Antibody-Antibiotic Conjugates: A Comprehensive Review on Their Therapeutic Potentials Against BacterialInfections.

INTRODUCTION: Antibodies are significant agents in the immune system and have proven to be effective in treating bacterial infections. With the advancement of antibody engineering in recent decades, antibody therapy has evolved widely. AIM: This review aimed to investigate a new method as a therapeutic platform for the treatment of bacterial infections and explore the novel features of this method in conferring pathogen specificity to broad-spectrum antibiotics. MATERIAL AND METHODS: A literature review was conducted addressing the following topics about antibody-antibiotic conjugates (AACs): (1) structure and mechanism of action; (2) clinical effectiveness; (3) advantages and disadvantages. RESULT: Antibody conjugates are designed to build upon the progress made in the development of monoclonal antibodies for the treatment of diseases. Despite the growing emergence of antibiotic resistance among pathogenic bacteria worldwide, novel antimicrobials have not been sufficiently expanded to combat the global crisis of antibiotic resistance. A recently developed strategy for the treatment of infectious diseases is the use of AACs, which are specifically activated only in host cells. CONCLUSION: A novel therapeutic AAC employs an antibody to deliver the antibiotic to the bacteria. The AACs can release potent antibacterial components that unconjugated forms may not exhibit with an appropriate therapeutic index. This review highlights how this science has guided the design principles of an impressive AAC and discusses how the AAC model promises to enhance the antibiotic effect against bacterial infections.

Characterization of bacteriocins produced by Lactobacillus species against adhesion and invasion of Listeria monocytogenes isolated from different samples.

BACKGROUND: Listeria monocytogenes is an important difficult to control and eradicate foodborne pathogen due to its resistance properties to extreme conditions. Bacteriocins produced by lactic acid bacteria (LAB) can be considered as natural alternatives for safety and quality of foods, since these molecules offer antimicrobial activity against other bacteria. METHODS: In this study, Lacticaseibacillus casei, Lactiplantibacillus plantarum, and L. monocytogenes isolates were first characterized by phenotypical tests and 16S rRNA gene using PCR. Then, six types of bacteriocins produced by Lactobacilli strains were identified using molecular tests. The ability of these strains to compete with L. monocytogenes for adhesion and invasion to HT-29 cells was evaluated through colony count and MTT assay. Finally, the level of bacteriocins expression was assessed using qRT-PCR. RESULTS: L. monocytogenes strains were categorized from A1 to A8 based on the source of isolation. In the adhesion assay, L. casei + L. monocytogenes isolated from milk and Lpb plantarum + L. monocytogenes isolated from feces presented the maximum adherence values. Further, Lpb plantarum + L. monocytogenes isolated from blood invaded to HT-29 cell line at the highest level. Eventually, L. casei + Lpb plantarum + L. monocytogenes isolated from placenta revealed more expression levels in comparison with other groups. CONCLUSION: These results suggest a practical approach to classifying bacteriocins into functional groups that could be used for identifying the best mixture of bacteriocins for usage against L. monocytogenes.

Molecular determination of O25b/ST131 clone type among extended spectrum ß-lactamases production Escherichia coli recovering from urinary tract infection isolates.

BACKGROUND: Escherichia coli (E. coli) O25b/ST131 clone causes urinary tract infection (UTI) and is associated with a broad spectrum of other infections, such as intra-abdominal and soft tissue infections, that can be affecting bloodstream infections. Therefore, since O25b/ST131 has been reported in several studies from Iran, in the current study, we have investigated the molecular characteristics, typing, and biofilm formation of O25b/ST131 clone type E. coli collected from UTI specimens. METHODS: A total of 173 E. coli isolates from UTI were collected. The susceptibility to all fourth generations of cephalosporins (cefazolin, cefuroxime, ceftriaxone, cefotaxime, ceftazidime, cefepime) and ampicillin, ampicillin-sulbactam and aztreonam was determined. Class A ESBLs, class D ESBL and the presence of pabB gene screenings to detect of O25b/ST131 clone type were performed by using of PCR. Biofilm formation was compared between O25b/ST131 isolates and non-O25b/ST131 isolates. Finally, ERIC-PCR was used for typing of ESBL positive isolates. RESULTS: Ninety-four ESBL positive were detected of which 79 of them were O25b/ST131. Antimicrobial susceptibility test data showed that most antibiotics had a higher rate of resistance in isolates of the O25b/ST131 clonal type. Biofilm formation showed that there was a weak association between O25b/ST131 clone type isolates and the level of the biofilm formation. ERIC-PCR results showed that E. coli isolates were genetically diverse and classified into 14 groups. CONCLUSION: Our results demonstrated the importance and high prevalence of E. coli O25b/ST131 among UTI isolates with the ability to spread fast and disseminate antibiotic resistance genes.

