dariush shokri

Resistant Klebsiella pneumoniae to the latest solution (carbapenem antibiotics) distributed worldwide. The proliferation of carbapenemase genes among Klebsiella pneumoniae strains has led to their resistance to the carbapenem group. The aim of this study is to estimate antibiotic resistancepatterns and distribution of carbapenemase genes  of Klebsiella pneumoniea in Iran. PubMed, Scholar ,SID, and Iran civilica  databases were searched for the related articles that were published between 1999 and 2019. A total  of 225 articles were found, out of which 70 relevant articles were selected for complete evaluation. According to the results, the highest rates of drug resistance in Klebsiella pneumoniae were observed against aztreonam (58%), cephalosporins family (54%), and then SXT (52%). The incidence rate of resistance was 19% for carbapenems family (IMP, MER), 37% for aminoglycosides family (GM, AN) and 41% for quinolones family (FM, CIP). Among the genes encoding CRE during 2014–2019, OXA, KPC, NDM, VIM, IMP, and GES were found with a prevalence of 39%, 35%, 18%, 13%, 11%, and 3%, respectively. Conclusion Carbapenem resistance and the production of the metallo-beta-lactamase enzyme in K. pneumoniae are increasing. Due to the presence of carbapenemase-producing genes and the possibility of horizontal transfer of these genes to other bacteria, combined with changing the patterns of antibiotic use, more attention should be paid to the predisposing criteria for controlling nosocomial infections.

Ferula assa-foetida L. (Asafoetida) a medicinal plant with antimicrobial and antioxidant properties, is crucial in the food and pharmaceutical industries. Ferula essential oils (EOs), rich in ferulic acid, flavonoids, alkaloids, and glycosides compositions, may offer a potential solution to antibiotic resistance. The aim of this work is to investigate the components of Ferula chemical essential oil (EO) and its antioxidant and antimicrobial properties in different habitats of Iran (Tabas, Yazd, Neishabur, and Kerman). Gas Chromatography-Mass Spectrometry (GC-MS) analysis was performed to determine the composition of the essential oils from the four different sources. The antimicrobial activity, the minimum inhibitory concentration (MIC), and the minimum bactericidal concentration (MBC) of the essential oils against both Gram-positive and Gram-negative pathogenic bacteria were evaluated using the broth microdilution method and the well diffusion test. Likewise, the antioxidant properties of the essential oils were examined using the DPPH radical scavenging method. GC-MS analysis identified the major components of the essential oils, with the Nishabur EO having the highest percentage of components. The Kerman EO had the lowest inhibitory concentration against Escherichia coli, at 6.25 mg/ml, while the Yazd EO demonstrated the highest inhibitory concentration against Staphylococcus aureus, at a minimum inhibitory concentration of 50 mg/ml. Yazd EO showed the strongest antimicrobial activity, particularly against Gram-positive bacteria, with a halo diameter of 22.5 mm. In contrast, the Kerman EO showed the least amount of antimicrobial activity against Escherichia coli, with a halo diameter of 11.5 mm. Kerman EO had the highest antioxidant activity, with 93.9393%. The Ferula EO has the ability to inhibit DPPH radicals and demonstrated activity against both Gram-positive and Gram-negative bacteria, making it a strong antioxidant and natural preservative in the pharmaceutical industry.

Vancomycin-resistant Enterococci are considered as a serious problem owing to limited selective therapies necessitating alternative antibiotic therapies. The aim of this study was to isolate and identify effective probiotics against vancomycin-resistant Enterococci strains and their biofilms.

In this experimental study, Enterococci samples were isolated from several hospitals in Isfahan and their vancomycin-resistant strains were selected by antibiotic susceptibility testing. The antimicrobial effect of various probiotic bacteria against them was investigated. After selecting the most effective probiotics, various tests including mortality time and minimum inhibitory concentration (MIC) and minimum bactericidal concentration (MBC) were performed. The inhibitory mechanism of these probiotics and the amount of lactic acid production as the main inhibitory mechanism were studied using high performance chromatography.

On total, 350 Enterococci samples were isolated, 46 of which were vancomycin resistant in which linezolid was among the few effective antibiotic. Two probiotic bacteria, Pediococcus acidilactici and Lactobacillus plantarum, were isolated which were effective against all vancomycin-resistant Enterococci and their biofilms. The lethal time of these two probiotics was 12 hours and the MIC and MBC were at concentrations of 0.5 µg/ml and 1 µg/ml respectively. Various tests on these two probiotics also showed no pathogenicity and no antibiotic resistance. The amount of lactic acid in Lactobacillus plantarum and Pediococcus acidilactici were 2.5 and 1.1 g per 100 ml respectively.

The optimal antimicrobial and antibiofilm properties of these two probiotics alongside producing high levels of lactic acid against all vancomycin resistant strains demonstrate their desirable and potential properties.

Documented streptococcal resistance to erythromycin has recently been raised. The aim of this study is to identify the molecular mechanism of erythromycin resistance among group B Streptococcus (GBS) strains and to correlate with the clinical origin of strains.

