afsaneh karmostaji

 Staphylococcus aureus is a significant bacterial pathogen globally recognized as the primary cause of numerous uncomplicated skin infections and severe invasive infections. The emergence of methicillin-resistant S. aureus (MRSA) poses a serious threat, leading to severe infections in both hospitals and community settings.

 The aim of this study was to identify antibiotic resistance patterns and perform molecular classification of S. aureus strains isolated from both hospital and community settings in southern Iran.

 In this cross-sectional study conducted in Bandar Abbas between 2020 and 2021, a total of 156 clinical strains of S. aureus were collected. Antibiotic susceptibility was determined using the disk-diffusion agar method. The presence of the pvl gene, Sccmec types, and Agr group was identified through PCR analysis. Additionally, Multilocus sequence typing (MLST) was performed on selected isolates.

 The study identified 156 strains, with 79 obtained from inpatients and 77 from outpatients, sourced from clinical samples. Among these isolates, 70 (44.8%) were classified as MRSA. The highest resistance was noted against azithromycin (83%), while the lowest resistance was observed for linezolid (5%) and gentamicin (7%). The presence of the pvl gene was detected in isolates from both hospital and community sources. Significant differences were noted in the occurrence of agr I and agr III genes between hospital and community isolates. Sccmec III was more predominant than other SCCmec types. Furthermore, MLST analysis revealed the presence of five distinct novel sequence types (STs): ST8634, ST8640, ST8650, ST8651, and ST8652.

 The findings indicate that the potential spread of hospital-acquired S. aureus strains to the community and vice versa poses a significant public health risk. This underscores the urgent need for robust infection control strategies and the identification of potential environmental and hospital sources of resistant strains, particularly MRSA strains.

With reducing the immune function of the pulmonary, smoking is considered a risk factor for contracting other infections with more severe outcomes. The present study investigates a meta-analysis of the association between smoking and the progression of COVID-19 infection in Iran.

The online databases of PubMed/MEDLINE and Web of Science were searched on August 23, 2022, with the following terms: (‘‘COVID-19’’ OR ‘‘SARS-CoV-2’’ OR ‘‘Coronavirus’’), AND (‘‘smoking’’ OR ‘‘smoker*’’), AND (“Iran”). In this review, we included the studies with molecular-confirmed cases of COVID-19 and the outcome of death. The Mantel-Hensel meta-analysis method with random effects was used to investigate the relationship in the data.

We identified 8 papers with a total of 9199 COVID-19 patients, of whom 1861(20.2%) had the outcome of death, and 1105(12%) had a history of smoking. A total of 274 patients with a history of smoking (24.7%) were dead. The meta-analysis showed a significant association between smoking and death related to COVID-19 (odds ratio=1.22, 95% confidence interval [1.03-1.44], P=0.001). Therefore, the probability of death in COVID-19 patients with a history of smoking is about 22% higher than other people.

Smoking is a risk factor for the progression of COVID-19, with smokers having higher odds of COVID-19 progression than non-smokers.

This study aimed to assess the molecular characteristics of methicillin-resistant Staphylococcus aureus (MRSA) strains isolated from community-acquired (CA) and hospital-acquired (HA) infections in Bandar Abbas, southern Iran.

This descriptive cross-sectional study was conducted on 110 S. aureus strains isolated from 59 outpatients and 51 inpatients during 2018-2019. Antimicrobial susceptibility testing was performed using disc diffusion method. Epsilometer test was used to measure vancomycin minimum inhibitory concentration (MIC). Cefoxitin disc (30 μg) was used to screen MRSA isolates. The presence of mecA gene was examined by PCR method.  Staphylococcal cassette chromosome mec (SCCmec) types were detected in S. aureus isolates using multiplex-PCR. Chi-square and Fisher's exact tests were used to analyze the results.

Out of 110 isolates, 45 (40.9%) isolates carried the mecA gene: 20 (39.2%) isolates from inpatients and 25 (42.4%) isolates from outpatients. MRSA isolates showed the highest resistance to azithromycin (69.8%), tetracycline (60.4%), and clindamycin (32.1%), respectively. Vancomycin MIC against MRSA isolates ranged from 0.75 to 5 μg/mL. SCCmec type I, III, IV, and V were detected in 20 (44.4%), three (6.7%), 16 (35.5%), and six (13.3%) isolates, respectively.

