Clinical features and antimicrobial resistance of bacterial agents of ventilator-associated tracheobronchitis in Hamedan, Iran

Objectives: Ventilator-associated tracheobronchitis [VAT] is a common cause of mortality and morbidity in patients admitted to intensive care units [ICUs]. This study was conducted to evaluate the clinical course, etiology, and antimicrobial resistance of bacterial agents of VAT in ICUs in Hamedan, Iran

Methods: During a 12-month period, all patients with VAT in a medical and a surgical ICU were included. The criteria for the diagnosis of VAT were fever, mucus production, a positive culture of tracheal secretions, and the absence of lung infiltration. Clinical course, including changes in temperature and tracheal secretions, and outcomes were followed. The endotracheal aspirates were cultured on blood agar and chocolate agar, and antimicrobial susceptibility testing of isolates were performed using the disk diffusion method

Results: Of the 1 070 ICU patients, 69 [6.4%] were diagnosed with VAT. The mean interval between the patient's intubation and the onset of symptoms was 4.7+/-8.5 days. The mean duration of response to treatment was 4.9+/-4.7 days. A total of 23 patients [33.3%] progressed to ventilator-associated pneumonia [VAP], and 38 patients [55.0%] died. The most prevalent bacterial isolates included Acinetobacter baumannii [24.6%], Pseudomonas aeruginosa [20.2%], and Enterobacter [13.0%]. P. aeruginosa and Enterobacter were the most prevalent bacteria in surgical ICU, and A. baumannii and K. pneumoniae were the most common in the medical ICU. All A. baumannii and Citrobacter species were multidrug-resistant [MDR]. MDR pathogens were more prevalent in medical ICU compared to surgical ICU [p < 0.001]

Conclusions: VAT increases the rates of progression to VAP, the need for tracheostomy, and the incidence of mortality in ICUs. Most bacterial agents of VAT are MDR. Preventive policies for VAP, including the use of ventilator care bundle, and appropriate empirical antibiotic therapy for VAT may reduce the incidence of VAP

prevalence of antibiotic resistance of Enterobacteriaceae strains isolated in community- and hospital-acquired infections in teaching hospitals of Hamadan, west of Iran

The prevalence of antimicrobial resistance among Enterobacteriaceae is increasing worldwide. Identification of pathogens and their resistance to antimicrobials is mandatory for successful empiric antibiotic treatment. The aim of this study was to investigate the prevalence of antimicrobial resistance of Enterobacteriaceae isolated from hospital-acquired and community-acquired infections. In a descriptive-comparative study, during 2010, all clinical isolates of Enterobacteriaceae and their antibiograms from laboratories of Sina and Bessat Hospitals, Hamadan, west of Iran were included. Hospital-acquired infections were identified by records from infection-control units. A questionnaire containing information about demographic characteristics, source of specimen, kind of En-terobacteriaceae and their antimicrobial resistance was filled for each patient. Data were analysed using SPSS. A total of 574 samples were collected, out of which the most prevalent pathogens were Escherichia coli and Klebsiella pneumoniae. Almost all isolates of Enterobacteriaceae were resistant to ampicillin [98.8%], and the least resistance was to piperacillin [3.7%]. In addition, most isolates were resistant to cefazolin, cefixime, and co-trimoxazole. Among third generation cephalosporins, the highest resistance to ceftriaxone and the least resistance to ceftizoxime were observed. 19.3% of isolates were resistant to imipenem. In terms of fluroquinolones, nosocomial infections and community acquired infections were resisitant to ciprofloxacin 33% and 4.1% respectively. The rate of resistance in nosocomial infections was higher than that of community-acquired infections. The prevalence of multidrug resistant Enterobacteriaceae is increasing both in community-acquired and hospital-acquired infections. Because of propable increasing resistance to fluoro-quinolones and newer betalactams, reassessment of resistance of Enterobacteriaceae must continue in future years

Prevalence and antibiotic resistance patterns of diarrheagenic Escherichia coli isolated from adolescents and adults in Hamedan, Western Iran

