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Background: Antibiotic resistance is now considered as a global problem. Due to the increasing use of antibiotics, and subsequent increase in antibiotic resistance, treatment of bacterial infections has faced many difficulties. Objectives: This study aimed to investigate the pattern of antibiotic resistance in Escherichia coli (E. coli) isolated from patients referred to the hospital during the years 2016 - 2018. Methods: In this cross-sectional study, 2250 samples were taken from outpatient and hospitalized patients (inpatients) during three years (2016 - 2018). After collection, the specimens were cultured in blood agar and EMB media. One thousand six hundred and forty-two positive samples were obtained that from these, a number of 1067 specimens were recognized as E. coli. Antibiotic susceptibility was determined using a disk diffusion method on Mueller Hinton agar media for eight antibiotics. The result was evaluated based on the Clinical Laboratory Standards Institute (CLSI). Results: In this study, 1642 positive samples were diagnosed that the largest isolated strains were associated with E. coli (65%). About 241 samples belonged to men (22.6%) and 826 samples were isolated from women (77.4%). Based on the findings, most cases of resistance were related to co-trimoxazole with 52.6% and the highest sensitivity was related to nitrofurantoin with 81%. Conclusions: The results of this study indicated that the pattern of antimicrobial resistance is increasing and urinary tract infection (UTI) caused by E. coli isolates with a high rate of resistance still remains an important healthcare problem. Therefore, continuous evaluation of the pattern of resistance in different areas is necessary for promotion of antibacterial management.

Background and Objective: The spread of carbapenem-resistant Klebsiella pneumoniae especially blaNDM-1-carrying isolates is a great concern worldwide. In this study we describe the molecular basis of carbapenem-resistant K. pneumoniae in three teaching hospitals at Bandar Abbas, south of Iran. Materials and Methods: A total of 170 nonduplicate clinical isolates of K. pneumoniae were investigated. Antimicrobial susceptibility test was performed by disc diffusion method. PCR was carried out for detection of carbapenemase (blaKPC, blaIMP, blaVIM, blaNDM, blaSPM, blaOXA-48, and blaOXA-181) and extended-spectrum β-lactamase (blaCTX-M, blaSHV, blaTEM, blaVEB, blaGES, and blaPER). Clonal relatedness of blaNDM-1-positive isolates was evaluated by multilocus sequence typing (MLST). Results: Tigecycline was the most effective antimicrobial agent with 96.5% susceptibility. In addition, 6.5% of the isolates were carbapenem resistant. BlaNDM-1 was identified in four isolates (isolate A–D) and all of them were multidru...

Three clinical syndromes including diarrhea/enteritis, urinary tract infection and septicemia/meningitis can be found as a result of infection with each of the E. coli pathotypes. Uropathogenic Escherichia coli toxins are one of the most important factors in the spread of these infections, including urinary tract infections, which we will review in this study. The first CDT toxin (Cyclomodulins) was reported in E. coli strains in 1987; CDT toxins show a new function and act on DNA. This unique CDTs has unlocked novel questions in the field of Toxicology. The E. coli strains involved in UTIs often produce exotoxins such as hemolysin, cytotoxic factor type 1 (CNF1), and colonization factors. Enteroaggregative E. coli (EAEC) toxins include heat-resistant enterotoxigenic toxin (EAST1) plasmid, a potent agent for diarrhea, encoded by a plasmid (Pet), which has cytotoxic activity against cultured intestinal cells and red blood cells,toxin Pic and ShET1 Toxins that have intestinal toxicity. EHEC toxins include Shiga Toxin (Stx) and Verotoxin (VT) and Enterohemolysin. Also, EAST1 was reported for the first time in EAEC strains, and this toxin is also present in EHEC strains. ETEC enterotoxins belong to one of the two heat-sensitive enterotoxins (LTs) and heat-resistant enterotoxins (STs). EPEC toxins include EspC enterotoxin. VAT toxin is a known cytotoxin that expresses through UPEC over a systemic infection. CysK also contributes to the expression of UPEC toxins and the cause of toxicity and cellular inhibition caused by UPEC infections.

Background and Objective: Acinetobacter baumannii (A. baumannii) in the last decade has been identified as one of the opportunistic pathogens and an important cause of nosocomial infections. Molecular typing plays an important role in studying the epidemiology of Acinetobacter. The aim of this study was to investigate the genomic pattern which was performed by Pulse Field Gel Electrophoresis (PFGE) and antimicrobial susceptibility of the isolates from patients in various hospitals in the city of Kermanshah, the city which is located in the west of Iran. Materials and Methods: 33 isolates of A. baumannii were collected from clinical samples in four general hospitals of Kermanshah. Isolates were identified by biochemical tests and API 20NE kit. The antimicrobial susceptibility of isolates was determined by Kirby-Bauer disk diffusion method. The clonal connection was estimated by PFGE and DNA patterns were analyzed by Gel compare II 6.5 software. Results: All isolates showed high-level of resistance, but resistance which was observed against Colistin and Minocycline was low, while no resistance to Polymyxin B and Tigecycline was observed. The PFGE analysis revealed the existence of 10 different genetic patterns among the 33 strains including: I (n = 12), II (n = 2), III (n = 4), IV (n = 3), V (n = 3), VI (n = 4), VII (n = 2). Clone I was the dominant clone. In terms of antibiotic resistance, no significant difference was observed among the different genetic patterns. Conclusion: Isolates were obtained from a large variety of patterns genetically. This study could represent the wide range of isolates of A. baumannii that were gathered from different parts of the hospital. Diverse sources of infection may, therefore, appear to control these infections, according to various sources, which are not simple.

Background: Klebsiella pneumoniae causes community and nosocomial infections. Drug treatment of extended-spectrum beta-lactamases (ESBLs) by K. pneumoniae isolates is costly, long, and sometimes problematic. Objectives: The aim of this study was to determine the antibiotic resistance patterns and the occurrence of bla CTX-M, bla TEM and bla SHV genes in the third-generation cephalosporin-resistant K. pneumoniae isolated from urinary tract infection in Kermanshah region, Iran. Materials and Methods:Fifteen K. pneumoniae isolates were collected and confirmed by the analytical profile index-20E system. Phenotypic confirmatory test was performed using combination disk method. The genes of bla CTX-M, bla TEM and bla SHV were investigated by polymerase chain reaction. SPSS version 20 (IBM, Chicago, IL, USA) was used for sample analysis. Results: Resistant isolates to ampicillin and imipenem represented 96% and 4%, respectively, which were the highest and lowest resistance. Seventeen (34%) out of the 50 isolates were ESBL producers by the synergy test. The prevalence of bla CTX-M, bla TEM and bla SHV among these isolates was 88% (n = 15), 70% (n = 12) and 58% (n = 10), respectively. Conclusions: Our research showed a possibility of the spread of multidrug-resistant ESBL-producing isolates. Monitoring control of risk factors and drug-resistant patterns with the use of phenotypic and/or genotypic analyses are very important to prevent the occurrence and dissemination of resistant strains due to ESBL-producing K. pneumoniae in hospital settings.

Background and aims Infections by non-tuberculous mycobacteria (NTM) has rapidly increased in recent years, due to high infection rates related to the populations at risk like immunocompromised individuals, patients predisposed by prior pulmonary. The aim of this study was to investigate the presence of NTM in clinical samples and genetic diversity using 16S rRNA and rpoB sequence analysis. Methods A cross-sectional study was conducted on 45 diverse isolates collected from sputum in 2 years 2014-2015 using standard decontamination procedure. All mycobacterial isolates were grown on LJ medium and also conventional tests for preliminary identification of mycobacteria rely on traits and then DNA extraction. PCR was performed, and sequencing of 16S rRNA and rpoB genes was applied for NTM strains identification. Results A total of 45 isolates collected, 37 samples (83%) were evaluated as NTM. All NTM strains using molecular methods by sequencing 16S rRNA and rpoB gene were identified, by this way 12 different species have been identified which sequencing of rpoB was able to identify all species. The major species obtained were Mycobacterium simiae (22%), M. fortuitum (19%), and M. abscessus (13%). Conclusions The results of our study showed that the patients were infected by a wide range of atypical mycobacteria. It was concluded that 16S rRNA gene sequencing coupled with rpoB marker is a high discriminatory power in identification of NTM. The presence of various species in clinical samples in Iran emphasizes the use of molecular method like sequence analysis of genes is necessary for reliable identification.

