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

Sequences type analysis of Candida albicans isolates from Iranian human immunodeficiency virus infected patients with oral candidiasis

The growing number of immunocompromised individuals has increased the incidence of infections caused by Candida species during the recent decades. Typing of C. albicans on the basis of DNA sequences at multiple loci has greatly advanced our knowledge about the epidemiology and phylogeny of candidiasis. The aim of this study was to evaluate the diversity, and genetic relationships among C. albicans isolates obtained from HIV patients in Iran using multilocus sequence typing [MLST] method. We analyzed 25 C. albicans isolates obtained from HIV positive patients referred to Iranian Research Center for HIV/AIDS. After diagnostic test and DNA extraction C. albicans isolates were typed using the original MLST scheme explained previously include of six loci: ACC1, VPS13, GLN4, ADP1, RPN2, and SYA1. Fifty one [2.17%] nucleotide sites were found to be polymorphic; all were found to be heterozygous in at least one isolate. For the 25 clinical isolates, 22 diploid sequence types were defined by the genotypes identified from the six loci. The MLST data suggest a relatively high level of divergence in the population structure of C. albicans isolated from HIV infected patients. These findings indicate that in these patients there is a favorable context for the growth of potential pathogenic C. albicans. We found no association between fluconazole resistance, highly active antiretroviral therapy [HAART] receiving and either sequence type or group

Brucella infection in HIV infected patients

The purpose of this study was to assess the possible correlation between Brucella and HIV infections. Iran is a country where HIV infection is expanding and Brucellosis is prevalent. In the present study. 184 HIV infected patients were assigned and for all of them HIV infection was confirmed by western blot test. In order to identify the prevalence rate of Brucella infection and systemic brucellosis in these subjects, sera samples were obtained and Brucella specific serological tests were performed to reveal antibody titers. Detailed history was taken and physical examination was carried out for all of patients. 11 [6%] subjects had high titers but only 3 of them were symptomatic. Most of these subjects were injection drug user [IDU] men and one was a rural woman. Considering both prevalence rates of Brucella infection [3%] and symptomatic brucellosis [0.1%] in Iran, our HIV positive patients show higher rates of Brucella infection and systemic brucellosis. Preserved cellular immunity of participants and retention of granulocytes activity may explain this poor association; whereas other explanations such as immunological state difference and non-overlapping geographical distribution of the 2 pathogens have been mentioned by various authors

Seroprevalence of toxoplasmosis in HIV+/AIDS patients in Iran

Toxoplasma gondii has arisen as an important opportunistic agent especially in the central nervous system and in advanced HIV disease can cause significant morbidity and mortality. This study was carried out to determine the seroprevalence of toxoplasmosis among HIV-positive patients in Iran. Blood samples were collected from 201 HIV-positive patients and anti-toxoplasma antibodies were detected by using conventional ELISA. An antibody titer of >3 IU/ml was considered positive. The majority of studied patients were male [male to female ratio: 5 to 1] with the mean age of 36 +/- 1 yrs. The seroprevalence of toxoplasmosis in HIV-positive patients was 49.75%. The mean CD4 count in HIV patients with positive toxoplasma serology was 332.5 +/- 22.4 cells/micro l. Only 1% of the patients had IgM anti-toxoplasma antibodies and 10% of the patients had clinical toxoplasma encephalitis. The mean CD4 count in this group was 66.4 +/- 15.5 cells/micro l and there was a significant association between CD4 count and rate of toxoplasma encephalitis [P<0.001]. Previous reports suggested that toxoplasma encephalitis could be prevented by appropriate chemoprophylaxis. In view of the relatively high prevalence of toxoplasma infection found among the HIV-infected patients in our study, we suggest that routine screening for toxoplasma should be undertaken for all HIV-infected patients in Iran

Respiratory complications in Iranian hospitalized patients with HIV/AIDS

The respiratory tract has been the most commonly affected site of illness in HIV-infected patients. The current study was done to identify the frequency of respiratory complications in a consecutive case series of HIV-positive patients in Iran. This study was a retrospective analysis at the national academic reference medical center of Imam-Khomeini Hospital, in Tehran, Iran. The study included 199 new admissions for 177 HIV-infected patients between 2000 and 2005. Demographic characteristics, risk factors for HIV infection, respiratory complications, and CD4+ lymphocyte counts were evaluated in these patients. All patients were males. The mean age was 35 years [age range: 15 to 63 years]. Among 34 cases with available CD4+ lymphocyte count results, 70.6% had results <200 cells/mm[3]. Nearly half the patients [47.7%] had respiratory symptoms. The most common pulmonary complications were cough [86.3%], sputum [71.6%], dyspnea [54.7%], and hemoptysis [10.5%]. The most common diagnosis was pulmonary tuberculosis [27.1%], followed by other bacterial pneumonias [16.6%] and pneumocystis carinii pneumonia [4.5%]. Intravenous drug users who had history of incarceration had the highest risk factors for Mycobacterium tuberculosis infection [59%], and other bacterial pneumonias [52%].Our study demonstrates that respiratory complications are highly frequent in HIV patients in Iran and that pulmonary tuberculosis is still a common complication in HIV infected patients, despite the availability of effective treatment. Results suggest the need for more effective preventive and prophylactic measures, wider use of antiretroviral treatment and effective chemotherapy for Iranian patients with HIV/AIDS

Serum zinc and copper concentrations in brucellosis patient

Micronutrients such as zinc [Zn] and copper [Cu] have a modulatory effect on immune system. Altered serum concentrations of these nutrients have been described in patients with specific disease conditions. The aim of this study was to evaluate serum Zn and Cu level alterations in patients with brucellosis in comparison with healthy individuals. Serum Zn and Cu level of 43 patients with brucellosis [34 men and 9 women] were compared with 43 matched healthy controls. Serum micronutrient concentrations were measured by automatic absorptive spectrophotometry. Mean serum Cu concentration was significantly higher in subjects with brucellosis when compared with age-matched healthy controls [p<0.05]. Mean serum Zn level was decreased in female patients compared with controls [p<0.05], however, there was no significant difference between male patients and controls. Serum Zn and Cu concentrations may alter in patients with brucellosis during the period of infection. Further studies are needed to determine whether these micronutrients have an effect on disease severity and outcome. Measuring serum Cu level may be suggested as a complementary screening tool for brucellosis