Management of Hospital Infection Control in Iran: A Need for Implementation of Multidisciplinary Approach

AbstractNosocomial, or hospital-acquired, infections are considered the most common complications affecting hospitalized patients. According to results obtained from studies conducted in the Children Medical Center Hospital, a teaching children's hospital and a tertiary care referral unit in Tehran, Iran, improvements in infection control practices in our hospital seem necessary. The aim of this study was to identify risk management and review potential hospital hazards that may pose a threat to the health as well as safety and welfare of patients in an Iranian referral hospital. Barriers to compliance and poor design of facilities, impractical guidelines and policies, lack of a framework for risk management, failure to apply behavioral-change theory, and insufficient obligation and enforcement by infection control personnel highlight the need of management systems in infection control in our hospital. In addition, surveillance and early reporting of infections, evaluation of risk-based interventions, and production of evidence-based guidelines in our country are recommended

A case of invasive aspergillosis in CGD patient successfully treated with Amphotericin B and INF-γ

BACKGROUND: Chronic granulomatous disease (CGD) is a rare disorder of phagocytes in which absence of superoxide and hydrogen peroxide production in phagocytes predisposes patients to bacterial and fungal infections. The most common fungal infections in these patients are caused by Aspergillus species. CASE PRESENTATION: Here, we describe Aspergillus osteomyelitis of the ribs and hepatic abscess in a 5-year-old boy. The patient was successfully treated with Amphotericin B and INF-γ. CONCLUSION: With respect to the high frequency of aspergillosis in the CGD patient, immune deficiency should be investigated in patients with invasive aspergillosis. Moreover, using antifungal drugs as prophylaxis can improve the quality of life in these patients

Frequency and antimicrobial susceptibility of Shigella species isolated in Children Medical Center Hospital, Tehran, Iran, 2001-2006

AbstractAppropriate antimicrobial treatment of shigellosis depends on identifying its changing resistance pattern over time. We evaluated 15,255 stool culture submitted from July 2001 to June 2006 to the Laboratory of Children Medical Center Hospital. Specimen culture, bacterial identification, and disk diffusion susceptibility testing were performed according to National Committee for Clinical Laboratory Standards guidelines. From 15,255 stool samples, 682 (4.5%) were positive for Shigella species. The most common species of Shigella were S. flexneri (48%) and S. sonnei (45%); other results were S. dysenteriae (5%) and S. boydii (2%). The rate of Sensitivity to ceftriaxone (95%), ceftizoxime (94%), and nalidixic acid (84%) were among our isolates. Resistance to co-trimoxazole and ampicillin was 87% and 86%, respectively. S. flexneri was more multiresistant than other species (47.9%). Our isolates are overall most sensitive to ceftriaxone, ceftazidime, and nalidixic acid (> 84%). They were most resistant to co-trimoxazole and ampicillin (> 86%). Because resistance varies according to specific location, continuous local monitoring of resistance patterns is necessary for the appropriate selection of empirical antimicrobial therapy

Clinical Manifestations, Laboratory Findings, and Therapeutic Regimen in Hospitalized Children with Brucellosis in an Iranian Referral Children Medical Centre

Brucellosis is considered a known widespread zoonotic disease and is endemic in Mediterranean region, like Iran. This study reviewed the clinical manifestations, laboratory findings, and therapeutic regimen in childhood brucellosis in Iran. In this retrospective study, we reviewed hospital-records of 34 consecutive children with a confirmed diagnosis of brucellosis among a total number of 10,864 patients admitted to Children\u2019s Medical Center, Tehran, Iran, between 2002 and 2010. Among the patients diagnosed with brucellosis, 22 (65%) were admitted during spring and summer. Clinical findings of these patients at admission were arthritis, splenomegaly, hepatomegaly, lymphadenopathy, maculopapular skin rashes, and fever. Anaemia (53%) and leukopenia (33%) were the most common findings in the children. Only one patient had presented with leukocytosis. Four children (12%) were thrombocytopenic, and none of patients had pancytopenia. Blood cultures were positive in 5 patients (23%). Only one patient underwent bone-marrow aspiration and had positive culture for Brucella spp. Positive titres were found in 33 cases (97%) in Wright test, 23 cases (96%) in Coombs test, and 16 patients (72.7%) in 2ME (2-Mercaptoethanol) test. In one case, Wright and Coombs test titres were below 1:80 while Brucella spp. were isolated from blood at the same time. It is concluded, prolonged fever with joint involvement and organomegaly may increase possibility of infection with Brucella spp. Appropriate treatment regimen by more tolerable oral drugs, with a duration of at least 8 weeks, is recommended

Seroprotection after hepatitis B vaccination in children aged 1 to 15 years in central province of Iran, Semnan

