Rise of antibiotic resistance in clinical enterococcal isolates during 2001-2016 in Iran: a review.

INTRODUCTION: The clinical significance of enterococci is mostly related to its antibiotic resistance which contributes to colonization and infection, in particular amongst the hospitalized patients. The present review has examined the literature to provide a comprehensive data on enterococci antibiotic resistance during the last 20 years in Iran. METHODS: Search engines such as Google Scholar and PubMed were used to identify all Persian and English-language articles investigating enterococci in Iran from 1996 to 2017. The search terms were "enterococci", "enterococcal", "enterococcus", "Iran", "bacterial resistance", "antibiotic resistance" and "resistance". RESULTS: Decrease in the resistance trend against ampicillin, gentamycin and ciprofloxacin was observed over a period of 15 years (2001 to 2016) in Iran. During a 10 years period from 2001 to 2015, the rate of resistance among Enterococcus faecalis species was less than Enterococcus faecium. The resistancerate, however, was considerably increased for both species during this period. The mean resistance rates for vancomycin, gentamicin, ciprofloxacin, erythromycin, nitrofurantoin, chloramphenicol, trimethoprim-sulfametoxazol, imipenem and teicoplanin were higher among complicated cases (patients with underlying debilitating disorders) compared to general cases (hospitalized or outpatients with no specific underlying disorder). CONCLUSIONS: E. faecalis and E. faecium showed a rise in the mean resistance against all the antibiotics during a 10-year period from 2010 to 2015. With the exception of penicillin and ampicillin, resistance to all antibiotics was higher amongst complicated cases compared to general patients.

Effects of breast milk on pain severity during muscular injection of hepatitis B vaccine in neonates in a teaching hospital in Iran.

INTRODUCTION AND AIMS: Human breast milk is a natural pain reliever that contains endorphins. The aim of this study was to compare the effects of breast milk and powdered milk on pain severity after a muscular injection in 1-day-old neonates. MATERIALS AND METHODS: One hundred neonates admitted to a teaching hospital in Ilam city, Iran, participated in a randomized clinical trial in 2016. One-day-old neonates were divided into four equal groups including: the control group (no feeding); the breastfed group; the bottle-fed mother's milk group and the powdered formula group. All infants received the hepatitis B vaccine by muscle injection in the same position of the thigh. The severity and duration of pain were compared among all groups during and after injection using the DAN scoring method (evaluation behavioral scale of acute pain in newborn infant). RESULTS: One hundred neonates (57% boys) participated in this study. The mean±SD age and weight for participants were 39.15±0.05 weeks and 3016±28g, respectively. Crying duration either during or after the injection in breastfed infants was significantly shorter compared to the control and powdered formula groups (9.2±3.9 and 16±4.6s vs. 38.2±8.9 and 30.0±4.4s, respectively, during injection, P<0.003); (11.8±3.4 and 20.6±5.1s vs. 56.2±6.5 and 49.8±9.6s, respectively, after injection, P<0.006). There was also a significant relationship between behavioral variations and pain during injection (P<0.0001). CONCLUSIONS: The results of this study showed that breastfeeding decreases pain severity during painful experiences in neonates, which is in accordance with other reports. Based on this finding, neonates are advised to be breastfed if a painful intervention such as vaccination is needed. The pain-relieving effect of breast milk could also be added to its other suitable effects.

Distribution of genes encoding tetracycline resistance and aminoglycoside modifying enzymes in Staphylococcus aureus strains isolated from a burn center.

Staphylococcus aureus (S. aureus) is one of the most common organisms associated with infections among burn patients and has shown a frequent and rapid development of antibiotic resistance. The presence of genes encoding aminoglycoside modifying enzymes (AME) and tetracycline resistance were detected by PCR and multiplex-PCR. Among the 151 S. aureus isolates recovered from the burn patients, 96 (63.6%) were detected to have mecA gene. The rate of tetracycline resistance genes associated with mecA was 61% (92/151). Forty nine isolates (32.4%) contained tetM, 26 (17.2%) possessed only tetK and 21 (13.9%) contained both tetM and tetK. The presence of the aac(6')-Ie-aph(2'')-I gene was determined in 18 isolates, aph(3')-IIIa in 8 isolates, both the aac(6')-Ie-aph(2'')-I, aph(3')-IIIa and the ant(4')-Ia genes in 69 isolates, both aac(6')-Ie-aph(2'')-I and ant(4')-Ia in 6 isolates, and both the aph(3')-IIIa and the ant(4')-Ia genes in 8 isolates. Most of the strains which harboured the mecA gene also contained the tet and AME genes.

Staphylococcus aureus (S. aureus) est l'un des organismes les plus communs associés à des infections chez les patients souffrant de brûlures et a montré une évolution fréquente et plus rapide de la résistance aux antibiotiques. La présence de gènes codant pour des enzymes de modification de l'aminoglycoside et de la résistance tétracycline a été détectée par PCR et PCR multiplexe. Parmi les 151 isolats de S. aureus récupérés des patients brûlés, 96 (63,6%) contenaient le gène mecA. Le taux de gènes de résistance à la tétracycline associés à mecA était de 61% (92/151). Quarante-neuf isolats (32,4%) contenaient tetM, 26 (17,2%) ne possédaient que tetK et 21 (13,9%) contenaient tetM et tetK. La présence du gène aac(6 ')-Ie-aph ('' 2)-I a été identifiée dans 18 isolats, et le gène aph(3')-IIIa dans 8 isolats. Les gènes aac(6 ')-Ie-aph(2'')-I, aph(3')-IIIa et ant(4')-Ia ont été identifiés dans 69 isolats, aaC (6 ')-Ie-aph (2'')-I et ant(4')-Ia dans 6 isolats, et l'aph (3')-IIIa et ant(4')-Ia dans 8 isolats. La plupart des souches qui hébergeaient le gène mecA contenait également des gènes tet et AME.

Distribution of extended spectrum beta-lactamase resistance genes among nosocomial imipenem resistant A. Baumannii strains harboring BLAoxa-23 carbapenemases isolated from Ilam and Tehran.

Antimicrobial susceptibility and ESBLs genes of 42 imipenem resistant A. baumannii carried out by DDST and PCR. The most antimicrobial agents against A. baumannii strains, harboring blaOXA-23-like carbapenemases, were meropenem (33.4 percent), piperacillin-tazobactam (23.9 percent), ceftazidime (14.3 percent) and gatifoxacin (19.1 percent), respectively. All the 42 isolates harbored the blaTEM gene, but the bla SHV and VEB genes were not present among all the isolates. With the exception of seven isolates, all the A. baumannii strains harbor blaTEM showed ESBL positivity in DDST. The result of this study show that resistance against antimicrobial agents, especially carbapenems, has increased and that blaTEM harboring A. baumannii strains can be help the blaOXA-like carbapenemase genes to code for resistance against carbapenem antibiotics.