Assessment of device-associated infection rates in teaching hospitals in Islamic Republic of Iran

Background: Surveillance of health care-associated infections (HCAIs) is an integral part of infection control programmes, especially in intensive care units (ICUs). Device-associated infections (DAIs) are a major threat to patient safety.

Aim: To measure DAI rates in ICUs.

Methods: Central line-associated bloodstream infection (CLABSI), ventilator-associated pneumonia (VAP), and catheter-associated urinary tract infection (CAUTI) were assessed in the ICUs of 4 tertiary-care teaching hospitals in Tehran, Islamic Republic of Iran.

Results: The incidence rate of CLABSI, VAP and CAUTI was 10.20, 21.08 and 7.42 per 1000 device-days, respectively. The utilization ratio for central lines, ventilators and urinary catheters was 0.62, 0.47, and 0.84, respectively. The most common organisms were Acinetobacter (33.5%) and Klebsiella (19.0%). Sixty to eighty percent of Enterobacteriaceae were extended-spectrum beta-lactamase producing. About half of Pseudomonas aeruginosa isolates were resistant to piperacillin/ tazobactam and carbapenem. Acinetobacter resistance rate to ampicillin/sulbactam and carbapenem was 70–80%. The prevalence of methicillin-resistant Staphylococcus aureus and vancomycin-resistant Enterococcus was 84.6% and 83.3%, respectively.

Conclusions: This study showed high incidence rates of DAIs and resistant organisms, and appropriate interventions are necessary to reduce these rates

[Evaluation of treatment effect of anti-tuberculosis drugs on the quality of life among tuberculosis patients admitted in Imam Khomeini hospital in Tehran]

Despite the possibility of curing TB with medical therapy, it has a sizable impact on the lives of afflicted patients. This study aimed to evaluate of treatment effect of anti-tuberculosis drugs on the quality of life on tuberculosis patients admitted in Imam Khomeini hospital in Tehran. The investigation was a before and after study. It was done in 2006-2007 by fill in Persian translated questionnaire of WHOQOL- BREF on 46 pulmonary or extra pulmonary TB infected patients. Paired samples T-test was performed to find out the differences. After 8 weeks of treatment, mean score elevation was significant in physical [15.76 +/- 23.89, p<0.001], psychological [7.84 +/- 17.57, p=0.004], and social [6.83 +/- 19.48, p=0.02] domains. It was not significant in environmental domain [2.15 +/- 8.48, p=0.09]. Mean score elevation at the discharge time in physical, psychological, social and environmental domains were: [5.65 +/- 16.56, p=0.09], [11.69 +/- 19.22, p=0.001], [1.04 +/- 8.60, p=0.41], and [4.37 +/- 17.77, p=0.1], respectively. In our study, after treatment of tuberculosis, patient's physical, psychological and social -not environmental- domains of quality of life were elevated, but at the discharge, there was a significant elevation in physical and psychological domains. These results emphasize the importance of patient's treatment at the first days of admission, with special attention to social and environmental domains

Fever in patients with HIV infection in a teaching hospital in Iran

Fever, is a common sign during the course of HIV infection. The aim of this study was to describe the etiology and clinical characteristics of fever among HIV/AIDS patients in a teaching hospital in Iran. In this existing data study, we retrospectively reviewed the charts of admitted HIV/AIDS patients with fever to Imam Khomeini hospital, from October 1995 to March 2005 to assess the causes of their fever. Totally, 125 admissions were performed for 120 patients. The mean [ +/- SD] age was 34.8 +/- 14.7 years. The final diagnosis of fever was determined in 65.6% of all admissions. Mostly [34.4%], the cause of fever remained undiagnosed. Pulmonary tuberculosis was the most commonly identified etiology of fever [33.6%], followed by opportunistic infections such as oral candidiasis, Pneumocystis jirovecii pneumonia and cerebral toxoplasmosis. Tuberculosis is the most common infection in Iranian HIV/AIDS patients and appropriate workup should be considered in all feverish HIV/AIDS patients

Evaluation of antimicrobial resistance among gram-negative isolates collected from intensive care units and reliability of routine disc susceptibility tests at a teaching hospital in Tehran

Antibiotic resistance of Intensive Care Unit [ICU] born aerobic gram-negative bacteria was evaluated during a six months period at a teaching hospital in Tehran, and determination of the validity of the results obtained from disc diffusion tests, using discs manufactured in Iran. Disc susceptibility tests using Iranian and standard discs [diffusion discs available in international markets] were performed on 108 aerobic gram-negative isolates obtained from the clinical samples of patients with at least 72 hours of stay in the ICU. The JVIinimum Inhibitory Concentrations [MIC] was subsequently determined by collaborators not involved with the disc testing evaluation. Acinetobacter was the most frequently isolated gram negative species [26%]. High resistance rates were obtained for all antibiotics studied except for imipenem [98% sensitive]. Results of disc diffusion tests performed by the Iranian discs were in moderate to strong agreement with those obtained from the standard discs. When comparing disc results with the MIC results, it was noted that the total number of very major, and minor discrepancies were approximately the same with both sets of discs. The total number of major discrepancies was higher for the Iranian discs [more false positive results]. The total number of very major discrepancy rates was more than the acceptable 1.5% limits for each antibiotic tested, using both Iranian and standard discs. High rates of resistance in aerobic gram-negative isolates studied, leaves imipenem as the only reliable agent for the empirical treatment of ICU infections. The high rates of very major discrepancies with both sets of discs show that physicians cannot rely on disc diffusion tests only, in order to guide therapy for the treatment of very serious infections in the ICUs, even if standard discs are used instead of the Iranian discs, and there is great need to establish a fast and easy way to determine the MIC values. Although it is better to repeat the study with a much larger sample size in order to make good judgment