[Bacterial colaonization of endotracheal tube connectors after 24, 48 and 72 hours of repeated intubation]

Colonization of bacteria on the equipments in touch with airway and respiratory mucosa may cause respiratory infections. According to available protocols, endotracheal tube connectors should be disposable, but because of financial issues many hospitals use it more than once. In the present study, the colonization rate of endotracheal tube connectors after 24, 48 and 72 hours of administration in multiple patients on mechanical ventilation in the operating room was assessed. In this study, 150 endotracheal tube connectors after repeated use in different patients have been sampled and cultured using standard microbiological methods. Samples were categorized in three groups based on the duration of administration [24, 48 or 72 hours]. Colony counts were identified and compared among the three groups. Colonization rate after 24, 48 and 72 hours of usage was 2%, 18% and 30%, respectively [p<0.05]. Separated bacteria usually were in kinds of Streptococci, Bacillus SP, Coagulate negative staphylococci, Klebsiella SP and Mold. Using endotracheal tube connector for more than 24 hours significantly increases the colonization rate. In hospitals with limited financial resources, repeated use of endotracheal tube connector up to twenty four hours maybe acceptable

[Frequency of ESBLs in Escherichia coli and klebsiella pneumoniae strains isolated from hospitalized and out-patients with urinary tract infection in selective centers in Esfahan [2009-2010]]

Urinary Tract Infection [UTI] is the second most common infection in human. Most of UTIs are due to Escherichia coli [E.coli] and Klebsiella pneumoniae [K.pneumoniae]. These bacteria are relevant opportunistic pathogens that account for nosocomial infections. Prevalence of Extended-Spectrum Beta-lactamase [ESBLs] in pathogenic bacteria leads to antibiotic resistance and mortality and morbidity in patients. The best method for controlling strains that produce ESBLs is use of standard method for recognizing ESBLs producer strains. The objective of this study was to evaluate and compare the frequency of ESBLs in Escherichia coli and Klebsiella pneumoniae strains isolated from hospitalized and out-patient with urinary tract infection in selective centers from Esfahan. The research was of descriptive type and performed in Al-zahra, Shariaty, and Kashany hospitals and Reference and Mahdieh laboratories during 2009-2010 in Isfahan. According to statistical formula 378 UTI samples were randomly selected. Bacterial identification was performed with microbiological methods and ESBLs production was performed with screening and confirmatory test. For data analysis, Chi square test and Whonet 5.4 software was used. From 378 samples, 167 bacteria were from hospitalized cases and 211 bacteria were from out-patient samples. Frequency of E.coli in hospitalized and out-patients was respectively 52% and 64% and frequency of K.pneumoniae in hospitalized and out-patient was respectively 64% and 22%. Frequency of ESBLs in E.coli strains in hospitalized and out-patient was respectively 58% and 17% and frequency of ESBLs in K.pneumoniae strains in hospitalized and out-patient was respectively 64% and 22%. The results showed high rate of nosocomial UTI and high frequency of ESBLs in isolated bacteria from hospitalized cases as compared to out-patients that represent high incidence of antibiotic resistant strains in hospitals

Emergence of cefepime resistance in gram-negative induced nosocomial infections

The rapid emergence of antibiotic resistance, especially broad-spectrum antibiotics, resulted in the avid use of new potent antibiotics. Ceftriaxone and ceftazidime, two third-generation cephalosporin, are usually used to manage complicated and uncomplicated infections. The use of cefepime in resistant infections is increasing gradually, which put this potent antibiotic at risk of resistance. During an 18-month period, a total of 220 gram-negative bacteria including Pseudomonas spp, Serratia spp, Acinetobacter spp, Proteus spp, E-coli and Kiebsiella spp. have been isolated by standard microbiological methods from nosocomial surgical site, abscess, blood stream and urinary tract infections. MIC of antibiotics on isolated bacteria was determined by gradient concentration method. Totally, 29.4%, 19.5% and 23.3% of isolated bacteria with MIC /= 256micro g/ml to cefepime, cefiriaxone and ceftazidime was also observed in 47.1%, 70.8% and 62.5% of cases, respectively [p<0.05]. High level resistance to cefepime were more commonly observed for pseudomonas [73.1%] and Klebsiella spp. [73.5%], respectively [p<0.05]. According to CLSI criteria, 47.1% of isolated bacteria in this study showed high level of resistance [MIC >/= 256micro g/ml] to cefepime. Therefore application of cefepime, as a drug of choice, for gram-negative organisms is not reasonable. Our result demonstrated that this potent antibiotic should not be used as a choice for empiric antibiotic therapy, in the cases of nosocomial infections caused by gram-negative organisms