Prevalence and mechanisms of aminoglycoside resistance among drug-resistant Pseudomonas aeruginosa clinical isolates in Iran.

BACKGROUND: Aminoglycosides have been a cornerstone of the treatment of nosocomial infections caused by Pseudomonas aeruginosa for over 80 years. However, escalating emergence of resistance poses a significant challenge. Therefore, this study aimed to investigate the prevailing patterns of aminoglycoside resistance among clinical isolates of P. aeruginosa in Iran; as well as the underlying resistance mechanisms observed in patients referred to Ardabil hospitals. METHODS: A total of 200 isolates from five hospitals were evaluated. The resistance profiles of P. aeruginosa isolates to tobramycin, amikacin, and netilmicin were determined using the disk diffusion method. The capacity of aminoglycoside-resistant isolates to form biofilms was assessed through a phenotypic assay, and the results were confirmed using the gene amplification technique. The presence of genes associated with aminoglycoside resistance was detected using polymerase chain reaction (PCR). Quantitative reverse transcription PCR (qRT-PCR) was performed to measure the expression levels of genes encoding the MexXY-OprM efflux pump and PhoPQ two-component system (TCS). RESULTS: The prevalence of aminoglycoside-resistant P. aeruginosa isolates was 48%, with 94.7% demonstrating multidrug resistance (MDR). All aminoglycoside-resistant P. aeruginosa strains exhibited biofilm-forming capabilities and harbored all the genes associated with biofilm production. Among the nine genes encoding 16S rRNA methylase and aminoglycoside-modifying enzymes, three genes were detected in these isolates: aac(6')-Ib (85.4%), ant(2'')-Ia (18.7%), and aph(3')-VI (3.1%). Additionally, all aminoglycoside-resistant P. aeruginosa isolates carried mexY and phoP genes, although the expression levels of mexY and phoP were 75% and 87.5%, respectively. CONCLUSION: Given the considerably high prevalence of aminoglycoside-resistant P. aeruginosa strains, urgent measures are warranted to transition towards the use of novel aminoglycosides and to uphold vigilant surveillance of resistance patterns.

The role of bacterial genital infections in spontaneous preterm delivery: a case-control study.

Background: Spontaneous preterm delivery is defined as the beginning of the birth process before the 37th week of pregnancy. The presence of microorganisms in the fetal membranes is accompanied by an increase in the production of prostaglandin, one of the important factors associated with the prevalence of preterm birth. The invasion of microorganisms leads to the production of protease, coagulase, and elastase, which directly stimulate the onset of childbirth. We investigated the role of genital infections in women with preterm birth. Methods: The present case-control study was conducted in the west of Iran on 100 women with spontaneous preterm delivery (following 24 weeks of gestation and before 36 weeks and 6 days) as the case group and 100 women with normal delivery as controls. A questionnaire was applied to collect the data. Polymerase chain reaction and pathological examination of the placenta were performed. Results: The average age in women with normal delivery (30.92 ± 5.10) in women with spontaneous preterm delivery (30.27 ± 4.93). The prevalence of Chlamydia trachomatis, Neisseria gonorrhea, Listeria monocytogenes, and Mycoplasma genitalium infections was zero in both groups. The highest prevalence of Gardnerella vaginalis was 19 (19%) in the case group and Ureaplasma parvum 15 (15%) in the control group. Also, Placental inflammation was zero in controls and 7(7%) in the patient group. There was a significant relationship between Gardnerella vaginalis bacteria and spontaneous preterm delivery. Conclusion: The results of our study showed that except for Gardnerella vaginalis bacteria, there is no significant relationship between the above bacterial infections and spontaneous preterm birth. Moreover, despite the significant reduction in the prevalence of many sexually transmitted infections in this research, it is still suggested to increase the awareness of people, including pregnant women, about the ways it can be transmitted by gynecologists and health and treatment centers.

Occurrence and Characteristics of Toxigenic Staphylococcus aureus in Retail Foods in Iran.

