shirin afhami

Colistin, a last-resort antibiotic, faces a growing threat from antibiotic resistance. This study aims to comprehensively assess colistin resistance in clinical isolates of Escherichia coli, Pseudomonas aeruginosa, Acinetobacter baumannii, and Klebsiella pneumoniae in Iran.

Relevant studies on the prevalence of colistin resistance among multidrug-resistant Gram-negative bacteria in Iran, published up to December 15, 2023, were identified through searches of databases such as PubMed/Medline, EMBASE, and Scopus. The overall frequency of colistin resistance for each bacterial species was determined using CMA version 3.

The comprehensive analysis of clinical isolates revealed varying frequencies of colistin resistance among the studied Gram-negative bacteria. E. coli displayed a resistance rate of 3.6%, while P. aeruginosa exhibited a rate of 6.5%. A. baumannii demonstrated a resistance rate of 4.7%, and K. pneumoniae displayed the highest resistance rate at 7.2%. Importantly, the analysis found no significant evidence of publication bias, enhancing the reliability of these resistance rate estimates.

Colistin resistance among these clinically significant Gram-negative bacteria in Iran is rising, limiting treatment options and posing serious challenges to healthcare providers. These findings underscore the urgency of enhanced surveillance, the development of alternative treatments, and the implementation of strict infection control measures. Addressing colistin resistance is crucial to effectively managing infections caused by these pathogens in Iran and globally.

 This study was conducted with the aim of investigating methods to reduce the use of urinary catheters in hospitalized patients, which can reduce the occurrence of urinary infections.

This prospective study was conducted during 10 months by collecting information from the files of 694 patients (in two groups before and after the intervention) in the non-Intensive Care Unit wards of a university hospital. The required information before and after the educational and managerial interventions were collected and compared.

 In the pre-intervention phase, 217 out of 347 patients (62.5%) and in the post-intervention phase, 199 out of 347 patients (57.3%) were male. Before the intervention, the average duration of hospitalization and urinary catheter utilization days were 8.7 and 7.9 days, respectively, which were decreased to 7.2 and 6.3 days, respectively, after the intervention. After the intervention, the number of catheters that were placed by the doctor's written order increased significantly (P-value: 0.002); Also, after the intervention, the cases of catheterization with indication increased significantly (P-value: 0.001). The most common indication for urinary catheter insertion was before and during surgery and later, was severe weakness of the patient to get out of bed.

 Combination of educational, executive and managerial interventions can reduce the number of urinary catheter insertion without physician's order and the number of urinary catheter insertion without indication. In this study, the number of cases who used catheter due to inability of getting out of bed, did not change significantly by the interventions.

Healthcare-associated infections (HAIs) in intensive care unit (ICU) patients significantly complicate the normal hospitalization process and affect patients’ condition, length of hospitalization, mortality, and treatment cost. In this study, we aimed to determine the prevalence and economic burden of HAIs.

The study involved all patients with a confirmed HAIs (based on CDC/NHSN case-definitions); in the general ICU of a tertiary university hospital in Tehran, from April 2020 to March 2021. The patients’ information, including length of hospitalization, outcome, type and cost of prescribed antibiotics, were recorded.

During the study period, 119 HAIs were found in 1395 (43% F / 57% M) patients. The prevalence of nosocomial infections was 8.53%. The mean duration of hospitalization in all ICU patients was 4.7 ± 3.1 days, and 31.85 ± 18.96 days in patients with HAIs. The most common organisms involved in HAIs are Acinetobacter baumannii (54.6%), Klebsiella pneumoniae (30.3%), E. coli (15.1%), and Enterococcus spp. (12%). Incidence density of ventilator-associated pneumonia (VAP), central line-associated bloodstream infection (CLA-BSI), and catheter-associated urinary tract infection (CA-UTI) per 1000 device-days were 36.08, 17.57, and 8.86, respectively. The total cost of antibiotics for HAIs was € 105,407. Among these, the highest consumption costs were for carbapenems, followed by colistin and caspofungin.

This study showed the high burden of nosocomial infections in ICUs. Strategies for more strict infection prevention and control are necessary to reduce this burden.