Effects of Pro/Prebiotics Alone over Pro/Prebiotics Combined with Conventional Antibiotic Therapy to Treat Bacterial Vaginosis: A Systematic Review.

Background: Bacterial vaginosis (BV), caused by an imbalance in the vaginal microbiota, can be treated and prevented by probiotics. Pregnant women with BV can experience premature labor and spontaneous abortions. Probiotics and prebiotics promote the proliferation of beneficial microorganisms, alter the composition of the vaginal microbiota, and prevent intravaginal infections in postmenopausal women. In addition to reducing infection symptoms, pre/probiotics can also help prevent vaginal infections. Materials and Methods: A systematic review was conducted on studies from 2010 to 2020 to determine the efficacy of pre/probiotics on the treatment of BV in pregnant and nonpregnant women. The databases Medline, Scopus, Embase, and Google Scholar were systematically searched using the following keywords: "bacterial vaginosis," "probiotics," "prebiotics," and "synbiotics." Results: A total of 1,871 articles were found in the initial search, and 24 clinical trials were considered eligible. In studies comparing the effects of pre/probiotics and placebos with or without antibiotic therapy in patients with BV, significant differences in clinical outcomes were observed. Probiotics reduced the levels of IL-1ß and IL-6, as well as the overall Nugent score and Amsel's criteria for restitution of a balanced vaginal microbiota. In addition, probiotics can reduce the vaginal colonization of Group B streptococci among pregnant women. In subjects treated with probiotics, BV cure rates were higher than those in subjects treated with antibiotics. There were no additional adverse events. Conclusion: Pre/probiotic regimens, when used for BV treatment, are usually safe and can exhibit long-term and short-term benefits. In order to prove the benefits of pre/probiotics in BV treatment, additional high-quality research is required.

The Influence of Probiotics Consumption on Management of Prediabetic State: A Systematic Review of Clinical Trials.

Prediabetes consists of the intermediary stage between normal glucose regulation and overt diabetes mellitus and develops when blood glucose levels are higher than normal but not high enough to confirm a type 2 diabetes mellitus diagnosis (T2DM). Recent evidence suggests that probiotics could be promising approaches to improve this state. In this study, we performed a systematic review to compile the results of clinical trials investigating the effects of pro-/pre-/synbiotics on prediabetes subjects from 2010 to 2020. The article search was carried out in Medline, Embase, Scopus, Web of Science, The Cochrane Library, Clinical trials.gov, ProQuest, Open Grey, and Google Scholar. Search filters were developed using 2 parameters: "prestate diabetes" and "probiotics." Of the 418 studies that were screened, 15 original articles reached the inclusion criteria. Pooling data from these trials showed positive and significant effects of probiotics in the reduction of hyperglycemia, insulin concentration levels, lipid profile, and BMI (Body mass index). Administration of probiotics may provide beneficial and healthful effects in the clinical management of patients with prediabetes and metabolic syndrome. Different probiotics compositions have shown beneficial and noticeable effects on glucose homeostasis, lipid profiles, BMI, and inflammatory markers in subjects with prediabetes, metabolic syndrome, and healthy individuals and could be advantageous in recomposing the gut microbiota back into the normal state during the prediabetic state.

