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.

Evaluation of Treatment Factors Response to Methotrexate Treatment in Ectopic Pregnancies in Imam Khomeini Hospital, Sari, 2016-2021

Background and purpose: After a diagnosis of ectopic pregnancy there are two choices for treatment: medical treatment with methotrexate and surgical treatment. It seems that medical treatment, has had acceptable success compared to surgery and lacks the complications of surgery. Nowadays, due to the progress achieved in the early diagnosis of ectopic pregnancy, a large number of patients are candidates for medical treatment. This study is conducted to evaluate the effective factors of medical treatment Response with methotrexate in ectopic pregnancies. Materials and methods: In this case-control study, the information related to patients who were diagnosed with ectopic pregnancy and were treated with methotrexate from March 2016 to March 2021 in Imam Khomeini Hospital in Sari was examined using hospital records by census method. In total, 160 patients out of 623 patients met the inclusion criteria and were studied. In the checklist prepared for each patient, the patient's age, number of gravity and parity and abortion, previous history of infertility, contraceptive method, presence of clinical symptoms (such as abdominal pain-vaginal bleeding-amenorrhea), History of using recent assisted reproductive methods, type of treatment regimen used (Single/Multiple Dose), serum beta human chorionic gonadotropin (BHCG) level before and after starting treatment, number of previous ectopic pregnancy, gestational age based on the last Menstruation, transvaginal ultrasound results(including the presence of the yolk sac & fetal heart rate & hematosalpinx - location and size of the ectopic mass-endometrial thickness) were recorded for each patient separately, The patients were divided into two categories: success and failure of treatment and the effect of different factors on the result of medical treatment with methotrexate was investigated. The collected data were entered into SPSS 26 software and qualitative variables were analyzed with the Chi-Square test. The normality of the distribution of quantitative variables was measured by the One-Sample Kolmogorov-Smirnov test, an independent t-test was used to examine quantitative variables with normal distribution, and the Mann-Whitney test was used for quantitative variables with non-normal distribution. Results: 160 patients were included in this study, 108 of patients (67.5%) were successfully treated and 52 patients (32.5%) faced treatment failure. In this study, the type of treatment regimen (P=0.001), Serum Beta Human Chorionic Gonadotropin (BHCG) level before treatment(P=0.000), BHCG level after treatment (P=0.000), the presence of fetal heart rate (P=0.002) and yolk sac (P=0.046) are factors affecting the response to methotrexate treatment in ectopic pregnancy. The presence of hematosalpinx, size of the ectopic mass, endometrial thickness, history of infertility and recent assisted reproductive procedures, presence of clinical symptoms, contraceptive method, gestational age, history of ectopic pregnancy, number of gravidity and parity, and abortion have no effect on the results of medical treatment with methotrexate. Conclusion: Based on the results obtained, Single Dose regimen of methotrexate treatment is associated with greater treatment success than a multiple-dose regimen and also high serum BHCG levels before and after the treatment, the presence of fetal heart rate and yolk sac in transvaginal ultrasound are factors to increase the probability of failure of medical treatment of ectopic pregnancy with methotrexat