The rational use of antibiotic prophylaxis before surgery can reduce surgical site infection, microbial resistance, and economic burden. Therefore, the present study was carried out to optimize the use of antibiotic prophylaxis before surgery using a ready-made drug package prepared in the pharmacy of Dr. Shariati Hospital. The current study is a semi-experimental intervention type, carried out in two stages before and after on 260 patients hospitalized in the heart surgery and neurosurgery departments of Dr. Shariati Hospital who were candidates for surgery and received antibiotic prophylaxis before surgery. A checklist containing patients ' information was completed before and after the preparation of antibiotic prophylaxis packages. Data were analyzed in spss18 software with descriptive and analytical statistics (p≤0.05). Before and after the optimization of antibiotic use, a statistically significant difference was observed in the two study groups regarding dosage, administration intervals, time, and duration of administration. (P<0.001) A 63.42% reduction in the number of doses of antibiotic prophylaxis was observed after the implementation of optimization. Also, there was a 57.33% reduction in the cost of antibiotic prophylaxis after the implementation of optimization. The use of a ready-made drug package before surgery optimizes the use of antibiotic prophylaxis. Also, the economic burden caused by inappropriate use of prophylactic antibiotics for the patient and the hospital is significantly reduced with this method.

 Invasive fungal infections (IFIs) are a significant cause of mortality and morbidity in patients with hematological malignancies. Given the considerable prevalence and consequences of IFIs, hence revealing the exact cause of fungal infections, their rate, associated risk factors, and complications could contribute to reducing both financial and life costs, choosing targeted antifungal treatment, and avoiding unnecessary toxic treatments in individuals who are not suffering from mycoses.

 This prospective cross-sectional study was conducted in the first semester of 2019. All patients with hematologic malignancies (HM) admitted to Dr. Shariati Hospital were studied. Only those with probable/proven IFIs defined according to the last update of EORTC/MSG criteria were included in the study. The demographic and clinical data were recorded from the hospital information registration system using a questionnaire. Statistical analysis was performed using SPSS software version 24.

Out of 1109 HM patients hospitalized during the study period, 67 (6.04%) IFIs were diagnosed. Of these, 57 (85.04%) were aspergillosis, 7 (10.4%) were mucormycosis, and 3 patients developed other fungal infections. Males constituted 67.2% of the entire IFI population. The mean±SD age of the samples was 43.16 ± 13.8 years. The most common type of malignancy was AML. Lung imaging showed lesions associated with fungal infections in 52 cases (77.6%), with multiple nodules as the most prevalent pattern being observed in 64.2% of cases. Sinus involvement was evidenced in the PNS CT scan of 46 (68.6%) patients. The attributable mortality rate for IFIs was 62.7%. Both the types of IFI and malignancies had no significant relationship with the outcome of patients. Central venous catheter, mucositis, and antibiotic use were the most frequent risk factors.

  IFI represents a frequent complication for HM patients with high mortality. Aspergillus species are the predominant etiology in these settings. Considering our results, in high-risk patients, manifestations of warning signs in the sinus and lungs, which would not be cleared despite receiving antibiotics, should raise the possibility of IFIs.

