Prevalence of ESBL-Producing Enterobacter Species Resistant to Carbapenems in Iran: A Systematic Review and Meta-Analysis.

Background: Carbapenems are the last-line therapy for multidrug-resistant (MDR) infections caused by Enterobacterales, including those caused by Enterobacter species. However, the recent emergence of carbapenem-resistant (CR) and extended-spectrum ß-lactamase (ESBL)-producing Enterobacteriaceae pathogens, which are resistant to nearly all antibiotics, has raised concerns among international healthcare organizations. Hence, because there is no comprehensive data in Iran, the current study aimed to evaluate the prevalence of antibiotic resistance among Enterobacter species, especially CR and ESBL-producing strains, in Iran. Methods: The literature search was performed up to June 21, 2021, in national and international databases using MeSH-extracted keywords, i.e., Enterobacter, antibiotic resistance, carbapenem, ESBL, and Iran. Study selection was done based on the predefined inclusion and exclusion criteria, and data analysis was carried out using the Comprehensive Meta-Analysis (CMA) software. Results: The pooled prevalence of Enterobacter species resistant to various antibiotics is as follows: imipenem 16.6%, meropenem 16.2%, aztreonam 40.9%, ciprofloxacin 35.3%, norfloxacin 31%, levofloxacin 48%, gentamicin 42.1%, amikacin 30.3%, tobramycin 37.2%, tetracycline 50.1%, chloramphenicol 25.7%, trimethoprim/sulfamethoxazole 52%, nalidixic acid 49.1%, nitrofurantoin 43%, ceftriaxone 49.3%, cefixime 52.4%, cefotaxime 52.7%, ceftazidime 47.9%, cefepime 43.6%, and ceftizoxime 45.5%. The prevalence rates of MDR and ESBL-producing Enterobacter species in Iran were 63.1% and 32.8%, respectively. Conclusion: In accordance with the warning of international organizations, our results revealed a high prevalence of ESBL-producing Enterobacter species in Iran, which is probably associated with the high prevalence of Enterobacter species resistant to most of the assessed antibiotics, especially MDR strains. However, the resistance rate to carbapenems was relatively low, and these drugs can still be considered as drugs of choice for the treatment of Enterobacter infections in Iran. Nevertheless, continuous monitoring of drug resistance along with antibiotic therapy based on the local data and evaluation of the therapeutic efficacy of new antibiotics or combination therapeutic strategies, such as ceftazidime/avibactam, meropenem/vaborbactam, plazomicin, and eravacycline, is recommended.

Prevalence of resistance genes to biocides in antibiotic-resistant Pseudomonas aeruginosa clinical isolates.

BACKGROUND: Biocides are frequently used as preservative, disinfectant and sterilizer against many microorganisms in hospitals, industry and home. However, the reduced susceptibility rate of Pseudomonas aeruginosa (P. aeruginosa) strains to biocides is increasing. The aim of this study was to evaluate the antimicrobial activity of four frequently used biocides against P. aeruginosa and to determine the prevalence of genes involved in biocide resistance. METHODS: A total of 76 clinical isolates of P. aeruginosa strains were used in the present study. The minimum inhibitory concentrations (MICs) of four biocides, i.e. chlorhexidine digluconate, benzalkonium chloride, triclosan and formaldehyde, against P. aeruginosa strains were determined using agar dilution method. In addition, the prevalence of biocide resistance genes was determined using the polymerase chain reaction (PCR) method. RESULTS: In the present study, the highest MIC90 and MIC95 (epidemiological cut-off) values were observed for benzalkonium chloride (1024 µg/mL), followed by formaldehyde (512 µg/mL), triclosan (512 µg/mL) and chlorhexidine digluconate (64 µg/mL). Furthermore, the prevalence of qacEΔ1, qacE, qacG, fabV, cepA and fabI genes were 73.7% (n = 56), 26.3% (n = 20), 11.8% (n = 9), 84.2% (n = 64), 81.5% (n = 62) and 0% (n = 0), respectively. A significant association was observed between the presence of biocide resistance genes and MICs (p < 0.05). Furthermore, there was no significant association between the presence of biocide resistance genes and antibiotic resistance (p > 0.05), except for levofloxacin and norfloxacin antibiotics and qacE and qacG genes (p < 0.05). CONCLUSION: Our results revealed that chlorhexidine digluconate is the most effective biocide against P. aeruginosa isolates in Ardabil hospitals. However, we recommend continuous monitoring of the antimicrobial activity of biocides and the prevalence of biocide-associated resistance genes for a better prevention of microorganism dissemination and infection control in hospitals.

