Bacteria Producing Extended Spectrum ß-lactamases (ESBLs) in Hospitalized Patients: Prevalence, Antimicrobial Resistance Pattern and its Main Determinants.

BACKGROUND AND OBJECTIVE: There is a growing concern regarding the lack of new antibiotics, especially for multidrug- resistant bacteria that produce Extended Spectrum ß-Lactamases (ESBLs). The present study aims to assess the preva- lence of bacteria producing ESBLs, their antimicrobial resistance pattern, and its main determinants among hospitalized patients. METHODS: The study population included 383 consecutive patients with a definitive diagnosis of urinary tract infection (UTI). All eligible subjects for the study had a positive culture for gram-negative microorganisms in urine specimens. ESBL producing isolates were characterized phenotypically for ESBL production using the double disc synergy test. RESULTS: In total, 383 specimens were assessed, among which 212 (55.4%) were related to bacteria producing ESBLs (ESBL+). Of those with ESBL + infections, 65.5% were sourced from catheters (as hospital-associated UTIs), and 35.5% were categorized as community-associated UTIs. In the group consisting of bacteria producing ESBLs, the high- est sensitivity was observed with Imipenem (72.2%), while the highest resistance was revealed with ceftriaxone (100%). CONCLUSION: We have shown that our community faces a high prevalence of bacteria producing ESBLs, mostly sourced from the catheterization of hospitalized patients. The highest bacterial sensitivity was observed with Imipenem, nitrofu- rantoin, and amikacin, while the highest resistance was found with ceftriaxone and cotrimoxazole, suggesting the inef- fectiveness of using the two latter antibiotics for eradicating these bacterial infections. On the other hand, a history of urinary catheterization and previous hospitalization were two main determinants of their presence, a finding which em- phasizes the importance of avoiding catheterization and hospitalization of patients with UTIs without proper indications.

Brucella endocarditis: a report from Iran.

Endocarditis is a rare focal complication of brucellosis but the most common cause of mortality. The diagnosis of the complications of endemic diseases is therefore important. We evaluated Brucella endocarditis cases in a teaching hospital in Iran between April 1998 and March 2006. Nine patients with a median age of 38.11 years were recorded, of whom seven (77.7%) were male. Underlying cardiopathy was present in three patients (33.3%). The median duration of the symptoms prior to diagnosis was 5.33 months. Endocarditis involved the aortic valve in six cases (66.6%), the mitral valve in two cases (22.2%) and the aortic valve plus the mitral valve in one case (11.1%). Serologic tests were positive in eight (88.8%) and blood culture was positive in two (22.2%). Aortic valve replacement surgery was undertaken for five patients (55.5%). One patient died due to arrhythmia. A high degree of suspicion is therefore necessary in order to ameliorate the course of Brucella endocarditis.

Renal disorders in HIV-infected patients.

BACKGROUND: HIV infection affects all body organs including kidney. Since the frequency of HIV-related renal disorders is unknown in Iran and the number of HIV-infected patients is increasing, this study was conducted for the first time in Iran to assess the frequency of electrolyte imbalance, renal failure, and proteinuria among HIV-infected patients. METHODS: Between April and December 2005, 65 HIV-infected patients who were receiving care at an outpatient counseling center in Tehran, participated in this study. Blood samples were collected to measure serum levels of sodium, potassium, calcium, phosphorus, blood urea nitrogen, and creatinine. Urine samples were analyzed to detect protein, red blood cells, white blood cells, and cast. RESULTS: Of the 65 HIV-infected patients, 86.2% were males. The mean age of the patients was 37+/-8.7 years, and 58.5% of the patients had a history of injecting illicit drugs. Urinalysis was normal in all patients, and serum levels of electrolytes, blood urea nitrogen, and creatinine were all in normal range. CONCLUSION: We found no electrolyte imbalance, proteinuria, or renal failure in HIV-infected patients. It seems that renal disorder is infrequent in Iranian HIV-infected patients.

Cardiopulmonary manifestations of typhoid fever: a prospective analysis of 65 cases in Iran.

For an evaluation of cardiopulmonary manifestations in typhoid in Iran, we studied 65 patients with positive blood or bone marrow culture for Salmonella typhi during a 2-year period. Cardiac complications were seen in 4.6% (myocarditis, pericarditis, pulmonary emboli) and pulmonary complications in 6.2%.