Staphylococcus aureus causes various toxigenic and invasive diseases in humans worldwide. This study examined the prevalence, virulence genes, and antibiotic resistance of S. aureus isolates collected from 894 retail food samples in Ardabil, Iran. Staphylococcal cassette chromosome mec (SCCmec), spa, and multilocus sequence typing methods were employed to further investigate the molecular characteristics of methicillin-resistant S. aureus (MRSA) isolates. The results revealed that 11.18% (n = 100) of food samples exhibited contamination with S. aureus (10.50% methicillin-sensitive S. aureus [MSSA] and 0.67% MRSA). Notably, raw minced meat (29.41%), Faloodeh (25%), and Olivier salad (21.42%) emerged as the most frequently contaminated food items. Among the 100 isolates of S. aureus, 94% were characterized as MSSA, with the remaining 6% identified as MRSA. The highest resistance was observed for penicillin (12%). MRSA isolates exhibited significantly higher resistance rates. Seventy-nine percent of the isolates were positive for sea, 14% for seb, 8% for a sec, and 0% for sed enterotoxin-encoding genes. Sixteen percent of isolates harbored two or more staphylococcal enterotoxin genes, simultaneously. Moreover, 97%, 94%, 24%, and 22% of isolates were positive for hla, hld, tst, and pvl virulence-encoding genes, respectively. No isolate was positive for the exfoliative toxins encoding eta and etb genes. MRSA isolates belonged to CC8 (n = 4) and CC22 (n = 2). Isolates in CC8 belonged to lineage ST239-MRSA-III and spa type t030; the isolates in CC22 belonged to ST22-MRSA-IV and spa types t310 and t223. In conclusion, a relatively high proportion of our retail food samples were contaminated with S. aureus. The high incidence of isolates with toxigenic genes raises serious health concerns. Furthermore, the presence of MRSA lineages linked to humans suggests that retail foods may be contaminated with human origin.

Genomic diversity of ß-lactamase producing Pseudomonas aeruginosa in Iran; the impact of global high-risk clones.

BACKGROUND: Hospital-acquired infections caused by multidrug-resistant Pseudomonas aeruginosa incline hospital stay and costs of treatment that resulted in an increased mortality rate. The frequency of P. aeruginosa high-risk clones producing carbapenemases was investigated in our clinical samples. METHODS: In this cross-sectional study, 155 non-repetitive P. aeruginosa isolates were included from different medical centers of Iran. Antibiotic susceptibility testing was determined, and the presence of ß-lactamases were sought by phenotypic and genotypic methods. The clonal relationship of all isolates was investigated, and multi-locus sequence typing (MLST) was used for finding the sequence types of carbapenemase-producers. RESULTS: The agent with highest percent susceptibility rate was recorded for colistin (94.9%). MOX and FOX were found both as low as 1.95% (3/155). The most frequent narrow spectrum ß-lactamase was SHV with 7.7% (12/155) followed by PER, OXA-1, and TEM with the frequency of 7.1% (11/155), 3.2% (5/155), and 1.3% (2/155), respectively. Carbapenemases were detected in 28 isolates (18%). The most frequent carbapenemase was IMP with 9% (14/155) followed by NDM, 8.4% (13/155). OXA-48 and VIM were also detected both per one isolate (0.65%). MLST of carbapenem resistant P. aeruginosa isolates revealed that ST244, ST664, ST235, and ST357 were spread in subjected clinical settings. REP-PCR uncovered high genomic diversity in our clinical setting. CONCLUSION: Clonal proliferation of ST235 strain plays a key role in the propagation of MDR pattern in P. aeruginosa. Our data showed that high-risk clones has distributed in Iran, and programs are required to limit spreading of these clones.

Molecular epidemiology typing of blaOXA-48 and blaNDM-1 producing Klebsiella pneumoniae causing nosocomial infection.