A total number of 134 colonizing (n = 36), invasive (n = 36), noninvasive (n = 46), and asymptomatic (n = 16) GBS isolates were characterized by the detection of dltS gene, capsular serotyping, antibiotic susceptibility profiles using disc diffusion method, and screening of the ermB, ermTR, and mefA resistance genes.

The distribution of capsular serotypes was as follow: serotype III (24.6%), Ia (21.6%), V (17.9%), Ib (14.9%), II (8.9%), IV (8.9%), VI (1.5%), and VII (1.5%). From 134 GBS isolates, 51 (38%) isolates were resistant to erythromycin. The constitutive macrolide lincosamide streptogrmin B (MLSB) was the most common resistance phenotype (62.7%), followed by inducible MLSB (27.4%) and M phenotype (9.8%). Erythromycin resistance rate was higher among asymptomatic GBS strains (13/16, 81.2%). Serotype III was the most prevalent type among resistant isolates (41.1%). The ermB gene highly distributed among resistant strains (64.7%), followed by ermTR (21.5%) and mefA (9.8%). The ermB gene was related to constitutive MLSB phenotype (84.3%, P < 0.05) and serotypes III (61.9%), Ib (87.5%), and V (83.3%). All M phenotype strains harbored mefA gene and were in association with serotype Ia (90%).

The current study suggests that ribosomal modification with erm genes is the main mechanism of erythromycin resistance. Because of relatively high prevalence of erythromycin resistance, double disc test highly recommended for GBS disease treatment and intrapartum prophylaxis among penicillin intolerant patients in our region.

Antibiotic resistance against uro-pathogens is a worldwide health concern. The aim of this study was to determine the causative bacteria and antibiotic susceptibility patterns among hospitalized patients with community acquired urinary tract infection (UTI).

This cross-sectional study was performed in 2016-2018 in Isfahan, Iran. Urine samples were examined for strain identification and antimicrobial resistance pattern using standard tests. Stratification was done based on gender and age (<20 and >20 years) groups. Chi-square and Fisher exact tests were applied to assess differences in etiology and susceptibility rates between groups.

Among 1180 patients, Escherichia coli was the commonest pathogen (68.1%) followed by Enterococcus spp. (8.8%) and Klebsiella pneumonia (8.0 %). Non-E. coli pathogens were more frequent among males (41.8% versus 24.8% in females, P<0.01) and in those aged under 20 years (61.0% versus 22.2% in older than 20 years, P<0.01). Isolated bacteria revealed high susceptibility to imipenem (94.9%), meropenem (92.2%), and amikacin (91.9%); moderate sensitivity to gentamicin (64.4%), cefepime (52.6%) and ceftazidime (47.2%); and low susceptibility to ceftriaxone (41.8%), cefotaxime (40.0%), ciprofloxacin (38.6%) and trimethoprim-sulfamethoxazol (31.3%). The sensitivity of isolates to ceftriaxone, ceftazidime, cefepime, imipenem, meropenem, amikacin and ciprofloxacin was significantly higher in females. Compared to the older age group, uro-pathogens were more susceptible to ciprofloxacin, ceftazidime and gentamicin in patients aged under 20 years.

We found that imipenem, meropenem and amikacin were good choices for empiric therapy of complicated or severe hospitalized patients with community acquired UTI; and gentamicin, cefepime and ceftazidime were acceptable as initial choices in non-severe infections in the area.

Isfahan Antibiotic Resistance Surveillance System‑1 has been instituted in Isfahan, Iran to construct a project for surveillance of clinically significant bacteria, and to help raise a logic regional stewardship program for prevention and control of disseminating‑resistant organisms.

During March 2016 to March 2018, an antibiotic resistance surveillance system was designed and implemented by Isfahan Infectious Diseases and Tropical Medicine Research Center. The surveillance program was implemented in three general hospitals in Isfahan. In addition to the routine microbiology data, clinical data (differentiation between true infections and contamination, healthcare‑associated infections (HCAI) and community‑acquired infections (CAI), as well as determination of the infection site) were obtained and analyzed by WHONET software.

During a 2‑year period, from 7056 samples that revealed growth of bacteria, 3632 (51.5%) isolates were detected as contamination and 3424 (48.5%) true bacterial isolates were identified. Of these, about 32% of isolates were recognized as HCAI. Totally, the most recognized infections were urinary tract infection, bloodstream infection and skin and soft tissue infections. In patients with HCAIs, 70% of isolates were gram negative and in patients with CAIs 73% isolates were gram negative bacteria.

The strength of the project is gathering enough clinical information in addition to microbiologic data, which would increase application of the results for empiric treatment and prevention of the infectious diseases in clinical settings.

 Fusarium species are hyaline saprophytic fungi that are frequently found in the soil, air, and water. They can cause severe systemic infections in immunocompromised patients. Clinical manifestations depend on the way of entry of the mold and host immune system status. The main ways of entrance are the airways, skin, and mucosal membranes. Disseminated fusariosis often occurs in patients with hematological disorders, patients with cancer, and solid organ transplant recipients.