The predominant SCCmec types were type I and type IV, which were detected in CA- and HA-MRSA isolates, respectively. No significant difference in the presence of SCCmec type III and antibiotic resistance was found between CA- and HA-MRSA isolates, indicating the possibility of cross-infection between these isolates. Developing appropriate treatment protocols to prevent the spread of MRSA infections in the community is currently an urgent need.

In recent years, Enterococcus species have emerged as a leading cause of nosocomial infections worldwide. The aim of this study was to determine the virulence biomarkers and antibiotic resistance profiles of Enterococcus spp. collected from a main tertiary teaching hospital in Bandar Abbas, Iran.

A total of 71 Enterococcus were isolated from clinical specimens of patients in different wards of a hospital. Enterococcus spp. were verified by detecting ddl gene using PCR-based method. Virulence-encoding genes including gelE and cylA were detected using PCR. Antibiotic resistance was assessed using the disk diffusion assay, and vancomycin resistance was identified using the E-test method.

Among Enterococcus isolates, 50 and 21 isolates were identified as E. faecalis and E. faecium, respectively. Most of the Enterococcus species were isolated from urine, followed by wound samples. The most prevalent virulence genes among E. faecalis isolates were cylA (60%) and gelE (30%); also, 19 and 14% of E. faecium isolates were positive for cylA and gelE genes, respectively. Many isolates of E. faecalis (84%) and E. faecium (76%) were resistant to one or more antibiotics and showed high resistance to gentamicin and ciprofloxacin.

This study revealed a high prevalence of ciprofloxacin and gentamicin resistance and a high frequency of virulence genes among E. faecalis isolates. Due to the high prevalence of MDR Enterococcus strains, control measures are necessary to prevent the emergence and transmission of these strains in different hospital wards.

Enterococcus is a part of normal gastrointestinal flora in human body. Nevertheless, antibiotic-resistant Enterococcus (ARE) is considered a key factor in nosocomial infections which result in a considerable increase in the rate of patient death due to referring of numerous patients to health centers annually, or lead to extended disease convalescence.

This study aimed to evaluate the bactericidal effect at 405nm diode at a laser power of 30 mW on ARE viability of clinical infections.

In the present study, 30 isolates underwent antibiotic susceptibility test (AST) in which sensitivity to piperacillin (100 µg), rifampin (5 µg), and oxacillin (1 µg) were measured based on the Clinical and Laboratory Standards Institute (CLSI) guidelines. Afterwards, ten most resistant isolates were selected and irradiated by a 405 nm diode laser at a power of 30 mW for 180 and 240 seconds. The data were reported statistically as mean ± standard deviation, and the analysis of the data on varied bacteria was performed using ANOVA. The result was evaluated by SPSS software and P value ≤0.05 was interpreted to be significant.

Bacterial viability decreased unsteadily to 10 resistant isolates. Moreover, enhancing irradiation time caused a lower viability rate in such a way that the viability of isolate 9 having the lowest viability rate was reduced from 2.94% in 180 seconds to 0.58% in 240 seconds. The result was evaluated by SPSS software and P value was determined to be significant, and P≤0.05 was laser irradiation for either 180 s or 240 s.

Following the study results, 405 nm diode laser could be applied as a tool for eliminating clinical ARE, and it was useful for preventing hospital-acquired infections.

Gram-negative bacilli are important hospital pathogens with an increasing prevalence of broad-spectrum beta-lactamase genes and integrons. Therefore, identification of these antibiotic resistance genes is essential to prevent the spread of resistant strains.The aim of this study was to determine the frequency of class 1, 2 and 3 integrons and bla-CTX-M, bla-SHV and bla-TEM broad-spectrum beta-lactamases genes in Gram-negative bacilli isolated from Bandar Abbas Pediatric Hospital.

Sixty Gram-negative bacilli strains were isolated from clinical specimens and identified by biochemical tests and their antibiotic resistance patterns were determined by Disk Diffusion method. Multiplex PCR was used for detection of class 1, 2 and 3 integronsand PCR wasperformed to identify the bla-CTX-M, bla-SHV and bla-TEM family’s genes, respectively.

