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Background : The opportunistic pathogens, methicillin-resistant-Stap hylococcus aureus (MRSA) and Staphylococcus epidermidis , are associated with severe nosocomial infections and high levels of mortality. Healthcare workers colonized with either MRSA or methicillin-resistant S. epidermidis (MRSE) in the nasal cavity are high risk groups for transmitting the agent to hospitalized patients. Objective: This study was carried out to investigate the prevalence of nasal carriage of MRSA and methicillin-resistant S. epidermidis among healthcare providers of Imam Reza University Teaching Hospital, Tabriz, Iran. Methods: A total of one hundred two nasal swabs were obtained from participants working on different wards of the hospitals. The antibiotic resistance pattern was investigated using disk diffusion methods, which were subsequently evaluated by polymerase chain reaction (PCR) for the mecA gene.Results: In the screened population, 22 isolates of S. aureus and 72 of S. epidermidis were detected. Of these, 7 isolates of S. aureus and 36 of S. epidermidis were cefoxitin resistant. Three isolates of S. aureus isolates and 35 of S. epidermidis were MRSE and positive for mecA amplification. Moreover, all isolates were penicillin G resistant but vancomycin and linezolid sensitive. High resistance was observed to clindamycin (74%). Conclusions: The present study indicates that healthcare workers are at high risk of acquisition and transmission of methicillin-resistant Staphylococci. Early screening and decolonization of hospital staff, as well as education on standard sanitation measures, especially hand hygiene practice, remain the most effective strategies for controlling transmission of infectious agents. Hintergrund: Die opportunistischen Erreger Methicillin-resistenter Staphylococcus aureus und Methicillin-resistenter Staphylococcus epidermidis (MRSE) können schwer verlaufende nosokomiale Infektionen mit hoher Mortalität verursachen. Medizinisches Personal, das entweder mit MRSA oder mit MRSE in der Nasenhöhle kolonisiert ist, kann die Erreger auf hospitalisierte Patienten übertragen.Zielsetzung: Die Studie wurde durchgeführt, um die Prävalenz der nasalen Vorkommens von MRSA und MRSE bei medizinischem Personal des Imam Reza-Universitätslehrkrankenhauses in Tabris, Iran, zu untersuchen.Methoden: Es wurden 102 Abstriche im Vestibulum nasi von medizinischem Personal auf verschiedenen Stationen der Krankenhäuser entnommen. Das Antibiotikaresistenzmuster wurde im Plättchendiffusionstest untersucht; anschließend wurde das mecA-Gen mittels Polymerase-Kettenreaktion (PCR) nachgewiesen. Ergebnisse: Bei 22 Personen (21,6%) wurde S. aureus , bei 72 Personen (70,6%) S. epidermidis nachgewiesen. Davon waren 7 S. aureus - und 36 S. epidermidis -Isolate Cefoxitin resistent. Drei S. aureus - und 35 S. e pidermidis -Isolate enthielten das mecA-Gen. Darüber hinaus waren alle Isolate resistent gegen Penicillin G, aber sensitiv gegen Vancomycin- und Linezolid. Es wurde eine hohe Resistenz gegenüber Clindamycin beobachtet (74%).Schlussfolgerungen: Die Studie weist darauf hin, dass Beschäftigte im Gesundheitswesen dem Risiko des Erwerbs und der Übertragung Methicillin resistenter Staphylokokken ausgesetzt sind. Früherkennung und Dekolonisierung des Krankenhauspersonals und die Aufklärung über die Einhaltung der Basishygienemaßnahmen, insbesondere der Händedesinfektion, sind nach wie vor die wichtigste Strategie zur Prävention nosokomialer Infektionen.

Background: Bifidobacteriaceae family are belonged to the gut microbiota that could exhibit probiotic or health promoting effects on the host. Several studies suggested that gut microbiota are quantitative and qualitative altered in patients with chronic kidney disease (CKD) and end-stage renal disease (ESRD). The present study was aimed to assess the members of Bifidobacteriaceae family in fecal samples of patients with CKD and ESRD in compared to non-CKD/ESRD patients to find any changes of their counts in these patients.Methods: Twenty fresh fecal samples of patients with CKD/ESRD and twenty from non-CKD/ESRD patients were included. The whole DNA of fecal samples were extracted and the gut microbiota composition was analyzed by next generation sequencing (NGS) method.Results: Total 651 strains were identified from 40 fecal samples, which 8 (1.23%) strains were identified as family Bifidobacteriaceae. The most abundance species in both control and disease group were Bifidobacterium adolescentis (2.10% ± 1.05% vs. 1.98% ± 1.53%, respectively) and the lowest abundance species in disease group was Bifidobacterium animalis subsp. lactis (0.0007% ± 0.0009%).Conclusions: There was no significant differentiation in the abundance of various species between disease group and control group (p