 Herein we report a case of Fusarium fungemia in a patient with adrenocortical carcinoma from Isfahan, Iran. The patient was a 41-year-old female with stage III adrenal cortical carcinoma. Despite antifungal therapy with liposomal amphotericin B, the patient passed away 6 days after admission. Internal transcribed spacer region sequencing applied for species identification and its sequence deposited in the GenBank (accession number: MK880379).

 Since the ideal strategies against invasive fungal infections remain uncertain and the mortality rate is high, we recommend primary prophylaxis with a broad-spectrum antifungal agent for vulnerable patients particularly those admitted to high-risk units such as oncology, hematology, and transplant units.

Carbapenem-resistant Enterobacteriaceae (CRE) bacteria are difficult to treat because of their high antibiotic resistance levels that can be mediated by carbapenemase enzymes such as Klebsiella Pneumoniae Carbapenemase (KPC). The purposes of this study were to determine the genetic and resistance patterns and to detect of KPC enzyme in carbapenem-resistant strains of Enterobacteriaceae isolates.

In this study, antibiotic resistant pattern and genotyping of carbapenem-resistant Enterobacteriaceae isolates and frequency of KPC enzyme were investigated. During 16 months of conducting the study (December 2016 until April 2018), strains of Escherichia coli, Enterobacter spp. and Citrobacter spp. were isolated and identified from different clinical specimens and antibiotic susceptibility test was determined. In addition, the prevalence of the KPC enzyme was determined by PCR and two phenotypic methods including Modified Hodge Test (MHT) and the combination test by boronic acid. Enterobacterial Repetitive Intergenic Consensus Polymerase Chain Reaction (ERIC-PCR) method was used for the determination of the clonal relationship of carbapenems resistant strains.

The results showed that among 520, 146 and 58 isolated of Escherichia coli, Enterobacter spp. and Citrobacter spp. effective antibiotics were carbapenems, piperacillin/tazobactam, amikacin, cefepime, fosfomycin, nitrofurantoin, and gentamicin, respectively. In addition, 12 strains (2.3%) of E. coli, 4 strains (2.7%) of Enterobacter and 4 strains (6.9%) of Citrobacter were resistant to carbapenems. The KPC investigation results showed the detection of this enzyme in 18 and 6 isolates using MHT and boronic acid methods respectively, but no producer strain was observed using PCR. The result of ERIC-PCR showed in carbapenem-resistant strains of Citrobacter, Enterobacter and Escherichia coli, 3, 4 and 9 distinct main clusters (patterns) were observed respectively. Discussion and

This study demonstrates the high antibiotic resistant prevalence and low specificity of standard phenotypic methods that were used for KPC detection in Isfahan City.

Gram‑negative bacilli are the most important cause of nosocomial urinary tract infections (UTIs). The production of extended‑spectrum β‑lactamase (ESBL) enzymes is a common mechanism of resistance among these bacteria. The aim of this study was to determine the rate of ESBL producing Gram‑negative bacteria causing nosocomial UTI in a referral hospital as well as their susceptibility pattern to the most commonly used antibiotics.

In a prospective cross‑sectional study performed over a 6‑month period, urinary specimens obtained from hospitalized patients with documented culture‑proved nosocomial UTI (age range of 1-87 years). Isolated aerobic Gram‑negative bacteria underwent further microbiologic tests for detection of ESBL, as well as antimicrobial susceptibility test using Kirby-Bauer (disk diffusion) and E‑test methods.

During the study period, 213 urine samples were detected to have growth of Gram‑negative organism. Escherichia coli was the most frequently isolated organism (61%). ESBL was detected in 102 isolates including 38.5% of E. coli, 39.5% of Klebsiella pneumonia, 88.5% of Pseudomonas aeruginosa, and 100% of Acinetobacter baumannii strains. Imipenem and meropenem were the most effective antibiotics on E. coli and K. pneumoniae strains. P. aeruginosa and A. baumannii strains showed high resistance to all tested antibiotics.

Large numbers of Gram‑negative bacteria causing nosocomial UTIs produce ESBL with most being multidrug‑resistant. Therefore, routine ESBL detection testing and subsequent antibiogram with disk diffusion method could be useful to determine the best treatment options for UTI.

  Acinetobacter baumannii is one of the most common causes of nosocomial infections. The knowledge about resistance and susceptibility of this bacterium to antibiotics is mandatory in every region. This study evaluated the susceptibility of A. baumannii strains to ampicillin-sulbactam and colistin in a total of 100 samples of A. baumannii obtained from intensive care unit (ICU) patients with nosocomial infections. After identification of A. baumannii, susceptibility to ampicillin-sulbactam and colistin was assessed using Epsilometer test (E-test). Regarding the resistance to ampicillin-sulbactam, sensitivity, resistance, and intermediate resistance of A. baumannii strains were 62%, 16%, and 22%, respectively. The distribution of resistance among A. baumannii strains was not significantly different regarding the gender, age, duration of ICU stay, background diseases, and type of interventional procedure. The obtained strains of A. baumannii from the patients who had taken β-lactam, aminoglycoside, anti-methicillin resistant Staphylococcus aureus (anti-MRSA), and colistin were significantly resistant to ampicillin-sulbactam (P value <0.05). Overall, 16% of Acinetobacter baumannii strains showed resistance to ampicillin-sulbactam and only one strain was detected with colistin resistance. It is suggested that a local antibiotic resistance regarding A. baumannii infection be defined in order to improve final outcome of antimicrobial treatment and prevent further resistance.