Background: The Brucellosis is recognized as a significant public health problem, with major economic and financial burdens in countries where the disease remains endemic. The disease is one of the most important worldwide zoonosis affecting livestock and humans. The aim of the present study was to genotypically characterize Brucella strains isolated from human and animal samples in two provinces of Iran. Methods: Twenty seven Brucella strains isolated from patients and animals during April 2015 - December 2016. Thirteen human and fourteen animal strains were identified by biochemical tests and confirmed by amplification of fragment 1100bp omp2a gene using Polymerase Chain Reaction (PCR) method. Isolates were genotypically characterized by XbaI digestion and pulsed-field gel electrophoresis (PFGE) technique. Results: In PFGE analysis totally, 7 common clones and 3 single clones were obtained. In genotyping, in two clones/clusters, human isolates were grouped with genotypes from animal isolates. Also PFGE results indicated 21 Brucella strains an overall similarity higher than 90, and three clusters based on 100 similarity were revealed. Conclusion: According to dendrogram clinical strains had a high degree of homology compared to animal strains. The information of this study indicating a close genetic relatedness or common origin of the isolates in the two geographical region of Iran and it implies that B. melitensis cross-infected between human and livestock.

Background Antimicrobial resistance in multidrug-resistant Acinetobacter baumannii (MDR-AB) isolated from burn wound infections is a major concern in intensive care or burns units worldwide, and molecular studies are considered critical strategies for control of MDR-AB outbreaks in this regard. Thus, in this study, antibiotic resistance, biofilm-forming ability, molecular epidemiology of MDR A. baumannii strains recovered from patients with burns were investigated in three major hospital centers of Iran. Methods In this cross-sectional research, 163 non-repetitive A. baumannii strains were tested for susceptibility to antimicrobial agents. Polymerase chain reaction (PCR) was performed to characterize ambler classes A, B, and D β-lactamases, ISAba1 and integrons, biofilm formation was also investigated. Clonal relatedness was analyzed using Pulsed-Field Gel Electrophoresis (PFGE). Results Among 163 A. baumannii strains collected, 94.5% of them were Carbapenem-Non-Susceptible A. baumannii (CNSAB) and also 90.1 and 52.2% of them were Metallo-β-Lactamases (MBL) and Extended-Spectrum β-Lactamases (ESBL) producing isolates, respectively. Colistin and polymyxin B exhibited excellent activity against CNSAB strains. High prevalence of blaOXA − 23-like (85.1%), blaVIM (60.5%), blaPER − 1 (42.3%), tetB (67.8%), and Class 1 integrons (65.6%) were identified in CNSAB strains. ISAba1 element was associated with 42 (25.8%) and 129 (98.5%) of blaOXA-51-like and blaOXA-23-like genes, respectively. 6 clusters with the ability to form strong biofilms were found to be dominant and endemic in our entire areas. Conclusions Results of the present study show that antimicrobial resistance in CNSAB isolates from burn wound infections in monitored hospitals in Iran is multifactorial, and also findings of the study suggested that local antibiotic prescription policies should be regularly reviewed, and efficient infection control measures should be observed. Therefore, further strengthening of surveillance of antimicrobial resistance is urgently needed in these regions.

Background: Klebsiella is a major human pathogen associated with nosocomial infections. Multi-drug resistant Klebsiella isolates have increased in the last decades and therefore, the use of drug resistance tests seems necessary before prescribing antibiotics. Objectives: This study aimed to determine the antibiotic resistance patterns of Klebsiella species recovered from inpatients and outpatients. Methods: This descriptive study was performed on inpatients and outpatients referring to Amir Al-Momenin Hospital, Gerash, Iran, for six months from September 2014 to February 2015. Samples were recovered from different clinical specimens including urine, sputum, wound, blood, and feces. All patients with culture positive for Klebsiella were included and examined for antibiotic resistance using the agar disk diffusion method. Results: After examining 60 samples positive for Klebsiella, it was shown that patients had the highest antibiotic resistance to vancomycin (83.3%), amikacin (71.6%), cephalexin (56.6%), nitrofurantoin (53.3%), ceftriaxone (25%), cefotaxime (25%), trimethoprim-sulfamethoxazole (21.6%), cefixime (18.3%), nalidixic acid (16.6%), ampicillin (11.6%), ciprofloxacin (10%), and gentamicin (6.6%), in sequence. Klebsiella showed the most sensitivity to ciprofloxacin at 83.3%, cefixime at 75%, and nalidixic acid at 71.6%. Conclusions: This investigation provided necessary information about the prevalence of infections caused by Klebsiella in Gerash region, which can be used by physicians and health care administrators to monitor and control multiple-drug resistance and plan for empirical treatments effective against infections caused by drug-resistant Klebsiella isolates. The obtained results showed that ciprofloxacin to which Klebsiella had the highest sensitivity was the most effective antibiotic.

Background: Nosocomial infections are one of the significant and important medical, social, and economic problems in all countries, which may cause loss of life and a financial burden on infected patients. Objectives: This study is aimed to investigate the frequency of nosocomial bacterial infections with multidrug-resistance in hospitalized patients referred to Amir Al-Momenin Hospital, Gerash, Iran. Methods: This cross-sectional study was performed within one year, from the beginning of October 2015 to the end of October 2016, on 300 hospitalized patients referred to Amir Al-Momenin Hospital, Gerash, Iran. Specific culture mediums were used based on each sample, and bacterial strains were isolated in sterile conditions. Appropriate antibiotics were used in case of each isolated strain. Urinary tract infections were not considered in this study. Nosocomial infection diagnosis criteria were according to the Center for Disease Control and Prevention (CDC) definitions for nosocomial infections. Results: The frequency of nosocomial bacterial infection and the rate of bacterial hospital-acquired infections with multidrug-resistance in this study were calculated 9.6% and 6%, respectively. The most isolated microorganisms were respectively Staphylococcus epidermidis (43.33%) and Escherichia coli (16.66%). Most cases of these infections were isolated from blood samples (60%) and sputum samples (20%). The highest resistance was shown to cefixime and ampicillin antibiotics. Conclusions: We conclude that Staphylococcus epidermidis was the most common cause of nosocomial infection in hospitalized patients, and blood infections were the most common type of hospital infection in this study.

Background The prevalence of pulmonary disease caused by nontuberculous mycobacteria (NTM) is reportedly on the rise in the world. Some of the species are resistant to various antibiotics; hence, limited treatment options are available. The aims of this study were to investigate the prevalence of NTM and to determine the effect of d-cycloserine against Mycobacterium fortuitum and Mycobacterium abscessus isolated from clinical specimens to find out the synergistic effect of d-cycloserine and clarithromycin. Methods A total of 95 nonduplicate pulmonary isolates of NTM were collected from three major Regional Tuberculosis (TB) Centers. NTM isolates were identified by conventional tests and PCR sequence analysis of the rpoB gene. PCR sequencing of erm-41 was performed for detecting the inducible resistance to macrolides. In vitro susceptibilities and activities of d-cycloserine-clarithromycin combinations were accessed using the broth microdilution method. Results Among 714-positive acid-fast bacilli from TB-suspected cases, 95 isolates were identified as NTM (13.3%). The prevalence of identified isolates was as follows: M. fortuitum 46 (48.4%), Mycobacterium simiae 16 (16.8%), Mycobacterium kansasii 15 (15.7%), M. abscessus 7 (7.3%), Mycobacterium thermoresistibile 4 (4.2%), Mycobacterium elephantis 3 (3.2%), Mycobacterium porcinum 2 (2.1%), and Mycobacterium chimaera 2 (2.1%). In addition, rpoB sequence analysis could identify all NTM isolates. The effect of d-cycloserine was better than that of clarithromycin. The synergistic effect of d-cycloserine with clarithromycin was observed for six (100%) and five (71.5%) strains of M. fortuitum and M. abscessus, respectively. Conclusion In the present study, we demonstrated a wide range of NTM in processed samples from different provinces of Iran. Our observations indicated that d-cycloserine was very active against M. abscessus and M. fortuitum; hence, d-cycloserine, either alone or in combination with clarithromycin, may be promising for the treatment of M. abscessus- and M. fortuitum-associated diseases.