Background: Microscopic smear examination is the most common test in tuberculosis (TB) detection. It is, however, not strong enough to identify TB in the majority of afflicted individuals; thus, a significant number of TB patients are smear negative and capable of transmitting the infection. The aim of this study was to evaluate the rate of smear-negative TB in northwest Iran. Methods: In this cross-sectional study, 329 TB-confirmed patients were evaluated through culture up to March 1, 2015, in northwest Iran. The demographic and clinical features of the smear-negative and smear-positive TB patients were compared. The χ2 test was used to compare the frequency of the variables. All the statistical analyses were conducted using SPSS, version 16 (Chicago, IL, USA). Results: Seventy-five cases were smear negative and 254 were smear positive. Smokers, asthmatics, and extra-pulmonary TB patients were primarily among the smear-negative cases. The rate of mortality was also relatively higher among the smear-negative TB patients. Conclusion: Totally, 22.8% of the TB cases in northwest Iran were smear negative, with a relatively higher rate of mortality than those with positive smears. A delay in these patients’ return to TB diagnosis and treatment centers increases the chance of transmission to others. This is a very sensitive issue in centers where there is no equipment for TB cultivation. Thus, it is essential to equip centers without TB cultivation facilities and to use appropriate diagnostic techniques in centers with those facilities to help rapidly detect smear-negative cases.

Background: Today because of immigration, HIV pandemic and spread of drug resistant tuberculosis, mortality caused by tuberculosis (TB) has increased. To control the disease it is essential to identify the sources of the infection and patterns of transmission. This becomes possible through using molecular epidemiology methods. Materials and Methods: This research reviewed studies based on IS6110-restriction fragment length polymorphism (IS6110-RFLP) as a primary method to recognize the role of molecular epidemiology researches in managing TB in Iran. Within 1995–2015 all human population based studies which had use IS6110-RFLP as the primary method systematically reviewed. Results: At the end, 11 articles were selected. The mean clustering rate obtained was 28.1%. The rate of recent transmission was variable from 2% to 49% and the mean value was determined 17%. Conclusion: The studies revealed that in Iran both reactivation and recent transmission were significant in developing new cases of TB. Yet, reactivation plays greater role. If the matter is supervised insufficiently and carelessly, because of increasing rate of drug resistant TB, immigration of HIV infected individuals, TB especially drug resistant TB will be problematic in the near future.

The growing incidence of community acquired infection due to Extended-Spectrum Beta-Lactamase (ESBL) - and plasmid-mediated AmpC β-lactamase prducing bacteria represent a great concern because there are few therapeutic choices. This study was aimed to determine the prevalence of faecal carriage of ESBL producing Klebsiella spp. and Shigella spp. among inpatient and outpatient and their phenotype-genotype resistance correlation that conveyed ESBL with or without AmpC genes at a university hospital in Tabriz, Iran. During March to May 2015, 200 faecal samples from hospitalized and non-hospitalized patients without gastrointestinal illness and diarrhea were cultured on MacConkey agar plate supplemented with 2 μg/mL of cefotaxime.Bacterial identification, antimicrobial susceptibility testing and ESBLs confirmatory tests were performed according to the standard guidelines. Also, polymerase chain reaction (PCR) was used to identify the genetic determinants responsible for ESBL production (TEM, SHV, and CTX-M) and AmpC β-lactamase genes. Of 200 faecal samples analysed, 23 (11.5%) Klebsiella pneumonia, and 4 (2%) Shigella spp. were isolated. The co-resistance frequencies in isolates recovered were as follows: Ciprofloxacin, 4.3%; Gentamicin, 4.3%; Ceftazidime, 13%; Cefepime, 17.4%; amoxicillin-clavulanic acid, 47.8%; and Ampicillin, 87%. Six (26.08%) of the Klebsiella isolates had phenotypic evidence of ESBL production, while blaSHV sequences were detected in 18 (66.6%), and blaTEM in 11 (40.7%) isolates. Also, blaCTX-M and blaCMY sequences were found in 4 (17.39%) and 5 (21.7%) Klebsiella isolates, respectively. This study revealed that ESBL production was relatively prevalent in faecal carriage of Klebsiella and Shigella isolates in Tabriz. In addition, Persons attending hospital could be a reservoir of such bacteria and enzymes.Keywords: Shigella; Klebsiella; ESBL; Faecal carriage; Iran