In this study the antibiotic susceptibility pattern and bla genes were characterized in Klebsiella pneumoniae clinical isolates that fingerprinted by rep-PCR and PFGE methods at Kurdistan Province, Iran. A total of 70 K. pneumoniae were isolated from clinical samples to detect the antimicrobial susceptibility, carbapenemase and MBL-producing isolates. The PCR assay was used to identify the bla genes. Isolates were typed by PFGE and Rep-PCR methods. The highest and lowest rates of resistance were observed in cefotaxime (67.1%) and imipenem (8.6%), respectively. The rate of blaNDM-1 and blaOXA-48 genes were 1 (1.4%) and 14 (20%) isolates, respectively. All were classified in 27 clusters by rep-PCR and 39 PFGE types. The low frequency of carbapenemase and MBL genes in this study are epidemiologically important.

Association of carbapenem and multidrug resistance with the expression of efflux pump-encoding genes in Pseudomonas aeruginosa clinical isolates.

Efflux pumps play an important role in the emergence of antibiotic-resistant Pseudomonas aeruginosa strains. The present study aimed to assess the expression of the MexAB-OprM, MexCD-OprJ, MexEF-OprN, and MexXY-OprM efflux pumps in carbapenem-resistant and multidrug-resistant (MDR) P. aeruginosa strains isolated from clinical specimens between June 2019 and January 2022 in Ardabil city. The presence of efflux pump-encoding genes, i.e. mexA, mexC, mexE, and mexY, was assessed using the polymerase chain reaction (PCR) technique in 48 carbapenem-resistant and MDR P. aeruginosa strains. Real-time reverse transcription PCR was employed to evaluate the expression levels of mexA, mexC, mexE, and mexY genes. All 48 carbapenem-resistant and MDR P. aeruginosa strains harbored efflux pump-encoding genes including mexA, mexC, mexE, and mexY according to the PCR results. Overexpression of the MexAB-OprM, MexCD-OprJ, MexEF-OprN, and MexXY-OprM efflux pumps was detected in 75% (n = 36), 83.3% (n = 40), 10.4% (n = 5) and 41.6% (n = 20) of the clinical isolates of P. aeruginosa, respectively. This study revealed that the presence and overexpression of efflux pumps are associated with the emergence of carbapenem-resistant and MDR P. aeruginosa strains. Therefore, research on efflux pump inhibitors of P. aeruginosa will be a worthwhile endeavor to increase the clinical efficiency of available antibiotics and prevent ensuing treatment failure.

Investigation of NDM-1 and OXA-48 producing carbapenem resistant Klebsiella pneumoniae ST15 in Iran.

The aim of this study was to determine the frequency of carbapenem resistant Klebsiella pneumoniae (CRKP) sequence types (STs) in Iran. Samples were collected from three university hospitals in Sanandaj, Iran, from December 2016 to March 2018. Antibiotic susceptibility testing, phenotypic and genotypic detection of carbapenemases were performed. Common K. pneumoniae capsular types were sought for all isolates. The genetic relatedness of isolates was investigated by multilocus sequence typing (MLST). Plasmids were detected by PCR-based Replicon Typing (PBRT). During the study, 67 K. pneumoniae isolates were identified. Of which, 18 (26.9%) isolates were detected as carbapenem-resistant. The most effective antibacterial agent was tigecycline (97%, 65 isolates) followed by imipenem and ertapenem (73.13%, 49 isolates). PCR showed that 13 isolates (19.4%) had blaNDM-1 gene and 5 (7.5%) harbored blaOXA-48. Examination of common capsular types showed that 2 isolates had K2 and 2 others had K54. REP-PCR revealed 10 clones and 11 singleton strains. MLST analysis of CRKP found ST15 as the most common type (13 isolates, 72.2%), but other STs were also detected namely, ST19, ST117, ST1390, and ST1594. ColE1 and IncL/M plasmids were the carriers of blaNDM-1 and blaOXA-48, respectively. The results showed that CRKP spread in our health centers. Our results, therefore, indicate a worrying trend of resistance to carbapenems in K. pneumoniae.

