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Abstract Background Shigella spp., which are facultative anaerobic bacilli within the Enterobacteriaceae family, present a significant public health burden due to their role as prominent contributors to diarrheal diseases worldwide. A molecular analysis can facilitate the identification and assessment of outbreaks involving this bacterium. So, we aimed to investigate the antibiotic susceptibility pattern and clonal relatedness of clinical Shigella spp. isolates obtained from patients with diarrhea in Hormozgan province, South of Iran. Methods From 2019 to 2021, a cross-sectional investigation was conducted on 448 stool samples obtained from patients who were experiencing diarrhea, in the southern region of Iran. Shigella spp. isolates were identified based on biochemical and serological tests. All Shigella species were verified using species-specific polymerase chain reaction (PCR), followed by susceptibility testing to antimicrobial agents. Subsequently, genotyping of all Shigella species was conducted using ERIC-PCR. Results Out of a total of 448 stool samples, the presence of Shigella was detected in 62 cases, accounting for a prevalence rate of 13.84%. Among the identified isolates, the majority were attributed to S. flexneri, representing 53.23% of the cases. This was followed by S. sonnei at 24.19% and S. boydii at 22.58%. Notably, no instances of S. dysenteriae were found. The highest prevalence of Shigella isolates was observed in infants and children under the age of five. A significant proportion of the identified isolates demonstrated resistance to various antibiotics. Specifically, high resistance rates were noted for ampicillin (90.78%), piperacillin–tazobactam (87.1%), cefixime (83.87%), trimethoprim–sulfamethoxazole (83.87%), cefotaxime (82.26%), and ceftriaxone (80.65%). In addition, a substantial number (87.1%) of the isolates exhibited a multidrug-resistant (MDR) phenotype. Using the ERIC-PCR method, a total of 11 clusters and 6 distinct single types were identified among all the Shigella isolates. Conclusion A notable occurrence of antibiotic-resistant Shigella species has been noted, with multi-drug resistant (MDR) strains presenting an increasing challenge for treating shigellosis worldwide, and this includes Iran. Techniques such as ERIC-PCR are useful for assessing the genetic variation and connections between Shigella strains, which indirectly contributes to understanding antimicrobial resistance patterns. Further research is needed to explore the specific correlation between resistance genes and ERIC genotyping patterns in Shigella strains.

Abstract Background and Aims Gastric cancer is a significant global issue with a high death rate. This malignancy could be associated with several viral agents such as EBV, CMV, HHV‐6, JCV, and BKV. Objective Evaluation of EBV, CMV, HHV‐6 ,and JCV, BKV frequency among gastric cancer patients. Methods In this cross‐sectional study, a total number of 60 gastric cancer specimens (32 male, 28 female) were retrieved from the pathology lab. Formalin‐fixed paraffin‐embedded tissue was used for molecular testing. DNA was extracted from samples, according to protocol, and used for PCR reaction. Polymerase chain reactions were used to assess CMV, EBV, HHV‐6, JCV, and BKV frequency. Results and Conclusion The mean age of the participants was 61 years and 53.3% (32) of the participants were Male. A total number of 5 samples (8.34%) were infected with viral agents. Four male gastric samples were infected with EBV (6.67%) and only one female sample contained the BKV genome (1.67%). Totally 8.34% of the samples were infected with EBV and BKV. The CMV, HHV‐6, and JCV genome was not detected in the samples. In conclusion, the presence of two viral agents including EBV and BKV among male and female samples respectively, and the genome of other viruses were not detected.