The most frequent strains belonged to Escherichia coli 70% and the highest resistance and sensitivity were Sulfomethoxazole 68% and Gentamicin 75% respectively.Of the 60 strains isolated, 61.7% and 26.7% had Class I and 2 integron genes, respectively, whereas no class 3 integron gene was detected in any of the isolates. PCR results showed that blaCTX-M, blaSHV and blaTEM family genes were 66.7%, 10% and 31. 7% strains, respectively.

In this study, there was a significant correlation (p < 0.05) between the presence of class 1 and 2 integrons, bla-CTX-M, bla-SHV and bla-TEMand antibiotic resistance. Therefore, determination of antibiotic resistance genes and the use of appropriate therapeutic methods based on antibiogram pattern determination of the strains are also suggested.

Due to the significant use of vancomycin antibiotic in hospitals and the need for rational use of this antibiotic to prevent the occurrence of antibiotic resistance, the present study was conducted to evaluate the administration and pattern of vancomycin antibiotic use in the Payambar-e-Azam Hospital of Bandar Abbas.

The present study was a retrospective descriptive study in the 2017 year. Patients treated with vancomycin during one year were selected by reviewing the information of patients admitted to the Payambar-e-Azam Hospital of Bandar Abbas. Then, referring to the records of these patients in hospital medical records, the required information was extracted. The information was then reviewed by an infectious disease specialist according to the Infectious Diseases Society of America (IDSA) and Defined Daily Dose (DDD) guidelines.

In this study, 189 patients receiving vancomycin antibiotics in different wards of the Payambar-e-Azam Hospital of Bandar Abbas were evaluated. Of the patients studied, 49 (26%) received vancomycin in the first line of treatment. 170 (90%) were prescribed antibiotics based on experience and 19 (10%) on antibiogram testing. Among the recipients of vancomycin antibiotics, antibiotic use for 92(48/7%) patients was based on a defined daily dose (DDD).

In the present study, about half of the prescribed vancomycin was administered according to DDD guidelines, but most of the treatments are experimental without regard to antibiogram and culture results.

Given the significant consumption of antibiotics in hospitals and the likelihood of resistance, this study was designed to determine the pattern of meropenem and cefepime administration and prescription dose, according to Infectious Disease Society of America (IDSA) and WHO Defined Daily Dose guidelines, at Payambare-Azam Hospital in Bandar Abbas, Iran.

A Retrospective study was performed from August 2016-March 2017, on 200 patients (100 patients receiving cefepime and 100 patients received meropenem) hospitalized in different wards of the hospital. A total of 189 patients were enrolled in the study, with was with consideration of the patients receiving the two antibiotics concurrently.

Of the examined patients, 58 (31%) were female and 131 (69%) male. In the group receiving meropenem and cefepime, 62% and 60% of the patients were above 50 years old, respectively. In terms of prescriptions, 85% cases of meropenen and 49% cefepime were performed according to the defined daily dose (DDD)’s guideline. Prescribing antibiotics for 170 (90%) of patients was empirical. Also, in the 176 (93%) patients, the dose was adjusted according to the creatinine clearance.

Increasing the number of empirical therapy, regardless of microbial cultures and susceptibility profiles, suggests further prospective studies to evaluate the reason for this finding

Laboratory science graduates are experts who together with other health care workers will be responsible for performing common clinical laboratories practices. In order to do this, the students must acquire the necessary knowledge and skills during the internship, and various problems will reduce the efficiency of internship in the field of laboratory sciences students. Identifying and solving these problems is essential to enhance the efficiency of this course. This research was done with the purpose of examining the laboratory sciences clerkship course by knowing about the viewpoints of the related faculty members, graduates and students at Hormozgan University of Medical Sciences.. In this qualitative study, a purposive sampling was used to select the subjects from the population of trainees, graduates and the faculty members, graduates and students of laboratory sciences. Semi-structured interviews were conducted. The results of the interviews led us to select the next sample, until no fresh ideas were gained. After gathering data from 13 persons, the results of the study were investigated by means of content analysis methodology. By analyzing research data, five key themes were identified including clerkship curriculum, Expectations from clerkship, motivation of students for clerkship involvement and clerkship planning and management. The results of this study demonstrated that general view of instructors and students are positive, but in the implementation, there are problems that should be addressed by the authorities.. So it is necessary for officials to improve the quality of clerkship through more incorporated plans.

