RESUMO
Background: Acinetobacter baumannii is one of the most common causes of ventilator-associated pneumonia (VAP) in patients hospitalized in ICU. Multiple resistance has resulted in excessive use of Colistin antibiotic, which is the latest treatment option for this bacterium. Therefore, the purpose of this study was to determine the abundance of multi-resistance and molecular characteristics of resistance to colistin among A. baumannii isolated from patients that are infected with VAP and hospitalized in ICU of "Qazvin" and "Masih Daneshvari" hospitals. Materials and Methods: In this study, 200 A. baumannii isolates related to VAP were collected from ICU of "Masih Daneshvari" (2012-2018) and "Qazvin" (2017-2018) hospitals, from bronchoalveolar lavage & tracheal aspirate specimens. Isolates were detected as A. baumannii by PCR with specific primers of the blaOXA-51-like gene. Antibacterial susceptibility of isolates to colistin was determined by the MIC method, and other antibiotics were examined by the disk diffusion method, according to the CLSI criteria. Multi-drug resistance (MDR) and extended-drug resistance (XDR) isolates were determined according to standard definitions of the CLSI. Results: All the isolates were susceptible to colistin. Moreover, they were resistant to piperacillin, piperacillin-tazobactam, ceftazidime, cefotaxime, ceftriaxone, amikacin, gentamycin, levofloxacin, co-trimoxazole, and ciprofloxacin. Antimicrobial resistance rates for tetracycline and ampicillinsulbactam were 8.5% and 20%, respectively. All isolates were MDR and XDR. All isolates were susceptible to colistin (MIC50=1 and MIC90=2 µg/ml). The sequencing results did not show any point mutation in pmr CAB genes, and mcr-1 gene was not detected in any isolates. Conclusion: In this study, all A. baumannii isolates collected from VAP patients were MDR and XDR. Although all isolates were susceptible to colistin, and this agent seems the most appropriate antibiotic for treatment of VAP, colistin resistance can become endemic in the world rapidly due to plasmid-mediated mobile colistin resistance mcr genes.
RESUMO
BACKGROUND: Halotherapy is a treatment modality suggested for patients with chronic pulmonary diseases. In this technique, inhalation of crystal salt stones extracted from mines improves patients' pulmonary function tests and symptoms by facilitating the secretion or expulsion of phlegm and mucus and reducing the risk of bacterial infections. Bronchiectasis is chronic disease of the airways characterized by irreversible dilation of airways. It has a progressive course and despite the available treatments, many of these patients eventually enter the advanced phase of disease. The aim of this study was to evaluate the effect of halotherapy on pulmonary function tests and quality of life of non-CF bronchiectatic patients. MATERIALS AND METHODS: This clinical trial evaluated the results of spirometry and 6-minute walk test as well as the quality of life (according to SF-36 questionnaire) of stable non-CF bronchiectatic patients presenting to the pulmonary clinic before and after the use of salt spray for 2 months. RESULTS: Of 40 study patients, 20 were excluded due to various reasons and 20 were evaluated. The mean age of patients was 35±11 years and the underlying cause of disease was chronic pulmonary infection in 65% of cases. Comparison of the results of pulmonary function tests and 6-minute walk test and quality of life indices in SF-36 questionnaire before and after the intervention showed no significant difference (P > 0.05). However, 65% of patients were satisfied with halotherapy and requested to receive the medication again. CONCLUSION: Our study results indicated that 2-month halotherapy with Salitair inhaler containing salt crystals extracted from the Klodawa mine in Poland could not improve the pulmonary function tests or quality of life of non-CF bronchiectatic patients. No significant side effects were noted in understudy patients. Future studies with larger sample size and longer duration of treatment are recommended to better determine the efficacy of this treatment modality.