Group A Streptococcus Antibiotic Resistance in Iranian Children: A Meta-analysis.

OBJECTIVES: Streptococcus pyogenes is associated with mild to severe infections, particularly in children and young adults. Proper antimicrobial treatment of S. pyogenes infections is important to prevent post-streptococcal complications. Therefore, the purpose of this meta-analysis was to evaluate the prevalence of S. pyogenes antibiotic resistance among Iranian children. METHODS: We identified all published studies up to 20 March 2019 related to S. pyogenes antibiotic resistance by searching Persian and English electronic databases. Search terms included S. pyogenes, children, and Iran. Out of 1022 publications, 12 articles were eligible and included based on the inclusion and exclusion criteria. RESULTS: Our analysis indicated the following prevalence pattern for S. pyogenes antimicrobial resistance in Iran: 4.2% to penicillin, 38.3% to amoxicillin, 5.4% to erythromycin, 12.0% to azithromycin, 12.6% to clarithromycin, 12.4% to clindamycin, 15.3% to rifampicin, 8.1% to ceftriaxone, 17.6% to cefixime, 36.9% to ampicillin, 14.1% to vancomycin, 8.4% to chloramphenicol, 30.4% to tetracycline, 8.8% to cefotaxime, 82.8% to trimethoprim/sulfamethoxazole, 39.6% to gentamicin, 11.9% to ofloxacin, 28.3% to carbenicillin, 3.1% to ciprofloxacin, 6.1% to imipenem, 18.2% to cephalothin, 57.6% to tobramycin, 49.3% to kanamycin, 79.0% to cloxacillin, 12.9% to cephalexin, 10.7% to cefazolin, and 89.5% to amoxicillin-clavulanic acid. CONCLUSIONS: Our findings suggest penicillin (in non-allergic children) and macrolides, lincosamides, and narrow-spectrum cephalosporins (in penicillin-allergic children) as the treatments of choice in Iran.

Antibiotic resistance patterns and prevalence of class I, II and III Integrons among clinical isolates of Klebsiella pneumoniae.

Klebsiella pneumoniae is a well-known pathogen and contributes to different types of infection. To investigate the antibiotic resistance profiles and prevalence of class I, II, and III integrons among clinical isolates of K. pneumoniae, a total of 142 non-duplicate clinical isolates were collected. Antibiotic susceptibility was assessed using Kirby-Bauer disk diffusion method and Clinical and Laboratory Standards Institute (CLSI) guidelines. Polymerase chain reaction (PCR) method was used to identify class I, II and III integrons. The isolates were mostly resistant against streptomycin (62 strains, 43.7 %) and ceftriaxone (42 strains, 29.6 %). Twenty-six (18.3%) isolates were found to be multi-drug resistant (MDR). Class I and II integrons were detected in 65 isolates (45.8%) and 1 (0.7%) isolate, respectively. The findings of this study revealed that the prevalence of streptomycin-resistant isolates is high, and its use must be restricted. Also, our results revealed that class I integrons are widely prevalent in clinical isolates of K. pneumoniae and a significant association was observed between resistance against imipenem, ciprofloxacin, gentamicin and streptomycin and the presence of integrons, necessitating appropriate infection control programs.

Prevalence of fluoroquinolone-resistant Salmonella serotypes in Iran: a meta-analysis.