Cholecystitis is a common surgical condition. Recently, several authors have reported that DNA of bile tolerant Helicobacter spp. has been found in the human bile colonizing the biliary tract. The aim of this study was to evaluate the association between the presence of Helicobacter spp. and gallstone cholecystitis.
In this case-control study, gallstones, bile, and gallbladder mucosa were collected from 25 patients without gallstone disease, 24 with acute cholecystitis, and 28 with chronic cholecystitis. The presence of Helicobacter pylori (H. pylori), Helicobacter bilis (H. bilis), Helicobacter hepaticus (H. hepaticus), and Helicobacter pullorum (H. pullorum) were investigated by polymerase chain reaction (PCR) using species-specific primers.
In this study, 77 subjects with acute and chronic cholecystitis and control groups with a mean age of 46.85±14.53 years, including 58 (67.25%) women and 19 (32.75%) men were included. DNA of 10 Helicobacter spp. was detected in the bile of the patients with cholecystitis including eight H. pylori and two H. bilis. However, we could not detect H. hepaticus and H. pullorum DNA in the samples. Moreover, there was an association between H. pylori and acute cholecystitis (p=0.048), which was found to be stronger in 31-40-year-olds group (p=0.003).
We found an association between the presence of H. pylori DNA and acute gallstone cholecystitis. There is not statistically significant correlation between three enterohepatic Helicobacter spp. (H. bilis, H. hepaticus, and H. pullorum) and cholelithiasis. Given the low sample size of the patients, more studies are required to clear the clinical role of Helicobacter spp. in the gallstone disease and cholecystitis.

The emergence of pan-drug resistant strains (PDR) of Pseudomonas aeruginosa has led to renewed efforts to identify alternative agents, such as bacteriocins and bacteriocin-like inhibitory substances (BLISs).
The aims of this study were to determine the acquired resistance profiles of multidrug-resistant (MDR), extensively drug-resistant (XDR), and PDR P. aeruginosa isolates based on the revised definitions of the CDC and ECDC and to screen and characterize effective BLISs against these isolates.
Patients and Materials: In a cross-sectional study, 96 P. aeruginosa strains were isolated during a 12-month period. The resistance profiles of these isolates were determined as MDR, XDR, and PDR, and the data were analyzed using WHONET5.6 software. A BLIS against the P. aeruginosa strains was characterized based on its physicochemical properties, size, growth curves, and production profiles.
Among the 96 isolates of P. aeruginosa, 2 (2.1%), 94 (97.9%), and 63 (65.6%) were non-MDR, MDR, and XDR, respectively, and 1 (1.1%) was PDR. The most effective antibiotics against these isolates were polymyxins and fosfomycin. A BLIS isolated from the P. aeruginosa DSH22 strain had potent activity against 92 (95.8%) of the 96 isolates. The BLIS was heat stable, (up to 100°C for 10 min), UV stable, and active within a pH range of 3 - 9. The activity of BLIS disappeared when treated with trypsin, proteinase K, and pepsin, indicating its proteinous nature. Based on its size (25 kDa), the BLIS may belong to the large colicin-like bacteriocin family. BLIS production started in the midexponential phase of growth, and the maximum level (2700 AU/mL) occurred in the late-stationary phase after 25 hours of incubation at 30°C..
This BLIS with broad-spectrum activity may be a potential agent for the treatment or control of drug-resistant strains of P. aeruginosa infection..

Since earlier identification of methicillin-resistant Staphylococcus aureus (MRSA)-colonized patients could be helpful for reducing the overall frequency of S. aureus infections, the investigation of persons colonized with MRSA is considered to be a key component of MRSA infection prevention programs, particularly among ICU patients.
The aim of the present study was to evaluate the prevalence of nasal and extra-nasal carriers of MRSA and risk factors associated with MRSA colonization among adult patients admitted to the ICU.
In a cross-sectional study, 164 adult patients who were admitted to the ICU of a teaching hospital were screened for nasal and extra-nasal carriage of MRSA. In addition, the ICU-hospitalized patients were evaluated for MRSA acquisition during their ICU stay.
Out of the 164 patients admitted to the ICU, 12 (7.3%) patients were methicillin-susceptible Staphylococcus aureus (MSSA) carriers, and 12 (7.3%) patients carried MRSA. Four (16.6%) patients were colonized at single or multiple extra-nasal sites based on negative nares screening. Of the 15 remaining patients hospitalized at the ICU, one (6.7%) patient acquired MRSA. The patients colonized with MRSA had more advanced ages (P = 0.008), longer hospital stays before being transferred to the ICU (P > 0.001), more underlying diseases with chronic obstructive pulmonary disease (COPD) (P = 0.028), and had undergone surgery (P = 0.003). Patients transferred from the surgical wards to the ICU were found to have significantly higher carriage rates of MRSA (P = 0.041)..
The prevalence of MRSA colonization upon ICU admission at our hospital was relatively high, and routine MRSA screening is suggested, especially for patients who have certain risk factors. In addition, extra-nasal MRSA screenings upon ICU admission will help in the early detection of MRSA.