Pathogenic strains of Escherichia coli are a common cause of acute infectious diarrhea. The aim of this study was to investigate the frequency, virulence markers and antibiotic resistance patterns of diarrheagenic E. coli [DEC] isolated from adolescents and adults in Hamadan, west of Iran. A total of 187 stool samples were collected from adults with acute diarrhea. Stool culture was performed by conventional methods for enteropathogenic bacteria. Virulence factor genes for DEC were detected by polymerase chain reaction. Antimicrobial susceptibility was tested using the disk diffusion method. Among the 187 patients, 40 [21.4%] were positive for DEC. The most frequently identified DEC was enteropathogenic E. coli [47.5%], followed by enteroaggregative [20%], enterotoxigenic [17.5%] and shiga-toxin producing E. coli [15%]. No isolates of enteroinvasive E. coli were detected. All STEC strains were stx[+] / eaeA[-]. Out of the seven ETEC strains, five [71.4%] produced ST, one [14.3%] produced only LT and one [14.3%] of the isolates produced both ST and LT encoded by est and elt genes, respectively. Among the 40 DEC strains 27[67.5%] were multidrug resistant. DEC contribute to the burden of diarrhea in adults in Hamadan. Enteropathogenic E. coli was the most commonly identified DEC strain in the region studied

Evaluation of fibronectin and c-reactive protein levels in patients with sepsis: a case-control study

Sepsis is a significant health problem with an estimated 750,000 new cases in the USA annually. It is also the third leading cause of death in developed countries, equaling the number of fatalities from acute myocardial infarction. The high sepsis-related mortalities mean there is an urgent need to improve the diagnosis and management of sepsis patients. The aim of this study was the evaluation of fibronectin and C-reactive protein [CRP] plasma levels in patients with sepsis and other infectious diseases without sepsis. In a case-control study, 90 patients with sepsis and 90 patients with other infectious diseases without sepsis were studied. Serum levels of fibronectin and CRP were measured. The data were analyzed by SPSS version 15. The mean levels of fibronectin in the cases and controls were 288.97 +/- 89.10 mg/l and 341.24 +/- 110.53 mg/l respectively [P=0.001]. The mean levels of CRP in the cases and controls were 89.42 +/- 54.05 micro g/ml and 27.42 +/- 25.89 micro g/ml respectively [P<0.001]. Concerning the source of infection, the mean CRP levels were significantly higher in septic patients with urinary tract infection, pneumonia, and soft tissue infection [P<0.001]. Decreased levels of fibronectin and increased levels of CRP may be considered as reliable diagnostic markers for sepsis. Also, CRP could be a better predictive factor for sepsis than fibronectin

Relationship between Helicobacter pylori infection and chronic obstructive pulmonary disease

There is some evidence indicating the role of Helicobacter pylori infection in pathogenesis of extragastrointestinal diseases including skin, vascular, and autoimmune disorders, as well as some respiratory diseases. The aim of this study was to investigate the association between H. pylori and chronic obstructive pulmonary disease [COPD]. In a case-control study, 90 patients with COPD and 90 age-and sex-matched control subjects were included. Serum samples were tested for anti-H. pylori and anti-CagA IgG by ELISA. A physician completed a questionnaire including demographic characteristics, habitual history, and spirometric findings for each patient. Of 90 patients with COPD 66 [51%] had mild, 31 [34.4%] moderate, and 13 [14.4%] sever disease. There was no significant association between H. pylori IgG seropositivity and COPD. Serum levels of anti-CagA IgG were significantly higher in patients with COPD than in the control subjects [P<0.001]. No association was observed between H. pylori infection and severity of COPD. The results suggest that there is an association between CagA-positive H. pylori infections and COPD. Further studies should be planned to investigate the potential pathogenic mechanisms that might underlie these associations

Nosocomial bacterial infections and their antimicrobial resistance paterns in university hospitals of Hamedan, Iran