Prevalence of Listeria monocytogenes infection in women with spontaneous abortion, normal delivery, fertile and infertile.

BACKGROUND: Listeria monocytogenes with a vast range of natural reservoirs is more known for being a food-borne pathogen. Human infections have shown an impact on pregnancy outcomes, so, this study surveyed the frequency of L. monocytogenes infection involving different groups of women. METHODS: This study enrolled a total sample consisting of 109 women with spontaneous abortion, 109 women with normal delivery, 100 fertile women, and 99 infertile women aged 19-40 years and willing to participate in the study. The research tool in this study was a questionnaire and Polymerase chain reaction (PCR) test. RESULTS: According to the results, the frequency of L. monocytogenes infection was 4/109 (3.66%) observed among women with spontaneous abortion, 2/109 (1.83%) among women with normal delivery, 3/100 (3%) among fertile women, and 0/99 (0%) among infertile women. CONCLUSION: There was no significant relationship between Listeria monocytogenes infection and pregnancy outcomes of spontaneous abortion and infertility.

Prevalence of algD, pslD, pelF, Ppgl, and PAPI-1 Genes Involved in Biofilm Formation in Clinical Pseudomonas aeruginosa Strains.

Introduction: Biofilm formation is one of the main virulence factors in Pseudomonas aeruginosa infections. This study is aimed at investigating the presence of genes involved in biofilm formation in clinical P. aeruginosa isolates. Material and Methods. A cross-sectional study was conducted on 112 P. aeruginosa isolates. The biofilm formation assay was performed on all isolates. Antimicrobial resistance was determined by the disk diffusion method, and the presence of genes was detected by polymerase chain reaction. Isolates were typed with Rep-PCR. Results: The results of biofilm formation demonstrated that 85 strains (75.9%) were biofilm producers, and 27 strains (24.1%) were nonproducer isolates. Antibiotic susceptibility pattern in biofilm-positive and biofilm-negative isolates obtained from hospitalized patients showed a high rate of antibiotic resistance to amoxicillin with 95.7% and 92.3%, respectively. Based on PCR amplification results, the frequency of genes involved in biofilm formation among all isolates was as follows: algD (78.6%), pelF (70.5%), pslD (36.6%), Ppgl (0%), and PAPI-1 (77.6%). Rep-PCR typing demonstrated that 112 P. aeruginosa isolates were classified into 57 types according to 70% cut-off. The predominant type was A which contained 15 isolates. Moreover, 7 isolates were clustered in genotype B, followed by C type (6), D (4), E (4), F (4), G (4), H (3), I (3), J (3 isolates), and 12 genotypes, each containing two isolates. Also, 35 isolates were distributed in scattered patterns and showed single types. Conclusion: Study results showed significant association between biofilm formation and resistance to antibiotics such as ceftazidime and meropenem. Analysis of Rep-PCR patterns indicated that the evaluated isolates were heterogeneous, relatively.

Effect of calcium hydroxide on morphology and physicochemical properties of Enterococcus faecalis biofilm.

Calcium hydroxide Ca(OH)2 has been used as an intracanal medicament to targets microbial biofilms and avert secondary infection in the root canal system. This study evaluated the effects of this material on the morphology and physicochemical properties of an established in-vitro biofilm of Enterococcus faecalis. A biofilm of E. faecalis was grown in multichannel plates. The chemicals including Ca2+, OH-, and saturated Ca(OH)2 (ie 21.6 mM) were prepared in order to evaluate which component eradicated or amplified biofilm structure. Various biochemical and microscopic methods were used to investigate the properties of the biofilm. Biofilms treated with Ca(OH)2 absorbed more Ca2+ because of the alkaline pH of the environment and the ions affected the physicochemical properties of the E. faecalis biofilm. A denser biofilm with more cavities and a granular surface was observed in the presence of Ca2+ ions. This resulted in a decrease in the surface-to-biofilm ratio with increases in its biomass, thickness, colony size, and volume. Calcium hydroxide did not destroy E. faecalis biofilms but rather contributed to the biofilm structure. This in-vitro study sheds light on a missing link in the formation of E. faecalis biofilm in which the Ca2+ in Ca(OH)2.