The present study was conducted to investigate the antimicrobial susceptibility profiles of Salmonella serotypes, especially fluoroquinolone-resistant strains, recovered from clinical samples in Iran. A full electronic search using related keywords was conducted in Persian and English languages in ISI Web of Knowledge, PubMed, Scopus, Google Scholar and the Scientific Information Database (SID) search engines to find papers published between 1983 and 1 July 2019. According to the inclusion and exclusion criteria, 46 eligible articles were selected for the final analysis out of the initial 13,186 studies retrieved. The pooled prevalence of quinolone-resistant Salmonella serotypes in clinical specimens in Iran was 2.9% to ciprofloxacin and 48.1% to nalidixic acid. Additional data on antibiotic resistance was as follows: 54.3% to tetracycline, 50.6% to ceftizoxime, 50.2% to streptomycin, 37.9% to ampicillin, 36.5% to kanamycin, 33.5% to trimethoprim-sulfamethoxazole, 27.2% to chloramphenicol, 19.1% to cephalothin, 8.8% to ceftriaxone, 7.6% to cefotaxime, 7.4% to aztreonam, 7.2% to gentamicin, 7% to cefepime, 6.8% to ceftazidime, 5.8% to cefixime, 2.7% to imipenem and 2.2% to meropenem. Findings of the present study showed a rising trend of resistance to the drugs of choice for the treatment of Salmonella infections, i.e. ampicillin, chloramphenicol and trimethoprim-sulfamethoxazole in Iran. However, ciprofloxacin, third-generation cephalosporins and carbapenems are still effective antibiotics especially against multi-drug resistant strains in Iran.

Prevalence of Antibiotic Resistance of Haemophilus Influenzae in Iran- A Meta-Analysis.

INTRODUCTION: Based on the World Health Organization reports, infections caused by ampicillin-resistant Haemophilus influenzae strains are a major threat to public health and need urgent therapy with new antibiotics. Given the lack of a previous comprehensive study on the prevalence of the antibiotic resistance of H. influenzae in Iran, this systematic review and meta-analysis was performed to increase the knowledge about antibiotic resistance status of this pathogenic agent. MATERIALS AND METHODS: For the purpose of the study, the articles related to the subject of interest and published up to August 2018 were searched in several English and Persian databases, including PubMed, Scopus, Web of Science, Scientific Information Database, and Magiran. The search process was accomplished using the following keywords: "Antibiotic resistance", "H. influenzae", and "Iran". The data were pooled from 13 eligible studies reporting the prevalence of antibiotic resistance of H. influenzae in Iran. RESULTS: The prevalence of H. influenzae resistance to various antibiotics in Iran, including ampicillin, amoxicillin, cephalexin, cefixime, ceftazidime, cefotaxime, and ceftizoxime, were obtained as 54.8%, 66.6%, 28.6%, 62%, 21.3%, 22.3%, 23.2%, respectively. These rates were reported as 27.7%, 46.7%, 53%, 82.6%, 40.3%, 30.8% for chloramphenicol, tetracycline, trimethoprim/sulfamethoxazole, penicillin, erythromycin, and ciprofloxacin, respectively. Additionally, ceftriaxone, gentamicin, amikacin, kanamycin, rifampin, azithromycin, and clindamycin had the H. influenzae resistance rates of 33.1%, 40.2%, 45.8%, 44.4%, 18.5%, 17.4%, and 71.3%, respectively. CONCLUSION: The majority of the antibiotics tested in Iran showed a high rate of resistance to H. influenzae. This may cause serious problems in the treatment of infections in the future. Therefore, precautionary measures, such as monitoring antibiotic prescription and resistance and using the new classes of antibiotics, are necessary.

Bacterial infections are associated with cardiovascular disease in Iran: a meta-analysis.

INTRODUCTION: The present study aimed to assess the prevalence and association of various bacterial infections with cardiovascular disease (CVD) in Iran. MATERIAL AND METHODS: An electronic search was performed using related keywords in the national and international databases up to June 30, 2017. Out of the 1807 articles found on the associations between bacterial infections and CVD, 20 relevant studies were selected for the meta-analysis. RESULTS: The prevalence of bacterial infections was higher in case groups compared with the control groups. Odds ratios for assessing the association between Chlamydia pneumonia infection and CVD based on PCR, IgG and IgA tests were 7.420 (95% CI: 3.088-17.827), 3.710 (95% CI: 1.361-10.115) and 2.492 (95% CI: 1.305-4.756), respectively. Moreover, the calculated odds ratio for Mycoplasma pneumonia infection was 1.815 (95% CI: 0.973-3.386). For Helicobacter pylori infection, odds ratios based on IgG and IgA tests were 3.160 (95% CI: 1.957-5.102) and 0.643 (95% CI: 0.414-0.999), respectively. CONCLUSIONS: The present meta-analysis suggested that there was a significant association between H. pylori, C. pneumonia and M. pneumonia infections and CVD in Iran. These findings confirm the potential role of bacterial infections as predisposing factors for CVD.