Nosocomial infections constitute a global health problem, leading to a high rate of morbidity and mortality. The aim of this study was to determine the frequency and antimicrobial resistance patterns of nosocomial infections in educational hospitals of Hamadan, western, Iran. During a 1-year period from April 2006 to March 2007, all patients with culture-proven nosocomial infections from educational hospitals in Hamedan, western Iran were included. Nosocomial infections were defined as a culture-proven infection, which occurred more than 48h after admission in the hospital. Antimicrobial susceptibility testing of isolated bacteria was performed by disc diffusion method. A total of 170 cases of culture-proven nosocomial infections were diagnosed. Most cases were in intensive care units [ICUs] [57.4%]. The common sites of infection were lower respiratory tract [51.8%] and urinary tract [31.9%]. Klebsiella pneumoniae, Pseudomonas aeruginosa, and Escherichia coli, were the most prevalent pathogens [32.7%, 22.9%, and 14.8% respectively]. Most enterobacteriacea isolates were resistant to third generation cephalosporins. The resistant rates to ceftriaxone were 75.5% for K. pneumoniae, and 76% for E. coli. Among P. aeruginosa isolates, 26.5% were resistant to ceftazidim, and 36% to ciprofloxacin. Among S. aureus isolates, 80% were methicillin-resistant. The patients in the ICUs are at a higher risk of nosocomial infections. The high prevalence of antimicrobial resistance in the hospitals highlights the need of further infection control activities and surveillance programs

Screening for tuberculosis among patients with chronic psychiatric disorders in Hamedan

Tubercle bacilli most often are transmitted from one person by the airborne route. The aim of the present study was to determine the frequency of latent tuberculosis infection and active pulmonary tuberculosis among patients with chronic psychiatric disorders in Hamedan. In a cross sectional study, 215 patients with chronic psychiatric disorders were investigated for tuberculin skin test. Those with an induration of >/= 10 mm were introduced for further evaluation, including a chest-x-ray and examination of the sputum for acid-fast bacilli for those with radiographic abnormalities. Of 215 patients, 62 [28.8%] had positive tuberculin skin test reaction. Age and duration of psychiatric disorders were significantly associated with test positivity. Of 62 tuberculin-positive patients, 25 [40.3%] had radiographic evidences of inactive pulmonary tuberculosis. None of them had positive sputum smear for tuberculosis. Chronic psychiatric patients are more susceptible to tuberculosis infection. Screening tests should be applied for these patients

epidemiology of burn wound infections in patients hospitalized in burn center of Hamedan, Western Iran

A total of 465 burned patients with wound infections who admitted to referral burns center of Hamedan Imam Khomeiny hospital from July 1998 to June 2001 were retrospectively studied. The required data including age, sex, season, causes of burns, burn size of wounds and types of organisms isolated from patients [wounds and blood], was recorded in a questionnaire. The susceptibility of the isolates to eight routine antibiotics was tested by disc diffusion method.The data was analyzed by SPSS and EP16 software package. Out of 465 burn wound infections 73.1% of isolates were Gram-negative bacilli and 26.9% were Gram-positive cocci. Pseudomonas aeruginosa [32.7%], Klebsiella pneumoniae [21.8%] and Staphylococcus aureus [21.2%] were the most common isolates. In 28.7% of patients, blood culture became positive, Klebsiella pneumoniae [30.4%], Pseudomonas aeruginosa [26.9%], were predominant isolates. 57.3% of patients were males and the most frequency of burn patients belonged to age group 0-9 years old [28.6%], most of the burns occurred during summer. Boiled water, fuel oil flames and firewood flames were the commonest causative agent for burns, respectively. The most effective antibiotics against isolates were ciprofloxacin, ceftizoxime, amikacin and gentamicin, while most of isolates showed high resistance to ampicillin, tetracycline and carbenicillin. Present results indicated that Pseudomonas aeruginosa, Klebsiella pneumoniae and Staphylococcus aureus were predominant isolates with high resistance to tested antibiotics. These data can be used to evaluate the effects of changes in burn treatment and antimicrobial resistance development in relation to antibiotic usage