Prevalence of Neisseria gonorrhoeae in Western Iran.

Neisseria gonorrhoeae is the causative agent of the sexually transmitted disease gonorrhoea. This bacterium infects the epithelial cells of the cervix of women and the urethra of men. However, its disease symptoms in the lower genitalia are found only in a small percentage of people. This study aimed to compare the frequency of N. gonorrhoeae genital infection among two groups of pregnant women, those with spontaneous abortions and those with normal pregnancies. This cross-sectional study was conducted in Western Iran. It included 417 women: 109 of whom had spontaneous abortions, 109 had normal deliveries, 100 were fertile, and 99 were infertile. Specific primers were used and DNA was extracted by endocervical swabs. A polymerase chain reaction test was then performed to detect N. gonorrhoeae. Data analysis was performed using the chi-squared test and t-tests. In all the above steps, a level of 5% was considered statistically significant, and the average ages in women with normal delivery, women with spontaneous abortion, fertile women, and infertile women were 27.8 ± 4.87, 29.6 ± 5.9, 32.1 ± 5.1, and 29.1 ± 6.3 years, respectively. The total frequency of N. gonorrhoeae infection was 0 (0%). The prevalence of N. gonorrhoeae infection was zero, and the disease was not associated with spontaneous abortion or infertility.

Frequency of Codon 306 Mutations in embB Gene of Mycobacterium tuberculosis Resistant to Ethambutol: A Systematic Review and Meta-Analysis.

BACKGROUND: Ethambutol (EMB) resistance is a major concern in patients with tuberculosis (TB). The aim of this study was to determine the frequency rate of mutations in the embB306 gene of Mycobacterium tuberculosis (M. tuberculosis) resistant to EMB, based on a systematic review and meta-analysis. METHODS: Thirty-seven original articles (1997-2015) that have been published in valid databases were considered for this research. The articles were systematically reviewed for the prevalence and rate of mutations in embB306 in EMB-resistant M. tuberculosis. Data were analyzed using meta-analysis and random effects models (CI 95%, P < 0.10). RESULTS: With a 6,931 sample size in 37 original articles, the lowest rate was related to EMB resistance that was observed in 2014 with 0.05 (95% CI: 0.04-0.07) and the highest prevalence rate was 0.84 (95% CI: 0.68-1.01), observed in 1997. Lowest and highest prevalence rates of embB306 gene mutation in M. tuberculosis were 0.03 (95% CI: 0.01-0.07) in 2014 and 0.78 (95% CI: 0.71-1.84) in 2005, in the USA, respectively. CONCLUSIONS: The present study revealed the prevalence and association of mutations in the embB306 gene of M. tuberculosis with resistance to EMB. Detecting EMB-resistant M. tuberculosis can help in controlling and correcting the administration of drugs for patients with TB.

Phenotypic and Molecular Survey of Metallo-beta-lactamase-producing Pseudomonas aeruginosa Isolated from Patients with Nosocomial and Non- Nosocomial Infections.