Global increasing broad-spectrum resistance to many antibiotics established Tuberculosis (TB) infections as worldwide health issue. The rising prevalence of multidrug-resistant (MDR) Mycobacterium tuberculosis (MTB) isolates around the world is a therapeutic challenge. Monitoring of resistance to anti-TB drugs is essential to implement the strategies to control tuberculosis. This study was aimed to identify the point mutations associated with resistance to isoniazid (INH) and rifampin (RIF) antibiotics by Polymerase chain reaction (PCR) and reverse hybridization methods in clinical isolated samples of MDR Mycobacterium tuberculosis in the west of Iran. Phenotypic and biochemical methods were used for the identification of TB strains. Then proportion and GeneXpert methods were used to determine resistance isolates. The DNA was extracted, and finally, PCR and reverse hybridization methods were performed to identify the mutations. Among 54 isolates of MTB, 22 isolates were INH and RIF susceptible, and 32 isolates were diagnosed as MDR isolates. Of 32 MDR isolates, 22 cases (%70) had a mutation in katG codon of 315, 1 case inhA (%3) and 9 (%28) isolated had no detectable mutation. About rifampin, the mutations associated with rpoB gene in codons 531, 516 and 626 comprised (n = 21, %66), (n = 7, %22) and (n = 1, %3) respectively and in 3 (%9) isolates no mutations were found. The sensitivity, specificity and accuracy for INH (%71, %100, %83) and rifampin (%91, %100, %94) obtained, also PPV and NPV were determined for INH (%100, %70), RIF (%100, %88) respectively. Our results showed that MDR isolates with mutations in the katG 315 and rpoB 531 regions are epidemic strains in our study area. Also, our results suggest that TB Resistance line probe assay (AID) method has high sensitivity for detection of point mutations among isoniazid- and rifampin- resistant TB isolates. However, gold-standard phenotypic methods must always confirm the molecular drug susceptibility test results.

Tuberculosis (TB) is a devastating infectious disease causing high mortality and morbidity worldwide. The most serious threat related to tuberculosis control is the recent emergence of drug-resistant tuberculosis strains. The aim of the present study was to identify various types of mutations in the rpoB region in rifampicin-resistant strains isolated from sputum of tuberculosis patients.Drug susceptibility of 125 Mycobacterium tuberculosis isolates was determined using the CDC standard conventional proportional method. Target DNA of M. tuberculosis was amplified by polymerase chain reaction, hybridized, and scanned. We used the low cost density array (LCD-array) to detect mutations within the 90-bp rpoB region. Each array is a transparent, prestructured polymer support using a nonfluorescent detection principle based on the precipitation of a clearly visible dark substrate.Of the 125 M. tuberculosis isolates, 35 (28%) were found to be rifampicin-resistant and using the LCD array revealed point mutations at nine different codons as follows: S512T (AGC→ACC) (20%), D516V (GAC→GTC) (20%), H526D (CAC→GAC) (6%), H526R (CAC→CGC) (20%), H526Y (CAC→TAC) (23%), and S531W (TCG→TGG) (8%), and the most frequent site mutations were L511P (CCG→CTG) (46%), followed by S531l (TCG→TTG) (40%) and D516Y (GAC→TAC) (26%).Our data significantly differs from previously reported mutation frequencies for codon 526 (CAC to GAC) among Italian isolates (40.1%) and Greek isolates (17.6%). Phenotypic testing is time-consuming and requires laboratory resources. Microarray rpoB is useful in detecting rifampicin resistance-determining region-associated site mutations of rifampicin-resistant M. tuberculosis isolates.

Background: Acinetobacter baumannii is usually multi-drug resistant (MDR), including third generation cephalosporins, amino glycosides and fluoroquinolone. Resistance to these antibiotics is mediated by multiple factors such as: lactamases, efflux pumps and other mechanisms of resistance. Pulsed-field gel electrophoresis (PFGE) was then used to investigate the genetic relationships among the MDR isolates. Aim: The aim of this study was to determine MDR isolates and the existence of OXAs genes among MDR isolates of A. baumannii collected from Kermanshah hospitals in west of Iran. Materials and Methods: Forty-two MDR A. baumannii were collected from patients at Kermanshah hospitals. The isolates were identified by biochemical tests and API 20NE kit. The susceptibility to different antibiotics by disk diffusion method was determined. Polymerase chain reaction (PCR) was performed for detection of blaOXA-23-like , blaOXA-24-like , blaOXA-51-like and blaOXA-58-like betalactamase genes in isolates and clonal relatedness was done by PFGE (with the restriction enzyme ApaI) and patterns analyzed by Bionumeric software. Results: This study showed high resistant to ciprofloxacin, piperacillin, ceftazidime and also resistant to other anti-microbial agents and more spread blaOXA-23-like gene (93%) in MDR isolate. The PFGE method obtained six clones: A (10), B (9), C (5), D (4), E (11) and F (3) that clone E was outbreak and dominant in different wards of hospitals studied. Conclusion: An isolate from the emergency ward of these hospitals had indistinguishable isolates PFGE profile and similar resistance profile to isolates from intensive care unit (ICU), suggesting likely transmission from ICU to emergency via patient or hospital staff contact.

Background: Antibiotics such as fluoroquinolones are used for treating infections caused by Gram-negative bacteria, including Acinetobacter baumannii strains some time have extended-spectrum β-lactamase (ESBL), but ESBL production is rather rare. Resistance to fluoroquinolones antibiotics is mediated by lactamases and other mechanisms of resistance. The aim of the present study was to investigate of the prevalence of ESBL production and clonal relatedness of A. baumannii in Iran. Materials and Methods: A. baumannii isolates identified from patients at hospitals in Kermanshah, Iran, were studied. The double disk method was used for detection of ESBL production. The susceptibility to different antibiotics was determined by the disk diffusion method (CLSI). Clonal relatedness was determined by pulsed-field gel electrophoresis (PFGE) and processed by Bionumerics 7.0 software. Statistical analyses were performed using SPSS-16.0. Results: This study showed high prevalence of resistance to ampicillin and cefpodoxim (98.1 and 92.3%). Fifty-two of the 84 isolates were identified as ESBL producers. Only colistin and tigecycline remained active against all isolates tested. The PFGE identified eight distinct pulsotypes: A (N=9), B (N=10), C (N=2), D (N=5), E (N=9), F (N=15), G (N=1) and H (N=1). The PFGE profiles A, B and F were believed to be endemic (specially clone F that was dominant across different wards of the hospitals and appeared to be endemic) in the ICU, emergency, pediatric and infection area throughout the years. Conclusion: Early and timely detection of ESBL-producing A. baumannii clones is useful for preventing their spread within the hospital. PFGE analysis is helpful for detection of common strains in different wards and prevention of further spread of these pulsotypes to other hospital environment.

Introduction: Multidrug-Resistant Tuberculosis (MDR-TB) is a growing concern which has always played a role in controlling infectious diseases. Pyrazinamide (PZA) is one of the four front line cures of tuberculosis during the first two months of the treatment course. Diagnosis of PZA resistance is imperative in order to optimize the efficacy of new treatment regimens and minimize the risk of developing resistance to new drugs. In addition, high prevalence of PZA resistance, especially among those afflicted with MDR-TB, points to the need for developing those medicinal regimens that can be used in patients with PZA resistant MDR-TB. Aim: The aim of this study was to determine anti-tuberculosis drug resistance rate and identify the correlation between MDRTB and of mutations in pncA gene among Mycobacterium tuberculosis isolates and frequency of mutations associated with PZA resistance in all the isolates. Materials and Methods: This is a cross-sectional descriptive study conducted from April 2014 to June 2015. A total of 118 Mycobacterium tuberculosis (M. tuberculosis) clinical strains were isolates from patients referred to TB reference laboratory of Kermanshah from 8 provinces including: Kermanshah, Lorestan, Hamadan, Ilam, Kurdistan, Ardabil, Uromia and Tabriz. Antimicrobial susceptibility testing was performed using the proportional method and Minimum Inhibitory Concentration (MIC) and mutations in pncA for the PZA resistant isolates were studied using monoplex- Polymerase Chain Reaction (PCR) and then PCR products were sent for sequencing. Results: Among the 118 clinical samples of M. tuberculosis investigated in various parts of Iran, 10 isolates (8.5%) were resistant to Isoniazid, 10 isolates (8.5%) were resistant to Rifampin, 7 isolates (6%) were MDR, and 23 isolates (19.5%) were resistant to PZA. Only did one MDR-TB isolate resistant (14.3%) to PZA show inactive mutation at Glu-122 codon that was found in pncA gene. According to our results, a significant correlation was found between MDR strains and of mutations in pncA gene (pv=0.049). pncA gene was not isolated from any of the PZA resistant isolates. Conclusion: Our findings indicated that only one MDR-TB isolate resistant to PZA showed a mutation in the pncA gene (14.3%) and mutations were not observed in the other PZAresistance isolates. The reason for resistance to PZA in the other PZA-resistance strains might be related to mutations in other genes or to some other factors. Thus, these reasons need to be further investigated in our study population.

