Epidemiology of nosocomial infections in pediatric patients in an Iranian referral hospital

Nosocomial infections (NI) are important causes of morbid- ity and mortality in pediatric hospitals. Different surveillance methods for detecting hospital-acquired infection have been developed. The selection of which varies according to specific surveillance objectives and the resources are available. The aim of this study was to determine the epidemiology of noso- comial infections in medical wards of a tertiary-levels teaching pediatric hospital in Tehran, Iran. We performed a prospective cross-sectional study and NI was identified by daily review of medical charts of patients hospitalized for at least 48 hours. We evaluated 1497 patients. The overall patient NI rate was 3.34 per 100 patients and the infection rate per 1000 patient-days was 5.27. The most common site of infection was the respira- tory tract (36%) followed by the gastrointestinal tract (32%). S. aureus, P. aeruginosa and Salmonella species were the most frequent pathogen isolates. The lethality rate associated with NI was 10%. Describing the epidemiology of NI in this hospi- tal enable us to estimate infection occurrence, distribution and expected incidence, as well as recognizing trends and keeping track of possible outbreaks

Clonal spread of vancomycin resistance Enterococcus faecalis in an Iranian referral pediatrics center

Vancomycin-resistant enterococci (VRE) represent as an immediate threat to public health. Since few active compounds are available for VRE infections, rapid identification of these isolates are essential. In the absence of any report on the genetic relatedness of Enterococcus faecalis especially Vancomycin-resistant E. faecalis (VREF) isolates in Iran, we undertook this study to characterize these isolates using random amplification of polymorphic DNA (RAPD?PCR) genotyp- ing method. In this study, E. faecalis strains isolated from various samples collected from different wards of Children Medical Hospital (Tehran, Iran). These isolates were identified by standard laboratory procedures and tested for antimicrobial resistance to vancomycin and teicoplanin. The genetic similarity of the strains was investigated by amplification of the RAPD?PCR. In our study among 91 E. faecalis isolates, 15 (16%) were identified as VREF. The similarity pattern built for E. faeca- lis isolates by RAPD?PCR, demonstrated the presence of four distinct clusters (A, B, C, D). It is of interest to note that 100% of VREF isolates belonged to Clusters A, indicating that there may have occurred horizontal transmission of the same strain between patients. In conclusion, rapid spread of VREF from a clonal origin calls for implementation of careful isolation and infection control measures. Therefore, environmental control by routine disinfection of patient area as well as screening of high risk patients and isolation of colonized patients should be imposed in order to diminish risk of acquiring nosocomial VRE

Pseudomonas aeruginosa infection among cystic fibrosis and ICU patients in the referral Children Medical Hospital in Tehran, Iran

Introduction. Pseudomonas aeruginosa is one of the important causes of hospital-acquired infections in Intensive Care Unit (ICU) and considered as a major determinant of morbidity and mortality in patients affected by cystic fibrosis (CF). The aim of this study was to investigate clonal diversity among randomly picked P. aeruginosa isolates of CF and the other hospitalized patients in ICU. Methods. Cultivation, identification, and antimicrobial suscep- tibility testing of P. aeruginosa isolates were performed using standard techniques. The genetic similarity of the strains was investigated by amplification of the Enterobacterial Repetitive Intergenic Consensus-polymerase chain reaction (ERIC-PCR) sequence. Results and discussion. Among 49 isolates, sixteen were isolated from 11 patients affected by CF and 33 came from an epidemiologi- cal investigation of 25 P. aeruginosa infected patients of ICU. Five clusters were generated for all isolates analyzed through ERIC-PCR genotyping. Two major clusters (B and C) were discovered in P. aer- uginosa isolates of ICU and CF patients during the whole period of this study. Fifteen unique antibiogram patterns obtained from all iso- lates and multi-resistant P. aeruginosa (MRPA) were identified in 23 isolates (47%). MRPA isolates were detected in all clusters (except A) while pan-resistant isolates were recovered only in cluster C. The high prevalence of related or identical isolates in CF and non-CF patients can be due to transmission of particular domi- nant clones in ICU ward. Therefore, enhanced infection-control may become necessary to prevent further spread of clonal strains

Staphylococcus aureus infections in children in an Iranian referral pediatric Hospital

Introduction. Staphylococcus aureus is associated with various infections ranging from skin and soft tissues such as surgical site infections and abscesses to lower respiratory tracts and blood- stream. The aim of this study was to evaluate underlying condi- tion of patients with S. aureus infections in an Iranian referral pediatric Hospital. Material and methods. Information was extracted retrospec- tively from the medical records of patients who were diagnosed with S. aureus infections. Data obtained about the study subjects included basic demographics, reason for admission, culture site, length of hospital stay, and methicillin susceptibility. Results. The underlyning condition of of patients with S.aureus infection during November 2011 and March 2013 were included in the study. The most frequent diagnosis in patients with S. aureus infection was jaundice (12%), abscess (10%), cellulitis (10%), wound infection (8%), septic arthritis (7%) and sezeire (5%). Wound was the most common infection sites among all subjects 34/98 (35%) following by blood (20/98, 20%) as well as skin and soft tissue (19/98, 19%). The proportion of MRSA infections among all S. aureus isolates was 79% (77/98) during the study period. In addition, 58/74 (78%) met the definition of Hospital-Associated Methicillin-Resistant S. aureus (HA- MRSA) infections and the rest; 20/24 patients (83%), were classified as Community-Associated Methicillin-Resistant S. aureus (CA- MRSA). Conclusion. In our study, the high frequency of MRSA was found not only in HA S. aureus but also in CA S. aureus isolates; there- fore, the strategic goals to optimize antimicrobial use includin

