فهرست مطالب

Archives of Clinical Infectious Diseases - Volume:11 Issue:2, 2016
  • Volume:11 Issue:2, 2016
  • تاریخ انتشار: 1395/02/15
  • تعداد عناوین: 9
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  • Maryam Karkhane, Mohamad Amin Pourhoseingholi*, Zahra Kimiia, Seyed Mehdi Mortazavi, Mohammad Reza Akbariyan Torkabad, Seyed Karim Hossieni Aghdam, Abdolrazagh Marzban, Mohammad Reza Zali Page 1
    Background
    Nosocomial infections (NIs) are an important public health problem worldwide, particularity in the intensive care units (ICUs)..
    Objectives
    The current study aimed to detect and highlight NIs as the critical factor in increasing mortality and morbidity to clarify the current health priorities and challenges in Iran..
    Patients and
    Methods
    It was a retrospective study on 376 selected patients admitted in ICU at a public hospital in Tehran, Iran, from 2012 to 2014. The major studied NIs included: ventilator associated pneumonia (VAP), central venous catheter related primary bloodstream infections (CRBSIs or BSI), surgical site infections (SSIs) and catheter associated urinary tract infections (CAUTI or UTI). NIs were defined based on the centers for disease control and prevention (CDC) definitions. Site specific NIs rates, mortality rate and the length of hospital stay and other demographic or clinical variables were extracted..
    Results
    Three hundred-four patients were examined for NIs. NIs rate was 19.7% and mortality rates were 44.4% and 21.72% in infected and uninfected patients, respectively. The most frequent NIs was VAP and the highest observed rates of mortality were BSI in males (P = 0.050) and UTI in females (P = 0.05). The mortality rate in the infected patients was twice the other patients [2.187 (CI: %95: 1.154.13), P = 0.010]. The results showed that patients with cardiovascular respiratory dysfunction were exposed to higher risk of death. Infection rate increased in patients with diabetes and endocrine disease..
    Conclusions
    To manage ICU patients, risk factors and causative procedures contributing to incidence and development of Nis should be considered. The most considerable points are accurate disinfection and more strict infection control procedure especially for prevent of VAP and BSI, which associated with the increasing of patient's mortality. This issue is more crucial in the cases of the cardiovascular respiratory and diabetic patients..
    Keywords: Nosocomial Infections, Death, Mortality Rate, Cardiovascular, Respiratory Dysfunction, Diabetes, Immune Dysfunction
  • Mohammad Motamedifar*, Khosro Zamani, Yashgin Hassanzadeh*, Sajedeh Pashoutan Page 2
    Background
    Urinary tract infection (UTI) is one of the most common infections in children. Timely diagnosis and appropriate treatment of UTI requires knowledge of etiologic agents and antibiotic resistance pattern of common uropathogens..
    Objectives
    The aim of this study was to determine bacterial agents and their antibiotic susceptibility patterns at pediatric ward of Dastgheib hospital, Fars province, Shiraz, Iran..
    Patients and
    Methods
    In this three-year (2009 - 2011) cross-sectional descriptive study, 2854 urine specimens were collected by midstream, urine bag, catheter and suprapubic methods from patients in the age range of 1 month to 14 years. For isolation of uropathogens, samples were cultured on differential and selective media and identified with biochemical tests. Antimicrobial susceptibility testing was then performed using the Kirby Bauer method, following the clinical and laboratory standard institute (CLSI) guidelines. All data were analyzed with the SPSS software (version 15)..
    Results
    The most common pathogen was Escherichia coli (65.2%) followed by Staphylococcus saprophyticus (10.9%). Escherichia coli isolates showed the highest and lowest resistance rates to cephalexin (60.5%) and imipenem (11.6%), respectively. Staphylococcus saprophyticus isolates were mostly susceptible to vancomycin (81%), followed by nitrofurantoin (76.8%); however, only 36% of staphylococcus saprophyticus isolates were susceptible to co-trimoxazole..
    Conclusions
    In this study, like previous researches, E. coli was the most common pathogen. Our results suggested a high rate of antibiotic resistance to common antibiotics for treatment of UTI. Because of the high resistance to cephalexin, cefotaxime and co-trimoxazole, their use is not recommended for treatment of UTIs. Imipenem and vancomycin were the most active drugs against E. coli and Staphylococcus saprophyticus, respectively..
    Keywords: Drug Resistance, Urinary Tract Infection, Pediatrics
  • Mahnaz Shahabimehr, Masoud Alebouyeh*, Nastaran Farzi, Arash Mahboubi, Reza Taslimi, Mohammad Reza Zali Page 3
    Background
    Constant monitoring of Helicobacter pylori resistance is necessary for selection of the best treatment regimen for eradication of the resistant strains..