The spread of carbapenem-resistant Klebsiella pneumoniae especially blaA total of 170 nonduplicate clinical isolates of K. pneumoniae were investigated. Antimicrobial susceptibility test was performed by disc diffusion method. PCR was carried out for detection of carbapenemase (blaTigecycline was the most effective antimicrobial agent with 96.5% susceptibility. In addition, 6.5% of the isolates were carbapenem resistant. BlaOur results indicate that NDM-1-producing K. pneumoniae ST 13 and ST 392 are disseminated in our region. Moreover, one of our major concerns is that these isolates may be more prevalent in the near future. Tracking and urgent intervention is necessary for control and prevention of these resistant isolates.

Background and Objective: Acinetobacter baumannii has emerged as an important pathogen in hospital and environment that can acquire transport element and antibiotic-resistant genes. The aim of this study was to determine the resistances to different antibiotics, frequency of Class 1 integron in A. baumannii and then molecular typing for A. baumannii isolated from Intensive Care Unit (ICU). Materials and Methods: A total of 100 isolates of A. baumannii were collected from patients admitted to hospitals in Kermanshah from April 2014 to September 2015. The isolates were identified using biochemical test. Antimicrobial susceptibility test for 20 antibiotics was determined by Kirby–Bauer antibiotic testing (or disc diffusion). The prevalence rate of class integrons among the isolates was determined using polymerase chain reaction and finally 80 isolates of A. baumannii obtained from the Intensive Care Unit were selected for molecular typing by pulsed-field gel electrophoresis (PFGE). Results: The maximum drug resistance was observed against cefotaxime, ceftriaxone, mezlocillin, imipenem, and ceftazidime and piperacillin. Twenty-nine isolates were multidrug resistant (MDR); about 21 isolates were extensively-drug resistant and none were pandrug resistance and 42 isolates (42%) contained Class 1 integrons. The results did not show a significant correlation between the presence of Class 1 integrons and incidence of MDR A. baumannii. Five clusters were obtained by PFGE. Conclusion: This study did not show a significant correlation between the presence of Class 1 integrons and incidence of MDR A. baumannii. By PFGE analysis, the high level of similarity between some pulsotypes in A. baumannii strains showed genetic correlation between them.

Despite a Mycobacterium tuberculosis control programme and anti-tuberculosis drugs, drug-resistant tuberculosis (DR-TB) is one of the most serious public health issues worldwide. Rapid laboratory diagnosis of M. tuberculosis is needed for the diagnosis of multidrug-resistant (MDR) TB and to find the optimal treatment protocol. The purpose of this study was to detect resistance to rifampicin in new cases of TB using the GeneXpert MTB/RIF ( M. tuberculosis /rifampicin) assay and the standard proportional method in west and northwest Iran. In this descriptive cross-sectional study, sputum samples were enrolled and screened for M. tuberculosis using Ziehl–Neelsen stain and mycobacterial culture. Samples from individuals with smear-positive TB were cultured on Lowenstein–Jensen medium; afterwards, the presence of resistance to rifampicin was examined by the GeneXpert MTB/RIF and standard proportional methods. A total of 400 new cases of suspected TB were collected, 162 (40.5%) of which were smear- and culture-positive for M. tuberculosis . The frequencies of rifampicin resistance in new smear-positive TB cases were 3.1% and 4.3% for GeneXpert and standard proportional method, respectively. Sensitivity and specificity of GeneXpert were 71% and 100%, respectively, compared with the proportional method. GeneXpert can be a quick and helpful method for the diagnosis of rifampicin-resistant TB in regions with high rates of DR-TB or MDR-TB. GeneXpert MTB-RIF assay must be used as an early diagnostic method whose results must be confirmed by the standard proportional method. The GeneXpert and proportional methods complement but do not replace each other.

Introduction: According to the results of various studies using phenotypic methods, the prevalence of Multidrug Resistant (MDR) Acinetobacter baumannii (A. baumannii) isolates has been increasing worldwide. Pulsed-Field Gel Electrophoresis (PFGE) technique is known as the gold standard method to determine clonal characterization of bacterial species, especially A. baumannii. Aim: To determine the clonal relatedness and investigate the prevalence of integron classes 1 and 2 and genes encoding OXA-23 and 24 in A.baumanii isolates. Materials and Methods: A cross-sectional study was conducted from November 2011 to January 2013. A total of 140 A.baumannii isolates collected from three hospitals of Kermanshah were considered out of which 75 ICU isolates were included in this study. Antibiotics susceptibility test was done by disk diffusion method. Polymerase Chain Reaction (PCR) was performed in order to detect class 1 and 2 integrons and blaOXA-23-like, blaOXA-24-like genes. Isolates identified as MDR from a total of 75 Intensive Care Units (ICU) strains were subjected to genotyping for clonal relatedness. Results: A total of 37 isolates among 75 ICU isolates were identified as MDR. The maximum drug resistance was observed against ceftriaxone, mezlocycline, cefotaxime, piperacilin, ciprofloxacin and imipenem. Frequency of Class 1 and Class 2 Integrons, blaOXA-23-like and blaOXA-24-like genes were 33(44%), 27(36%), 60(80%) and 14(18.6%) respectively. Four clusters with high level of similarity were obtained showing homogeneity among MDR isolates. Conclusion: Significant correlation between presence of integrons and resistance to different classes of antibiotic was observed in this study. Monitoring of drug resistance using gene integrase PCR and blaOXA gene by cluster analysis is very important to plan specific infection control measures due to MDR A. baumannii.

Objective To determine the antimicrobial susceptibility patterns and prevalence of blaOXAtype carbapenemases among Acinetobacter baumannii (A. baumannii) isolates obtained from Iranian patients. Methods The isolates were identified from patients hospitalized between July 2011 and June 2013 in three hospitals in the Kermanshah region, Iran. All of the suspected colonies were assessed by using standard biochemical tests. Antimicrobial susceptibility testing was performed on all isolates by the Kirby-Bauer disk diffusion method. The main groups of OXA carbapenemase genes (blaOXA-23-like, blaOXA-24-like/40-like, blaOXA-51-like, blaOXA-58-like) were detected using PCR and finally carbapenem-resistant A. baumannii were genotyped by pulsed field gel electrophoresis. Results Eighty four clinical isolates were collected from the hospitalized patients. These isolates were confirmed as A. baumannii. All isolates were found to carry blaOXA-51-like. blaOXA-23-like and blaOXA-24-like/40-like were seen in 56 and 24 isolates respectively and blaOXA-58-like was not detected in any of the isolates with similar in our previous study. Among 40 A. baumannii isolates that selected for pulsed field gel electrophoresis analysis, we obtained 6 pulsotypes (including 4 common types and 2 single types). Conclusions Our study and our previous study (2010–2011) indicated that multidrug-resistant A. baumannii strains are spreading and carbapenemase resistance are common in Iran. More researcher and greater emphasis on the prevention of health care-associated transmission of multidrug-resistant Acinetobacter infection are essential.