Pseudomonas aeruginosa biofilm is a community of bacteria that adhere to live or non-living surfaces and are encapsulated by an extracellular polymeric substance. Unlike individual planktonic cells, biofilms possess a notable inherent resistance to sanitizers and antibiotics. Overcoming this resistance is a substantial barrier in the medical and food industries. Hence, while antibiotics are ineffective in eradicating P. aeruginosa biofilm, scientists have explored alternate strategies, including the utilization of natural compounds as a novel treatment option. To this end, curcumin, carvacrol, thymol, eugenol, cinnamaldehyde, coumarin, catechin, terpinene-4-ol, linalool, pinene, linoleic acid, saponin, and geraniol are the major natural compounds extensively utilized for the management of the P. aeruginosa biofilm community. Noteworthy, the exact interaction of natural compounds and the biofilm of this bacterium is not elucidated yet; however, the interference with the quorum sensing system and the inhibition of autoinducer production in P. aeruginosa are the main possible mechanisms. Noteworthy, the use of different drug platforms can overcome some drawbacks of natural compounds, such as insolubility in water, limited oral bioavailability, fast metabolism, and degradation. Additionally, drug platforms can deliver different antibiofilm agents simultaneously, which enhances the antibiofilm potential of natural compounds. This article explores many facets of utilizing natural compounds to inhibit and eradicate P. aeruginosa biofilms. It also examines the techniques and protocols employed to enhance the effectiveness of these compounds.

Candidiasis is one of serious problems in immunosuppressed patients, including HIV patients. Candida albicans is a fungi causing different humans diseases. Immunosuppression is a hallmark of HIV infection, and its’ deficiency can introduce complications through impairment of immune cells, such as CD4+ lymphocytes. The aim of the current review was to investigate the importance of candidiasis co-infection in HIV Iranian patients. In addition, it focused on prognosis, prevention, and management of candidiasis since this infection could have a large scale of mortality in people living with HIV and AIDS (PLWHA). For the current systematic review, multiple electronic bibliographic databases were searched, including PubMed, EMBASE, Scopus, Web of Science, Google Scholar, and Iranian databases from 1 January 2011 until 24 February 2020. Majority of articles (n = 11) investigated oral and oropharyngeal candidiasis (OPC) with a prevalence range of 16.5% to 43.82% in HIV-positive patients. Apart from oral candidiasis, one reference also evaluated vagina, nail, and skin candidiasis. C. albicans isolates were the most prevalent species, with a 34.42%, 52.2%, and 82.2% frequency rate in three studies, while in other papers, there was a fluctua¬tion in C. albicans prevalence. Candidiasis is the most prevalent opportunistic infection in AIDS patients. Due to high prevalence rate of oropharyngeal candidiasis, routine screening of HIV patients is recommended. Since CD4+ T cells count decreased in HIV patients, periodic examinations are necessary. Fluconazole is most commonly used azole to treat Candida due to its mechanism; however, anti-fungal prophylaxis needs more investigation to reduce mortality and morbidity associated with mucosal candidiasis.

Introduction: Sepsis is a syndrome of host systemic inflammatory response and is caused by microbial pathogens invading the bloodstream. Quick and accurate diagnosis is a key factor in the treatment of sepsis before complications occur. Therefore, this study aimed to identify the bacterial agents of sepsis from blood culture using phenotypic and polymerase chain reaction (PCR) techniques. Materials and Methods: A total of 287 blood culture bottles of suspected patients in Imam Reza Hospital were taken and transferred to the microbiology laboratory of the medical school. Isolates were identified by Microgen Kit and API 20 E kit. The PCR sequence analysis of the 16S rDNA gene was implemented for molecular detection of bacterial isolates. Results: Of the 287 suspected sepsis samples, 231 were negative and 56 were positive. Among the positive samples, five were positive by PCR despite being negative in the culture. Among 56 isolates, 16 (28.57%) were Gram-negative bacteria and 40 (71.42%) were Gram-positive bacteria. Conclusion: In this study, the result of PCR-based 16S rDNA gene analysis revealed high sensitivity compared with other methods of bacterial detection. Overall, the fast sampling and quick and accurate diagnosis reduce unnecessary prescription of antibiotics by physicians.