Identification of Etiologic Agents of the Pertussis-like Syndrome in Children by Real-time PCR Method

The aim of this study was to recognize the identity and frequency of etiologic agents of the pertussis-like syndrome in children < 2 years of age. A cross-sectional hospital-based study conducted from August 2014 to August 2015. All children < 2 years of age (n=100) who were suspected as pertussis infected were enrolled in this study and tested for Bordetella pertussis, adenovirus (Adv), respiratory syncytial virus (RSV), human metapneumovirus (hMPV), and influenza virus A (INF-A) by real-time PCR technique. RSV was the most detected pathogen (20), followed by B. pertussis (18), Adv (16), INF-A (11), and hMPV (10). Co-infection was observed in 8 patients (11) and the combinations of RSV/INF-A (n=3, 4), and AdV/B. pertussis (n=3, 4) were more frequent. RSV, B. pertussis, and hMPV were more frequent pathogens among infants < 4 months of age. However, Adv and INF-A were more frequent pathogens among children > 6 months of age. In this study, RSV was the most frequent identified pathogen (n=20, 20), followed by B. pertussis (n=18, 18) and AdV (n=16, 16). Pertussis was more frequent in spring (8) and summer (6). In addition, clinical symptoms of pertussis were the same as some viral pathogens, which can lead to misdiagnosis of infection. Therefore, diagnosis of pertussis should be established on the bases of both the clinical symptoms and the laboratory methods

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

i Sexual function in breast cancer patients: a prospective study from Iran

Background: Sexual function in patients with breast cancer especially in younger patients is an important issue from clinical and psychosocial perspectives. This study aimed to assess sexual function among Iranian breast cancer patients. Methods: This was a prospective study of sexual function in breast cancer patients attending the Cancer Institute of Iran. Sexual function was assessed using the Female Sexual Function Index (FSFI) at two points in time: baseline (pre-treatment) and after completion of cancer treatment at follow-up visits (post-treatment). Pre- and posttreatment data were compared. In addition logistic regression analysis was performed to find out factors that contributing to post-treatment sexual dysfunction. Results: In all 277 breast cancer patients were approached. Of these, 231 patients (83%) were sexually active and data for 216 patients (93.5 % of sexually active patients) were available at pre-and post-treatment. Overall pre- and post-treatment sexual dysfunction was found to be 52 % and 84%, respectively indicating a significant deterioration in sexual function among breast cancer patients. The results obtained from multiple logistic regression analysis indicated that younger age [OR = 0.95, 95 % CI = 0.93-0.98; P = 0.04], receiving endocrine therapy [OR = 3.34, 95% CI = 1.37-7.91; P = 0.007] and poor sexual function at pre-treatment [OR = 12.3, 95 % CI = 3.93-39.0; P < 0.0001

Global antibiotic dosing strategies in hospitalised children: Characterising variation and implications for harmonisation of international guidelines

Background Paediatric global antibiotic guidelines are inconsistent, most likely due to the limited pharmacokinetic and efficacy data in this population. We investigated factors underlying variation in antibiotic dosing using data from five global point prevalence surveys. Methods & findings Data from 3,367 doses of the 16 most frequent intravenous antibiotics administered to children 1 month–12 years across 23 countries were analysed. For each antibiotic, we identified standard doses given as either weight-based doses (in mg/kg/day) or fixed daily doses (in mg/day), and investigated the pattern of dosing using each strategy. Factors underlying observed variation in weight-based doses were investigated using linear mixed effects models. Weight-based dosing (in mg/kg/day) clustered around a small number of peaks, and all antibiotics had 1–3 standard weight-based doses used in 5%-48% of doses. Dosing strategy was more often weight-based than fixed daily dosing for all antibiotics apart from teicoplanin, which had approximately equal proportions of dosing attributable to each strategy. No strong consistent patterns emerged to explain the historical variation in actual weight-based doses used apart from higher dosing seen in central nervous system infections, and lower in skin and soft tissue infections compared to lower respiratory tract infections. Higher dosing was noted in the Americas compared to the European region. Conclusions Antibiotic dosing in children clusters around a small number of doses, although variation remains. There is a clear opportunity for the clinical, scientific and public health communities to consolidate behind a consistent set of global antibiotic dosing guidelines to harmonise current practice and prioritise future research

Impaired Release of Antimicrobial Peptides into Nasal Fluid of Hyper-IgE and CVID Patients

Patients with primary immunodeficiency (PID) often suffer from frequent respiratory tract infections. Despite standard treatment with IgG-substitution and antibiotics many patients do not improve significantly. Therefore, we hypothesized that additional immune deficits may be present among these patients.To investigate if PID patients exhibit impaired production of antimicrobial peptides (AMPs) in nasal fluid and a possible link between AMP-expression and Th17-cells.Nasal fluid, nasopharyngeal swabs and peripheral blood mononuclear cells (PBMCs) were collected from patients and healthy controls. AMP levels were measured in nasal fluid by Western blotting. Nasal swabs were cultured for bacteria. PBMCs were stimulated with antigen and the supernatants were assessed for IL-17A release by ELISA.In healthy controls and most patients, AMP levels in nasal fluid were increased in response to pathogenic bacteria. However, this increase was absent in patients with common variable immunodeficiency (CVID) and Hyper-IgE syndrome (HIES), despite the presence of pathogenic bacteria. Furthermore, stimulation of PBMCs revealed that both HIES and CVID patients exhibited an impaired production of IL-17A.CVID and HIES patients appear to have a dysregulated AMP response to pathogenic bacteria in the upper respiratory tract, which could be linked to an aberrant Th17 cell response