Background and Objective.Urinary tract infection (UTI) is one of the most common bacterial infections in the world. Molecular fingerprinting of UTI isolates such as pulsed-Field Gel Electrophoresis using for Clonal distribution and determine of predominant type. The aim of the study was to determine genotyping of ESBL producing UPECs.Material and Methods.200 UPEC isolates from outpatients with UTI were obtained. Antimicrobial susceptibility and interpretation were performed by disk diffusion. Virulence factors for UPECs were screened by using PCR. UPECs were analyzed by Pulsed-Field Gel Electrophoresis and images analyzed by Phoretix1DPro software.Results.A total of 200 isolates of UPECs, 24.5% (n=49) of isolates, were positive for ESBL production. Resistance ranged from 0% for amikacin and imipenem to over 93.9% for carbenicillin and ampicillin. Frequencies of haemagglutination, haemolysin, and hydrophobicity were 51%, 18.3%, and 14.28%, respectively. A total of 10 different genotypes were obtained, which include nine common clones and one single clone.Conclusion.We confirmed the prevalence of virulence phenotyping especially Haemagglutination among UPEC strains and that it can also contribute to virulence in these strains. Large diversity in genotypes was observed in the isolates that could be indicative of different sources of infection in community acquired.

Background and Objective: Carbapenem‐resistant A. baumannii has been isolated highly in recent years. Metallo‐b‐lactamases (MBLs) have been detected and reported from A. baumannii producing carbapenemases in recent times. The aim of this study was to determine both phenotypic and Genotyping of MBL producing A.baumannii isolates. Methods:A total of 110 Acinetobacter spp. were cultured from clinical specimens of hospitals of Kermanshah in western. To screen for the MBLs, Etest strips (AB Biodisk, Solna, Sweden) were used according as per the manufacturer’s instructions. DNA genomic of A. baumanniiisolates were SmaIdigested and analyzed by CHEF Mapper PFGE. Results: 89 (80.9%) of isolates producing MBL by E‐test MBL. Of 89 MBL producing A. baumannii tested were recovered from ICU 68 (76.4%), emergency wards 16 (17.9%), and pediatric wards 5 (5.6%). Among 47 MBL producing A.baumannii that selected for Pulsed‐field gel electrophoresis analysis, we obtained 7 pulsotypes that including 4 common types and had 3 single types. Discussion: MBL producing A.baumannii has severely limited therapeutic options. The high MBL producing isolates found in this study may be associated with the high frequency at which these antimicrobial drugs were used for both prophylactic and therapeutic treatment of hospitalized. Our study showed that most of the isolates of A.baumannii were obtained from ICU and most members of clone A are collected from this ward. Present of CloneA in ICU ward is warning.

Background: Microorganism transmission is an important route for the outbreak of microbial pathogens in outdoor and indoor environments. Objectives: In this study, we performed air sampling and analysis of various bio-aerosol particles (bacteria and fungi) by a passive method in order to measure the level of contaminant particles. Materials and Methods: Air sampling was done in five hospitals in Iran, which included Imam Ali Hospital (IAH), Taleghani Hospital (TH), Imam Khomeini Hospital (IKH), Farabi Hospital (FH) and Imam Reza Hospital (IRH). In each hospital, units such as surgery, intensive care unit, angiography, emergency, oncology, nursing station, pathology laboratory, microbiological laboratory, operating room, isolation room (infectious section), delivery room and outdoor environment were investigated. Results: The total counts for viable bacteria and fungi in the sampled air from the hospitals were as follows: IAH (bacteria 0–>100 colony-forming unit [CFU]/m3;fungi 0–14 CFU/m3), FH (bacteria 1–18 CFU/m3; fungi 0–7 CFU/m3), IRH (bacteria 0–14 CFU/m3; fungi 4–>100 CFU/m3), TH (bacteria 4–>250 CFU/m3; fungi 0–43 CFU/m3) and IKH (bacteria 11–1766 CFU/m3; fungi 0–25 CFU/m3). Conclusions: Results showed that microbial counts following the air sampling are strongly dependent on the environment. However, a low number of air microorganisms do not mean a clean and healthy environment.

Background Pseudomonas aeruginosa is an opportunistic pathogen involved in many infections. Carbapenem-resistant P. aeruginosa has emerged as an important cause of infection in different hospitals worldwide. We aimed to determine frequencies of the four main resistance mechanisms [metallo-beta lactamase (MBL) production (blaIMP, blaVIM, blaSPM and blaNDM), overproduction of the MexAB–OprM and MexXY efflux pumps, overproduction of chromosome-encoded AmpC β–lactamase, and reduced OprD expression] in high-level carbapenem-resistant P. aeruginosa isolated from patients with burns. Methods In a descriptive study, 107 P. aeruginosa isolates were collected from patients with burn injuries and tested for antibiotic susceptibility, by an E-test for carbapenems, an E-test for metallo-β-lactamase producer isolates, and PCR to detect MBL genes. Furthermore, high-level carbapenem-resistant isolates were tested by real-time PCR for the expression levels of the mexB, mexY, ampC, and oprD genes. Results Amongst all P. aeruginosa isolates, 78.5%, 46.7%, and 15% were imipenem-, meropenem-, and doripenem-resistant, respectively; 72% of isolates were multidrug-resistant. The blaIMP and blaVIM genes were detected in 17.9% and 1.2% of isolates; respectively. The blaSPM and blaNDM genes were not observed. Among the resistant isolates, mexB overexpression (63.2%) was the most frequent mechanism, followed by mexY overexpression (52.6%), ampC overexpression (36.8%), and reduced oprD expression (21.1%). Conclusion Emerging antimicrobial resistance in burn wound bacterial pathogens is a serious therapeutic challenge for clinicians. In the present study, most of the isolates were MDR. This finding indicated an alarming spread of resistant isolates and suggested that infection control strategies should be considered. Resistance to carbapenems is influenced by several factors, not all of which were evaluated in our study; however, the results showed that production of MBLs and overexpression of the mexB gene were the most frequent mechanisms in carbapenem-resistant isolates.

Introduction: Mycobacterium tuberculosis Beijing genotype is gaining importance all over the world because this genotype is highly prevalent in several areas and is also frequently associated with drug resistance. Aim: To identify and determine the frequency of Beijing genotype and mix infection with Beijing and non-Beijing in west of Iran and analyse the association between Beijing genotype and drug resistance. Materials and Methods: This cross-sectional study was conducted on 146 Tuberculosis (TB) samples collected at the TB reference laboratory in Kermanshah west of Iran from January 2014 to February 2015, Mycobacterium tuberculosis isolates from sputum samples, detected by microcopy, biochemical tests and solid culture were included and then the confirmed samples with Cepheid Xpert MTB/RIF assay were subjected to drug susceptibility tests for rifampicin, isoniazid, ethambutol using proportional method. The prevalence rate of Beijing and non-Beijing genotype was determined by Multiplex- Polymerase Chain Reaction (PCR). Result: A total of 15/146 (10%) isolates were diagnosed as Beijing genotypes and the remaining 131/146(90%) isolates were non-Beijing genotypes by Multiplex PCR method. Among the 15 Beijing cases, 14 samples have shown mix infection indicating the presence of both Beijing and non-Beijing strains in samples. Three isolates from all cases were drug resistant. Interestingly all drug resistance isolates were from Beijing genotype which shows strong association between drug resistance and Beijing genotype. Also this genotype was more prevalent in younger age-group people (p=0.035). Conclusion: Frequency of Beijing genotype in west of Iran is more than other sites of Iran but less than Asia. According to our result, mix infections with Beijing and non-Beijing, had the most prevalence therefore we should be concerned more about mix infections. Multiplex-PCR method is feasible, trustworthy and can distinguish mix infections. It is suggested to perform spoligotyping in addition to multiplex PCR method to discriminate mix infections.

Nontuberculous mycobacteria are habitants of environment, especially in aquatic systems. Some of them cause problems in immunodeficient patients. Over the last decade, 16S rRNA gene sequencing was established in 45 novel species of nontuberculous mycobacteria. Experiences revealed that this method underestimates the diversity, but does not distinguish between some of mycobacterium subsp. To recognize emerging rapidly growing mycobacteria and identify their subsp, rpoB gene sequencing has been developed.To better understand the transmission of nontuberculous mycobacterial species from drinking water and preventing the spread of illness with these bacteria, the aim of this study was to detect the presence of bacteria by PCR-sequencing techniques.Drinking water samples were collected from different areas of Kermanshah city in west of IRAN. After decontamination with cetylpyridinium chloride, samples were filtered with 0.45-micron filters, the filter transferred directly on growth medium waiting to appear in colonies, then DNA extraction and PCR were performed, and products were sent to sequencing.We found 35/110 (32%) nontuberculous mycobacterial species in drinking water samples, isolates included Mycobacterium goodii, Mycobacterium aurum, and Mycobacterium gastri with the most abundance (11.5%), followed by Mycobacterium smegmatis, Mycobacterium porcinum, Mycobacterium peregrinum, Mycobacterium mucogenicum, and Mycobacterium chelonae (8%).In this study, we recognized the evidence of contamination by nontuberculous mycobacteria in corroded water pipes. As a result of the high prevalence of these bacteria in drinking water in Kermanshah, this is important evidence of transmission through drinking water. This finding can also help public health policy makers control these isolates in drinking water supplies in Kermanshah.