Ventilator-associated pneumonia is One of complication of mechanical ventilation and Its diagnosis in surveillance system based on the judgments of clinical, causing a large difference in reporting it. Centers for Disease Control and Prevention(CDC)has used objectively measures(ventilator-associated events) to overcome these barriers. Considering that in Iran, for surveillance system and reporting ventilator-associated pneumonia in hospitals, as well as from previous surveillance definitions of CDC are used ,and the new surveillance definitions (VAE) are supposed to replace the previouse surveillance definitions in Iran, this study was conducted to compare ventilator-associated pneumonia based on previous and new surveillance definitions of CDC.
In order to do this prospective study, Information on surveillance system in 4 intensive care units during 1 month were collected. The diagnosis of ventilator-associated pneumonia with CDC previous definitions (PNEU1) based on radiographic finding and clinical signs or symptomes(cnange in temperature,change in white blood cell count,altered mental status,change in respiratory secretions,cough or dyspnea,rales and worsening gas exchanges) and ventilator-associated events (VAE) based on daily minimum PEEP or FIO2, change in temperature,change in white blood cell count,start of new antimicrobial agent and culture of respiratory secretions,lung tissue,pleural fluid or lung histopathology.
12 Ventilator-associated pneumonia during a month in which all of them were PNEU1. Ventilator- Associated Events, in 6 cases (50%) were seen; 2(33%) were Infection-related Ventilator-Associated Complication(IVAC) and 4 (67%) were Possible Ventilator –Associated Pneumonia (PVAP). ventilator associated events revealed about half of the cases of ventilatorassociated pneumonia. McNemar non-parametric test showed no significant difference between the two methods (P = NS), obtained content of the agreement between the two methods using the Kappa was 0.656.
In our study, VAE surveillance detected half of VAP cases, but there was no statistically significant difference between the two methods which may be due to the small number of pneumonia cases and short duration of study. Also,given that the new surveillance definitions are supposed to be in place of the previous definitions in Iran and this, requires the accurate recording and daily monitoring of PEEP or FIO2 in the manual chart of intensive care units and requires a sufficient number of trained personel .the operation of Ventilator –Associated Pneumonia based on the new surveillance definitions of CDC,requires further study in Iran.

Background and Nosocomial infections, especially those occurring in intensive care units (ICUs), are one of the major health problems in every community. Nosocomial infections are associated with increased mortality rate and high treatment costs. Effective control of these infections essentially depends on the knowledge of healthcare providers regarding the detection and eradication of the associated causes. This study aimed to investigate the main challenges involved in the prevention and control of nosocomial infections in hospital ICUs.
This qualitative study was conducted on 21 healthcare providers selected via purposive sampling from various medical subgroups, including anesthesiologist, nursing managers, supervisors, faculty members, head nurses, and hospital managers. Data were collected via semi-structured interviews with the participants. Data analysis was performed using qualitative conventional content analysis.
In total, four main themes were emerged from conventional content analysis, as follows: 1) complex nature of work in the ICU; 2) lack of knowledge of healthcare providers; 3) inadequate equipment and resources and 4) human resource shortage.
According to the results of this study, appropriate resource allocation, improvement of organizational health structures, and competency of healthcare personnel in hospital ICUs could be remarkably effective in the prevention, control and reduction of nosocomial infections.

Background and To prevent Surgical Site Infection (SSI), a short duration of antimicrobial agents is prescribed just before the surgery which is known as preoperative antibiotic prophylaxis (PAP). In spite of evidenced-based guidelines for PAP administration, many studies have shown poor adherence to the guidelines. The aim of this study was to determine an effective intervention in improving surgeons’ adherence to the standard guideline of PAP administration in cardiac surgeries.
An interventional prospective study (before-after design) was performed in 335 patients undergoing cardiac surgery during 2011-2012. Three consecutive interventions were conducted including educational, managerial and regulatory interventions. The outcome measures were the duration and type of the PAP administration which was measured before and after each intervention. The changes were also monitored through a 5 months follow up.
No significant changes were detected after the educational intervention. After the managerial intervention significant changes in the type and duration of the PAP were detected in coronary artery bypass grafting (CABG) (P= 0.03), but no significant change was observed for PAP administration in valve repair/replacement surgeries (P= 0.54). Regulatory intervention caused significant changes in the type and duration of PAP in both CABG and the valve repair/replacement surgeries (P=0.01). The improvements lasted for at least 5 months after the regulatory intervention.
Managerial and regulatory interventions in addition to educational intervention could be of benefit in optimizing the PAP administration.

Aim. The aim of the study is to investigate the need for hospital infection control and prevention.
Background. Nosocomial infections are among the major health problems which increase mortality and hospital costs, especially in intensive care units. Successful control of nosocomial infections depends on recognition of hospital challenges in this issue.
Method. This study is an overview study. The keywords “hospital infection” and “ICU”, alone or together, with Persian equivalents were searched in websites such as Iranmedex, CINAHL, Scopus, Medline, Embase, SID, PubMed, Magiran and Irandoc.
Findings. Based on the findings, the main causes of nosocomial infections included multiple procedures and invasive diagnostic and therapeutic treatments, especially in ICUs. Compromised immune system, duration of hospitalization, absence of hospital surveillance reporting system, inappropriate disinfection and sterilization of equipment, inappropriate physical structure of ICU, non-cooperative managers and departments, and lack of knowledge of medical staff, especially physicians and nurses.
Conclusion. Identifying causes of hospital infections and the use of especial measures to promote safety and enhance quality of care in the treatment and prevention of these infections are necessary for a comprehensive and integrated controlling program.

