Relationships between Efflux Pumps and Emergence of Heteroresistance: A Comprehensive Study on the Current Findings.

Heteroresiatnce (HR) is the type of resistance toward one or more antibiotics appearing as a population of the bacterial load consisting of one or more subpopulations with lower antibiotic susceptibility levels than others. Due to the lack of appropriate diagnosis of HR isolates and their importance in resistance emergence to antibiotics, investigating the origins, emergence factors, and HR inhibitors is critical in combating antibiotic resistance. Efflux pumps (EPs) are bacterial systems that own an influential role in acquiring resistance toward anti-bacterial compounds. Studies on EPs revealed that they can affect HR emergence mechanisms and are competent to be introduced as a suitable bacterial target for diagnostic and therapeutic development in combating HR isolates. This review will consider the relations between EPs and the emergence of HR isolates and discuss their importance in confronting this type of antibiotic resistance.

Recall of Intensive Care Unit Stay in Critical Illness Survivors in Southeast Iran.

BACKGROUND: In survivors of critical illness, recall of an intensive care unit stay plays an important role in the development of post-intensive care unit syndrome, which includes psychological impairment after intensive care unit discharge. OBJECTIVE: To investigate memories of the intensive care unit among survivors in southeast Iran. METHODS: In this descriptive study, the intensive care unit memory tool was used to assess patients' memories of intensive care units. RESULTS: All participants (N = 100) had 1 or more factual memories (89%), memories of feelings (66%), or delusional memories (34%) from the intensive care unit. Patients who received mechanical ventilation were 4 times as likely to have delusional memories as those who did not receive mechanical ventilation. Unmarried patients were 4.8 times as likely as married patients to have memories of feelings from the intensive care unit. CONCLUSIONS: Steps should be taken to minimize distressing memories of an intensive care unit admission. Follow-up programs should take into account the psychological problems faced by intensive care unit survivors.

Spa gene-based molecular typing of nasal methicillin-susceptible staphylococcus aureus from patients and health-care workers in a dialysis center in southeast Iran.

Staphylococcus aureus is an important infectious agent in hemodialysis patients. This study was conducted to determine the frequency of S. aureus nasal carriage in hemodialysis patients (HD) and health-care workers (HCW) at the main dialysis center of Bam city, located in southeast of Iran. In this cross-sectional study, a total of 52 nasal swabs were obtained from health-care workers and hemodialysis patients to detect methicillin-sensitive S. aureus (MSSA) isolates. The resistance to different antibacterial agents was determined by disk diffusion method. Also, Panton-Valentine Leukocidin (PVL) - encoding gene as well as Staphylococcal protein A (spa) type were determined. The nasal carriage rate of S. aureus was found to be 24.4% and 18.8% in patients on hemodialysis and health-care workers, respectively. Among identified isolates, no methicillin-resistant S. aureus (MRSA) was found. Only two MSSA isolates (16.7%) were resistant to trimethoprim/sulfamethoxazole. One isolate (8.6%) was positive for pvl gene. Moreover, 8 spa types were found. According to BURP analysis, six out of the 12 S. aureus isolates (50%) belonged to the same clone, indicating a prevalence of a major clone among MSSA in carriage, including patients and HCW. Mupirocin is still the appropriate drug for reducing nasal colonization in our setting. Accumulation of isolates from patients and staff in one spa clonal complex is alarming for the necessity of more serious infection control in this center. Therefore, it is necessary to screen patients and health-care workers as a health priority, in order to prevent cross transmission.