Safety evaluation of mutagenicity, genotoxicity, and cytotoxicity of Lactobacillus spp. isolates as probiotic candidates.

BACKGROUND: Probiotics promote a healthy balance of gut bacteria and have many beneficial effects on human digestive physiology. Although, few side effects of probiotics have been reported. This study aimed to assess the safety of five probiotic candidate Lactobacillus strains isolated from healthy individuals by examining mutagenicity, genotoxicity, and oral toxic effects. METHODS: Five selected candidate probiotic (SCPs) strains were evaluated for genotoxicity (Ames test with Salmonella typhimurium), in vitro mammalian chromosome aberration test and an in vivo mouse micronucleus assay on peripheral blood of mice. To evaluate the oral dose toxicity, BALB/c mice models were treated repeatedly (2000, 1000, and 500 mg/kg body weight /day) for 28-days. RESULTS: The Ames test performed for two S. typhimurium strains TA 98 and TA100 (both in the absence and in the presence of S-9 metabolic activation system) did not show an increase in reverse mutation because of exposure to the SCPs in any of the doses (5.0, 2.5, 1.25, 0.625, and 0.3125 mg/plate). There was no genotoxicity in the SCPs treatment in the vitro chromosome aberration assay with Chinese hamster ovary cells (CHO-K1). In addition, none of the tested strains increased the frequency of micronucleated reticulocytes in reticulocytes, the SCPs with the studied doses caused no substantial variation in the experimental groups compared to the negative control group (p > 0.05). SCPs were not acutely toxic when administered to male and female BALB/c mice by single gavage at (2000, 1000, and 500 mg/kg b.w/day) with no mortality or clinical signs, change in body weight or macroscopic abnormalities were observed in this dose range. CONCLUSION: As a result, SCPs did not induce mutagenic potential in vitro with bacterial reverse mutation, clastogenicity, and in vivo tests in the ranges of concentrations evaluated in our study.

The effect of probiotics on gestational diabetes and its complications in pregnant mother and newborn: A systematic review and meta-analysis during 2010-2020.

This study was aimed to evaluate the effect of probiotics consumption on gestational diabetes (GD) and its complications in pregnant mother and newborn. The study was registered on PROSPERO (CRD42021243409) and all the enrolled articles were collected from four databases (Medline, Scopus, Embase, and Google Scholar) as randomized controlled trials (RCTs) from 2010 to 2020. A total of 4865 study participants from 28 selected studies were included in this review. The present meta-analysis showed that the consumption of probiotics supplementation has the potential to decrease GD-predisposing metabolic parameters such as blood glucose level, lipid profile, inflammation, and oxidative markers which may reduce GD occurrence among pregnant women.

Bacteriocins: Properties and potential use as antimicrobials.

A variety of bacteriocins originate from lactic acid bacteria, which have recently been modified by scientists. Many strains of lactic acid bacteria related to food groups could produce bacteriocins or antibacterial proteins highly effective against foodborne pathogens such as Staphylococcus aureus, Pseudomonas fluorescens, P. aeruginosa, Salmonella typhi, Shigella flexneri, Listeria monocytogenes, Escherichia coli O157:H7, and Clostridium botulinum. A wide range of bacteria belonging primarily to the genera Bifidobacterium and Lactobacillus have been characterized with different health-promoting attributes. Extensive studies and in-depth understanding of these antimicrobials mechanisms of action could enable scientists to determine their production in specific probiotic lactic acid bacteria, as they are potentially crucial for the final preservation of functional foods or for medicinal applications. In this review study, the structure, classification, mode of operation, safety, and antibacterial properties of bacteriocins as well as their effect on foodborne pathogens and antibiotic-resistant bacteria were extensively studied.

Pan drug-resistant Acinetobacter baumannii causing nosocomial infections among burnt children.

