ABSTRACT
The goal of this study was to attempt to determine the rate of con-tamination of health-care workers' [HCWs] hands and environmental surfaces inintensive care units [ICU] by the main bacteria associated with hospital acquiredinfections [HAIs] in Tehran, Iran. A total of 605 and 762 swab samples wereobtained from six ICU environments and HCWs' hands. Identification of the bac-terial isolates was performed according to standard biochemical methods, andtheir antimicrobial susceptibility was determined based on the guidelines recom-mended by clinical and laboratory standards institute [CLSI]. The homology ofthe resistance patterns was assessed by the NTSYSsp software. The most frequent bacteria on the HCWs' hands and in the environmental samples were Acinetobac-ter baumannii [1.4% and 16.5%, respectively], Staphylococcus aureus [5.9% and 8.1%,respectively], S. epidermidis [20.9% and 18.7%, respectively], and Enterococcus spp.[1% and 1.3%, respectively]. Patients' oxygen masks, ventilators, and bed linens werethe most contaminated sites. Nurses' aides and housekeepers were the most contam-inated staff. Imipenem resistant A. baumannii [94% and 54.5%], methicillin-resistantS. aureus [MRSAs, 59.6% and 67.3%], and vancomycin resistant Enterococci [VREs, 0%and 25%] were detected on the hands of ICU staff and the environmental samples,respectively. Different isolates of S. aureus and Enterococcus spp. showed significanthomology in these samples. These results showed contamination of the ICU environ-ments and HCWs with important bacterial pathogens that are the main risk factorsfor HAIs in the studied hospitals
ABSTRACT
Device-associated health care-acquired infections [DA-HAIs] pose a threat to patient safety, particularly in the intensive care unit [ICU]. However, few data regarding DA-HAI rates and their associated bacterial resistance in ICUs from Iran are available. A DA-HAI surveillance study was conducted in six adult and pediatric ICUs in academic teaching hospitals in Tehran using CDC/NHSN definitions. We collected prospective data regarding device use, DA-HAI rates, and lengths of stay from 2584 patients, 16,796 bed-days from one adult ICU, and bacterial profiles and bacterial resistance from six ICUs. Among the DA-HAIs, there were 5.84 central line-associated bloodstream infections [CLABs] per 1000 central line-days, 7.88 ventilator-associated pneumonias [VAPs] per 1000 mechanical ventilator-days and 8.99 catheter-associated urinary tract infections [CAUTIs] per 1000 urinary catheter-days. The device utilization ratios were 0.44 for central lines, 0.42 for mechanical ventilators and 1.0 for urinary catheters. The device utilization ratios of mechanical ventilators and urinary catheters were higher than those reported in the ICUs of the INICC and the CDC's NHSN reports, but central line use was lower. The DA-HAI rates in this study were higher than the CDC's NHSN report. However, compared with the INICC report, the VAP rate in our study was lower, while the CLAB rate was similar and the CAUTI rate was higher. Nearly 83% of the samples showed a mixed-type infection. The most frequent pathogens were Acinetobacter baumannii,Staphylococcus aureus and Pseudomonas aeruginosa, followed by Klebsiella pneumoniae andEnterococcus spp. In the S. aureus isolates, 100% were resistant to oxacillin. Overall resistances of A. baumannii and K. pneumonia to imipenem were 70.5% and 76.7%, respectively. A multiple drug resistance phenotype was detected in 68.15% of the isolates. The DA-HAI rates in Iran were shown to be higher than the CDC-NHSN rates and similar to the INICC rates. Resistance to oxacillin and imipenem was higher as well. Comparing device use, DA-HAI rates, and bacterial resistance for the primary isolated bacteria indicated a direct association between urinary catheter use and the rates of CAUTI
ABSTRACT
Intestinal normal flora can become reservoirs of antibiotic resistance genes present among the strains responsible for nosocomial infections. It is suggested that gram negative intestinal bacterial flora have increased capacities to obtain antibiotic resistance genes and therefore can act as main reservoirs for transfer of resistance genes to other pathogenic bacteria. This study aimed to compare fecal carriage of clinically important resistance markers for more frequent members of enterobacteriacae between nondiarrheal and community associated diarrheal patients [control group] versus their counterparts from the patients with nosocomial infections [case group]. 261 stool and 190 clinical samples were collected from outpatient and hospitalized patients from 6 hospitals in Tehran, Iran. The samples were cultured on MacConkey agar plates and colonies were identified by standard biochemical methods. Antibiotic sensitivity testing of the isolates against 13 antibiotics was performed according to the CLSI guideline using the disk diffusion method. Among stool and clinical samples, more frequent identified enterobacteriaceae bacteria were included E. coli [58.99/ 3.15%], Klebsiella spp. [22.61/7.36%], and other members of enterobacteriaceae [8.86/1.06%], respectively. Overall, resistance against four of the main antibiotics [3[th] and 4[th] generation cephalosporins, gentamicin, imipenem, and ciprofloxacin] was significantly higher among the case group [50-75% versus 10-14%]. Analysis of these results showed similar dissemination of resistance phenotypes among the isolates from the control group in ranges of 1.5-7.6% and 4.4% for E. coli and Klebsiella spp., respectively. Our results suggested that the fecal carriage of resistant phenotypes related to the beta-lactam antibiotics in E. coli and Klebsiella spp. in compare to the clinical isolates is rapidly increasing. This may be caused by dissemination of beta-lactamase producing E. coli in the community from the hospitals. There were no significant correlations between the two groups of the samples, as the clinical samples had shown 3 to 7 folds excess resistance phenotypes. Surveillance studies of the resistance patterns among the samples from different regions will provide awareness about dissemination of these bacteria within the community as reservoirs of main resistance markers