Molecular characterization of intestinal carriage of carbapenem-resistant Enterobacteriaceae among inpatients at two Iranian university hospitals: first report of co-production of bla NDM-7 and bla OXA-48.

Gastrointestinal colonization of carbapenem-resistant Enterobacteriaceae (CRE) could serve as a reservoir for the transmission of these pathogens in the clinical setting. The aim of this study was to investigate the intestinal carriage of CRE and to analyze risk factors for CRE carriage. Rectal swabs were collected from 95 patients at two Iranian university hospitals. CRE screening was performed using selective media (CHROMagar and MacConkey agar). Polymerase chain reaction (PCR) was used to detect carbapenemase-encoding genes. Clonal relatedness was investigated by pulsed-field gel electrophoresis (PFGE). The rate of carriage of CRE in hospitalized patients was 37.9%. Overall, 54 CRE isolates were identified, of which 47 were carbapenemase-producers. All of the 54 CRE were detected using CHROMagar compared with 52 CRE detected using MacConkey agar. Fifteen patients were colonized by multiple CRE isolates. Three significant risk factors for CRE carriage were detected: intensive care unit (ICU) hospitalization, antibiotic exposure, and mechanical ventilation. bla OXA-48 was the most frequent carbapenemase detected, followed by bla NDM-1 and bla NDM-7. Eleven carbapenemase-producing Enterobacteriaceae (CPE) isolates co-harbored bla NDM-1 and bla OXA-48. Also, six CPE isolates co-harbored bla NDM-7 and bla OXA-48. We did not detect bla KPC, bla GES, bla IMP, or bla VIM. PFGE analysis showed that Escherichia coli clones were diverse, while Klebsiella pneumoniae isolates were divided into four clusters. Cluster I was the major clone carrying bla OXA-48 and bla CTX-M-15 genes. In our study, the carriage rate of CRE was high and the emergence of CPE isolates among patients is alarming. The implementation of adequate preventive measures such as active surveillance is urgently needed to control the spread of CPE in the healthcare setting.

Detection of New Delhi Metallo-Beta-Lactamase-1 (NDM-1) in carbapenem- resistant Klebsiella pneumoniae isolated from a university hospital in Iran.

BACKGROUND: New Delhi metallo-beta-lactamase-1(NDM-1) is a novel type of metallo-beta-lactamase (MBL) which inactivates all ß-lactam antibiotics except aztreonam. Enterobacteriaceae expressing NDM-1 have been identified worldwide. The aim of this study was to detect MBLs in carbapenem-resistant K. pneumoniae isolates obtained from patients hospitalized in one of the university hospitals in Isfahan, Iran. METHODS: Of the 112 isolates obtained from various clinical samples, 49 were selected for carbapenemase detection based on their reduced susceptibility to imipenem or meropenem according to the disc diffusion method. These isolates were screened for carbapenemase and MBL production using the Modified Hodge Test (MHT) and Epsilometer test (E-test) MBL strips. Polymerase chain reaction was performed on all 49 isolates using specific primers to detect genes encoding IMP (active on imipenem), VIM (Verona integron-encoded metallo-ß-lactamase), SPM-1 (Sao Paulo metallo-ß-lactamase) and NDM-1. RESULTS: Among 49 carbapenem-resistant isolates, 32 (65.3 %) were positive for MHT and 6 (12.2 %) were found positive for blaNDM-1. Other MBL genes were not detected. CONCLUSION: This is the second report on the detection of blaNDM-1 in Iran since it was first reported by Shahcheraghi and colleagues in 2012. This study indicated that resistance to carbapenems and isolation of bacteria producing NDM-1 is increasing. Therefore, the rapid detection of isolates expressing NDM-1 is essential to control their spread. Hippokratia 2015; 19 (3): 205-209.

The relationship between plasma leptin and FSH concentrations with ovulation rate in Iranian native sheep.

The aim of this study was to determine the relationship between plasma leptin and FSH concentration in Iranian sheep. Forty female Mehraban and Sanjabi sheep were used. All ewes were cyclic and synchronized with cloprestenol. The ewes were divided into two breed groups: Mehraban breed (n = 20) and Sanjabi breed (n = 20), feeding at maintenance level. On the first and second days of estrus cycle, blood samples were collected from the jugular vein. Ovulation number was determined by endoscopy 7 days after the second injection. Mean Plasma leptin concentrations on second day (4.74 +/- 0.15 and 4.68 +/- 0.10 ng mL(-1)) were significantly higher than those on first day (2.64 +/- 0.11 and 2.56 +/- 0.04 ng mL(-1)) for Mehraban and Sanjabi sheep, respectively (p<0.01). Mean plasma FSH concentrations on second day (2.75 +/- 0.17 and 2.74 +/- 0.15 ng mL(-1)) were also significantly greater than those on first day (1.19 +/- 0.05 and 1.19 +/- 0.04 ng mL(-1)) for Mehraban and Sanjabi ewes, respectively (p<0.01). In the present study, positive relationship has been shown between plasma Leptin and FSH concentrations (p<0.01) in Mehraban and Sanjabi sheep. Ovulation rate had a significant difference between Mehraban (1.20 +/- 0.33) and Sanjabi (1.07 +/- 0.1) ewes. Significant differences were not observed between concentrations of FSH and leptin with ovulation rate in both breeds (p < or = 0.01).