Carbapenem-Resistant Klebsiella Pneumoniae in Iran: a Systematic Review and Meta-Analysis.

The global emergence and dissemination of carbapenem-resistant (CR)-Klebsiella pneumoniae is an important healthcare concern owing to the limited therapeutic options that are available. The aim of the present study was to evaluate the prevalence of CR K. pneumoniae in different parts of Iran. A comprehensive literature search was performed in national and international databases. After applying predefined inclusion and exclusion criteria, 36 articles reporting prevalence of CR K. pneumoniae were collected. The pooled prevalence of CR K. pneumoniae was estimated to be 11.3% (95% CI: 0.084-0.15). The highest and lowest prevalence rates of CR K. pneumoniae were in Isfahan 58% (95% CI: 0.48-0.67) and Tehran 0.004 (95% CI: 0.00-0.05), respectively. The highest and lowest resistance rates were seen against aztreonam (55%, 95% CI: 0.48-0.62) and amikacin (23%, (95% CI: 0.17-0.29), respectively. The findings of the present study revealed that the prevalence of CR K. pneumoniae is alarmingly high in the majority of Iranian hospitals.

Molecular characteristics of Staphylococcus aureus nasal carriage among health care workers at a Referral Hospital in Zabol, Iran.

INTRODUCTION: Staphylococcus aureus (S. aureus) is known as one of the most important hospital pathogens responsible for a wide range of infections. Limited data concerning the prevalence of nasal carriage of S. aureus and its molecular characteristics are available in Zabol province, Iran. Therefore, the aim of the present study was to determine the prevalence of nasal carriage of S. aureus and its molecular characteristics isolated from health care workers (HCWs). METHODS: Totally, 251 nasal swabs were collected from HCWs at a referral hospital, from March to September 2017. Disk diffusion method was used to identify Methicillin-Resistant S. aureus (MRSA). PCR amplification method was used for the detection of following genes; sea, seb, sec, sed, see, tst, eta, etb, lukF-PV, lukS-PV and SCCmec types. RESULTS: Of 251 collected swabs, 31 (12.4%) cases were identified as S. aureus carriers, which 14 (14/31; 45.2%) isolates were MRSA. The most prevalent detected genes were sea and tst, with 22.6% and 9.7%, respectively. The most prevalent SCCmec type was SCCmec type IV (28.6%). CONCLUSION: We found that the prevalence of MRSA nasal carriage is at high level and must be considered as a significant health care problem at the investigated hospital. Strict implementation of infection-control policies and rational use of antibiotics are the main pillars for controlling the spread of S. aureus at hospital.

Multidrug Resistant Pseudomonas aeruginosa in Iran: A Systematic Review and Metaanalysis.

BACKGROUND: Multidrug-resistant Pseudomonas aeruginosa (MDR P. aeruginosa) is known as a serious threat to human health worldwide. Limited information is available concerning the prevalence of MDR P. aeruginosa in Iran. The aim of the present study was to investigate the relative frequency of MDR P. aeruginosa in different parts of Iran. MATERIALS AND METHODS: Using appropriate keywords and well-known English and Persian database, available data about MDR P. aeruginosa in Iran were retrieved. After applying predefined criteria, relevant studies were selected. RESULTS: By using random-effect models, the pooled incidence of MDR P. aeruginosa was estimated 58% (95% confidence interval [CI]; 0.54-0.61). The highest and lowest prevalence of MDR P. aeruginosa were observed in Tehran (100%) (95% CI; 0.94-1.00) and Zahedan (16%) (95% CI; 0.10-0.24), respectively. The highest resistance rate was against ceftazidime (50%) (95% CI; 0.46-0.54) and amikacin (50%) (95% CI; 0.46-0.54). CONCLUSION: Our findings are of concern since they demonstrate the high prevalence rate of MDR P. aeruginosa in the majority of Iranian hospitals.