BACKGROUND: Resistance to antimicrobial agents in Pseudomonas aeruginosa (P. aeruginosa) including carbapenems is a prominent problem in patients. The aim of this study is surveying Metallo-beta-lactamase (MBL)-producing P. aeruginosa isolated from patient specimens with nosocomial and non-nosocomial infections in Kurdistan province, Iran. METHODS: In total, 146 Pseudomonas spp. were collected (December 2015 to August 2017). P. aeruginosa isolates were detected by phenotypic and polymerase chain reactions (PCR) of gyrB gene. Combination disk (CD) phenotypic test was used for the identification of MBL-producing strains and PCR was applied for identification of blaIMP and blaVIM genes in P. aeruginosa. Sensitivity and specificity of phenotypic tests were calculated as well. Fisher's exact test and logistic regression were used for data analysis (p≤0.05). RESULTS: A total of 134 (91.78%) and 133 (91.09%) P. aeruginosa were detected using PCR and the phenotypic test, respectively. Fifty-six (41.79%) clinical isolates were isolated from patients with nosocomial infection. CD test proved that 67 out of 134 (50%) P. aeruginosa isolates were positive for MBL, of which 11 (8.20%) carried blaIMP gene. No significant relationship was found between MBL-producing P. aeruginosa and blaIMP genes; as well as between MBL-producing P. aeruginosa and blaIMP genes with age, sex, city of residence, inpatient/outpatient and specimen's type (p≥0.05). CONCLUSION: Presence of MBL-producing P. aeruginosa strains and blaIMP genes were proved in this study; thus more precaution should be taken in the administration of carbapenem antibiotics to patients.

Prevalence of Cefepime-Resistant Escherichia coli in Iran: A Meta-Analysis (2007-2016).

BACKGROUND: Cefepime-resistant Escherichia coli (E. coli) is one of the seven important types of microbial resistance. This meta-analysis study was conducted to identify the prevalence of cefepime-resistant E. coli in Iran during 2007-2016. METHODS: Studies published were searched in Persian databases (including Magiran, and SID) and international databases (including PubMed, ScienceDirect, and Scopus). The selected studies included all types of laboratory methods. Moreover, the random effects model (DerSimonian Laird method) was used to addresses the high heterogeneity (50% < I2) between the reviewed studies. The collected data were categorized into different subgroups on the basis of the year of study and province. Data analysis was performed using the Statsdirect software. RESULTS: Overall, 516 articles were selected from the searched medical databases. After reviewing and applying the inclusion criteria, irrelevant papers were excluded and the remaining 26 studies were meta-analyzed. The overall prevalence of cefepime-resistant E. coli was 53.42% (95%: 43.35, 63.35), ranging from 25% (95%CI: 21.67, 28.55) in 2009 to 61.95% (95%CI: 56.62, 67.09) in 2016. CONCLUSION: The prevalence of cefepime-resistant E. coli in Iran has had an increasing and alarming trend during the recent years. Therefore, it is necessary to use practical strategies and interventions to control and monitor cefepime-resistant E. coli in the country.

Combined Effect of Levofloxacin and N-Acetylcysteine against Enterococcus faecalis Biofilm for Regenerative Endodontics: An in Vitro Study.

Introduction: Endodontic treatment of necrotic immature teeth poses several clinical challenges. A major problem is the elimination of microorganisms from the root canal system. This study evaluates the in vitro antibacterial efficacy of ciprofloxacin (CIP), levofloxacin (LEV), and their combination with N-acetylcysteine (NAC) in root canals infected with Enterococcus faecalis (E. faecalis). Methods and Materials: A total of 120 human extracted teeth with single canals were prepared and randomly divided into six groups: Calcium hydroxide (CH), ciprofloxacin (CIP), levofloxacin (LEV), ciprofloxacin and N-acetylcysteine (CIP+NAC), levofloxacin and N-acetylcysteine (LEV+NAC), and normal saline as a positive control. According to the name of the groups, intracanal medicaments were placed into the canals and the teeth were restored with a temporary filling. After one week, intracanal medicament was removed and the final count of bacteria was measured. Antibacterial effect of medicament was assessed by measuring the percentage reduction in the colony counts (RCC) and scanning electron microscopy (SEM). The Mann-Whitney U test and the Kruskal-Wallis test were used to compare the overall antibacterial efficacy of the intracanal medicaments at significance level of 0.05. Results: All intracanal medicaments were significantly more effective than calcium hydroxide (P<0.05). The combination of LEV and NAC caused significantly higher reduction in colony count in comparison with other tested medicaments (P=0.001). Conclusion: The combination of LEV and NAC showed greater antibacterial activity compared with other tested medicaments against biofilm of E. faecalis. Thus, it has the potential to be used in regenerative endodontic treatments.