The resistance of Klebsiella pneumoniae strains to antibiotics is an important challenge for human health. The aims of this study were evaluation of the carbapenemase resistance and Klebsiella pneumoniae carbapenemase (KPC) enzyme in Klebsiella pneumoniae isolates and determination of their acquired resistance profiles.
In a cross-sectional study, Klebsiella pneumoniae strains were isolated from different clinical specimens during one year. Their acquired resistance profiles were determined by 31 antibiotics from 17 classes and the numbers of Multi-drug resistance (MDR), extended drug resistance (XDR) and pan drug resistant (PDR) strains were determined. In carbapenem resistant strains, the Minimum Inhibitory Concentration (MIC) of imipenem and meropenem were calculated by Epsilometer test (Etest) method. Prevalence of the KPC enzyme in these strains was determined by phenotype method using Modified Hodge Test.
Findings: Among the 98 isolated Klebsiella pneumoniae strains, the most effective antibiotics were colistin, tigecycline and chloramphenicol respectively. The 99% of strains were MDR and 6% were XDR and no PDR strain was detected. Resistance to carbapenems in these strains were 64.3% for Doripenem, 69.4% for Ertapenem, 58.2% for imipenem (55.1% in E-test method) and 64.3 for meropenem (65.3% in E-test method). Expression of KPC enzymes in 71% of strains was identified.
Discussion & This study demonstrates the high prevalence of MDR strains and carbapenem drugs resistance and also high frequency of Klebsiella pneumoniae carbapenemase (KPC) enzyme in the Klebsiella pneumoniae isolates that it shows the urgent revision of the patterns of antibiotics consumption is necessary.

The major resistance mechanisms of Pseudomonas aeruginosa to fluoroquinolones and carbapenems are associated with the mutations in the genes gyrA and oprD encoding type II topoisomerases (DNA gyrase) and OprD porin, respectively.
In this cross-sectional study, sixty five clinical samples were collected from patients hospitalized in Al-Zahra Hospital of Isfahan, Iran. Susceptibility testing was performed by using disk diffusion and minimum inhibitory concentration (MIC) by E-test methods as recommended by Clinical Laboratory Standards Institute (CLSI). The assay was based on a DNA sequencing method using polymerase chain reaction (PCR).
The disk diffusion and E-test methods showed significant concordance in determining the in-vitro activity of the meropenem and ciprofloxacin against P. aeruginosa isolates. The mutations associated with antibiotic resistance were detected in the codon 83 of the gyrA gene, and various codons of the oprD gene.
Our results showed that the main mechanism of fluoroquinolone resistance in P. aeruginosa is mediated primarily through mutations in gyrA and carbapenem resistance was driven mainly by the mutational inactivation of oprD gene.

Only a short time after the discovery of antibiotics by Alexander Fleming, antibiotic-resistant bacteria were reported. Besides the traditional mechanisms of resistance in bacteria, new mechanisms have been described by different researchers. For example, recently a new gene operon of D-alanine-D-serine called VanL that cuased resistant to the antibiotic vancomycin was reported. Other researchers have shown that Klebsiella pneumoniae strains lost purine Ompk36 that have a major role in the antibiotic diffusion into cells, are resistant to carbapenem. In 2011, the first full resistance to tigecycline was reported that the enzyme-linked monooxygenase flavin hydroxyl TetX cause deactivation of antibiotics. In 2012, high resistance to mupricin antibiotic was described that intermediated by a new locus named mupB. In addition, in 2013, it was showed that some strains of Enterococcus faecalis can move daptomycin antibiotic from its target to other places and so inhibit its activity. Removal of whole target gene (PBP3) of ceftazidime in Burkholderia pseudomallei was reported in 2012. In other hand, new role of riboswitch for resistance to aminoglycoside antibiotics reported in 2013. In addition, recent studies have indicated a relationship between SOS response and quorum sensing with antibiotic resistance and new antibiotic resistance mechanisms in bacterial biofilm and persister cells are known. In this review, recent studies have been conducted to identify these new mechanisms.

The antibiotic resistant of In Enterobacteriaceae bacteria family to carbapenem drugs is continuously increasing. The aims of this study were to determine the prevalence of carbapenems resistance in multidrug-resistant (MDR) strains of E. coli and Enterobacter and to determine their standard antibiotic resistance patterns and frequency of Klebsiella pneumoniae carbapenemase (KPC) enzyme in Isfahan.

This cross-sectional study, was carried out on 300 clinical samples collected from three hospitals in Isfahan. Antibiotic susceptibility of bacteria was determined by disk diffusion method. In carbapenem resistant strains, the minimum inhibitory concentration (MIC) of imipenem and meropenem were calculated by E-test. The resistance rate to 31 antibiotics belonging to 17 classes were evaluated. The frequency of MDR, extended drug resistance (EDR) and pan drug resistant (PDR) strains were determined. The prevalence of the KPC enzyme in these strains was determined by phenotype method.

