RESUMEN
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 7080%. 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
RESUMEN
<p><b>OBJECTIVE</b>To estimate and outline the frequency and etiology of lymphadenopathy in HIV/AIDS patients.</p><p><b>METHODS</b>This study was conducted on 178 consecutive HIV/AIDS patient files for etiologies (categorized into three sub-groups: definite, probable and possible) and associated factors of local and generalized lymphadenopathy.</p><p><b>RESULTS</b>Seventy-two (40.45%) patients including 63 male patients (87.5%) developed lymphadenopathy. HIV in lymphadenopathy(+) patients was most commonly transmitted intravenously (n=49). Generalized and localized lymphadenopathy respectively occurred in 27 (37.50%) and 45 (62.50%) patients, mainly in the cervical region (28.9% for local and 63% for generalized lymphadenopathy). The most common causes of lymphadenopathy were tuberculosis (n=24, 33.3%) and lymphoma (n=12, 16.6%). The frequency of lymphadenopathy was non-significantly higher in patients with AIDS (CD4 count <200 cell/µL) vs. HIV(+) patients (CD4 count >200 cell/µL).</p><p><b>CONCLUSIONS</b>Lymphadenopathy in HIV/AIDS patients may reflect a serious condition, most likely tuberculosis and lymphoma. Since patients might underestimate lymphadenopathy, physicians would rather list these entities for diagnosis.</p>
RESUMEN
Methicillin-Resistant Staphylococcus aureus [MRSA] is the one of most commonly isolated organisms from clinical samples which can cause life-threatening infections. The emergence and spread of antibiotic resistance makes the treatment of these infections more complicated. In this study, we aimed to determine the patterns of antibiotic resistance among MRSA isolates from Tehran, Iran. From December 2012 to April 2014, 120 clinical samples were collected. MRSA was identified by cefoxitin disc diffusion. Antimicrobial susceptibility testing was performed on MRSA isolates for eight other antibiotics by disc diffusion method according to CLSI [2013] recommendations. Also, the minimum inhibitory concentration [MIC] was determined for vancomycin by MIC test strips. According to disc diffusion, 60 [50%] isolates showed resistance to cefoxitin. Among these isolates, the rate of resistance to nitrofurantoin, vancomycin, teicoplanin, doxycycline, trimethoprim, erythromycin, clindamycin, and ciprofloxacin were 0%, 0%, 0%, 28.3%, 28.3%, 58.3%, 63.3%, and 70%, respectively. All isolates were susceptible to vancomycin according to disc diffusion and MIC. Compared to other reports from Iran, our study indicated a moderate rate for MRSA. However, the rates of resistance to generally prescribed antibiotics in these isolates were high. In this situation, it is recommended to monitor the antibiotic resistance in these hospitals
RESUMEN
HIV infection reduces the immune system and is the most significant factor in the spread of TB in recent years and one of the causes of death in HIV-seropositive patients. TB is the most commonly diagnosed opportunistic infection and the most frequent direct cause of death among HIV infected patients. The HIV infection can accelerate progression of TB infection to active TB disease. Among patients with active TB, those with HIV coinfection have the greatest risk for relapse. Regardless of increasing rate of TB and HIV in Iran, we decided to survey outcome of TB in HIV positive patients who treated with standard regimens in the years 2003-2012. This retrospective cohort study was conducted on HIV-positive patients with TB referred to Behavioral Diseases Consultation Center and Infectious Diseases Ward of Imam Khomeini Hospital from 2003 to 2012. Outcome was defined as failure, relapse and mortality. Moreover, the relationship between outcomes and number of CD4, co-trimoxazole and antiretroviral intake, type of TB and AIDS defining illness was studied. This study had 135 patients, 8 [5.9%] were females and 127 [94.1%] were males. The mean age of the patients was 40.14+10.02 and the most way to catch HIV in this study was intravenous drug user. There were 3 [2.22%] cases of failure, 15 [11.1%] relapse, and 21 [15.8%] deaths. Antiretroviral therapy, AIDS defining illness, type of TB and co-trimoxazole intake did not soley affect relapse. CD4 level was the most effective variables in relapse [Hazard ratio: 0.392 [0.11-1.4]; Relative Risk: 0.809 [0.593-1.103] [P=0.068]]. However, regard to CI95%, the impact of CD4 on relapse is not significant and antiretroviral intake was the most important and effective variable in increasing their survival. Hazard ratio: 0.137 [0.141-0.45]; Relative Risk: 0.686 [0.513-0.918] [P=0.001]. Overall, receiving antiretroviral was the most important factor influencing the outcome of patients
RESUMEN
Staphylococcus aureus infection pervasively occurs in communities and hospitals and observing related guidelines is essential in preventing development of antibiotic resistance in Hospitals. In this study we tried to determine the prevalence of Methicillin and vancomycine resistant staphylococcus aureus [MRSA and VRSA] and find the most suitable diagnostic tool and treatment in affected patients. This study was performed on hospitalized patients in Sina Hospital in Tehran, Iran during 2009-2010. Eighty-five staphylococcus aureus samples were evaluated for resistance to oxacillin and vancomycine by both disc diffusion and E-test methods. The study population included 46 male and 39 female patients. The mean age of the participants was 51.46 +/- 19.21 years. The MRSA frequency was 50%. 67 [78.8%] patients had hospital-acquired staphylococcus infection. The rate of hospital-acquired MRSA was 93%. Length of hospital stay, undergoing invasive methods, history of antibiotic use three months prior to hospitalization and its kind were recognized as MRSA risk factors. There were no reports of VRSA except one case of vancomycine-intermediate S. aureus [VISA]. The results of disk effusion and E-test methods were consistent. Considering the prevalence of methicillin resistance in hospital-acquired infections, it seems that oxacillin should not be used as the first-line option for empiric therapy against S. aureus till antibiogram results are available. Disc diffusion can also be reliably used instead of the more expensive E-test