Staphylococcus is an important pathogen for humans, which is found on skin, mucous membranes and oropharynx of healthy individuals. The bacteria can cause a range of infections from simple wounds and skin abscesses to severe infections such as pneumonia, septicemia, osteomyelitis and endocarditis. Unfortunately because of emerging drug resistance, infections caused by this organism are difficult to treat and may be a leading cause of mortality. This study was aimed to assess the pattern and trend of resistance in Staphylococcus aureus in a referral hospital Shahid mohammadi hospital at Bandar abbas, South of Iran. A prospective cross-sectional study was designed from 2009-2014 on 406 strains of Staphylococcus aureus isolated from patients admitted to a referral hospital in south of Iran. The samples were collected from urine, wounds, ear discharge, burn wound, throat, tracheal secretions, abscess and joint fluid. Antibiotic susceptibility pattern was tested by disc diffusion. The results were analyzed with SPSS 21, using descriptive statistics. Of the collected isolates, 63% were from Men and 37% were from Women. Mean age of the patients was 35 Years. Highest resistance rate was observed for Amoxicillin (88.6%) and lowest resistance was identified for Ciprofloxacin (19.9%). Emerging of multidrug resistance is alarming among Staphylococcus aureus in south of Iran. The abundance of antibiotic prescription and antibiotic sensitivity pattern should be considered because The antibiotic sensitivity varies in different times and different regions. Necessary measures should be taken. appropriate patient treatment and planning should be designed to control and reduce the resistant species, morbidity and mortality associated with MRSA infections.

Escherichia coli (E. coli) lives naturally in the human gut; however, emerging increase in bacterial resistance to antibiotics in some strains leads to chronic infection. Thus, more studies have recently focused on the characterization of potential plant natural antimicrobial agents, with fewer side effects. In the present study, antibacterial effects of salvia (teucrium polium) and rosemary officinalis extract have been evaluated against clinical isolated E. coli from urinary samples.
In parallel with using Trimethoprim, Ceftriaxone, Cefixime, Cefotaxime, Ciprofloxacin, Gentamicin, Ceftazidime, and Meropenem against E. coli, salvia and rosemary plant extracts have also been used separately and in association with the antibiotics to detect the sensitivities of the bacteria to the components.
Salvia and rosemary had synergistic effects on ceftazidime against E. coli. The components decreased sensitivities of E. coli to some of the antibiotics.
Based on the results, salvia and rosemary are able to increase anti-E. coli effects of ceftazidime and can be considered as future supplementary components against the bacteria.

Multi-drug resistant Escherichia coli and Klebsiella pneumoniae with various resistance determinants are a major concern in hospital and community acquired infections around the world.
To describe the presence of blaCTX-M, blaTEM, blaPER, blaVEB, and integrons class 1, 2, 3 and extended spectrum β lactamase (ESBL) phenotype in E. coli and K. pneumoniae isolates from clinical samples of inpatients and outpatients.
One hundred and eighty six E. coli and fifty-eight K. pneumoniae were collected. Antimicrobial susceptibility test was performed by disk diffusion method. Extended-spectrum beta-lactamase phenotype were screened by phenotypic confirmatory test. PCR assay was performed for blaTEM, blaCTX-M, blaPER and blaVEB and class 1, 2, 3 integrase genes. Statistical analysis was performed by chi-squared test.
Extended-spectrum beta-lactamase phenotype was detected in 49 (26.3%) E. coli and 19 (32.8%) K. pneumoniae isolates. BlaVEB gene in 32 (17.2%) E. coli and 5 (8.6%) K. pneumoniae isolates. BlaPER gene in 4 (2.1%) E. coli and 0 (0%) K. pneumoniae isolates. BlaCTX-M gene in 113 (60.7%) E. coli and 34 (58.6%) K. pneumoniae isolates. BlaTEM gene in 106 (57%) E. coli and 25 (43.1%) K. pneumoniae isolates. One hundred and nine (58.6%) of E. coli and 33 (56.9%) of K. pneumoniae were carrying Class 1 integron and 18 (9.7%) of E. coli and 3 (5.2%) of K. pneumoniae were carrying Class 2 integron. Class 3 integron was not detected.
High prevalence of ESBLs in E. coli and K. pneumoniae isolated from the community and hospital acquired infections could lead to the wide spread of multi-drug resistance clones that also contain new mechanism of resistance.