Background: Nosocomial infection caused by Acinetobacter baumannii has emerged as a world-wide serious problem in the emergence of multidrug-resistant (MDR). Infections caused by antibiotic-resistant strains of A. baumannii cannot be completely eliminated among the infected patients. This study aimed to monitor antibiotic resistance among A. baumannii strains isolated from burnt children. Methods: After performing biochemical identification tests on 115 isolates, 62 were detected as A. baumannii . Minimum inhibitory concentration (MIC) was used to test susceptibility to colistin, and disk agar diffusion was used for the susceptibility of the isolates to the antibiotics Ciprofloxacin, Amikacin, Gentamicin, Cefepime, Meropenem, Imipenem, Ceftazidime, Levofloxacin and Piperacillin/Tazobactam. Bacterial species were isolated and identified as multidrug-resistant (MDR), extensively drug-resistant (XDR) and pan drug-resistant (PDR), based on the susceptibility patterns to elected antibiotics, deputing different classes of antimicrobial. Results: The antibiotic susceptibility pattern out of a total of 62 bacterial strains used in this study. Thirty-six (58%) strains were categorized as MDR, 17 (27.5%) as XDR, and nine (14.5%) as PDR. Conclusion: To reduce the threat of antimicrobial resistance, MDR, XDR and PDR A. baumannii strains must be evaluated by all clinical microbiology laboratories.

Investigating the antimicrobial and anti-inflammatory effects of Lactobacillus and Bifidobacterium spp. on cariogenic and periodontitis pathogens.

Background: The use of probiotics is emerging as an innovative approach to managing oral health issues and mediating the immune system. The current study assessed the in vitro impacts of non-orally isolated probiotics on periodontitis and tooth decay pathogens. Methods: Briefly, the persistence of probiotics in exposure to oral cavity enzymes, hydrogen peroxide, and saliva samples was examined. It was also investigated the biofilm formation and aggregation ability of probiotics, the adherence of probiotics in human gingival fibroblast cell (HGFC) lines and molar teeth samples, and the potential of probiotics to co-aggregate with oral pathogens. Additionally, the current study evaluated the effects of live probiotics on virulence gene expression, biofilm production of main oral pathogens, and changes in inflammation markers. Results: The probiotics remained alive when exposed to enzymes in the oral cavity, hydrogen peroxide, and saliva at baseline, 1, 3, and 5 h after incubation at 37°C (p-value <0.05). Probiotics demonstrated to produce biofilm and aggregation, as well as adherence to HGFCs and maxillary molars (p-value >0.05). They showed significant co-aggregation with oral pathogens, which were recorded as 65.57% for B. bifidum 1001 with S. mutans, 50.06% for B. bifidum 1005 with P. gingivalis, 35.6% for L. plantarum 156 with F. nucleatum, and 18.7% for B. longum 1044 with A. actinomycetemcomitans after 8 h of incubation. A balance between pro-inflammatory and anti-inflammatory cytokines, along with inhibition of biofilm formation and changes in virulence gene transcripts, were observed. However, most of these changes were not statistically significant (p-value >0.05). Conclusion: This study demonstrated the direct link between adhesiveness, aggregation, and biofilm formation with probiotic antibacterial activity. In addition to the careful selection of suitable probiotic strains, the concentration and origin of probiotic isolates should be considered.

The Effects of Probiotics, Prebiotics, and Synbiotics on Wound Infection: A Systematic Review.

INTRODUCTION: This systematic review aimed to summarize the currently available evidence on the effect of oral probiotic therapy on infected wound healing among patients who underwent surgery. MATERIALS AND METHODS: An electronic search was conducted for articles published during 2010- 2022 in Embase, PubMed/Medline, Scopus, Web of Science, and Google Scholar using the keywords "probiotics," "prebiotics," "synbiotics," and "wound infection." The titles and abstracts of 2625 articles were screened, and 22 publications that fulfilled the inclusion criteria were included. RESULTS: The current review provides evidence of the beneficial effects of probiotics on wound infection, significantly reducing the duration of antibiotic usage and the length of hospital stay for patients, with no serious side effects reported. Wound infections following various surgeries, such as abdominal wound surgery, colorectal cancer resection, periampullary neoplasms treatment, liver and bile duct resection, pancreaticoduodenectomy, esophagostomy, dental wound surgery, plastic surgery, and burns, are shown to be positively affected by probiotic usage. Although, in some cases, the improvements were not statistically significant, overall, the administration of probiotics appears to be satisfactory in this regard. CONCLUSION: Probiotics demonstrate the ability to prevent the growth of pathogens and maintain wound space sterility by recruiting M2 macrophages, which produce anti-inflammatory markers and enhance the activity of phagocytic cells. Additionally, probiotics can reduce bacterial translocation from their niche to other areas and inhibit the production of bacterial mediators that lead to bacterial invasion.