Totally, 191 strains of E. coli and 43 Enterobacter strains were isolated, among them 151 (79%) and 35 (81%) were MDR respectively. In both bacteria, effective antibiotics were carbapenem, piperacillin/tazobactam, amikacin, cefepime and nitrofurantoin. Five strains of E. coli (3.3%) and three strains of Enterobacter (6.8%) were resistant to carbapenems and the MIC results confirmed these results. Overall 7 strains out of these 8 strains were MDR and only one strain of E. coli was XDR. No PDR strain was detected. KPC enzymes in four E. coli strains (6.2%) and two strains  (7.5%) belonged to Enterobacter strains.

This study demonstrated the high prevalence of MDR among hospitalized patients in Isfahan. This results shows the emergent changes in the level of antibiotic utilization in hospitals.

Extended-spectrum beta-lactamases (ESBLs) are a group of enzymes that hydrolyze antibiotics, including those containing new cephalosporins, and they are found in a significant percentage of Escherichia coli and Klebsiella pneumoniae strains. With the widespread use of antibiotics, difficulties with infection therapy caused by drug resistant organisms, especially those that have acquired resistance to beta-lactams, such as broad-spectrum cephalosporins, have amplified the above-mentioned organisms.. This study was conducted to characterize ESBLs among E. coli and K. pneumonia isolates by molecular and phenotypic methods.. Different strains of E. coli and K. pneumonia were collected from patients with urinary tract infections. The ESBL phenotype was determined by a double disk diffusion test (DDDT). In addition, polymerase chain reaction (PCR) analysis specific for β-lactamase genes of the TEM and SHV family was carried out. The PCR products were run on agarose and examined for DNA bands.. A total of 245 E. coli and 55 K. pneumonia strains were isolated from different samples. In total, 128 of the 300 isolates were confirmed as potential ESBLs producers as follows: 107 (43.67%) E. coli and 21 (38.18%) K. pneumonia. ESBLs genes were found in 24 isolates (18.75%): 21 E. coli and 3 K. pneumonia isolates. The TEM gene was present in 13 (12.14%) E. coli strains, but it was not detected in K. pneumonia. In addition, the SHV gene was present in 8 (7.47%) E. coli and 3 (14.28%) K. pneumonia isolates. Five (4.67%) of the E. coli isolates harbored both TEM and SHV genes. All isolates (100%) were susceptible to imipenem. The lowest rates of resistance to other antibiotics were observed for; piperacillin-tazobactam (6.25%), amikacin (12.5%) and gentamicin (14.84%). The rates of resistance to other antibiotics were as follow: nitrofurantoin (16.4%), nalidixic acid (23.43), co-trimoxazole (25%), cefepime (32%), ciprofloxacin (55.46%), ampicillin (69.53%), ceftazidime (100%), and cefotaxime (100%).. The results of this study indicate the widespread prevalence of ESBLs and multiple antibiotic resistance in E. coli and K. pneumoniae. Therefore, beta-lactam antibiotics and beta-lactamase inhibitors or carbapenems should be prescribed based on an antibacterial susceptibility test..

Production of β-lactamase enzymes is the most common and important mechanism of resistance in Gram-negative bacteria. Th e objective of this study was to assess frequency of three main β-lactamase enzymes, including extended spectrum β-lactamases (ESBLs), metallo-β-lactamase (MBL), and Klebsiella pneumoniae carbapenemase (KPC) enzymes in Escherichia coli and Klebsiella spp. isolated from nosocomial and community urinary tract infections (UTI).

In a cross-sectional study from March to December 2012, midstream urine samples were obtained from patients suspicious of UTI who were hospitalized or referred to Al-Zahra Hospital, Isfahan, Iran. Samples were cultured and E. coli and Klebsiella spp. were isolated. Prevalence of ESBLs, KPC, and MBLs producing E. coli and Klebsiella spp. were studied by double-disk (combined-disk), the modifi ed Hodge test and imipenem-ethylenediaminetetraacetic acid combined disc methods respectively. In addition, their antimicrobial susceptibility patterns determined and resistant to carbapenem drugs confi rmed by minimum inhibitory concentrations based on E-test method.

A total of 1080 E. coli and 484 Klebsiella strains were isolated during study period. Among 720 E. coli and 384 Klebsiella isolates from hospitalized patients, 300 (41.7%) and 198 (51.5%) were ESBLs producers, respectively. In out-patients samples, the rate of ESBLs production was 25% (90/360) and 40% (40/100) in E. coli and Klebsiella isolates, respectively. Prevalence of MBLs producing in hospital E. coli and Klebsiella isolates were 0.3% (2/720) and 2.6% (10/384), and for KPC data were 1.4% (10/720) and 48.4% (186/384), respectively. No MBLs and KPC producing isolate was seen in non-hospital E. coli and Klebsiella isolates except for one non-hospital KPC producing Klebsiella isolate.

Th e result of our study showed high prevalence of ESBLs and KPC, but low prevalence of MBLs in cultured bacteria from urine samples of patients with acute UTI. In addition, KPC was the main carbapenem resistance mechanism in Klebsiella and E. coli isolates.