Acinetobacter species are important opportunistic pathogens, widely spread in hospital's environment and responsible for different health care associated infections. Because of its ability to rapidly develop resistance to the major groups of antibiotics, treatment of Acinetobacter infections is difficult and antibiotic susceptibility tests can help in choosing the best antibiotics, decreasing the cost and duration of hospitalization. The goals of this study were to determine frequency and antimicrobial susceptibility pattern of Acinetobacter species, clinical parameters and outcomes of patients, in Shahid Mohammadi hospital, Bandar Abbas.
Between April 2010 and March 2011, a total of 2132 positive cultures were obtained from various clinical specimens of hospitalized patients. Suspicious isolates of Acinetobacter were identified by routine microbiological methods. Antibiogram patterns of isolates for 12 currently used antibiotics were determined by Kirby-Bauer method. Clinical and microbiological data of patients was analyzed by SPSS 16 software.
A total of 68 (3.2%) Acinetobacter species was isolated. Acinetobacter isolates was mostly obtained from ICU (24 cases, 35.8%) and emergency (12 cases, 17.9%) wards, and trachea was the major site of infection (41.2%). Colistin with 83.7% susceptibility rate was the most effective antibiotic, followed by ofloxacine 47.4% and chloramphenicol 39.5%. A high rate of resistance was observed to meropenem (98.1%), and cefepime (90.4%). Mortality rate was 14.7% in patients, mostly because of bacteremia.
Because of its serious infections and high-drug resistance, continuous monitoring of antimicrobial susceptibility and strict adherence to infection guidelines are essential to prevent and decrease Acinetobacter infections.

Pseudomonas aeruginosa is one of the main causes of nosocomial infections with a mortality rate up to 40-50%. Resistance to antibiotics is a global challenge in the treatment of infections caused by this bacterium. The Class A beta-lactamases genes, including blaSHV, blaPER, blaVEB, are the most common causes of resistance in this microorganism. This study was conducted to determine antibiotic resistance pattern and the presence of blaper, blaveb, blashv and blaoxa-10 genes in clinical isolates of P. aeruginosa isolated from patients in a hospital in Bandar Abbas.
This cross-sectional study was conducted on 72 P. aeruginosa clinical isolates. Antibiotic susceptibility testing was performed by disk diffusion method according to the clinical Laboratory Standard Institute. MIC (Minimum inhibitory concentration) of ceftazidime was performed by E-Test. Polymerase chain reaction (PCR) was performed to identify blashv, blaveb-1, blaoxa-10, and blaper-1 genes.
Most of the isolates were detected from intensive care unit and urine samples. The highest resistance rate which was observed to sulfamethoxazole and ceftazidime, were 68 (94.44%) and 44 (61.11%), respectively. 27.8% of these isolates were multidrug resistance. Among 44 ceftazidime resistance isolates, 15 isolates (34%) showed MIC ≥32 µg.ml in the E- test. The prevalence rates of genes were 4.16, 12.5, 8.33, and 1.38% for blaOxa-10, blaShv, blaVeb-1, and blaPer-1 genes, respectively.
The ceftazidime resistance rate and the prevalence rate of resistance genes in the present study were lower than other Iranian studies. However, isolation of these genes is alarming that excessive use of antibiotics can lead to over expression of resistance genes and bacterial efflux pumps and the emergence of MDR phenotypes.

Infections caused by Pseudomonas aeruginosa or Acinetobacter baumannii are of greatest concern for hospitalized patients, particularly those in intensive care units (ICUs). The aims of this study were to investigate the prevalence of integrons and biofilm formation among P. aeruginosa and A. baumannii isolates collected from ICU and non-ICU inpatients. A total of 90 P. aeruginosa and 90 A. baumannii isolates were recovered from patients admitted into diverse units of Shahid Mohammadi hospital in Bandar Abbas from January to December 2014. Bacterial identification was carried out by phenotypic methods and PCR. Antibiotic susceptibility was measured by disk diffusion assay. The presence of Class 1, 2, and 3 integrons were evaluated by multiplex-PCR. Biofilm quantification was done by microtiter method. The highest number of isolates (48%) were recovered from ICU patients. 81% of P. aeruginosa isolateswere sensitive to piperacillin/tazobactam and ticarcillin, while 60% were resistant to third generation of cephalosporins. In case of A. baumannii, all the isolates were sensitive to colistin, but 98% were resistant to other antibiotics (p≤0.05). Susceptibility to ceftazidime, ticarcillin, imipenem, and piperacillin/tazobactam were higher among isolates obtained from non-ICU patients. Class 1 integron was detected in 13.3% of the P. aeruginosa and 40% of the A. baumannii isolates, while Class 2 integron was harbored by 7 and 6.6% of the isolates, respectively. Furthermore, 23% of the A. baumannii and 12% of the P. aeruginosa isolates showed strong biofilm activity. Class 1 integron-positive isolates were resistant to three classes of antibiotics and predominantly observed in specimens collected from ICU patients showing strong biofilm.