Nasal carriage of Staphylococcus aureus (S. aureus) probably causes the transmission of infection between individuals in hospital and community. This study aimed to evaluate the molecular epidemiology and antibiotic resistance pattern of nasal carriage S. aureus in pediatric ward patients and personnel. A total of 122 Nasal samples were taken from 28 personnel and 94 hospitalized patients in the pediatric ward. Minimum Inhibitory Concentration (MIC) to vancomycin and cefoxitin was determined by Agar dilution method strips. All S. aureus isolates were analyzed by pulsed-field gel electrophoresis (PFGE). A total of 41 S. aureus were isolated from the patients. 16 isolates (39.09%) were hospital-associated S. aureus (HA-SA) and 25 (60.97%) were community-associated S. aureus (CA-SA); also, 13 S. aureus isolates were obtained from the personnel. Based on MIC results, all of S. aureus isolates were susceptible to vancomycin, and in 41 patient isolates, 13 isolates (31.7%) were resistant to cefoxitin (MRSA). Of 13 S. aureus isolates of the personnel, 3 (23%) isolates were MRSA. Totally 11 common clones and 13 single clones were obtained. In conclusion the prevalence of CA-SA in the ward was higher than that of HA-SA. In the strains obtained from a hospital ward, there was a high epidemiology, genotypic diversity in the studied ward. However, horizontal transfer of S. aureus was observed between patients and between personnel and patients, which indicated the risk of transmission of resistant strains in the hospital wards.

Background Carbapenem-resistant Acinetobacter baumannii has emerged as an important cause of infection in burn patients. This study aimed to characterize the antimicrobial susceptibility pattern, determine the prevalence of oxacillinase and metallo-beta-lactamase (MBL) genes, and type the A. baumannii isolates obtained from burn patients. Methods During a 1-year period, a total of 40 nonduplicated isolates of A. baumannii were obtained from burn patients who were hospitalized in the Taleghani Burn Hospital in Ahvaz, in the southwest of Iran. Testing for antimicrobial susceptibility was carried out by disk diffusion and E-test. To screen MBL production, a double disk synergy and MBL E-test were performed. The presence of bla OXA-23-like , bla OXA-24-like , bla OXA-51-like and bla OXA-58-like , bla VIM , bla IMP and bla SPM , and bla NDM was sought by polymerase chain reaction (PCR). Repetitive extragenic palindromic sequence-based PCR was carried out for determination of isolates clonality. Results Overall, 92.5% of isolates were carbapenem-resistant. Polymyxin B, colistin, and ampicillin-sulbactam were the most effective agents in vitro , with a susceptibility rate of 100%, 97.5%, and 72.5%, respectively. According to the double disk synergy and E-test, 55.6% and 97.3% of isolates were MBL producers, respectively. Furthermore, 70% of isolates harbored bla OXA-23-like and 20% were positive for bla OXA-24-like. However, no encoding genes were detected for bla VIM , bla IMP and bla SPM , bla NDM , and bla OXA-58-like . Repetitive extragenic palindromic sequence-based PCR revealed that carbapenem-resistant isolates belonged to four clones, including A, B, C, and D; the predominant clones were B and C. Conclusion The rate of carbapenem resistance was high, and it appeared that bla OXA-23-like and bla OXA-24-like contributed to the carbapenem resistance of A. baumannii isolates. This result suggests that the two predominant clones of A. baumannii were spread among burn patients. In order to prevent future dissemination of resistant isolates among burn patients, an effective infection control plan is necessary.

According to the results of various studies using phenotypic methods, the prevalence of Multidrug Resistant (MDR)To determine the clonal relatedness and investigate the prevalence of integron classes 1 and 2 and genes encoding OXA-23 and 24 inA cross-sectional study was conducted from November 2011 to January 2013. A total of 140A total of 37 isolates among 75 ICU isolates were identified as MDR. The maximum drug resistance was observed against ceftriaxone, mezlocycline, cefotaxime, piperacilin, ciprofloxacin and imipenem. Frequency of Class 1 and Class 2 Integrons, blaSignificant correlation between presence of integrons and resistance to different classes of antibiotic was observed in this study. Monitoring of drug resistance using gene integrase PCR and bla

Background: Acinetobacter baumannii which is a Gram-negative bacterium can cause several different infections. The appearance of carbapenemase-producing A. baumannii in recent years has made the treatment process more difficult. The identification of virulence factors (VFs), such as nonadhesives in A. baumannii, helps to fight against related infections. Materials and Methods: A total of 104 samples from teaching hospitals in Kermanshah, Iran, were collected during a 24 months period (2011-2013). Sample identification was first carried out by biochemical tests, and then their susceptibility to carbapenems was determined using the Kirby-Bauer method. For confirmation of carbapenemase-producing A. baumannii, polymerase chain reaction (PCR) was done for carbapenemase-encoding genes. In addition, the frequency of nonadhesive VFs in carbapenemase-producing isolates was determined by PCR. Results: There were 50 isolates that were identified as carbapenemase-producing A. baumannii. The PCR results showed; 40 isolates (80%) for traT, 17 isolates (34%) for cvaC, and 8 isolates (16%) for iutA, and these encode serum resistance, colicin V and aerobactin, respectively. No significant correlation was observed between these three genes. Conclusions: The mechanism of A. baumannii virulence has always been in question. The role of VFs has also been recognized in other Gram-negative bacteria. According to the prevalence of traT, cvaC and iutA, as nonadhesive VFs, we can suggest that they could be the main mechanism of carbapenemase-producing A. baumannii pathogenesis.

Background: Methicillin-resistant Staphylococcus aureus (MRSA) is a bacterial pathogen frequently isolated in both hospital and community environments. Methicillin-resistant Staphylococcus aureus is considered a major nosocomial pathogen that causes severe morbidity and mortality. Objectives: The main objective of this study was to determine the genotypes of MRSA strains isolated from the nares of hospitalized and community patients in Kermanshah Hospital, western Iran, by PCR-restriction fragment length polymorphism (PCR-RFLP). Materials and Methods: Of 1387 patients, 1217 patients were screened for more than 48 hours after admission in hospital wards and 170 patients were screened in the hemodialysis unit of Kermanshah Hospital, which is the largest hospital in western Iran. S. aureus was identified by standard biochemical tests, including colonial morphology, production of coagulase, and DNase and the API20 Staph test. Methicillin-resistant Staphylococcus aureus was identified by the Oxacillin strip test. Results: In total, 258 S. aureus isolates were recovered from 1387 samples, of which 96 isolates were MRSA, 82 were hospital acquired, and 14 were community acquired. Digestion of the aro A gene revealed only one distinctive RFLP pattern in the 258 isolates. Conclusions: Methicillin-resistant Staphylococcus aureus is an increasingly common cause of nosocomial infections. Our results are in agreement with those of other studies reporting that a few specialized clones are responsible for most cases of MRSA nasal carriage. In this study, MRSA strains isolated from different wards of hospital were closely related when analyzed by coagulase gene typing. Identifying patients colonized with MRSA during hospitalization and rapidly typing them with these methods may facilitate detection of outbreaks and prevention of the spread of organisms in hospitals.