Deodorant products prevent the growth and activity of the degrading apocrine gland bacteria living in the armpit. Common antibacterial agents in the market like triclosan and aluminum salts, in spite of their suitable antibacterial eff ects, increase the risk of Alzheimer’s disease, breast and prostate cancers or induce contact dermatitis. Th erefore, plant extracts possessing antibacterial eff ects are of interest. Th e aim of the present study was to verify the in vitro antimicrobial eff ects of diff erent sage extracts against two major bacteria responsible for axillary odor, and to evaluate the deodorant eff ect of a silicon-based stick containing sage extracts in diff erent densities in humans. Diff erent fractions of methanolic extract of Salvia offi cinalis (sage) were evaluated on a culture of armpit skin surface of volunteers through agar microdilution antimicrobial assay. Th en, randomized, doubleblind placebo-controlled clinical trial with the best antibacterial fraction was conducted on 45 female healthy volunteers. Participants were treated with a single dose in four groups, each containing 15 individuals: Group 1 200 g/mL), 2 (400 g/mL), 3 (600 g/ mL) of dichloromethane sage extract, and placebo (without extract). A standard sensory evaluation method for the evaluation of deodorant effi cacy was used before, and two hours, four hours, and eight hours after single application of a deodorant or placebo (ASTM method E 1207-87 Standard Practice for the Sensory Evaluation of AxillaryDeodorancy). Th e data were analyzed with two factors relating to densities and time. In 45 participants with a mean [± standard deviation (SD)] age of 61.5±11.8 years, statistically signifi cant within-group diff erences were observed before and two, four, and eight hours after deodorant treatment for groups 1, 2, and 3. Groups 1, 2, and 3 had a signifi cantly smaller odor score than placebo after two, four, and eight hours (P < 0.001). In a comparison of diff erent deodorant densities, the interaction eff ect was not signifi cant between deodorant 200 and 400 g/mL, but was signifi cant between 200 and 600 and between 400 and 600 g/mL sage extract sticks (P < 0.001). Before running the sensory evaluation of the deodorant sticks on the subjects, a rabbit skin patch test was used to demonstrate that the formulation had no irritants. A single treatment with a stick deodorant containing dichloromethane sage extract of 200, 400, or 600 g/mL concentrations was eff ective in reducing the axillary malodor level compared with the control, in healthy subjects.

The aim of this study was to isolate and identify KPC (Klebsiella pneumonia carbapenemase) enzyme producing strains of Enterobacteriaceae، and determine their antibiotic susceptibility pattern in three hospitals of Isfahan، Iran. This subject has not previously been investigated comprehensively. KPC detection was done by Modified Hodge Test (MHT) and their antibiotic susceptibility patterns were determined by disc diffusion method. The total of 475 strains were isolated and detected as Enterobacteriaceae during the period of 9 months (July 2012-March 2013) in three hospitals in Isfahan province، Iran. These isolates contained Escherichia coli: 285 strains (60%)، Klebsiella: 128 strains (27%)، Enterobacter aerogenes: 16 strains (3. 4%)، Enterobacter cloacae: 9 strains (1. 9%)، Proteus vulgaris: 12 strains (2. 5%)، Proteus mirabilis: 4 strains (0. 84%)، Citrobacter freundii: 8 strains (1. 7%)، Citrobacter diversus: 3 strains (0. 6%)، Serratia marcescens: 3 strains (0. 6%)، Shigella sonnei: 4 strains (0. 84%)، Salmonella paratyphi A: 2 strains (0. 42%)، and Providencia stuartii: 1 strain (0. 2%). Percentage resistant to ceftazidime and cefotaxime and non-susceptibility to imipenem and meropenem for above isolates were، respectively، as follows: for Escherichia coli isolates 60، 63، 6، and 9; for Klebsiella isolates 70، 75، 55، and 58; for Klebsiella pneumoniae 100، 100، 95، and 94; and for other Enterobacteriaceae isolates 20، 17، 5، and 3. Our results showed that KPC test was positive for 2 isolates (0. 7%) among Escherichia coli strains، 65 (87%) isolates among Klebsiella pneumoniae، and 1 isolate (6%) among Proteus strains. This was approved by Etest based MIC method. In general، our results showed that among Enterobacteriaceae isolates، Klebsiella pneumoniae isolates had higher KPC enzyme production، and most strains had multidrug resistant.

Furthermore application of bacteriocins as alternates for antibiotics، they are fermented as food preservation currently. The aim of this study was isolation and purification of ultraviolet-resistant bacteriocins from enterococci strains active against Listeria monocytogenes. Different strains of enterococci bacteria were isolated and identified from various clinical specimens and bacteriocin production were evaluated against strains of Listeria monocytogenes. An isolate of enterococcus bacteria that produce significant bacteriocin against all studied strains of Listeria monocytogenes was identified based on its phenotypical and biochemical properties as well as its 16SrRNA gene sequencing. In the next stage، this bacteriocin was purified and the effects of proteolytic enzymes، pH، temperature and ultraviolet radiation (UV) on its activity were tested and its molecular weight was determined by SDS-PAGE (Sodium dodecyl sulfate polyacrylamide gel electrophoresis) method. 17 strains of enterococci were isolated and five isolates exhibited an inhibitory effect against Listeria monocytogenes strains and among them، one enterococcus had inhibitory effect against all four strains of Listeria monocytogenes. This enterococcus was identified as Enterococcus faecium strain DSH20 (access number: JX567733. 1). Using proteolytic enzymes led to the loss of antimicrobial activity; so، protein nature of it was confirmed. Bacteriocin production was resistant to UV، high temperature and pH changes. The molecular weight of the bacteriocin was at approximately 35 kilodaltons. Biochemical properties of this bacteriocin، such as thermal stability، resistance to UV radiation and pH، were significant. These properties present it as an alternative of antimicrobial agents against Listeria monocytogenes and preserving of fermented foods.