Acinetobacter baumannii has emerged as an important nosocomial pathogen. Hospital outbreaks of extensively drug resistant (XDR) A. baumannii are a great concern. Aims of this study were to characterize the resistance determinants and genetic relatedness of (XDR) A. baumannii isolates in hospitals in Tehran, Iran. During a three-year study, clinical isolates of A. baumannii were collected from two hospitals in Tehran, Iran. Susceptibility testing to antibiotics was performed by disk diffusion method and XDR A. baumannii isolates were identified. Genes’ encoding for carbapenemase production and integrons were identified by PCR. MICs of imipenem and meropenem were determined by agar dilution. Multiple locus variable-number tandem repeat analysis (MLVA) typing was used to determine genetic relationships of XDR isolates. Using PCR for amplification of blaOXA-51, 93.9% (123.131) of isolates were identified as A. baumannii and 24.4% (30.123) were XDR. These isolates were resistant to gentamicin, ciprofloxacin, amikacin, cotrimoxazole, cefepime, cefotaxime, aztreonam and ceftazidime. Thirty percent of the isolates were resistant to tigecycline. All isolates were susceptible to colistin and polymyxin-B, while 93.3% (28.30) possessed blaOXA-23-like and 6.7% (2.30) possessed blaOXA-24-like. All isolates possessed insertion sequence (ISAba1) in the upstream region of the OXA-23-like gene. Almost 96.7% (29.30) of the isolates were positive for class I integron and 43.3% (13.30) for class II. These isolates were also positive for class I. Class III integron was not detected. MLVA typing of XDR isolates showed seven clonally complexes and 16 singletons. The population structure of the A. baumannii isolates in our hospitals was genetically diverse. A significant association between XDR pattern and presence of class 1 integron (P < 0.001) was found indicating that many antibiotic resistance determinants are involved in development of XDR strains.

Multiple drug-resistant strains of Acinetobacter have become common in hospitals worldwide. The problem becomes more acute with increasing resistance to carbapenems, the last resort in the treatment of hospital acquired Acinetobacter baumannii infections.. The current study was conducted to determine the antimicrobial susceptibility patterns and prevalence of OXA-type carbapenemases, among clinical isolates of A. baumannii, in Tehran hospitals, Iran.. Isolates were identified as A. baumannii by PCR with specific primers for bla OXA-51-like gene. Their susceptibilities to different antibiotics were determined using disk diffusion method. Isolates were then subjected to multiplex-PCR targeting bla oxa-51, bla oxa-24, blaoxa-23 and bla oxa-58 genes.. Results showed that 123 of 131 (93.89%) Acinetobacter species, possessed bla oxa-51-like gene and were identified as A. baumannii. 54.47% of isolates were resistant to amikacin, 67.47% resistant to imipenem and 84.55% resistant to meropenem. All isolates were susceptible to colistin and polymixin B. 43 of 123 A. baumannii isolates (34.95%) were MDR. These isolates were resistant to amikacin, ciprofloxacin, imipenem, cefrazidim. Among 123 isolates, 100(81.3 %) had an acquired oxa-23like carbapenemase 10 (8.1%) possessed oxa-24-like, and 1 (0.81%) possessed oxa-58-like carbapenemase.. The present study showed that bla OXA-23-like was the most frequent carbapenemase identified among carbapenem-resistant A. baumannii isolated in Tehran hospitals. Evaluation of antibiotic resistance genes in A. baumannii, is necessary to control further dissemination of these antibiotic resistant genes..