Prevalence of Metallo-ß-Lactamases in Acinetobacter Baumannii in Iran: A Review and Meta-Analysis.

Acinetobacter baumannii (A. baumannii) is an important opportunistic pathogen that causes major public health concerns, especially in hospitalized patients due to acquisition of resistant genes. The aim of this study was to systematically review the published data on the prevalence and dispersion of metallo-ß-lactamases (MBLs) genes in A. baumannii in different provinces of Iran and provide an overall prevalence rate using meta-analysis. All available national and international databanks from 2011 to 2017 were searched to find published studies. Quality of studies was assessed by STROBE. Due to the fact that a significant heterogeneity was observed, the random effects model was used to combine the results. Statistical analysis was performed by comprehensive meta-analysis (CMA) V2 software. Out of 78 articles, 28 were extracted based on certain inclusion and exclusion criteria. Most of the A. baumannii isolates were obtained from intensive care unit (ICU) ward of hospitals. Based on phenotypic and molecular detection tests, pooled prevalence of all MBLs was 58%, and blaVIM, blaIMP, and blaSPM-1 genes were estimated to be at 10.5, 6, and 5%, respectively. Based on the results, further attention should be given to report MBL genes in A. baumannii based on molecular detection rather than the phenotypic one. Furthermore, more effort should be focused on ICU sections in order to avoid the distribution of resistant genes.

Group B Streptococci and Trichomonas vaginalis infections in pregnant women and those with spontaneous abortion at Sanandaj, Iran.

BACKGROUND AND OBJECTIVES: Group B Streptococcali (GBS) is an important factor in newborn deaths in developed and developing countries. Trichomoniasis is one of the most prevalent sexually transmitted diseases (STDs) in the world, which is caused by protozoan Trichomonas vaginalis (T. vaginalis). The present study compares the frequency of GBS and T. vaginalis genital infections in pregnant women, women with spontaneous abortion, as well as its role in spontaneous abortion. MATERIALS AND METHODS: In this case-control study, 109 women were included with spontaneous abortion with gestational ages between 11-20 weeks and 109 pregnant women with gestational ages between 35-37 weeks in Sanandaj, Iran. DNA was extracted by endocervical swabs and subjected to PCR assays. The independent t-test was used; and for comparing other qualitative variables in each group, the Chi-Square Test was used. RESULTS: The age of the women ranged from 19-43 years (29.6 ± 5.9) and in the control group the age range was from 19-42 years (27.8 ± 4.87). The rate of prevalence of Group B Streptococcal infection in the control group was 3.6%; and in the patient group there were 7.2% with the rate of prevalence of T. vaginalis in both groups as zero. CONCLUSION: The present study showed that there is no relationship between GBS infections (P-value = 0.235) and T. vaginalis.

Association of Chlamydia trachomatis infections with preterm delivery; a systematic review and meta-analysis.

BACKGROUND: Premature birth is a primary cause of infant mortality and its etiology varies in different countries. Chlamydia trachomatis (CT) is a common infectious agent transmitted through sexual contact. The purpose of this study is to investigate the connection between CT infections and preterm birth by meta-analysis. METHODS: All articles published in literature databases including Google Scholar, PubMed, ISI (Web of Science), Biological Abs, IranMedex, SID, and Scopus were investigated. Twenty-four relevant articles, authored betweenm 1998-2014 were analyzed through a random effects model. Heterogeneity of the studies was evaluated by I2 index. The relationship between years of data collection, sample size, and CT infections with preterm delivery prevalence was examined by meta-regression. Data were analyzed with R and STATA [Ver. 12]. RESULTS: The overall prevalence of CT infections leading to preterm deliveries was estimated to be 0.13% (CI 95%: 0.11-0.16). The prevalence of CT infections leading to preterm deliveries were calculated based on the study method including PCR [0.06 (CI 95%: 0.04-0.09)], serology [0.23 (CI 95%: 0.10-0.35)] and culture [0.17 (CI 95%: 0.10-0.24)]. Analysis indicates that women with chlamydia infections were 2.28 more likely to deliver pre-term in comparison with those who were not infected. It can be concluded that chlamydia infections increase the risks of preterm delivery, OR = 2.28 (95% CI:1.64-3.16). CONCLUSIONS: In regard to the results in numerous studies performed on different continents, this meta- analysis showed a clear association between preterm delivery and prior CT colonization.