    Objectives
    The aim of this study was to investigate diversity of resistance and minimum inhibitory concentration (MIC) of H. pylori strains against metronidazole in Tehran, Iran..
    Patients and
    Methods
    This cross-sectional study was performed among 96 patients, who had undergone gastric endoscopy at Imam Khomeini hospital in Tehran, during years 2013 to 2014. Helicobacter pylori isolates were obtained from gastric biopsy samples on selective culture media after characterization by conventional biochemical tests and polymerase chain reaction. Minimum inhibitory concentration of metronidazole was determined by the agar dilution method..
    Results
    Helicobacter pylori infection was detected in 22 patients (22.92%). Identity of the isolates was confirmed by PCR using glmM primers. Chronic gastritis, duodenitis, intestinal metaplasia, dysplasia and cancer were detected among 70.1%, 6.25%, 1.04%, 1.4% and 10.41% of the patients, respectively. Smoking showed a negative relationship with H. pylori infection. The rate of antibiotic resistance was 81.8% (18/22) and MIC ranges of 8 to 512 μg/mL were detected. Furthermore, MIC50 and MIC90 were determined as 256 and 512 µg/mL, respectively..
    Conclusions
    In conclusion, these results suggested a need for a switch to second line therapy regimens for treatment of infected patients in the Iranian population..
    Keywords: Microbial Sensitivity Tests, Metronidazole, Helicobacter pylori Infection
  • Kouros Aghazadeh*, Seyed Alireza Nadji, Shervin Shokouhi, Payam Tabarsi, Raziyeh Niyati Page 4
    Introduction
    Cryptococcal meningitis is a rare disorder that is caused by Cryptococcus neoformans in immunocompromised host..
    Case Presentation
    The case was a 64-year-old man with a history of stem cell transplant for acute leukemia, who presented chronic meningitis caused by Cryptococcus neoformans and concurrent neoplastic meningitis with presence of malignant cells only in his cerebrospinal fluid (CSF)..
    Conclusions
    Chronic meningitis in immunocompromised hosts can be due to more than one pathologic etiology and we should do all diagnostic evaluation to rule out all possible differential diagnosis..
    Keywords: Cryptococcal Meningitis, Neoplastic Meningitis, Meningeal Co, Infection, Hematopoietic Stem Cell Transplant
  • Salman Khazaei, Shahab Rezaeian, Hamid Salehiniya, Razieh Rezaei, Javad Torkaman Nejad Sabzavari *, Mokhtar Soheilyzad Page 5
    Background
    Despite the importance of post-exposure prophylaxis (PEP), studies conducted in Iran on PEP showed different findings and it is not well documented yet..
    Objectives
    The current study aimed to evaluate the delayed time of PEP and associated factors in bitten people..
    Materials And Methods
    This cross-sectional study was conducted on 397 subjects of animal bites in Khalilabad County, Northeast of Iran, from March 2012 to March 2013. The census method was employed to use the data on animal bites recorded in the rabies treatment center (RTC)..
    Results
    Overall, 93.4% of the subjects received PEP in less than 48 hours after exposure. Of the 397 subjects, 86.0% were male, 61.7% aged 0 - 30 years, and 64.7% lived in rural areas. The subjects were mainly bitten by domestic dogs (79.8%), most of the subjects (91.9%) were involved with superficial wounds, and the most common sites of the animal bite were legs (48.1%) and hands (40.6%). The bite incidents happened more frequently in spring (29.2%) followed by summer (26.7%). There was only significant difference in delayed PEP with respect to the type of biting animal (x2 = 30.8, P
    Conclusions
    The rabies PEP is well monitored in the region and its delayed time depends on the type of biting animal especially domestic dogs. Considering the high proportion of stray and domestic dogs as a public health concern in the district, the educational programs and the rabies vaccinations of dogs is recommended in the community..
    Keywords: Animal Bites, Post, Exposure Prophylaxis, Rabies, Iran
  • Shahin Najar Peerayeh*, Elham Rostami, Majid Eslami, Mohammad Ahangarzadeh Rezaee Page 6
    Background
    The number of extended-spectrum β-lactamase (ESBL)-producing Enterobacteriaceae reported cases all over the world has continued to increase faster than the other resistance mechanisms, particularly in E. coli and K. pneumoniae..
    Objectives
    This cross-sectional study was designed to assess the prevalence of multidrug resistance of ESBL-producing urine isolates of E. coli and K. pneumoniae collected in Tehran hospitals, as well as the molecular characterizations of some ESBL genes, with an emphasis on occurrence rates by sex..