Novel coronavirus outbreak in December 2019 leads to current pandemic condition worldwide. Severe acute respiratory syndrome coronavirus-2 known as the aetiologic agent of coronavirus disease 2019 (COVID-19). The major characterisation of COVID-19 is to involve lung and induce pneumonia, multiorgan failure, hypoxia and deat h. This systematic literature review aimed to assess the clinical manifestation and laboratory and radiologic features in patients with COVID-19. A literature review of the indexed articles in the Web of Science, PubMed, Scopus and Embase was performed to evaluate pathophysiology of COVID-19. Between 77,406 assessed COVID-19 patients, the most reported background diseases were cardiovascular and cerebrovascular disease. After fever, cough was the second most common repeated clinical feature. Furthermore, the laboratory investigations reveal that the C-reactive protein (CRP) increasing is the most common frequent laboratory finding. Chest imaging assessment indicates that bilateral involvement of the lungs is more common than unilateral involvement. Despite the fact that some of the COVID-19-infected patients are asymptomatic, the majority of patients showed a broad range of manifestation. The clinical findings help in better understanding of COVID-19 pathogenesis and patient's management. The primary concept of understanding of COVID-19 pathophysiology is necessary for reach to target therapeutics approach. According to the results, further in vivo investigations on animal models could be recommended for the treatment of COVID-19 patients in future.

Abstract Background Parvovirus B19 is the causative agent for erythema infectiosum, and also as a potentially life-threatening infectious agent, it is mainly presented in high erythrocyte turnover patients. Sickle cell disease (SCD) is an inherited monogenic hematological disorder resulting from the mutations in the hemoglobin β-chain gene. Thalassemia is a hereditary hematological syndrome that happens in consequence of deficiencies in the production of one or more globin chains. We summarize current knowledge about the prevalence rates of the parvovirus B19 infection in sickle cell anemia and thalassemia patients. Methods Several online databases were searched including, Scopus, EMBASE, Web of Science, Google Scholar, and PubMed, which were performed amidst 2009–2019 by using distinct keywords: “Thalassemia,” “Parvovirus,” “Anemia,” “Sickle cell anemia,” “parvoviridae,” “parvoviridae infection,” and “parvovirus B19.” Results Search results indicated 4 and 7 studies for the prevalence of the parvovirus B19 in β-thalassemia and SCD, respectively. Among the β-thalassemia patients, the B19V seroprevalence for IgG and IgM were ranged from 18.2–81% and 14.5–41.1%, respectively; meanwhile, B19V DNA positively results was 4–15.3%. Moreover, in the SCD group, the extent of B19V IgG was varied from 37.6 to 65.9% and that of IgM was in a range of 2.9–30%, and the DNA detection rate was 4–54%. Conclusion B19V seroprevalence changes in several conditions including, different epidemiological features, socio-economic status, and overpopulation. Age can expand the incidence of anti-B19V IgG/IgM in SCD and beta-thalassemia patients. Reinfection and diverse genotypes are relevant factors in the seroprevalence of B19v. The patients’ immunological-hematological station and higher abundance of transfusions can affect the B19V seroprevalence in SCD and beta-thalassemia group. Further investigations in this field could be suggested to better understand the virus distribution in this susceptible population of patients.

The outbreak of a novel coronavirus disease 2019 (COVID-19) began in China in December 2019 and spread worldwide. The current review summarized clinical, radiological, and laboratory findings of patients infected with COVID‐19. Based on many studies, the main symptoms of the disease include respiratory symptoms, fever, cough, and dyspnea; there is also a wide range of biochemical, hematological, and radiological changes in the patients. The signs (or symptoms) and other variables in the early stage or the mild stage of the disease appear in a highly heterogeneous and non-specific manner. Identifying the clinical and paraclinical symptoms of COVID-19 can be effective in controlling it.

Abstract 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 bla OXA − 23-like (85.1%), bla VIM (60.5%), bla PER − 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 bla OXA-51-like and bla OXA-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.