Secondary Klebsiella pneumoniae infection in patients with COVID-19: A systematic review.

This study aims to investigate the development of secondary bacterial infection and risk factors associated with it in critical COVID-19 patients, and to identify the most common pathogen groups in them. All the cohort studies were retrieved from Scopus, Google Scholar, Web of Science, and MEDLINE from the inception of COVID-19 to 2022 for the following keywords: 'Klebsiella" AND "COVID-19". The most common comorbidities among the patients with COVID-19 were respiratory disease (33.62%), obesity (28.99%), and heart disease or cardiovascular disease (16.31%). We report 42.91% rate of Klebsiella spp co-infection in ICU admission patients, mostly related to K. pneumonia (26.81%), K. aerogenes (9.4%), and K. oxytoca (6.7%). The overall incidence of bacterial infection in hospitalized COVID-19 patients is estimated at 15.5% and in 32.5% of cases of co-infection patients deceased. The threat of carbapenem-resistant K. pneumoniae infections in patients with COVID-19 is imminent, therefore rational antibiotic therapy based on antibiotic sensitivity test should be implemented.

Epidemiology of first- and second-line drugs-resistant pulmonary tuberculosis in Iran: Systematic review and meta-analysis.

Drug resistance among Mycobacterium tuberculosis (MTB) strains is a growing concern in developing countries. We conducted a comprehensive search for relevant studies in Iran on PubMed, Scopus, and Embase until June 12, 2020. Our study focused on determining the prevalence of antibiotic resistance in MTB isolates, with subgroup analyses based on year, location, and drug susceptibility testing (DST) methods. Statistical analyses were performed using STATA software. Our meta-analysis included a total of 47 articles. Among new TB cases, we found the following prevalence rates: Any-resistance to first-line drugs: 31 % (95 % CI, 24-38), mono-drug resistance: 15 % (95 % CI, 10-22), and multidrug resistance to first-line drugs: 6 % (95 % CI, 4-8). There was a significant variation in the rate of MDR among new TB cases based on the year of publication, location, and DST methods (P < 0.0001). We observed substantial variability in multidrug-resistant TB rates among new cases across the studies. Stratified analyses revealed that publication years and DST methods significantly affected resistance rates. Studies from southern and central Iran reported higher any-drug resistance rates, suggesting regional differences. Among retreatment cases, the prevalence rates were as follows: Any resistance: 68 % (95 % CI 58-78), mono-resistance: 19 % (95 % CI 7-34), multidrug resistance: 28 % (95 % CI 15-43). Our study revealed that the prevalence of drug-resistant TB (DR-TB) among TB cases in Iran is higher than the global average. Particularly, MDR-TB among retreatment TB cases is a significant public health issue.

Prevalence of linezolid resistance in Streptococcus pneumoniae isolates: a systematic review and meta-analysis.

Aim: This study aimed to understand the current level of linezolid (LNZ) resistance in Streptococcus pneumoniae isolates reported over the past 10 years. Material & methods: An electronic search was conducted for the following keywords: ((Streptococcus pneumoniae [title/abstract]) OR (Pneumococcus [title/abstract]) OR (Pneumococci [title/abstract]) AND (linezolid [title/abstract]) OR (Zyvox [title/abstract])) OR (Zyvoxid [title/abstract])). Result: Out of all the studies, 80 had a cross-sectional design, while 11 followed a cohort approach. The prevalence of LNZ resistance among S. pneumoniae isolates ranged from 0% to 4.86%. Discussion: Urgent, high-powered, randomized, controlled trials with participants from endemic regions are needed to gain a comprehensive understanding of the impact on and significance of LNZ treatment to patients.