Bacterial Co-infections in HIV/AIDS-positive Subjects: A Systematic Review and Meta-analysis.

BACKGROUND: Bacterial infections are the most common complications in people with HIV/AIDS. There has been no previous report on the prevalence of bacterial co-infections in Iranian HIV/AIDS-positive subjects. AIM: To evaluate the frequency of bacterial infections in hospitalized HIV/AIDS-infected patients in Iran. MATERIALS AND METHODS: Based on PRISMA guidelines, a computerized search in related data banks using relevant keywords was performed in both Persian and English languages for articles that were published until March 10, 2017. A total of 1118 original articles were systematically reviewed to identify eligible studies on the prevalence of bacterial co-infections in HIV/AIDS-infected patients from Iran. After screening for inclusion and exclusion criteria, we extracted data from 28 eligible articles for the meta-analysis. RESULTS: The overall bacterial infection rate among Iranian HIV/AIDS-positive individuals was estimated to be 48.6%. Gastrointestinal disorders (59.5%) were the most frequent bacterial infections in this group of patients followed by bacterial lymphadenopathy (38.9%), TB infection (38.2%), bacterial pneumonia (31.2%), brucellosis (26.3%), skin infections (13.3%) and sexually transmitted infections (9.7%). The prevalence of other bacterial infections including endocarditis, sepsis and Staphylococcus aureus (S. aureus) were 10%, 9.1%, and 6.9%, respectively. CONCLUSION: The prevalence of a wide spectrum of bacterial co-infections, especially endemic infections, in Iranian HIV/AIDS-infected patients, is alarming and calls for urgent need to improve the currently applied diagnostic and preventive methods. In addition, timely treatment of these infections is pivotal to decrease the morbidity and mortality rates in HIV/AIDS-infected patients.

Metallo-beta-Lactamase-producing Pseudomonas aeruginosa in Iran: a systematic review and meta-analysis.

Metallo-beta-lactamase (MBL)-producing Pseudomonas aeruginosa is considered to be a serious threat to human health worldwide. Limited information is available concerning the prevalence of MBL-producing P. aeruginosa in Iran. The aim of the present study was to investigate the prevalence of MBL-producing P. aeruginosa in different parts of Iran. We searched major electronic databases including PubMed, ISI Web of Science, Scopus and Google Scholar as well as two Iranian search engines using appropriate keywords. After applying inclusion and exclusion criteria, related papers were recruited for the study. The prevalence of MBL-producing P. aeruginosa in Iranian population was about 32.4 %. Our findings also revealed that the highest prevalence of MBL-producing P. aeruginosa was in Isfahan with 60% (95% CI: 0.27-0.86). In addition, in Iranian population the most reported MBL gene was blaVIM and blaIMP, with frequencies of 19% (95% CI: 0.15-0.23) and 11% (95% CI: 0.08-0.14), respectively. Based on our findings, in the majority of Iranian hospitals, the prevalence of MBL-producing P. aeruginosa is alarmingly high necessitating the need for designing appropriate infection control programs.

Are chitosan natural polymers suitable as adjuvant/delivery system for anti-tuberculosis vaccines?