Abstract Background As an opportunistic pathogen, Escherichia coli (E. coli) is widely recognized as the main cause of nosocomial infections as well as some disorders especially those associated with urinary tract infections (UTIs). This study, therefore, sets out to determine the extent of antibiotic resistance to quinolones and to measure the frequency of qnr genes (A, B, and S) within extended-spectrum beta-lactamase (ESBL) and non-ESBL-producing strains of E. coli isolated from UTI-diagnosed patients as well as to investigate their antimicrobial susceptibility patterns for some selected antibiotics in southwest Iran. Methods Two hundred E. coli strains were isolated from UTI-diagnosed patients, hospitalized in nine different wards of Ahvaz Golestan Hospital between November 2015 and March 2016. The isolates were confirmed through well-practiced phenotypical methods. Moreover, the antimicrobial susceptibility test was successfully performed using a disk diffusion method. ESBL production among the isolates was screened by double disk synergism test (DDST), and the qnr genes were identified using a multiplex PCR. Results Out of the 200 samples collected, 167 isolates were confirmed to be E. coli strains. Maximum and minimum resistance were reported against nalidixic acid and chloramphenicol with 65.3% and 17.4%, respectively. Most of the isolates were resistant to all three types of quinolones studied in this research. Using multiplex PCR, the qnr genes were found in 100 (59.88%) strains (qnrA = 10, qnrB = 21, qnrS = 41, qnrB-S = 21, qnrB-A = 1, qnrA-S = 3, qnrA-B-S = 3), 58% of which was found among ESBL-producing isolates. Conclusions Resistance to quinolones antibiotics was highest among ESBL-producing isolates harboring, especially qnrS among other determinants of the qnr gene. There is a need for sensitive antibiotic stewardship especially in hospitals of Ahvaz, Khuzestan province. Further research is needed to ascertain the gravity of quinolones resistance in Iran and to quickly act against its spread among other nosocomial pathogens.

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.

Introduction: Bacterial bloodstream diseases cause important public health problems and are considered as significant issues in morbidity and mortality in patients who are hospitalized. This study aimed to investigate the frequency of bacterial isolates from suspected septicemia and subsequent drug resistance patterns in affiliated patients to the Amir Al-Momenin Hospital of Gerash, Fars, Iran. Materials and Methods: In this hospital-based cross-sectional study, 2485 blood samples were examined in the Bacteriology Laboratory of Amir Al-Momenin Hospital of Gerash, during 2018-2019. Then, drug susceptibility tests were done for positive blood cultures. All specimens were cultivated in MacConkey agar, Blood Agar, and chocolate agar mediums. A total of 120 positive samples were obtained, and biochemical tests were used to classify bacteria to species levels. After identification, a drug susceptibility test was carried out on the Mueller-Hinton agar via 16 antibiotics based on the Clinical and Laboratory Standards Institute guidelines. Results: Of the 2485 blood culture results, 120 (4.82%) were determined as positive. The blood culture examination revealed the most common isolated as Staphylococcus epidermidis (45%, n=54 cases), Acinetobacter baumannii (10.83%, n=13 cases), Escherichia coli (10%, n=12 cases), Klebsiella pneumoniae (5.83%, n=7 cases), respectively. Additionally, among all the antibiotics tested, the highest percentage of resistance was related to cefoxitin in 48 cases (40%), cephalexin in 47 (39.1%), clindamycin in 47 (39.1%), and erythromycin in 42 (35%). Conclusions: Results revealed that most of the bacterial isolates had a high rate of resistance to the most commonly used antibiotics. Therefore, continuous antibiotic resistance pattern evaluation in different areas is necessary.

Background. Currently, a novel coronavirus found in 2019 known as SARS-CoV-2 is the etiological agent of the COVID-19 pandemic. Various parameters including clinical manifestations and molecular evaluation can affect the accuracy of diagnosis. This review aims to discuss the various clinical symptoms and molecular evaluation results in COVID-19 patients, to point out the importance of onset symptoms, type, and timing of the sampling, besides the methods that are used for detection of SARS-CoV-2. Methods. A systematic literature review of current articles in the Web of Science, PubMed, Scopus, and EMBASE was conducted according to the PRISMA guideline. Results. Of the 12946 patients evaluated in this investigation, 7643 were confirmed to be COVID-19 positive by molecular techniques, particularly the RT-PCR/qPCR combined technique (qRT-PCR). In most of the studies, all of the enrolled cases had 100% positive results for molecular evaluation. Among the COVID-19 patients who were identified as such by positive PCR results, most of them showed fever or cough as the primary clinical signs. Less common symptoms observed in clinically confirmed cases were hemoptysis, bloody sputum, mental disorders, and nasal congestion. The most common clinical samples for PCR-confirmed COVID-19 patients were obtained from throat, oropharyngeal, and nasopharyngeal swabs, while tears and conjunctival secretions seem to be the least common clinical samples for COVID-19 diagnosis among studies. Also, different conserved SARS-CoV-2 gene sequences could be targeted for qRT-PCR detection. The suggested molecular assay being used by most laboratories for the detection of SARS-CoV-2 is qRT-PCR. Conclusion. There is a worldwide concern on the COVID-19 pandemic and a lack of well-managed global control. Hence, it is crucial to update the molecular diagnostics protocols for handling the situation. This is possible by understanding the available advances in assays for the detection of the SARS-CoV-2 infection. Good sampling procedure and using samples with enough viral loads, also considering the onset symptoms, may reduce the qRT-PCR false-negative results in symptomatic COVID-19 patients. Selection of the most efficient primer-probe for target genes and samples containing enough viral loads to search for the existence of SARS-CoV-2 helps detecting the virus on time using qRT-PCR.