Effects of Antimicrobial photosensitizers of Photodynamic Therapy (PDT) to Treat Periodontitis.

Along with antimicrobial photosensitizers or antimicrobial photodynamic therapy (aPDT), Photodynamic therapy (PDT) is a therapeutic approach in which lasers and different photosensitizers (PSs) are used to eradicate periodontopathic bacteria in aggressive and chronic periodontitis. Periodontitis is a localized infectious disease caused by periodontopathic bacteria and can destroy bones and tissues surrounding and supporting the teeth. The aPDT system has been shown by in vitro studies to have high bactericidal efficacy. It was demonstrated that aPDT has low local toxicity, can speed up dental therapy, and is cost-effective. Several photosensitizers (PSs) are available for each type of light source which did not induce any damage to the patient and are safe. In recent years, significant advances have been made in aPDT as a non-invasive treatment method, especially in treating infections and cancers. Besides, aPDT can be perfectly combined with other treatments. Hence, this survey focused on the effectiveness and mechanism of aPDT of periodontitis by using lasers and the most frequently used antimicrobial PSs such as methylene blue (MB), toluidine blue ortho (TBO), indocyanine green (ICG), Malachite green (MG) (Triarylmethanes), Erythrosine Dyes (ERY) (Xanthenes dyes), Rose bengal (RB) (Xanthenes dyes), Eosin-Y (Xanthenes dyes), Radachlorin group and Curcumin. The aPDT with these PSs can reduce pathogenic bacterial loads in periodontitis. Therefore, it is clear that there is a bright future for using aPDT to fight microorganisms causing periodontitis.

Clinical Efficacy of Probiotics on Oral Health: A Systematic Review of Clinical Trials.

INTRODUCTION: Periodontal diseases and dental caries are the two most common dental diseases caused by the dental plaque. OBJECTIVE: The aim of the present study was to review the clinical efficacy of probiotics for oral health in randomized controlled trials. METHODS: An electronic search was conducted in December 2021 in Embase, Medline, The Cochrane Library, ProQuest, and Google Scholar using the following keywords: "mouthwash" and "probiotics". The titles and abstracts of 3,775 articles were screened and 24 publications that fulfilled the inclusion criteria were included. RESULTS: A total of 24 clinical trials were reviewed, including 1612 participants receiving either probiotics or mouth treatments. The results of this review indicated that individuals receiving probiotic products have a significant reduction (65% reduction; p < 0.05) in the count of Streptococcus mutants in their mouths. It was also found that probiotic products were more effective or equal in effect compared to chlorhexidine in reducing oral pathogens, gingival index, and plaque index scores. On the other hand, the consumption of xylitol mouthwash was shown to cause an improvement in salivary parameters. Considering their safety and effectiveness, the use of probiotic products, such as kefir and mouthwashes, has been recommended against cariogenic bacteria and periodontal diseases. CONCLUSION: Probiotics are considered a safe alternative to conventional therapies, such as chlorhexidine and fluoride. Co-administration of chlorhexidine, fluoride, and probiotics seems to be a perfect package.

Clinical efficacy of probiotics in prevention of infectious diseases among hospitalized patients in ICU and non-ICU wards in clinical randomized trials: A systematic review.