Today, the effectiveness of the only approved tuberculosis (TB) vaccine, bacillus Calmette-Guerin (BCG), has encountered several serious problem in the control of TB infections including variable protection in adolescents and adults, the emergence of drug-resistant strains of Mycobacterium tuberculosis (Mtb) as well as HIV/AIDS co-infection. Various studies have shown that chitosan, a natural polymer, can serve as a potent carrier for the delivery of various hydrophilic molecules such as peptide, protein and drug agents due to some of its excellent characteristics including low toxicity, biodegradable and biocompatible properties and stability. Currently, these polysaccharide polymers have gained more attention as candidates for the adjuvant/delivery of anti-TB vaccines due to better cellular uptake, muco-adhesive characteristics, prolonged control release, persistent stimulation of the immune system, more efficient uptake by antigen processing cells (APCs), adjuvant/immunopotentiator function, and preventing antigen degradation in-vivo. The present study showed that the new generation of TB vaccine candidates when used in combination with chitosan and its derivatives as adjuvant or delivery system, could potently induce both protective and cell-mediated (CD4 and CD8) immune responses in animal models. In addition, they could also enhance protection against Mtb infection in TB-challenged mice and act as booster-vaccines to improve BCG-primed immunity and excellent prime-vaccines. The results of this study showed that parenteral and non-parenteral immunization of chitosan-based TB vaccines can induce appropriate immune responses; however, we suggest that based on some advantages of chitosan polymers and mucosal delivery route, non-parenteral immunization may be a better administration route for chitosan-based TB vaccines.

Prevalence of bacterial vaginosis in pregnant and non-pregnant Iranian women: a systematic review and meta-analysis.

PURPOSE: Bacterial vaginosis (BV) is a vaginal disorder which occurs either symptomatic or asymptomatic because of an imbalance between H2O2-producing Lactobacillus and Gardnerella vaginalis in the vagina. This systematic review and meta-analysis is the first to determine the prevalence of BV in pregnant and non-pregnant women in Iran. METHODS: We used national (SID, Irandoc, Iranmedex and Magiran) and international (PubMed, Scopus, Google Scholar and ISI web of knowledge) electronic databases to systematically search and collect available studies using related keywords (up to 1 December 2017). Inclusion and exclusion criteria were defined to select eligible studies. RESULTS: The overall prevalence of BV among Iranian women was 18.9% (95% CI 14-25). Gardnerella vaginalis was the most prevalent isolated bacteria. The prevalence of BV in non-pregnant women was 28% (95% CI 15.1-45.9) which was higher compared with pregnant women who had a prevalence of 16.5% (95% CI 12.5-21.6). CONCLUSION: The present review revealed a high prevalence of BV in non-pregnant women. Given that BV is associated with a series of reproductive complications such as infertility, taking preventive measures such as awareness of patients as well as monitoring and controlling of syndrome are essential.

Antibiotic Resistance of Helicobacter pylori in Iranian Children: A Systematic Review and Meta-Analysis.

Antibiotic therapy for children infected with Helicobacter pylori is important. However, resistance to antibiotics is one of the main causes of treatment failure. This study was designed to evaluate the prevalence pattern of antibiotic resistance of H. pylori in Iranian children using a systematic review and meta-analysis of literature. A computerized search (until June 10, 2017) using related keywords in the national and international databases was performed. A total of 261 original articles on antibiotic resistance of H. pylori in Iranian children were collected. After screening for inclusion and exclusion criteria, six eligible articles were included in the meta-analysis. Resistance rates of H. pylori to different antibiotics were as follows: metronidazole: 71%, clarithromycin: 12.2%, amoxicillin: 20.4%, tetracycline: 8.4%, ampicillin: 21.4%, rifampin: 28.6%, furazolidone: 8.4%, ciprofloxacin: 16.2%, azithromycin: 19%, erythromycin: 15.3%, and nitrofurantoin: 0%. The prevalence of H. pylori resistance to metronidazole, amoxicillin, ampicillin, and rifampin among Iranian children was high. Therefore, a careful monitoring of antibiotic resistance to select the best treatment options and prevent treatment failure is required. Although resistance to some antibiotics such as clarithromycin, tetracycline, furazolidone, and ciprofloxacin was less prevalent, frequent consumption of these drugs in children should be controlled owing to their known adverse events.

Characterization of clarithromycin-resistant Helicobacter pylori strains in Iran: A systematic review and meta-analysis.

