role of the intensive care unitenvironment and health-care workers inthe transmission of bacteria associatedwith hospital acquired infections

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

Prevalence of inflammatory bowel disease among patients with primary sclerosing cholangitis in Iran

Background and study aims: In Iran, the epidemiology of primary sclerosing cholangitis [PSC] and its association with inflammatory bowel disease [IBD] have not been studied thoroughly. This study investigates the epidemiology and prevalence of IBD among patients with PSC

Patients and methods: A retrospective study of 154 patients with PSC was conducted. The demographic and clinical data were collected, and the variables were analysed in the following two patient groups: patients with both PSC and IBD, and patients with PSC and without IBD

Results: A total of 154 patients with a mean age of 40.3 years [range 20-81 years] were included, of whom 57 [37%] were female and 97 [63%] male. Ninety-six patients [62.3%] were diagnosed with IBD, 92 [59.7%] with ulcerative colitis, and four [2.6%] with Crohn's disease. In this study, elevated alkaline phosphatase levels were found in 90.8% of patients. The intra-hepatic duct [IHD] and extrahepatic duct [EHD] were involved in 70.5% of patients, isolated intrahepatic bile duct in 24.4%, and isolated extrahepatic duct in 3.8%. Small-duct PSC [normal results of imaging and PSC proved by histology of liver biopsy] was observed only in 1.3% of patients

Conclusion: PSC has become increasingly diagnosed in Iran. This is possibly because of better diagnostics and the increasing prevalence of IBD in this country. For diagnosing PSC and identifying the presence of IHD strictures, the results of both magnetic resonance cholangiopancreatography [MRCP] and endoscopic retrograde cholangiopancreatography [ERCP] showed good interobserver agreement, but the ERCP results could be used to evaluate the presence and severity of EHD strictures

Device-associated infection rates and bacterial resistance in six academic teaching hospitals of Iran: Findings from the International Nocosomial Infection Control Consortium [INICC]

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

Antibiotic susceptibility profile of Helicobacter pylori isolated from the dyspepsia patients in Tehran, Iran

Helicobacter pylori is an important pathogen for gastroduodenal diseases. Infection with H. pylori can be limited by regimens of multiple antimicrobial agents. However, antibiotic resistance is a leading cause of treatment failure. The aim of this study has been to determine the resistance patterns of H. pylori strains isolated from gastric biopsies of patients with dyspepsia by agar dilution method, in Tehran, Iran. H. pylori isolates from patients with gastrointestinal diseases were evaluated for susceptibility testing by agar dilution method. Susceptibility testing was performed to commonly used antibiotics including clarithromycin, tetracycline, amoxicillin, metronidazole and ciprofloxacin. Among 92 patients with dyspepsia, H. pylori strains were isolated from 42 patients. Seventeen [40.5%] of the isolates were resistant to metronidazole [MICs >/= 8 microg/1], whereas one isolate [2.4%] was resistant to amoxicillin [MICs

Functional bowel disorders in Iranian population using Rome III criteria

To study the prevalence and risk factors of functional bowel disorders [FBD] in Iranian community using Rome III criteria. This study was a cross-sectional household survey conducted from May 2006 to December 2007 in Tehran province, Iran, including 18, 180 participants who were selected randomly and interviewed face-to-face by a validated questionnaire based on Rome III criteria. In all, 1.1% met the Rome III criteria for irritable bowel syndrome [IBS], 2.4% for functional constipation [FC], and 10.9% of the participants had any type of FBD. Among participants with functional dyspepsia, 83.3% had FBD; the majority cases were unspecified functional bowel disorder [U-FBD]. Of the subjects fulfilling the IBS criteria, IBS with constipation [52%] was the most frequent subtype. In the multivariate analysis, women had a higher risk of any FBDs than men, except for functional diarrhea [FD]. The prevalence of FBD, FC and FD increased and IBS decreased with increasing age. Marital status was only associated with a decrease in the risk of FBD and FD, respectively. IBS subtypes compared with FC and FD. There was no significant difference between FC and IBS with constipation [IBS-C], except for self-reported constipation; while, IBS with diarrhea [IBS-D] had more symptoms than FD. This study revealed a low rate of FBDs among the urban population of Tehran province. The ROME III criteria itself, and the problems with interpretation of the data collection tool may have contributed in underestimating the prevalence of FBD. In addition the reliability of recall over 6 months in Rome III criteria is questionable for our population