Promoter polymorphism of cytokine genes may lead to inter-individual differences in cytokine levels, therefore, polymorphisms may associate with susceptibility to infectious diseases. In this study, we investigated a possible association between interleukin-10 (IL-10) -1082A⁄G (rs1800896) and interferon (IFN)-gamma +874T/A (rs2430561) promoter polymorphisms and tuberculosis (TB) in the Azeri population of Iran. IL-10 -1082G/A and IFN-gamma +874T/A single nucleotide polymorphisms (SNPs) were genotyped by amplification refractory mutation system (ARMS)-PCR in 200 healthy controls and 124 tuberculosis patients. IL-10 -1082 A allele was more frequent in the control group than in the patient group (p=0.001, odds ratio [OR]=2.183). On the other hand, the AA genotype was significantly more frequent in the control group (p=0.0001). The frequency of IFN-gamma +874 T allele was significantly higher in the controls (p=0.013, OR=1.56). There was no significant association between IFN-gamma +874 T/A genotypes and susceptibility to tuberculosis (p=0.078), but TT genotype was more frequent in the control group. Our findings suggest that interleukin-10 -1082G/A polymorphism may play an important role in susceptibility to tuberculosis in our population. On the other hand, the +874T allele, which has been suggested to be associated with high IFN-gamma levels, was significantly higher in the controls and TT genotype was also more frequent in the control group. Thus, +874 T allele may be associated with resistance to tuberculosis in this Azeri population of Iran.

Background:Pseudomonas aeruginosa, as Gram-negative rod bacilli, has an important role in human infection. In the present study we aimed to investigate the presence of exo genes and biofilm production among Pseudomonas aeruginosa isolates in Northwest Iran. Material and methods: 160 isolates of P. aeruginosa were collected and identified by biochemical tests and were characterized for antibiotic resistance. Biofilm production was evaluated by microtiter plate assay and the presence of exo genes was evaluated by allele-specific PCR (polymerase chain reaction). Chi-square test was used for statistical analysis. Results: The most effective antibiotics against isolates were colistin and polymyxin B. 87% of the isolates were biofilm producers of which 69% were strongly biofilm producers. 55% of the isolates carried exoY, 52% of the isolates carried exoU, and 26.3% and 5% carried exoS and exoT, respectively. Conclusion: Our findings showed different distribution of exo genes in clinical isolates of P. aeruginosa in Northwest Iran. ExoS and exoU were more prevalent in non-biofilm producers and exoY was more prevalent in biofilm producer isolates. These results might indicate the importance of exoY in biofilm production of Pseudomonas aeruginosa., Hintergrund:Pseudomonas aeruginosa, ein Gram-negatives Stäbchenbakterium, besitzt eine wichtige Rolle als Krankheitserreger. Daher untersuchten wir Pseudomonas aeruginosa-Isolate im Nordwestiran auf das Vorkommen von exo-Genen und Biofilmbildnern. Material und Methode: 160 P. aeruginosa-Isolate wurden biochemisch identifiziert und die Antibiotikaresistenz charakterisiert. Die Fähigkeit zur Biofilmbildung wurde im Mikrotiterplatten-Assay, das Vorkommen von exo-Genen mit Allel-spezifischer PCR (Polymerase-Kettenreaktion) analysiert. Zur statistischen Analyse wurde der Chi-Quadrat-Test eingesetzt. Ergebnisse: Als effektivste Antibiotika erwiesen sich Colistin und Polymyxin B. 87% der Isolate waren Biofilmbildner, davon 69% mit massiver Biofilmbildung. In 55% der Isolate wurden exoY, in 52% exoU, in 26,3% exoS und in 5% exoT nachgewiesen. Schlussfolgerung: Die Analyse ergab eine unterschiedliche Verteilung der exo-Gene bei klinischen Isolaten von P. aeruginosa im Nordwestiran. ExoS und exoU kamen häufiger bei nicht biofilmbildenen Isolaten, exoY häufiger bei Biofilmbildnern vor. Die Ergebnisse können ein Hinweis auf die Bedeutung von exoY bei Biofilm bildenden Pseudomonas aeruginosa-Isolaten sein., GMS Hygiene and Infection Control; 11:Doc04

Background and objectives: The Escherichia coli (E. coli ) bacterium is one of the main causative agents of urinary tract infections (UTI) worldwide. The ability of this bacterium to form biofilms on medical devices such as catheters plays an important role in the development of UTI. The aim of the present study was to investigate the possible relationship between virulence factors and biofilm formation of E. coli isolates responsible for urinary tract infection.Materials and methods: A total of 100 E. coli isolates isolated from patients with UTI were collected and characterized by routine bacteriological methods. In vitro biofilm formation by these isolates was determined using the 96-well microtiter-plate test, and the presence of fimA , papC , and hly virulence genes was examined by PCR assay. Data analysis was performed using SPSS 16.0 software.Results: From 100 E. coli isolates isolated from UTIs, 92% were shown to be biofilm positive. The genes papC , fimA , and hly were detected in 43%, 94% and 26% of isolates, respectively. Biofilm formation in isolates that expressed papC , fimA , and hly genes was 100%, 93%, and 100%, respectively. A significant relationship was found between presence of the papC gene and biofilm formation in E. coli isolates isolated from UTI (P

Is Hair Lice Still a Public Health Problem?

