[The frequency of class 1 integrons in multi-drug resistant Klebsiella pneumoniae isolated from clinical samples using polymerase chain reaction assay]

Background and Aim: the development of multidrug resistant [MDR] strains of K. pneumoniae is a matter of great concern and horizontal transfer of integrons is one of the most important factors in the creation of multidrug-resistant [MDR] bacteria. This study was aimed to determine the frequency of class 1 integrons and their gene cassettes among MDR K. pneumonia strains isolated from clinical specimens

Materials and Methods: this cross-sectional study included 181 samples of Klebsiella pneumoniae isolated from outpatients and hospitalized patients between November 2013 and June 2014. Antimicrobial susceptibility patterns of isolated samples were determined by disk diffusion method according to the CLSI guidelines. The presence of class 1 integrons and embedded gene cassettes were investigated in MDR strains by polymerase chain reaction assay. Using SPSS 17, statistical analyses were carried out by chi-square [Chi[2]] and Fisher exact tests. P-values of less than 0.05 were considered statistically significant

Result: of 181 isolated samples, 150 [82.9%] were multidrug resistant. The most and the least resistance rates belonged to ampicillin [98.7%] and imipenem [24%] respectively. Class I integrons were seen in 150 [100%] of MDR isolated samples and 147 [98%] of them contained gene cassettes of five different kinds

Conclusion: we found a high frequency rate of class 1 integrons and embedded gene cassettes in MDR Klebsiella pneumoniae in the hospitalized patients in Kashan which can play an important role in the creation and transmission of antibiotic resistance

[Frequency of group B capsular serotypes of Streptococcus using the multiplex PCR among the pregnant women in Kashan during 2011-2013]

Group B Streptococcus [GBS] has been described as an important pathogen in newborns and pregnant women. Maternal vaccination against GBS can reduce maternal GBS colonization and enhance antibody transfer to the fetus and also prevent the subsequent infections. Nine serotypes can be identified based on capsular polysaccharide: Ia, Ib, II-VIII. Due to the changes in serotypes' distribution pattern over time and also variation in different geographic areas, production of a universally optimal vaccine is impossible. This study aimed to evaluate the serotype distribution of GBS using the multiplex PCR among the pregnant women. This study was performed on 382 pregnant women. Vaginal swab samples were placed in the LIM selective medium and incubated at 37°C for 24 h. Then the samples were cultured in blood Agar medium and the GBS was identified and confirmed using the standard tests and gene encoding dlts, respectively. Capsular typing was performed using the multiplex PCR method to identify the Ia, Ib, II-VIII serotypes. Thirty-six [9.4%] out of 382 pregnant women were carriers of GBS. The most common types were III [32.14%], V [21.43%], and IV [14.3%], respectively. Types II and VIII were not identified in this study. Considering the high prevalence of III, V and IV serotypes in this study, they are potential sources for the production of multivalent GBS vaccines in near future

[Identification of serological groups A, B, C, W135, Y, X Neisseria meningitidis carriers by multiplex PCR in the nasopharynx of students in Kashan during 2011-2012]

Neisseria meningitidis [N. meningitidis] is a pathogen which colonizes in the nasopharynx without any clinical manifestations. Among the 13 different serological groups, only the serogroups A, B, C, W135, Y, X play a major role in disease development. This study aimed to determine N. meningitidis cases carrying these serological groups using the multiplex PCR method in the nasopharynx of students in Kashan schools. This cross-sectional study was conducted on 1289 students in Kashan during 2011-2012. Samples were collected from the students' nasopharynx using a sterile swab and cultured on a selective medium. Strains were identified through biochemical tests. Then the serological groups were determined using the multiplex PCR method. One-hundred and fifteen [8.9%] out of 1289 students were N.meningitidis carriers; 75 [65.2%] male and 40 [34.8%] female. There was a significant difference between gender and the rate of carriers [P=0.032]. The highest rate of carriers [12.3%] was in the 15 to 19 year age group. There was a significant relationship between the rate of carriers and increase in the number of family members [P<0.001]. In this study, only the serological groups B [8 cases] and C [107 cases] were detected. Since the serological group C is involved in the outbreak and there is no vaccine currently available for the serological group B to prevent the infection, detection of these serological groups can be important