Rotavirus and coeliac autoimmunity among adults with non-specific gastrointestinal symptoms

To determine celiac disease [CD] serology and rotavirus [RV] by polymerase reaction [PCR] in adults with non-specific gastrointestinal complaints. The study comprised 5176 randomly selected individuals living in Tehran, Iran between September 2006 and September 2007. Six hundred and seventy individuals with GI symptoms were identified with a questionnaire and invited for a further study including stool sampling and blood tests. Stool samples were examined for detection of RV by amplification of specific gene [VP6] and by light microscopy and formalin-ether concentration methods for parasite detection. The subjects also tested for CD including anti-transglutaminase [tTG] antibodies and total immunoglobulin A [IgA]. The study was carried out in the Research Center of Gastroentrology and Liver Disease, Taleghani Hospital, Tehran, Iran. The VP6 gene was detected in 150 [22.3%] individuals. Anti-tissue transglutaminase [tTG-IgA] was positive in 22 individuals [95% CI 2.3-5.1] and IgG-tTG antibody in 3 individuals who were IgA deficient. Amplification of VP6 gene was positive in 8/25 [32%] with positive CD serology and in 142/645 [22%] with negative CD serology. This difference was not statistically significant [p=0.2]. This study shows that RV infection is common among Iranian patients with non-specific gastrointestinal symptoms. However, in contrast to studies in children, this study shows that the prevalence of active RV infection was not statistically significantly different between individuals who were tTG antibody positive and those who were tTG antibody negative

Uninvestigated dyspepsia and its related factors in an Iranian community

To determine the prevalence and determinants of uninvestigated dyspepsia in the Iranian population. A cross-sectional study conducted in Tehran province from May 2006 to December 2007, included 18,180 adult persons selected randomly. The study took place at Shahid Beheshti University, MC, Tehran, Iran. A questionnaire was completed in 2 steps. In the first part, personal characteristics and 11 gastrointestinal symptoms were inserted. Those who reported at least one of these 11 symptoms were referred for the second interview, which consisted of questions on different gastrointestinal disorders based on Rome III criteria, including uninvestigated dyspepsia. The prevalence rate of uninvestigated dyspepsia was 8.5% [10.9% in women and 6.4% in men]. Among the subjects diagnosed with dyspepsia, bothersome postprandial fullness was the most common symptom [41.5%]. Uninvestigated dyspepsia was more common in low educated and widowed participants. Approximately 41.4% of patients had a history of depression, and 66.1% had self report of stress. The prevalence of functional irritable bowel syndrome in patients with uninvestigated dyspepsia was 8.3% and gastroesophageal reflux disease was 64.9%. Uninvestigated dyspepsia has a less common prevalence in the general Iranian population than developed countries. Women, older, obese, widowed, and low education subjects are more likely to suffer from dyspepsia

Electiveness of hepatitis B vaccination in children of chronic hepatitis B mothers

Although all newborns in Iran have been vaccinated against hepatitis B since March 1993, routine screening of pregnant women has not been conducted in prenatal care programs, yet transmission of hepatitis B via the maternal-fetal route is still a viable likelihood, which must be entertained. The subjects were divided into 2 groups. The exposed group comprised 97 vaccinated children whose mothers were seropositive for hepatitis B surface antigen [HBsAg] and had not received hepatitis immunoglobulin at birth. The unexposed group consisted of 87 vaccinated children whose mothers were seronegative for hepatitis B surface antigen. We compared these 2 groups to determine the efficacy of vaccine alone in high-risk children. This study was conducted in Tehran, Iran, from June 2002 to December 2002. All children were born after 1993. Chronic infection [HBsAg positivity] was detected in 14.3% of children in the exposed group. There were no instances of chronic infection in the unexposed group [relative risk [RR]=13.48, 95% confidence intervals [CI] 1.8-100.02]. Previous infection of hepatitis B [HBcAb positivity] was found in 29 [29.9%] children in the exposed group, but only one [1.2%] in the unexposed group [RR=26.01, 95% CI: 3.61-186.95]. Immunity [HBsAb positivity] in the exposed group measured 48 [49.5%] and unexposed group measured 56 [64.4%] [R.R=0.76, 95% CI: 0.59-0.99]. Vaccination alone did not induce immunity against hepatitis B in high-risk children; it seems that routine screening of pregnant women is necessary for determining whether neonates need hepatitis B immunoglobulin after birth