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Background: Today, one of the important challenges related to the emergence of antibiotic resistance among hospital-acquired infections is Vancomycin-Resistant Enterococci (VRE). The identification of the hospital transfer pattern and accurate laboratory diagnosis can be effective in preventing or selecting the appropriate antibiotics for the treatment of these types of infections, especially in hemodialysis patients. Case report: This report discusses the hospitalization of a 2.5-year-old boy with End-Stage Renal Disease (ESRD) and Focal Segmental Glomerulosclerosis (FSGS) at a nephrology center in a tertiary hospital. The patient received hemodialysis treatment, followed by an abdominal tap, which revealed an infection. Peritoneal and blood cultures were conducted using the BACT/ALERT®3D instrument, and the results indicated a bacterial infection during the hospital stay. Further analysis confirmed that the infection was caused by enterococci, and susceptibility testing revealed that the isolated strain was resistant to vancomycin. Fortunately, the enterococci infection responded well to linezolid antibiotic treatment, administered at a dose of 600 mg PO/IV q12hr for 14 days. Conclusions: This report highlights the importance of healthcare workers being aware of the transmission routes of VRE among patients. It emphasizes the need for appropriate hand hygiene, sterility of extracorporeal devices, and proper catheter care in medical centers.
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Ralstonia pickettii is a rare Gram-negative opportunistic bacterium that causes rare infections such as bacteremia, neonatal sepsis, endocarditis, and meningitis in hospitalized or immunocompromised patients. In this study, we identified and reported bloodstream infection caused by R. pickettii in a 15 -year-old boy patient with an autoimmune disease, Guillain-Barré syndrome, under plasmapheresis and intravenous immune globulin (IVIG) therapy. He was referred for admission to the neurology center of the teaching hospital of Shiraz, Iran for inability to walk, and lower extremity muscle weakness. After he was treated with plasmapheresis once during hospitalization, and after severe fever besides shivering blood cultures using BACT/ALERT®3D instrument were positive for R. pickettii.According to antibiotic susceptibility test reports, Ciprofloxacin (5 µg) was prescribed. Fortunately, after starting antibiotic treatment, blood culture results reported no growth after 5 days. Indeed, the patient was infected with nosocomial hepatitis A and URSOBIL (300 mg/BID/Po) was administered. Hence, after reporting the infection occurrence to the hospital infection control unit, initial and possible measures such as device infection control, replacement of potentially polluted plasmapheresis fluids, disinfecting the environment and replacing old sterile washing water with new sources were carried out in plasmapheresis unit. In conclusion, R. pickettii is a rare nosocomial infection that is responsible for the contamination of medical equipment, especially in hemodialysis, plasmapheresis devices and sterile solutions. Also, it is suggested that the role and importance of rare environmental bacteria as the causative agents of human infections should not be ignored in medical centers.
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Introduction. One of the most important resistant mechanisms in Gram-negative bacteria is extended spectrum ß-lactamases (ESBLs). Harbour-related genes on plasmids, increase the risk of resistance transmission among commonly reported hospital infections.Aim. This study was designed to explore the dissemination of Pseudomonas aeruginosa producing ESBLs on their plasmids recovered from the different wards of Amir-Al-Momenin burn center, Affiliated with Shiraz University of Medical Sciences.Methodology. Among 256 isolates, 88 (34.38 %) P. aeruginosa strains were isolated from burn hospitalized patients. Samples were processed for antibiotic resistance using the Kirby-Bauer method while MIC was performed for colistin. MIC was used by the microdilution broth method as recommended by Clinical and Laboratory Standards Institute guidelines. Related studied genes were evaluated on extracted plasmids by the PCR method.Results. According to the phenotypic and molecular steps, a total of 58 (65.91 %) and 74 (84.10 %) strains detected positive ESBLs, respectively. Based on antibiogram tests, a total of 63 (71.59 %) isolates were detected as multidrug resistant. All ESBL P. aeruginosa isolates showed identical antimicrobial susceptibility profiles. The genotypic prevalence of ESBLs for bla SHV, bla TEM, bla GES, bla OXA-10 and bla PSE genes was 47.73, 78.41, 5.58, 3.41, 4.55 %, respectively.Conclusion. All P. aeruginosa strains producing ESBLs had plasmids containing related genes. The data indicated a high prevalence of ESBL among P. aeruginosa isolates in the southwest of the Iran burn center and their enzyme types were diverse.