A PRISMA systematic review and meta-analysis on Chlamydia trachomatis infections in Iranian women (1986-2015).

BACKGROUND: Chlamydia trachomatis (CT) is the cause of genital tract infections in women. Some evidence has shown the role of this infection with CT in spontaneous abortions. The purpose of this study is to study the frequency of CT infection in Iranian women. METHODS: This study was performed based on PRISMA guidelines. A total of 75 articles published in Google Scholar, PubMed, ISI Web of Science, Biological abs, Iranmedex, SID, and Scopus databases were found (1986-2015) using the following keywords: CT in women, CT and Iranian women, CT and infection in Iran, CT and pregnancy in Iran, CT and preterm delivery in Iran, CT and preterm labor in Iran, CT and fertility in Iran, CT and infertility in Iran, and CT and abortion in Iran. Finally, 40 studies from different regions of Iran were included. Statistical analyses were performed using R3 and STATA 12. RESULTS: From 1986 to 2015, the lowest rate of prevalence was from 2010 to 2011 (3.9%) and the highest prevalence rate was in 2009 (69.39%) in northern Iran. Fixed effects for different parts of Iran (North, South, East, and West) were Pooled proportion: 0.13 (95% confidence interval [CI] = 0.12-0.14) and for samples (cervical, vaginal, urine, and blood) the pooled proportion was = 0.14 (95% CI = 0.12-0.14). CONCLUSION: CT infection in this study was prevalent in urine samples and the rate of CT was observed from culture methods in comparison to other methods. Because women with CT play an important role because of sexual activity for transmission and untreated women are at risk of developing sequels. Also, most studies in Iran use sensitive polymerase chain reaction tests for the detection of genital CT infections.

Detection of Extended-Spectrum Beta-Lactamases (ESBLs) and Antibiotic Susceptibility Patterns in Klebsiella pneumoniae in Western, Iran.

BACKGROUND: Production of Beta-Lactamase enzymes, especially extended- spectrum Beta -Lactamases (ESBL), is a primary mechanism of resistance in these bacteria.The purpose of this study was detection of blaTEM, blaSHV, blaCTXM, blaCTX-M-15, blaPERand blaVEBin K. pneumoniae, isolated from clinical specimens by the PCR method and antibiotic susceptibility patterns in these strains isolated. MATERIALS AND METHODS: During a period from October 2015 to July 2016, 52 K. pneumoniae isolates were collected from general hospitals in the city of Sanandaj, Iran. After identifying the strains by biochemical testing, the disc diffusion method was used for determining antimicrobial susceptibility and screening the ESBL-producing isolates. Detection of blaTEM, blaSHV, blaCTX-M, blaCTX-M-15, blaPER and blaVEBESBL-producing K. pneumoniae was carried out by PCR. RESULTS: Out of 52-collected K. pneumoniae, highest and lowest rates of resistance related to co-trimoxazole with 67.3 % and amikacin with 30.7 %. 55.7% identified as MDR and 69.23% were ESBL-producing K. pneumoniae.blaSHV was the most prevalent gene in ESBL-producing K. pneumoniae. blaTEM,blaCTX-M,blaCTX-M-15 producing K. pneumoniae strains showed higher rates of drug resistant compared with negative strains (P < 0.05). CONCLUSION: Results of this study showed that the prevalence rate of ESBL-producing K. pneumoniae isolates is increasing in MDR strains, which raises concerns regarding the treatment of K. pneumoniae. Therefore, molecular research in the field of antimicrobial resistance of bacteria is essential to prevent the spread of resistant strains.