Pseudomonas aeroginosa (P. aeroginosa) is one of the most important causes of hospital infections، especially in the intensive care unit (ICU). Increasing antibiotic-resistance of P. aeroginosa cause a lot of problems for patients and in some cases، lead to septicemia and death. The most important antibiotics used in the treatment of P. aeruginosa infection are ceftazidime، ciprofloxacin، imipenem and piperacillin mainly used in hospitals. Unsuitable and prolonged use of antibiotics has led to the emergence of multidrug (MDR) and pandrug resistant (PDR) strains. In fact، infections with MDR and PDR strains often result in increased cost of treatment، lengthy stay، and overall morbidity and mortality. This study aimed to determine the pattern of drug resistance in P. aeruginosa infection in ICU of Al-Zahra hospital (Isfahan، Iran).

66 isolates of P. aeruginosa from different clinical specimens from ICU wards of Al-Zahra hospital were isolated. Antibacterial susceptibility test for imipenem، meropenem، amikacin، gentamicin، ciprofloxacin، levofloxacin، aztreonam، cefepime، piperacillin، piperacillin/tazobactam and ceftazidime was performed using disk diffusion (Kirby-Bauer) method.

Of 66 separated isolates، 51 (77. 2%) were of MDR and 33 (50%) were of PDR strain. 75. 8% were resistant to ceftazidime and 72. 7% to piperacillin. In fact، most of isolates were resistant to both antibiotics.

This study shows that overuse and misuse of antibiotics in hospitals has increased drug resistance and creation of the PDR and MDR strains. The results suggest that antibiotic resistance can be determined by choosing the appropriate drug to treat patients.

Staphylococcus aureus (S. aureus) is an important human pathogen associated with hospital- and community-acquired diseases، a wide range of infectious disease including minor skin disease to more sever and aggressive infections such as septicemia، pneumonia، endocarditis، and deep skin abscess. S. aureus has a high mortality rate of 35%. Therefore، it is crucial to identify the methicillin resistant S. aureus (MRSA) strains and implement the necessary treatment in order to control the spread of hospital infections. A total of 150 S. aureus isolates were collected from samples of patients admitted to Alzahra and Shariati hospitals in Isfahan، Iran. Polymerase chain reaction (PCR) for mecA gene was performed in all strains. Thereafter، the minimum inhibitory concentration (MIC) for oxacillin was carried out using agar dilution method. Then، antibiogram using disk diffusion for cephoxitin was performed according to Clinical and Laboratory Standards Institute (CLSI) regulations on isolates containing mecA gene. The three methods were then compared. Of the 150 samples، 62 samples (41. 33%) were found to carry mecA gene using PCR. However، agar dilution for oxacillin found 56 of 62 samples (90. 33%) to harbor mecA gene. Disk diffusion method revealed that 53 of 62 samples (85. 48%) contain mecA gene. Agar dilution method was found to have a higher sensitivity in determining antibiotic sensitivity compared to disk diffusion method. However، PCR was identified as the ideal method for detecting MRSA strains; since a number of strains were found to be sensitive to oxacillin in phenotypic test due to lack of mecA expression while still containing the gene.

Staphylococcus aureus (S. aureus) is one of the important causes of nosocomial infections in intensive care unit (ICU) patients. This study was performed to evaluate the S. aureus colonization in ICU patients in admission and the incidence of colonization during hospitalization and their associations with the relevant risk factors. From January to September 2012, a total of 164 patients were enrolled in this study. All of the patients were hospitalized for the first time in ICU of Alzahra hospital (Isfahan, Iran) and all of them were admitted more than 24 hours. Samples were collected by sterile swabs from the anterior nostrils, axillary and inguinal region. S. aureus positive samples were detected by microbiological examinations. If a patient was hospitalized more than a week in ICU and was not colonized in admission, re-sampling was done once a week. A total of 164 patients, 24(14.6%) were colonized with S. aureus in admission and 1(6.7%) was colonized with S. aureus during the ICU stay. Of these, 21(87.5%), 5(20.8%) and 2(8.3%) patients were colonized with S. aureus in anterior nostrils, axillary and inguinal regions, respectively. Compared to those without, patients with S. aureus colonization were significantly associated with surgery (P = 0.013), central venous catheter (P = 0.044) and the length of hospital stay before being transferred to the ICU (P < 0.005). The evaluation of patients for S. aureus colonization in admission is necessary especially for patients who have been hospitalized for long time. This will be effective in reducing nosocomial infections caused by S. aureus.