[Antibiotic resistance pattern of Vibrio cholerae strains isolated from the stool of cholerae patients in Kashan during 1998-2009]

Cholera is an acute diarrhoeal disease that can cause severe dehydration and death within the hours of its onset. Considering the importance of the disease, this study was carried out to assess the antibiotic resistance pattern of Vibrio cholerae [V. cholerae] strains isolated from the stool of cholerae patients in Kashan during 1998-2009. This cross-sectional study was carried out on stool specimens obtained from acute diarrhea cases referred to health care centers in Kashan. The samples were identified according to the guidelines established by the National Committee for Clinical Laboratory Standards [NCCLS] and then the biotype and serotype of V. cholerae isolates were identified using the enzymatic method. Finally, antibiotic sensitivity testing was performed using the Kirby-Bauer disk diffusion method. Resistance to all antibiotics except erythromycin was seen in all isolates of V. cholerae [58 isolates]. The highest antibiotic resistance rate was seen for ampicillin [31%] and the lowest ones for doxycycline, ciprofloxacin and tetracycline [7.1%], respectively. Moreover, among different V. cholerae serotypes, the lowest and highest levels of antibiotic resistance were seen for Inaba and Ogawa serotypes, respectively. There was no significant difference in resistance pattern between the different age and gender groups. According to the results of this study, an increased antibiotic resistance in V. cholerae has been observed which can result in the emergence of multidrug resistance and therapeutic complications

[ impact of public partnership to identify patients with tuberculosis in Darashar, Iran]

Participation of community-based services in the National Tuberculosis Control Programme is [NTCP] necessary to identify and treat all patients with tuberculosis [TB]. We developed a novel model to encourage family members and relative to participate in the RNTCP in Darahshar city. This community-based intervention was included of two groups of community [relatives of patients and schools]. They were trained to identify and refer of patients to allocated health centers. Case finding indices were compared initially and one year intervention. The exponential distribution and logarithmic of incidence were used to compare the incidence of tuberculosis after the intervention with other cities of the province. The incidence of smear positive cases increased from 5.1/100,000 to 35.2/100,000 [p <001]. There was a statistically significant difference between incidence of smear positive cases in Darehshar city and other cities in Ilam province [p <001]. During the intervention, 408 suspected patients was identified, it showed about 297 percent increased in case finding [cases in the previous year of the intervention were 137 cases] [p <001]. It seems that community-based intervention could be an effective method to enhance of identify and control of patients with tuberculosis

[Frequency of extended-spectrum beta-lactamase [ESBL] multidrugresistance produced by Pseudomonas aeruginosa isolated from clinical and environmental specimens in Kashan Shahid Beheshti hospital during 2010-11]

Pseudomonas aeruginosa is among the most important nosocomial bacterial infections with innate resistance to many antibiotics. This study was designed to evaluate the frequency of extended-spectrum beta-lactamase [ESBL] multidrug-resistance produced by P. aeruginosa isolated from clinical and environmental specimens in Kashan Shahid Beheshti hospital. This descriptive study was conducted on clinical isolates [n=76] of P. aeruginosa from Kashan Shahid Beheshti hospital during 2010-11. Antibiotic susceptibility testing for eight antimicrobial agents was carried out according to the clinical and laboratory standards institute [CLSI] guidelines and ESBL-producing strains were confirmed using double-disk diffusion test. MDR-isolates were defined as those resistant to three or more classes of antibiotics. Among all P. aeruginosa isolates, the highest resistance was seen for piperacillin, imipenem, cefotaxime, ceftriaxone, gentamicin, ceftazidime, aztreonam and ciprofloxacin, respectively. Seven strains [9.2%] were ESBL-positive. Twenty-seven percent of the isolates were resistant to at least three classes of antibiotics; 8 out of 14 tracheal discharges; 4 out of 9 wound and 2 out of 3 blood samples were MDR. The study emphasizes the high frequency of MDR-P. aeruginosa in clinical and environmental specimens isolated from this hospital. Imipenem resistance in MDR-P.aeruginosa isolates is also high in this study. This calls for strict infection control measures to prevent further microbial spread