Background and Aims: The present study aimed to review probiotics' clinical efficacy in preventing infectious diseases among hospitalized patients in ICU and non-ICU wards. Methods: A search of Medline, EMBASE, The Cochrane Library, Science Direct, Open Grey, and Google Scholar was conducted for eligible publications from 2002 to 2020 following the requirements outlined in the PRISMA guideline. The search strategy was based on the combination of the following terms: "probiotics," "prebiotics," "synbiotics," and "cross-infection." The logical operators "AND" (or the equivalent operator for the databases) and "OR" (e.g., probiotics OR prebiotics OR synbiotics) were used. Results: The results indicated that the probiotic consumption caused a significant reduction in antibiotic-associated diarrhea (AAD) and Clostridioides difficile infection (CDI) in 2/8 randomized clinical trials (RCTs) investigating AAD/CDI. Also, 5/12 clinical trials highlighted the considerable effects of probiotics on the reduction or prevention of ventilator associated pneumoniae (VAP), so the mean prevalence of VAP was lower in the probiotic group than in the placebo group. The total rate of nosocomial infections among preterm infants was nonsignificantly higher in the probiotic group compared to the control group. Conclusion: This systematic review shows that the administration of probiotics has moderate preventive or mitigating effects on the occurrence of VAP in ICU patients, CDI, AAD, and nosocomial infections among children. Consequently, applying antibiotics along with the proper probiotic species can be advantageous.

Nitrofurantoin: properties and potential in treatment of urinary tract infection: a narrative review.

Nitrofurantoin (NF), a wide-spectrum antibiotic accessible since 1953, is utilized widely to treat urinary tract infections as it usually stays active against drug-resistant uropathogen. The use of Nitrofurantoin has increased exponentially since new guidelines have repositioned it as first-line therapy for uncomplicated lower urinary tract infection (UTI). To, although fluoroquinolones are usually used to re-evaluate the first- and second-line therapies for treating uncomplicated UTI, their level of utilization is thought to be inappropriately excessive and will eventually have a detrimental impact; thus, we hypothesize that NF might be the best choice for this condition, because of its low frequency of utilization and its high susceptibility in common UTI pathogens. It can be concluded from this review that NF can be considered as the most effective drug in the treatment of acute urinary infection, but due to the long-term side effects of this drug, especially in elderly patients, it is essential to introduce some criteria for prescribing NF in cases of chronic UTI.

Trends in the Antibiotic Resistance of Non-Tuberculous Mycobacteria in Iran: A Systematic Review and Meta-Analysis.

Background: Non-tuberculous mycobacteria (NTM) infections have been continuously increasing as major concerns of public health in Iran. Because innate resistance of NTM species, the treatment of these infections is difficult task, but until now resistance pattern of NTM and suitable regimens are not determined. Methods: We systematically searched the relevant studies in PubMed, Scopus, and Embase (Until Dec 2022). All statistical analyses were carried out using the statistical package R. Results: Eleven studies included in the analysis were performed in 6 provinces and investigated 1223 NTM clinical species. The majority of the studies originated in Tehran. Among the first-line anti-TB drugs, almost all NTM species were highly resistant to first-line anti-TB drugs. No significant difference in the isoniazid resistance rate was found in the slow or rapid-growing species and Runyon's classification of NTM isolates. A decreased in the prevalence of ciprofloxacin, clarithromycin, and moxifloxacin resistance were showed in during 2013-2022 years. Conclusion: Most investigated antibiotics have a minor effect on NTM species and a steady increase of resistance has been seen in last few years then, need more-effective alternative regimens is clear.

Brucellosis control methods with an emphasis on vaccination: a systematic review.

INTRODUCTION: Brucellosis is considered as one of the main zoonotic infections and a major public health concern worldwide. The aim of the present study was to evaluate various strategies for controlling brucellosis with an especial emphasis on efficacy of vaccination. AREAS COVERED: International databanks (Web of Science, PubMed, Embase) were searched for potentially relevant studies published from 1 January 2011 to 25 March 2021 using the following keywords: 'Brucella,' 'Brucella abortus,' 'Brucella melitensis,' 'Brucella canis,' 'Brucella suis,' 'brucellosis,' 'Bang disease,' 'undulant fever,' 'Malta fever,' 'vaccination,' 'vaccine,' and 'immunization.' The literature search was restricted to original articles published in English. EXPERT OPINION: Various methods are employed to prevent and control brucellosis, such as removing sick animals by slaughtering, separating sick animals from the herd, and vaccination. Preventing, controlling, and eradicating brucellosis requires a lot of financial support, perseverance, and time. In order to conduct a detailed study, it is recommended that more studies be conducted in developing countries and different parts of the world.