First report of New Delhi metallo-beta-lactamase-1-producing Klebsiella pneumoniae in Iran.

New Delhi metallo-beta-lactamase (NDM-1) is a novel metallo-beta-lactamase (MBL). Sporadic cases of NDM-1 positive strains have been reported from different countries, suggesting a widespread dissemination. The aim of this study was the detection of MBLs in Enterobacteriaceae isolated from patients in Tehran hospitals. After identification tests, the susceptibility to the antibiotics was done by Kirby-Bauer method and broth microdilution. Carbapenem-resistant isolates were tested for carbapenemase production using the modified Hodge test (MHT). Carbapenem-resistant strains screened for bla(KPC) gene and genes encoding MBLs. Twenty-three isolates (6.3%) were resistant to meropenem, eleven isolates (3%) were resistant to ertapenem, and four isolates (1.1%) were resistant to imipenem. MHT was positive in 11 (47.8%) of the carbapenem-resistant isolates. In March 2011, we detected a multiple drug-resistant Klebsiella pneumoniae isolate that was resistant to all tested antibiotics except colistin. PCR confirmed that this isolate contained bla(NDM-1), bla(TEM), bla(SHV), and bla(CTX-M). This is the first report on the detection of MBL NDM-1 in Iran. The rapid spread of NDM-1-positive bacteria proved to be a major challenge for the treatment and control of infectious diseases.

Correlation of ESR, C3, C4, anti-DNA and lupus activity based on British Isles Lupus Assessment Group Index in patients of rheumatology clinic.

This study aimed to determine the correlation between of ESR, C3, C4, anti-DNA, and lupus activity and also the construct and criterion validity of the British Isles Lupus Assessment Group (BILAG) index for assessing disease activity in systemic lupus erythematosus (SLE). Patients with SLE were recruited into a cross-sectional study. Data were analyzed for estimating of SLE disease activity [scores on the BILAG index and Systemic Lupus Erythematosus Disease Activity Index 2000 (SLEDAI-2K)]. Overall BILAG scores were determined by the highest score achieved in any of the individual systems in the respective index. Erythrocyte sedimentation rates (ESRs), C3 levels, C4 levels, anti-double-stranded DNA (anti-dsDNA) levels, and SLEDAI-2K scores were used in the analysis of construct validity. Statistical analyses were performed using ordinal logistic regression for construct validity. Of the 100 patients with SLE, 90% were women. Their mean ± SD age was 31.1 ± 9.8 years. Increasing overall scores on the BILAG index were associated with increasing ESRs, decreasing C3 levels, decreasing C4 levels, elevated anti-dsDNA levels, and increasing SLEDAI-2K scores (all P < 0.01). These findings show that the ESR, C3, C4, and anti-DNA should be used in the evaluation and management of patients with SLE. Also the results show that the BILAG index has construct validity.