Introduction. There are controversies over the long-term persistence of post vaccination immunity to hepatitis B and the need for booster doses of the vaccine. The aim of this study was to verify antibody levels of antibody against hepatitis B virus surface antigen (anti-HBs) in children aged 1 to 15 years who received vaccination against hepatitis B in the central province of Iran, Semnan. Materials and methods. We performed a seroepidemiological survey (n = 210) of anti-HBs in 2011 in the central province of Iran, Semnan using enzyme-linked immunosorbent assay (ELISA). The levels of anti-HBs inf. 10 mIU/mL were considered to be negative and samples showing an anti-HBs titer ? 10 mIU/mL was considered protective. Results. Protective antibody levels were detected in 88% of the children less than 5 year after vaccination, decreased to 78% between 5 to 10 years after vaccination, and further declined to 74% in 10 years after vaccination, respectively. Conclusion. The vaccination program has been proven effective in Semnan and immunological protection against hepatitis B infection was found in the majority of children even more than 10 years after being vaccinated

High frequency of vancomycin resistant Enterococcus faecalis in children: an alarming concern

Introduction: Enterococcus spp. is considered as important etiological agents of nosocomial infections. However, a little is known about the epidemiology of vancomycin resistant Enterococcus faecalis (VREF). The aim of this study was to investigate the frequency of  VREF and detecting of two prevalent resistance genes (vanA, vanB) in pediatric population in an Iranian referral pediatric Hospital.Material and methods: During January 2013 to December 2013, 180 E. faecalis was isolated from clinical samples of hospitalized children at Children Medical Center Hospital, tertiary care and teaching hospital in Tehran, Iran. Antimicrobial testing was performed by Kirby-Bauer disk diffusion and E-test method according to Clinical Laboratories Standards Institute (CLSI). Two prevalent resistance genes (vanA, vanB) were investigated in VREF isolates.Results: Cephalosporin resistance was found in majority of E. faecalis isolates. There were no linezolid-resistant E. faecalis among all isolates. Teicoplanin resistance was observed in 13.8% of E. faecalis (n=25). MIC ≥32 µg/ml for vancomycin was found in 29 isolates (16%) and vanA gene was detected in 21 (72%) VREF strains, while vanB gene was not detected in any of these isolates. The mortality rate of all cases was 3.4% and 10% of patients with VREF infection died.Conclusion: This study reveals high rate of multidrug-resistant as well as vancomycin resistance in E. faecalis strains. Thus periodic surveillance of antibacterial susceptibilities is recommended to detect emerging resistance.

Detection of Epstein Barr Virus by Chromogenic In Situ Hybridization in cases of extra-hepatic biliary atresia

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Detection of Toxoplasma gondii in Acute and Chronic Phases of Infection in Immunocompromised Patients and Pregnant Women with Real-time PCR Assay Using TaqMan Fluorescent Probe

Background: Toxoplasma gondii, cause severe medical complications in infants and immune-compromised individuals. As using early, sensitive and rapid technique has major in diagnosis of toxoplasmosis, the present study was aimed to detect parasite by using from repetitive element (RE) and B1genes, in blood samples of seropositive immunocompromised patients and pregnant women. Methods: A total of 110 peripheral blood samples were collected from seropositive cases with anti-T. gondii antibodies, including immunocompromised patients and pregnant women. DNA was extracted by a commercial kit and subjected to TaqMan probe-based real-time PCR assay by using primers and probes specific for RE and B1 genes, separately. The data were analyzed by Kappa test and SPSS-22 software. Results: In the pregnant women, 17 (68%) and 14 (56%) samples from 25 IgM+/ IgG+ cases and, 7 (25%) and 6 (21.4%) samples from 28 IgG+/IgM- cases were positive by RE and B1 real time PCR, respectively. Likewise, in immunocompromised group, 20 (66.6%) and 17 (56.6%) samples from 30 IgM+/ IgG+ cases and 2 (7.4%) and 2 (7.4%) samples from 27 IgG+/ IgM- cases were positive by RE and B1 real time PCR, respectively. Conclusion: Probe-based real time PCR assay is a quantitative approach for early diagnosis of T. gondii infection in clinical samples. Moreover, this method can be more appropriate in diagnosis of acute and reactivated toxoplasmosis. In addition our results indicated that RE gene is more sensitive than B1 gene

Candiduria in children: a first reportfrom an Iranian referral pediatric hospital

Candida spp. especially Candida albicans is considered as one of the most common cause of fungal infections. The aim of our study was to determine epidemiology of candiduria in children who were referred to an Iranian referral hospital. During May 2011 to February 2013, among 4813 urine culture positive, 209 candida spp. isolates (4.3%) was found. Forty-one percent of cadiduria infection was seen in patients between 1 month and 1 year, 24% in neonatant and 24% in patients 1 to 5 years. Cadiduria was mainly found in patients who had received more than 2 or 3 antibiotic during their hospitalization (37% and 24%, respectively). In our study, the highest frequency of cadiduria was seen in patients who had received more than 2 antibiotics and more than 3 antibiotics during their hospitalization; therefore, the strategic goals to opti- mize antimicrobial use including optimizing choice and duration of empiric therapy as well as monitoring and providing feedback regarding antibiotic resistance are recommended