Materials and methods: In a cross-sectional study, 10 MRSA isolates were identified between September to December 2018 by conventional microbiology methods from clinical isolates of a university hospital. Then, SCCmec typing was carried out using Multiplex PCR. One strain was included in the evolutionary experiment as ancestor and was cultivated for up to 900 generations. Minimum inhibitory concentration (MIC) of oxacillin of the evolved strains was evaluated. The selected strains were compared with the ancestral strain in terms of growth characteristics such as generation time and competitive cultivation. Results: Out of ten MRSA isolates, six and four were found to harbor SCCmec type III and SCCmec type IV, respectively. One strain with SCCmec III was randomly selected as ancestral strain. The ancestor was resistant to oxacillin while the evolved strains were susceptible. Generation times in the evolved strains were 6-8 minutes shorter than those in the ancestral strain. The evolved strains, with the ratio of 1% in competition experiment, accounted for 20-48% of the final population. Conclusion: Compared to the ancestor, the evolved strains presented higher fitness in the oxacillin-free environment. The current study indicates the powerful effect of antibiotic rotation strategy on reducing methicillin resistant MRSA

Chlamydia trachomatis, Neisseria gonorrhoeae, and Trichomonas vaginalis among women with genitourinary infection and pregnancy-related complications in Tehran: A cross-sectional study

The present study investigates the prevalence of Chlamydia trachomatis (CT), Neisseria gonorrhoeae (NG), and Trichomonas vaginalis (TV) among women with genitourinary infection and pregnancy-related complications in Tehran. It also evaluates the demographic information, symptoms, and sequelae. Endocervical samples were obtained over a period of eight months from 360 women including 180 symptomatic patients and 180 patients with pregnancy-related complications and infertility. CT, NG, and TV were detected in 10.8%, 6.9%, and 8.3% of all patients, respectively. The prevalence of CT, NG, and TV among women in the symptomatic group was 11.1%, 7.2%, and 13.3%, respectively, and among women with pregnancy-related complications and infertility was 10.6%, 6.7%, and 3.3%, respectively. Associations between chlamydia and ectopic pregnancy (p = 0.001), and infertility (p < 0.001) were observed. Abortion (p = 0.008), infertility (p = 0.005), and ectopic pregnancy (p < 0.001) were associated with gonorrhea. Abnormal vaginal discharge (p = 0.02) and vulvar itching (p = 0.02) were associated with trichomoniasis. Overall, the prevalence rates of CT, NG, and TV were high in these patient groups. These high prevalences suggest that screening programs are required to reduce the burden of these sexually transmitted infections and their effects on genitourinary symptoms, pregnancy-related complications, and infertility