Despite the possibility of curing TB with medical therapy، it has a sizable impact on the lives of afflicted patients. This study aimed to evaluate of treatment effect of anti-tuberculosis drugs on the quality of life on tuberculosis patients admitted in Imam Khomeini hospital in Tehran. The investigation was a before and after study. It was done in 2006-2007 by fill in Persian translated questionnaire of WHOQOL- BREF on 46 pulmonary or extra pulmonary TB infected patients. Paired samples T-test was performed to find out the differences. After 8 weeks of treatment، mean score elevation was significant in physical (15. 76±23. 89، p<0. 001)، psychological (7. 84±17. 57، p=0. 004)، and social (6. 83±19. 48، p=0. 02) domains. It was not significant in environmental domain (2. 15±8. 48، p=0. 09). Mean score elevation at the discharge time in physical، psychological، social and environmental domains were: (5. 65±16. 56، p=0. 09)، (11. 69±19. 22، p=0. 001)، (1. 04±8. 60، p=0. 41)، and (4. 37±17. 77، p=0. 1)، respectively. In our study، after treatment of tuberculosis، patient’s physical، psychological and social -not environmental- domains of quality of life were elevated، but at the discharge، there was a significant elevation in physical and psychological domains. These results emphasize the importance of patient’s treatment at the first days of admission، with special attention to social and environmental domains.

Catheter-related bloodstream infections (CR-BSIs) are the most serious and frequently occurring complications of vascular catheters, carrying a high morbidity and mortality, and increasing the cost of medical treatment and length of hospitalization. This study was designed to determine both the incidence of CR-BSIs and the accuracy of Iran Nosocomial Infections Surveillance Software (INIS Software). A prospective study was performed during a 4 month period in 2009 to assess the incidence density of CR-BSI per 1000 catheter-days in patients with central venous catheter admitted to the ICUs of a teaching hospital in Iran, according to the CDC criteria for diagnosis of CR-BSIs. Then the primary data were input to the INIS Software, and the results were compared. In this study, among 67 admitted patients, blood cultures were positive in 9 patients (13%) and 2 patients (2.98%) developed CR-BSI. The incidence of CR- BSI was 1.98 per 1000 catheter days. The mean age of patients in CR-BSI group was 66 ±19.79 years. The mean length of ICU stay was significantly higher among patients with CR-BSI (49±14.14 days) than patients without CR-BSI (14.41±11.62 days) (P value < 0.001). The mean catheterization days was also higher among CR-BSI group (49±14.14 days) than non CR-BSI group (14±11.34 days) (P value<0.001).These results were 100% consistent with Iran Nosocomial Infections Surveillance Software. The incidence of CR-BSI in our study was not high, and there was a positive correlation between ICU stay and catheterization days and occurrence of CR-BSI. The application of INISS can cause convenience and accuracy in diagnosis of CR-BSI.

Fever, is a common sign during the course of HIV infection. The aim of this study was to describe the etiology and clinical characteristics of fever among HIV/AIDS patients in a teaching hospital in Iran.Patients and

In this existing data study, we retrospectively reviewed the charts of admitted HIV/AIDS patients with fever to Imam Khomeini hospital, from October 1995 to March 2005 to assess the causes of their fever.

Totally, 125 admissions were performed for 120 patients. The mean (±SD) age was 34.8± 14.7 years. The final diagnosis of fever was determined in 65.6% of all admissions. Mostly (34.4%), the cause of fever remained undiagnosed. Pulmonary tuberculosis was the most commonly identified etiology of fever (33.6%), followed by opportunistic infections such as oral candidiasis, Pneumocystis jirovecii pneumonia and cerebral toxoplasmosis.

Tuberculosis is the most common infection in Iranian HIV/AIDS patients and appropriate workup should be considered in all feverish HIV/AIDS patients