No Abstract.

Background: Tuberculosis (TB) is a public health problem in developing countries and yet the numbers of people with the disease are abundant. Early detection of transmission sources and effective treatment of the cases is essential to control the disease which will be possible by application of molecular epidemiology approaches. Studies conducted based on Mycobacterial Interspersed Repetitive Units-Variable Number of Tandem Repeats (MIRU-VNTR) method in Muslim Middle East countries were evaluated to determine their role in TB control. Materials and Methods: All studies from January 2005 to April 2016 were systematically reviewed in four electronic databases and finally 16 articles were found eligible to be included in this study. The mean clustering rate was determined as 44% and the recent transmission rate was 12.3 to 78.8% with average of 33%. Results: The results showed that both reactivation and recent transmission were important in developing new cases of TB in Middle East countries; but, reactivation plays a more critical role. Conclusion: Regarding to ongoing war and immigration in the region along with the increasing of drug-resistant TB, in the case of improper supervision in the future, the disease, especially drug- resistant TB, will be problematic.

The emergence and spread of carbapenemase-producing bacteria, that hydolyze most β-lactams, including carbapenems, are a major concern of public health system worldwide, particularly in the Middle East area. Since the plasmids harboring resis- tance genes could be spread across other bacterial populations, detection of carbapenemase-producing organisms has become more problematic. These organisms produce different types of enzymes including the most prevalent types including KPC, VIM, IMP, NDM, and OXA-48. Carbapenemase producers are mostly identified among Escherichia coli, Klebsiella pneu- moniae, Pseudomonas aeruginosa and Acinetobacter baumannii. This study reviewed almost all papers, which conducted in the Middle East. In order to decrease the spread of resistance, the regional cooperation has been emphasized by the Middle East countries. The highest resistance, which is mediated by KPC has been observed in Afghanistan, Saudi Arabia and Jordan followed by NDM in Pakistan and OXA in Turkey and Pakistan. It is important to mention that the spread of these types have been reported sporadically in the other countries of this area. This review described the widespread carbapenemases in the Middle East area, which have been identified in an alarming rate.

The current study was conducted to determine prevalence and antimicrobial susceptibility patterns, ESBL, AmpC and carbapenemase- producers among clinical isolates of Enterobacteriaceae. Three hundred and seven non-duplicative clinical isolates were collected from hospitalized patients in five medical centers in Azerbaijan, Iran. Initial screening for β-lactamase production was performed using disc agar diffusion according to Clinical Laboratory Standards Institute (CLSI) guidelines. Phenotypic confirmatory tests was done using total ESBL/AmpC confirm kit, KPC/MBL and OXA-48 confirm kit according to manufacturer’s instructions. The overall prevalence of ESBL, AmpC, and carbapenemase-producing strains were 42.7% (131/307), 14.0%(43/307) and 4.9% (15/307), respectively. The prevalence of ESBLs was 38.35%, 64.9% and 35.7% for E. coli, K. pneumoniae and E. cloacae, respectively. Carbapenemase activity was only observed among 15 K. pneumoniae isolates and detected phenotypes include MBL (9/57, 15.8%), KPC (4/57, 7.0%), and OXA-48 (2/57, 3.5%). Fourteen out of 307 isolates (4.6%) were recognized to have ESBL or AmpC hyper-producer with decreased cell wall permeability phenotype. All 4 shigella strains were positive for ESBL and 4 isolates of P. mirabilis, 2 isolates of M. morganii and 1 seratia spp. were detected as AmpC producer. The only C. freundii strain isolated was positive for both ESBL and AmpC. This study reveals high prevalence of multidrug-resistant (MDR) β-lactamase-producing Enterobactericeae reaching 89.5%. Imipenem and meropenem showed potent antibacterial activities against all MDR β-lactamase-producers except for carbapenemase producers. After carbapenems, amikacin, piperacillin/tazobactam and amoxicillin/clavulanic acid were second the most effective drugs against β-lactamase-producing E. coli isolates.

Tuberculosis is a major health problem throughout the world and there are still a great number of people with the disease. Planning for controlling tuberculosis is required to identify the sources of infection and screening for the disease. The aim of this study is the differentiation of Mycobacterium tuberculosis strains for better understands the spread of the disease in North West Iran. In this study, 194 positive cultures of M. tuberculosis in North West Iran were evaluated by the MIRU-VNTR method. MIRU-12 differentiated the 194 isolates into 138 different patterns, comprising 30 clusters and 108 unique patterns (HGDI=0.9930). The largest cluster contained twelve isolates. The results showed that the majority of TB cases in North West Iran are due to reactivation and the 12-MIRU typing method can be used as a first-line method for strain differentiation of M. tuberculosis.