BACKGROUND: The high prevalence of clarithromycin-resistant strains of Helicobacter pylori is a main challenge for the successful treatment of gastrointestinal infections. Point mutations in the 23S rRNA gene are one of the main mechanisms leading to the resistance to clarithromycin in Iran. The purpose of the present review was to evaluate the prevalence of clarithromycin-resistant H. pylori strains in Iran and to identify the major molecular mechanisms of resistance in the resistant isolates. METHODS: Using related keywords and computer search in English and Persian databases (up to November 21, 2016), available data about prevalence of clarithromycin-resistant H. pylori strains and molecular mechanisms of resistance in Iran were retrieved. Relevant articles were selected using pre-defined inclusion and exclusion criteria. RESULTS: The results of the meta-analysis showed that the overall prevalence of clarithromycin-resistant H. pylori strains in Iran is 14.7%. The highest and the lowest resistance to clarithromycin were reported from Kashan (33.7%) and Rasht (5.5%), respectively. The most prevalent point mutations in Iran were A2143G (59.1%), A2142G (17.8%), A2142C (8.8%), and A2144G (6.2%), respectively. CONCLUSION: The prevalence of clarithromycin-resistant H. pylori strains was in an acceptable level in our region. Therefore, clarithromycin can be used for the eradication of H. pylori infection in Iran. However, it seems that investigation about the role of other mechanisms involved in the induction of resistance to clarithromycin is needed.

Systematic review and meta-analysis of imipenem-resistant Pseudomonas aeruginosa prevalence in Iran.

INTRODUCTION: Imipenem-resistant Pseudomonas aeruginosa (IRPA), due to resistance to different classes of antibiotics and its remarkable capacity to survive in harsh and adverse conditions such as those in the hospital environment, is considered a serious threat to the healthcare system. Given the great impact of IRPA on patients' outcome and in order to possibly improve antibiotic prescription, this study was conducted to determine the prevalence of clinical isolates of IRPA in different parts of Iran. METHODS: A systematic literature search was performed in PubMed, Web of Science, Google Scholar and Scopus, as well as in two Iranian domestic search engines, i.e., Iranian Scientific Information Database and Magiran. Finally, after applying exclusion and inclusion criteria 37 articles with full-texts describing the prevalence of imipenem-resistant P. aeruginosa were selected for meta-analysis and systematic review. RESULTS: The pooled estimation of 5227 P. aeruginosa isolates in this analysis showed that the percentage of imipenem-resistant P. aeruginosa is about 54% in the Iranian population (95%CI: 0.47-0.62, logit event rate=0.19, 95%CI: -0.12,0.49). CONCLUSION: The findings of this analysis show that in the majority of Iranian hospitals the relative frequency of IRPA is high, therefore, in order to prevent further dissemination of IRPA, more appropriate antibiotic prescription and infection control policies must be implemented by decision-makers.

Antibiotic Resistance Patterns and Genetic Diversity in Clinical Isolates of Pseudomonas aeruginosa Isolated From Patients of a Referral Hospital, Isfahan, Iran.

BACKGROUND: Pseudomonas aeruginosa is a well-known opportunistic pathogen, which affects hospitalized patients in different wards due to its natural resistance to drugs. OBJECTIVES: The purpose of the current study was to determine the antibiotic susceptibility profiles and genetic relatedness in P. aeruginosa isolated from patients admitted to a referral hospital in Isfahan, Iran. MATERIALS AND METHODS: Out of 150 analyzed samples, 54 P. aeruginosa isolates were recovered and were subjected to antibiotic resistance patterns and genetic diversity determination by Kirby-Bauer's disk diffusion method and RAPD-PCR, respectively. RESULTS: The highest percentage of resistance was observed against ceftazidime and imipenem with 30 (55.6%) isolates; meanwhile all isolates were sensitive to polymyxin B. Twenty-eight (51.8%) isolates revealed resistance to all applied antibiotics. RAPD-PCR (Random Amplified Polymorphic DNA- Polymerase Chain Reaction) results showed 54 unique genotypes, which were divided into 39 clusters. CONCLUSIONS: Although different source of P. aeruginosa may involve in patient colonization, genetically related strains were isolated from different wards and or the same ward of the hospital. Our results pointed to the restriction of currently used antibiotics in studied hospital. We hope that our results cast light on the control and transmission of the infection in the investigated hospital.