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.

Infectious diseases are the biggest cause of mortality and morbidity in humans, especially in poor and developing countries. For many years, no new vaccine has been developed, which indicates the limitations of the development of common vaccines, including destruction and inactivation of the vaccine, weakened vaccines toxoids known as first-generation vaccines. Types of vaccines including: (1) First-generation vaccines, (2) second-generation vaccines or recombinant vaccines, (3) third-generation vaccines (gene vaccine). The study on DNA vaccines first began in the 1990s, when the plasmid DNA is injected into the skin or muscle was reported to induce antibody responses to antigens. Since DNA vaccines are easily designed and manufactured, they are easier to preserve them, and they are inexpensive, as one of the most desirable types of vaccine. However, more clinical trials are needed to prove the immune responses that immune to DNA vaccine in humans. Information on the vaccination method, adjuvant and the genetic structure of the vaccine is still not complete.

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.

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.

ABSTRACT 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.

Background & Aims: Staphylococcus aureus is one of the most common pathogens in nosocomial infections. Vancomycin is the most important therapeutic drug of choice for treatment of infections caused by methicillin-resistant Staphylococcus aureus (MRSA) strains. Therefore, vancomycin-resistant Staphylococcus aureus (VRSA) or vancomycin-intermediate Staphylococcus aureus (VISA) strains are warnings for the medical community. The aim of this study was to evaluate the prevalence of vancomycin resistance in methicillin-resistant Staphylococcus aureus isolated from the nose of patients hospitalized in Imam Reza Hospital, Kermanshah, Iran. Methods: In the present study, 85 strains of methicillin-resistant Staphylococcus aureus were isolated from patients in Imam Reza Hospital and evaluated for vancomycin resistance with microdilution test, Epsilometer test (E-test), and polymerase chain reaction (PCR). Results: None of the strains were completely resistant to vancomycin; however, 39 strains (45.9%) were diagnosed as hetero-VRSA (hVISA)strains. Conclusion: VISA and VRSA strains were not observed in this study which is a promising finding in the treatment of clinical infections due to Staphylococcus aureus in our society. However, in our study, the prevalence of hVISA strain was 45.9%, which is perhaps a sign of the appearance of more resistant strains (VISA and VRSA) in our country in the future.

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.

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.

Background and Objective: Mycobacterium tuberculosis has developed resistance to antituberculosis drugs and becoming a major and alarming public health problem in worldwide. This study was aimed to determine antituberculosis drug resistance rate and to identify multidrug resistant tuberculosis (MDR-TB) in West of Iran. Materials and Methods: Of 130 samples were included between December 2011 and July 2012 in the study from that 112 cases were M. tuberculosis. The proportional method was carried out according to the Clinical and Laboratory Standards Institute on Lowenstein-Jensen against isoniazid, rifampicin, streptomycin, ethambutol, pyrazinamide, para aminosalicylic acid, ethionamide, cycloserine (CYC). The microdilution method was carried out using 7H9 broth with 96 well-plates. Results: From 112 isolates, resistance was observed to isoniazid 18 (16.07%), rifampicin 16 (14.28%), streptomycin 25 (22.32%), ethambutol 15 (13.39%), pyrazinamide 27 (24.10%), para aminosalicylic acid 19 (16.96%), CYC 4 (3.57%), and ethionamide 14 (12.5%) cases. 16 isolates were MDR. Conclusion: The high prevalence of MDR-TB in our study is assumed to be due to recent transmission of drug-resistant strains. Overall, the rate of drug resistance in our study was high, which is in line with findings of some high-burden countries. Hence that early case detection, rapid drug susceptibility testing, and effective anti-TB treatment is necessary.