[Prevalence and multi-drug resistance of enteropathogenic Escherichia coli [EPEC] isolated from children under 5 years of age with diarrhea in Kashan Shahid Beheshti hospital during 2009-10]

Enteropathogenic Escherichia coli [EPEC] is the most important diarrheagenic agent among children in developing countries. However, recent studies have shown its prevalence in developed countries. The purpose of this study was to evaluate the prevalence and multi-drug resistant [MDR] of EPEC isolated from children under 5 years of age with diarrhea hospitalized in Kashan Shahid Beheshti hospital during 2009-10. In this descriptive study 313 fecal specimens were collected using rectal swab method from all children under 5 years of age with diarrhea hospitalized in Kashan Shahid Beheshti Hospital during 2009-10. Specimens were examined by PCR test to determine the eae Gene for detection of EPEC pathotype. The isolated multi-drug resistance pattern of EPEC was evaluated by disk diffusion agar. The antimicrobial disks used were ampicillin, nalidixic acid, ceftriaxone, ciprofloxacin, cefalexin, ceftazidime, streptomycin and imipenem. Of all 178 E. coli cases 51 [28.6%] EPEC pathotypes were isolated. The prevalence of EPEC was higher in children under 1 year of age. MDR rate in EPEC was 70.6%. The exact application of antibiogram test is necessary before antibiotic prescription for complete treatment and prevention of diarrhea caused by multi-drug resistance agents

Imipenem resistance among gram-negative and gram-positive bacteria in hospitalized patients

Recent analyses of hospital outbreaks have documented the spread of resistance to imipenem, which is currently a major problem among gram positive and gram-negative bacteria. The aim of this study was to describe the rate of gram-positive and gram-negative isolates resistance to imipenem as an antibiotic. Recorded files of 242 hospitalized patients with at least one sample of positive culture specimens in one of the two general hospitals of Shahid Beheshti and Naghavi in Kashan, Iran in 2005 were randomly selected and reviewed. All strains were tested for antibiotic susceptibility by Disk Diffusion and were designated for imipenem. Escherichia coli [21.9%], Kelebsiella [19.8%] and coagulase-negative Staphylococci [17.8%] were the most common isolated organisms. Imipenem had coverage against 96.2% of Escherichia coli, 58.4% of Kelebsiella, 79.1% of coagulase-negative Staphylococci, 81.8% of Pseudomonas aeruginosa, and 85.7% of Entrococci isolates. Proteus and Salmonella isolates susceptibility to imipenem was 100%. Susceptibility of Escherichia coli, Salmonella and Proteus to imipenem is satisfactory; however, the susceptibility of Pseudomonas aeruginosa to this antibiotic was dramatically lower in our region. Because of the major health problems caused by imipenem resistance, attempts have been made to organize a national surveillance program in our country

Comparison of metronidazole and furazolidone against giardia lamblia in children

This study was conducted on children infected by Giardia lamblia to evaluate the effectiveness and side effects of Metronidazole and Furazolidone drugs in Kashan. One hundred twenty two individuals infected with Giardia lamblia were assigned in 2 groups. They were 5-12 years old. Patients were surveyed four weeks following the therapy with Metronidazole and Furazolidone. Results were compared using chi-square method. Of 122 infected patients, 68.8% were urban residents, 43.4% were females and 56.6% were males. Abdominal pain was the most common clinical symptoms [84.2%]. Four weeks after the therapy, the efficacy of metronidazole and furazolidone were 87 and 81.6%, respectively. Malaise [12.9%] and dark urine [25%] was the most frequents side effects of metronidazole and furazolidone, respectively. With respect to the efficacy of antiparasite drugs in the treatment of giardiasis, further studies in different parts of the country are highly recommended