Background: Staphylococcus aureus is known to be responsible for nosocomial infections, and the typing method was useful in managing the reservoir of bacteria. The main aim of this study was to determine the prevalence of S. aureus in the nares and hands of nurses working in Imam Khomeini hospital, Ilam, Iran, as well as to determine the clonal relatedness, antimicrobial susceptibility profiles, different virulence, and resistance determinants among these isolates. The evolution of mupirocin activity in the eradication of methicillin-resistant S. aureus (MRSA) and methicillin-susceptible S. aureus (MSSA) colonization in the nares of the healthcare workers in Ilam, Iran, was also determined in this study.Materials and Methods: In this cross-sectional study, 80 nurses, auxiliary nurses, and service workers from Imam Khomeini Hospital were enrolled. MRSA, antibiotic susceptibility, and virulence determinants were evaluated. Then, the isolates were subjected to pulsed field gel electrophoresis (PFGE) and Staphylococcal cassette chromosome mec typing. Results: Our results demonstrated that 23% of isolates were MRSA. PFGE results demonstrated that pulsotypes A (3 out of 30; 10%) and J (3 out of 30; 10%), pulsotypes E (2 out of 30; 6.7%), M (2 out of 30; 6.7%), P(2 out of 30; 6.7%), and V (2 out of 30; 6.7%) were the most predominant pulsotypes, respectively. Conclusion: We cannot give conclusive suggestions about the correlation between nasal carriage and infections, but we suggest the monitoring of all healthcare workers annually, decontamination of their noses by using mupirocin and other antistaphylococcal agents, and also the washing of their hands at least every 2 h.

PURPOSE: To determine the genetic diversity of MDR P. aeruginosa strains isolated from burn and wound infections in Ahvaz, Iran, by ERIC-PCR. METHODS: From total 99 strains of P. aeruginosa defined as MDR by using drug susceptibility testing, 66 were subjected to ERIC-PCR analysis, comprises 53 strains isolated from burn infection, and 13 randomly selected strains from wound infection with higher resistance to combinations of more numbers of drugs. RESULTS: Eight clusters (I to VIII), and 50 single clones were generated for tested MDR isolates analyzed by ERIC-PCR. The high heterogeneity was observed among the isolates from burn infections including 16 isolates which were categorized in eight clusters and 37 single clones. The isolates in clusters II, III, VI, VIII showed 100% similarity. CONCLUSIONS: The high level of genotypic heterogeneity in P. aeruginosa strains demonstrated no genetic correlation between them. Extremely high drug resistance in isolates from burn, suggests that efficient control measures and proper antibiotic policy should be observed.

The present article provides an overview of the role of oxidative stress in the development and progression of liver cancer (LC). Oxidative stress ensues when the balance between the production of reactive oxygen species (ROS) and reactive nitrogen species overrides the antioxidant defense of the target cell and body fails in detoxifying their harmful effects. Therefore, the interaction of these reactive species with critical cellular macromolecules may cause oxidative damage. Moreover, ROS may interact with cellular components including proteins, lipids, and DNAs, which results in altered target cell function. The accumulation of oxidative damage products has been implicated in both acute and chronic cell injury suggesting a possible role in the pathogenesis of Parkinson's disease, Alzheimer's disease, atherosclerosis, heart failure, myocardial infarction, and cancers. Alcoholism, viral agents, obesity, and smoking increase the occurrence of oxidative stress and consequently the risk of LC.

Background and Objective: The acquisition and dissemination of antibiotic-resistant agents in Acinetobacter baumannii ( A. baumannii ) is highly facilitated through integrons that are DNA transposable elements and able to receive genes through site-specific recombination. Class 1 and 2 integrons are the most known integrons that are frequently available in A. baumannii . The aim of this study was to determine the frequency of class 2 integron in multidrug resistance (MDR) A. baumannii . Methods: A total of 100 isolates of A. baumannii were collected from patients that are admitted to hospitals in Kermanshah in the year 2014-2015. The isolates were identified using biochemical tests and the kit API 20 NE, and then their sensitivity to 20 antibiotics was examined. The prevalence rate of class 2 integrons among the isolates was determined using Polymerase chain reaction (PCR). The results were analyzed using Fisher's test and the non-parametric Chi-squared test. Results: The maximum drug resistance was observed against Cefotaxime (93%), Ceftriaxone (92%), Mezlocillin (91%), Ceftazidime (86%), Imipenem (82%), and Piperacillin (82%). The minimum drug resistance was observed against Colistin (12%), Polymyxin B (7%), Minocycline (10%), and Tigecycline (6%) and seems as the most efficient antibiotics. Twenty-nine (29%) isolates out of the 100 isolates were multidrug resistance (MDR); about 21 isolates (21%) were extensive drug resistance (XDR); and none were pan drug resistance (PDR). Thirty four (34%) isolates contained class 2 integrons. The results did not showed a significant correlation between the presence of class 2 integrons and incidence of MDR A. baumannii . Conclusion: The transmission of antibiotic-resistant agents by the class 2 integrons resulted in further durability and spread of these isolates in the environment. Therefore, it seems that resistance to A. baumannii is always changing, and different countries should attend to these changes.

Background: Staphylococcus aureus is known as a powerful pathogen that causes various infections. Emergence of methicillin-resistant S. aureus (MSRA) is responsible for nosocomial and community-acquired infections worldwide. Aims: The present study aimed to evaluate the performance and ability of eight different phenotypic and genotypic methods for the detection of MSRA. Materials and Methods: A total of 186 S. aureus isolates were defined as methicillin-susceptible S. aureus (MSSA; 95) and MSRA (91) using polymerase chain reaction (PCR) as the gold standard. Susceptibility to methicillin was investigated using oxacillin, methicillin, cefotetan, cefoxitin, and cefmetazole disks, by oxacillin Adata Tab and strips. For all S. aureus isolates minimal inhibitory concentrations of oxacillin were determined using the broth microdilution method according to Clinical and Laboratory Standards Institute guidelines. Results: Among the diagnostic methods studied, broth microdilution and the cefoxitin disk had the highest specificity (98.9 and 94.7%), sensitivity (100 and 98.9%), and concordance with PCR results (98.9 and 93.6%). The cefotetan and cefmetazole disks had the lowest concordance with PCR results. Conclusion: Our results suggest that microdilution and cefoxitin disk methods have high sensitivities compared with other methods for detection of MSRA. The cefoxitin disk method may be preferred in clinical laboratories because it is easy to perform and does not require special equipment.

Background: Isoniazid (INH) is one of the main line drugs used in the treatment of tuberculosis (TB) and the development of resistance against this compound can result in serious problems in the treatment procedures. Resistance to INH is associated with a variety of mutations. Objectives: The aim of the present study is to determine the frequency of major drug resistance mutations across katG and inhA loci of multidrug-resistant (MDR)-MTB isolates using a molecular test. Materials and Methods: 125 Mycobacterium Tuberculosis (MTB) clinical isolates were studied. The Centers for Disease Control and Prevention (CDC) standard conventional proportional method was implied to test drug susceptibility. DNA extraction, katG and InhA amplification, and microarray were performed. Results: From 125 MTB clinical isolates, 34 strains were INH-resistant and 91 strains were INH-sensitive. Of 34 INH-resistant strains, the mutation was identified in 32% KatG 315 (Ser→Thr), in 14% KatG315 (Ser→ Asn), in 52% InhA 15 (C→T), and in 2.9% InhA 17 (G→T). Conclusions: Rapid diagnosis of MDR-TB is essential for the prompt initiation of effective second-line therapy to improve the treatment outcome and limit transmission of this obstinate disease. A range of molecular methods that aid in rapid detection of mutations implicated in MDR-TB have been developed. The sensitivity of the methods is dependent, in principle, on the repertoire of mutations being detected, which is typically limited to mutations in the genes katG and the promoter region of inhA.

Background: Urinary tract infections (UTIs) are common cause of infections described in out-patient's setting and increase in antibiotic resistance of Escherichia coli , is encountered world-wide. Antibiotic treatment is usually empirical; therefore, this study to provide the knowledge of local resistance pathogen patterns in Kermanshah. Materials and Methods: We conducted a retrospective analysis of all E. coli isolates from urine samples admitted to Kermanshah Central lab between March 2011 and 2012 were included. Antimicrobial resistance was tested by the Kirby-Bauer disk diffusion. Results: This study showed a total of 20,742 samples, 1228 (5.92) were positive for pathogenic bacteria. E. coli were the predominant 801 isolate (65.2%). Out of the 13 antibiotics tested for E. coli isolates, minimum and maximum resistance were observed to ampicillin (9.4%) and augmentin (68.6%). Almost 59-66% of the uropathogenic E. coli strains were resistant to amikacin, co-trimoxazole, tetracycline and cephalotin and nearly half of them were resistant to nalidixic acid and cephalexin. Conclusion: This study confirms that E. coli is still the most common uropathogen isolated. Augmentin and amikacin are not as a first choice for treatment of UTI in Kermanshah area. Ampicillin and nitrofurantoin may be considered as a first choice empiric agent in out-patients.