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.

Backgrounds: Non tuberculous mycobacteria (NTM) are of importance now-a-days due to their increasing virulence outbreaks and emerging antibiotic resistance. Since the most common NTM in Iran is reportedly Mycobacterium fortuitum, the present study was designed with the aim of molecular identification of clinical isolates of M. foruitum to analyse their heterogeneity. Materials and Methods: A total of 81 isolates of NTM isolated from various samples were collected. The clinical isolates were assigned to species M. fortuitum by using conventional and molecular methods. The DNA banding patterns of ERICPCR and RAPD- PCR were analysed by using Bionumeric 7.5 software. Results: Out of 81 tested NTM, 36 strains of M. fortuitum were identified. 33 isolates were selected for molecular typing in this study. Based on RAPD and ERIC analysis, M. fortuitum isolates were divided into 3 and 6 clusters, respectively. Most of the isolates were distributed into types of II RAPD (20 members/ 60.6 %) and V (14 members/ 42.4% with sub cluster I& II) of ERIC. In RAPD analysis, the major fragments were 300 bp, followed by fragment 1000. In ERIC analysis, the major fragments were 280 bp followed by fragment 1200 bp. Conclusion: In conclusion, though the results from this study represented higher discriminatory power of ERIC, however the combination of RAPD and ERIC analysis were able to sufficiently discriminate the genotypic diversity, infection control, and gain useful epidemiological information regarding M. fortuitum isolates.

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: Acinetobacter baumannii is an aerobic non-motile Gram-negative bacterial pathogen that is resistant to most antibiotics. Carbapenems are the most common antibiotics for the treatment of infections caused by this pathogen. Mechanisms of antibiotic-resistance in A. baumannii are mainly mediated by efflux pumps-lactamases. The aim of this study was to determine antibiotic susceptibility, the possibility of existence of OXAs genes and fingerprinting by Pulsed- Field Gel Electrophoresis (PFGE) among clinical isolates of Acinetobacter collected from Kermanshah hospitals. Materials and Methods: One hundred and four isolates were collected from patients attending Imam Reza, Taleghani and Imam Khomeini hospitals of Kermanshah (Iran). Isolates were identified by biochemical tests and API 20NE kit. The susceptibility to different antibiotics was assessed with Kirby-Bauer disk diffusion method. PCR was performed for detection of bla OXA-23 , bla OXA-24 , bla OXA-51 OXA-58 beta-lactamase genes. Clonal relatedness was estimated by PFGE (with the restriction enzyme Apa I) and DNA patterns were analyzed by Gel compare II 6.5 software. Results: All isolates showed high-level of resistance to imipenem, meropenem as well as to other antimicrobial agents,while no resistance to polymyxin B, colistin, tigecylcine and minocycline was observed. The bla OXA-23like and bla OXA-24 like were found among 77.9% and 19.2% of the isolates, respectively. All isolates were positive for bla OXA-51,but none produced any amplicon for bla OXA-58 . PFGE genotype analysis suggested the existence of eight clones among the 104 strains [A (n = 35),B (n = 29), C (n = 19), D (n = 10), E (n = 4), F (n = 3), G (n = 3), H (n = 1)]. Clone A was the dominant clone in hospital settings particularly infection wards so that the isolates in this group, compared to the other clones, showed higher levels of resistance to antibiotics. Conclusion: The bla and bla OXA-23like were the predominant mechanisms of resistance to imipenem in A. baumannii.A high prevalence of clone A, B and C in different parts of the healthcare system showed that hospitalized patients should be safeguarded to prevent the spread of these clones. Early recognition of the presence of carbapenem-resistant A. baumannii clones is useful for preventing their spread within the hospital environment.