    Materials And Methods
    A total of 190 E. coli and K. pneumoniae isolates were collected from patients’ urine samples in hospitals from Tehran, Iran during 2009 - 2010, and were screened for antibiotic susceptibility, ESBL phenotype, and presence of blaCTX-M and blaTEM genes. Minimal inhibitory concentration (MIC) for ceftazidime and cefotaxime were made by agar dilution method..
    Results
    The ESBL phenotype was detected in 55.5% of E. coli and 46.4% of K. pneumoniae isolates. Presence of blaCTX-M-1 was dominant in both organisms. The prevalence of blaCTX-M-1 carrying isolates among ESBL-producing K. pneumoniae and E. coli isolates were 49.1% and 85.7%, respectively. Among ESBL-producing isolates, 68.5% of E. coli and 59.3% of K. pneumoniae isolates carried the blaTEM genes, and simultaneous carrying of blaCTX-M and blaTEM genes was observed in 68.5% of E. coli and 33.3% of K. pneumoniae isolates. The resistant rate to ceftazidime, cefotaxime, and cefepime was significantly higher in K. pneumoniae and E. coli isolates from male patients urine samples. A significant higher rate of blaCTX-M-1, blaTEM, and co-blaCTX-M-1-blaTEM genes were seen for E. coli and K. pneumoniae isolates in male patients’ urine..
    Conclusions
    The results indicate that the rates of ESBLs are high in urine E. coli and K. pneumoniae isolates from Tehran hospitals. Also this study indicates that the urine isolates from male patients are significantly more resistant than the female isolates..
    Keywords: UTI, ESBLs, TEM, CTX, M1, Klebsiella pneumonia, Escherichia coli
  • Hossein Goudarzi, Arezou Taherpour, Fatemeh Fallah, Bita Pourkaveh, Soroor Erfanimanesh, Ali Hashemi* Page 7
    The nosocomial infections, caused by multi-drug resistant bacteria, are the most important cause of mortality throughout the world. One important mechanism against beta-lactam antibiotics is the production of beta-lactamases. Enterobacteriaceae and non-fermentative bacteria, like Pseudomonas aeruginosa and Acinetobacter baumannnii may produce these enzymes. Currently, there is no vaccine to prevent the infections caused by β-lactamase-producing bacteria. Consequently, it is necessary to identify β-lactamase-producing bacteria by phenotypic and molecular methods.
    Keywords: Beta, Lactamases, Gram, Negative Bacteria, Drug Resistance, Carbapenemases, Antibiotics
  • Fahimeh Ehsanipour, Masoumeh Mirghorbani, Hossein Masoumi Asl, Nahid Vahid Harandi, Khadijeh Khanaliha* Page 8
    Background
    Group A β-hemolytic Streptococcal (GAS) pharyngitis is a common illness in children. Diagnosis and proper treatment of group A streptococcal sore throat is important particularly to prevent non-superlative sequel. Clinical findings continue to be used in differentiating streptococcal infection from viral sore throat..
    Objectives
    The aim of this study was to evaluate the accuracy of clinical findings and rapid test in comparison with culture in the diagnosis of group A Streptococcal (GAS) pharyngitis..
    Patients and
    Methods
    Ninety-four children between 3 to 16 years, who were referred to the pediatric clinic of Rasoul-e-Akram hospital with clinical findings of fever or sore throat were evaluated from October 2006 to May 2007. Clinical findings were recorded and swabs were taken for group A streptococcal cultures and streptococcal rapid antigen detection test. Analysis of statistical significance was performed using the chi-square method. The accuracy of clinical findings and rapid test was compared with the culture method as the gold standard, and sensitivity, specificity, positive predictive values, negative predictive value, positive likelihood ratio (LR) and negative likelihood ratio (LR-) were calculated..
    Results
    The culture was positive in 38 (40.4%) of the 94 evaluated children. The mean age of children was 8 ± 3.7 years. The presence of petechiae, exudate and Lymphadenopathy (LAP) was more likely in children with positive streptococcus culture and rapid test (P value
    Conclusions
    Although LAP had good performance in early diagnosis of GAS, a combination of clinical findings, including tonsillar exudates, petechiae with results of rapid antigen test or culture is necessary for clinician judgment. Throat culture is the gold standard test for detecting group A Streptococcal infection, but rapid test is a good replacement for culture..
    Keywords: Clinical, Rapid, Culture, Streptococcal, Pharyngitis
  • Masoud Mardani* Page 9