Background: Uropathogenic Escherichia coli (UPEC) can cause urinary tract infection (UTI). To prevent urine flow lavage, UPEC has acquired several virulence factors called adhesins. These adhesins are expressed and controlled by different genes. Aim: This study was aimed to determine some of the most important genes that control virulence factors of UPEC (pyelonephritis associated pili [pap], S fimbrial adhesion [sfa] and A fimbrial adhesion [afa] genes), which code for adhesins and phenotypic factors. Materials and Methods: In total, 205 UPEC isolates from in- and out-patients with UTI were obtained. Polymerase chain reaction was used for gene amplification. One drop of bacterial suspension, one of red blood cells and one of peripheral blood smear were mixed for hemagglutination (HA). Formation of a clump was considered to be positive. Bacteria were grown on blood agar to determine hemolysis. Surface hydrophobicity was determined using the SAT test. Result: Frequencies of pap, afa and sfa were 42 (20.5%), 17 (8.3%) and 44 (21.5%), respectively. Frequencies of HA, hemolysis and hydrophobicity were 138 (67.3%), 56 (27.3%) and 39 (19%), respectively. Among HA-positive bacteria, 103 (74.6%) were mannose resistant. Our results highlight higher frequency of HA than that of other virulence factors, indicating a crucial role of this virulence factor in UPEC. Discussion: We concluded that major differences exist in the prevalence of virulence factors among different UPEC isolated from different countries. The association observed between pathogenicity and virulence factors may promote UPEC survival and growth within the urinary tract. Detecting these genes as the primary controllers of UPEC virulence factors may aid in better management of related infections.

Background and Objective: For many years, extended-spectrum-beta-lactamase (ESBL)-producing bacteria were problems mainly located in medical facilities. Within the last decade, however, ESBL-producing bacteria have started spreading into the community and the hospital. The aims of this study were to detect ESBL-producing uropathogenic Escherichia coli (UPEC), susceptibility to antibiotics, and β-lactamase genes. Materials and Methods: Two hundred bacterial isolates were collected from inpatients and outpatients in the west of Iran from December 2011 to February 2013. All isolates were identified by conventional bacteriological tests. Antimicrobial susceptibility and interpretation were assessed by disk diffusion. ESBL-producing E. coli isolates were tested by polymerase chain reaction (PCR) assay for blaTEM , blaSHV , blaCTX-M , blaOXA-I , and blaOXA-II genes. Results: Of 200 UPEC, 22% (n = 44) were ESBL-producing; 0% showed the least resistance to imipenem, and 97.7% showed high resistance to carbenicillin and ampicillin. The ESBLs CTX-M, SHV, TEM, OXAI, and OXAII were detected in 93.3%, 68.2%, 43.2%, 31.8%, and 22.7% of isolates respectively. Conclusion: A prevalence of ESBL-producing UPEC was observed in outpatients and inpatients; the high levels of resistance to different antibiotics show that treatment options are limited and that infection control measures remain of high importance.

The urinary tract infections regarded as a health problem around the world and not only as an agent of nosocomial infections but also infections in the community. Community acquired UTIs cause significant illness in the first 2 years of life [1]. Urinary tract infections in both inpatient and outpatient are common and widespread use of antibiotics is often the cause of emerging one or more antibiotic-resistant microorganisms [2]. Most studies have shown higher antibiotic resistance in bacterial strains isolated from hospitalized patients than outpatients. In this study, antibiogram was performed using disk diffusion susceptibility method according to NCCLS standards of the International Committee [3]. 8 different antibiotics, including ciprofloxacin (CP: 30 μg), ceftriaxone (CRO: 30 μg), cephalotin (CF: 30 μg), cefixime (CFM: 5 μg), cotrimoxazole (SXT), nalidixic acid (NA: 30 μg), nitrofurantoin (FM: 300 μg), gentamicin (GM: 10 μg) were used for antibiogram. During 1388 the total number of urine samples sent to hospital microbiology laboratories valiasr (aj) of Arak was 5156, of which 446 samples (65.8%) were positive for E. coli culture.

Background: Breastfeeding is the most natural and essential way for feeding newborn babies. This is an ideal approach for physical and emotional development of babies, as well as for the recovery of mothers. This study was aimed to determine the effect of breastfeeding education based on the health belief model (HBM) toward primiparous women. Materials and Methods: In a case-control group, quasi-experimental study, 88 subjects were allocated in control and experimental groups. Subjects who were assigned to the experimental group were provided a program consisting of group education based on HBM during their prenatal period. Instrument for data gathering was made by the researchers and standard questionnaire from Dennis and Faux for Breastfeeding Self-efficacy Scale (BSES). Baseline interviews were conducted before delivery and follow-up visits were conducted after 30 days and at the fourth month after delivery. Data were analyzed using SPSS (version 16) with c 2 , independent sample t-tests, and paired t-test. Results: Mean age of pregnant women who participated in the study was 22 ± 3.29 years. After the program, the experimental group had significantly better scores in terms of self-efficacy, knowledge, and attitude scores statistically. In the fourth month, the mean of child weight in the experimental group was significantly higher than that of the control group (P=0.001) and exclusive breastfeeding was significantly higher than in the control group (P=0.007). Conclusion: Prenatal education in this study based on HBM was successful, and knowledge, attitude, self-efficacy, and related indicators improved. The necessity of producing standard education package and education of pregnant mothers, especially in their first pregnancy, by health professionals is perceived.

Objectives: The present study, for the first time investigated the prevalence of MRSA isolates in nasal carriers in Imam Reza Hospital in the western province of Iran. Materials and Methods: Nasal samples from 1269 hospitalized patients were tested for S. aureus. The sensitivity of these isolates to various antibiotics was evaluated by the disk diffusion method and E-test oxacillin strips. After determining the MIC and inducible clindamycin resistance, the mecA gene was investigated by PCR. Results: 17.57% (223) of patients were HA-SA nasal carriers, with 82 isolates (36.8%) being resistant to methicillin (MRSA). The infant ward had the highest rate of carriage (80%). The difference in the sensitivity of MRSA and MSSA isolates to several antibiotics was significant (P< 0.05); furthermore, 80.5% of MRSA isolates and 2.8% of MSSA isolates were multi-drug resistant (MDR). A lower resistance was observed against clindamycin (58.5%), rifampicin (19.5%), and chloramphenicol (7.3%). Conclusions: The high prevalence and antibiotic resistance of HA-MRSA isolates in western Iran indicates the necessity of continuous monitoring of hospital patients in the country for the presence of MRSA, particularly in infant wards.

Immunotoxins such as pseudomonas exotoxin are Molecules with a unique structure like toxin-antibody part. These immunotoxins are two functional which crossing the cell membrane and enters the target cell and destroy the cell. Toxin-based treatments are a widespread research field and can have broad applications in the biology and public health. Immunotoxins act selectively against cancer cells and have a good potential for detecting and targeting cancer cells. Specific immunotoxins to target immune cells due to the selection type antibody and antibodies are responsible for the identification of the target cells. Cancer is becoming a major cause of death in most developed countries. In order to have a strong factor in cancer repression, that agent must target the cancer cells directly and specifically. Often, but not always, immunotoxins are produced for disabling and killing cancer cells, that this issue is one of new therapeutic approaches in recently. Clinical aims to designing and create new cancer therapies focused with this approach, a lot of information about the toxin and intracellular pathways have been obtained. So, toxins in medicine are useful for the treatment of human disease and study of professional cellular functions. So, immunotoxins have a high potential for cancer treatment. Other applications of immunotoxins, including immune system regulation and treatment of viral diseases and parasites diseases. More research is needed to improve the immunotoxin effects and to reduce their side effects. On the whole, with design creative, clever and experienced programs, many human diseases, particularly cancers can be in a short period of time and faster than other methods of treatment that the treatment of long, to be treated. Following the design and implementation of clinical trials, the effects of immunotoxins on animal tumorigenic models were performed. In fact, in this study, we focus on the use of protein-bound toxins with bacterial and herbal sources and more specifically Pseudomonas immunotoxins which attached to antibodies to target cancer cells.