---

Abstract

Background and objectives:

(ESBL) strain is one of the emerging health related problems in the world recently.

Some of the species of the gram-negative bacilli including Klebsiella Pneumonia &

Escherichia Coli are well known ESBL producing among bacteria, and they cause

uncontrollable infections. This Cross-sectional study was designed to asses the

ESBL producing gram negative bacilli among inpatients of Shohada-ye- ashayer

hospital (Khorram Abad).

Extended Spectrum Betalactamase producing

Materials and methods:

methods. ESBL producing gram negative bacilli were screened with MacConkey

Agars containing 4 mg/liter Ceftazidime and confirmed with double disk synergy

method as recommended by national standard laboratory institute.

Samples were processed with routine laboratory

Results:

positive for ESBL.The most isolated species of ESBL are 20 Klebsiella

pneumonia(8.88%), 10 Escherchiia coli(4.44%) and 10 pseudomonas

aeruginosa(4.44%). The most ESBL producing gram-negative bacilli were Isolated

from urine samples (21 cases 39.62%).and Ten cases (18.86%) from bronchoscopy

sterile samples.

Fifty- there cases (23.55%) of 225 total isolated gram negative bacilli are

Conclusion:

frequently isolated from Shohada-ye-Ashaier Hospital. Regarding the high

resistance of these strains against many of the antibiotics and even against

Carbapenems, health- care providers need to plan controlling policies for such

strains.

The Results indicate that ESBL producing gram-negative bacilli are

Key words:

 

Extended Spectrum Betalactamase.

Hospital acquired infection, Escherichia coli, Klebsiella Pneumoniae,

---

Abstract Background and objectives: Coronary Artery Disease is one of the most important causes of death in the world. Atherosclerosis is a complex disorder and many factors cause it . In recent years , a relationship between infectious agents, particularly Chlamydia pneumonia, and atherosclerosis was found. This research was aimed at serological studying of Chlamydia pneumonia in the coronary artery patients and healthy ones. Material and Methods: We carried out this cross-Sectional study on 102 patients with CAD and 142 individuals without any history of CAD. The subjects were admitted to Dr. Beheshty hospital, Babol, from July 2005 to September 2006. The subjects’ serums were collected to detect specific anti Chlamydia pneumonia antibodies (IgA and IgG), using ELISA method. Data were analyzed by chi-square, using SPSS software. Results: The mean age of patients and healthy subjects were 60.6 and 43.7 years, respectively. Fifty-nine point eight percent of cases and 40.8% of healthy subjects are men. The results show that 45.1% of patients and 47.9% of healthy subjects have positive titer of IgG and negative titer of IgA (chronic). There is no significant correlation between patient and healthy groups (P=O.698). Also 88.2% of patients and 81% of healthy group have positive titer of anti Chlamydia pneumonia antibody (IgG). Conclusion: In spite of high titer of IgG, there is no significant relationship between Chlamydia pneumonia and atherosclerosis. It seems that further experiments are necessary to prove the relationship between Chlamydia and atherosclerosis. Key words: Atherosclerosis, Chlamydia pneumonia, IgA, IgG

---

Abstract Background and objectives: The aim of this study was the detection of S.pneumoniae infection by rapid urinary test and blood culture in children with pneumonia in comparison with healthy children. Material and Methods: This case control study was carried out in pediatric ward of Rasoul Akram hospital in Tehran, Iran (2006 - 200٧).Fifty-four Community acquired pneumonia (CAP) and 50 healthy children were selected by simple sampling. The urinary antigen detection test (BINAX NOW co.) was performed on both cases and controls and blood culture was done for the cases suffered from Pneumonia. Results: Pneumococcal antigenuria is detected in 31.5 % of CAP and 6 % of controls groups. There is Significant difference between cases and controls (fisher test CI 95%, P =0.01). None of the children with nonpneumococcal Pneumonia (positive culture) has antigenuria. Conclusion: The possibility of diagnosis of pneumococcal pneumonia in children, by means of blood culture, is low. Thirty-one percent of CAP is due to S.pneumonia, by using the rapid antigenuria test. There fore, we recommend using rapid urinary antigen test, in addition to blood Culture test. Key words: CAP (community-acquired pneumonia) S pneumoniae urinary antigen test (BINAX now), Blood culture, Children

---

Abstract Background and objectives: Colonization of nasopharynx by Streptococcus Pneumoniae can lead to pneumococcal disease. This study was performed to determine the carriage rate of nasopharyngeal S.pneumoniae in adolescents and their antibiotic susceptibility and serotype prevalence in Zahedan, Iran Material and Methods: Nasopharyngeal specimens were obtained from 865 adolescents aged 10-19 years old of eight schools in Zahedan and then assessed by standard procedures to isolate S. Pneumoniae. The serotyping was carried out by latex agglutination test, the minimum inhibitory concentration (MIC) of penicillin, as well as other commonly used antibiotics, was determined by a broth-dilution method. Results: Pneumococci were Isolated from 15.7% [136/865, 95% confidence interval (CI) 12.3-18.9] of total samples. Of 136 samples, 119 isolates are typified by the available antisera which the most frequent ones are 1, 19A, 15C, 9V, 11A and 19F. Ninthythree pneumococcal isolates are sensitive to penicillin. The MIC values of antibiotics tested are (μg/ml): penicillin 0.01-4, cefotaxime 0.01-4, ceftriaxone 0.02-128, chloramphenicol 0.08-32, ciprofloxacin 0.06-16, erythromycin 0.01-128, tetracycline 0.08- 128 and vancomycin 0.02-1. Conclusion: A clear diversity is seen in the serotype distribution of the S. Pneumoniae isolates and most of the antibiotic resistant strains belonge to a few serotypes. Healthy adolescents in Zahedan commonly show pneumococcal carriage and antibiotic resistance. Keywords: Streptococcus Pneumoniae, nasopharyngeal carriage, penicillin resistance, serotype

---

Abstract Background and objectives: the increasing use of antibiotics, especially the third generation cephalosporins, is an important factor in the spread of antibiotic resistance in bacteria. The main reason for the development of resistance phenotype such as Extended Spectrum Beta Lactamas (ESBL) is the extensive use of broad-spectrum cephalosporins. In phenotypic survey, the Phenotyping confirmatory test and the minimum inhibitory concentration (MIC) are used. In this study, the prevalence of the isolates resistant to third generation cephalosporin (cefotaxime) was determined based on MIC. Material and Methods: form September 2010 to September 2011, 75 isolates of Klebsiella pneumoniae were collected from the infections of inpatients and outpatients, referred to state and private laboratories of Gorgan. For all of the Klebsiella pneumoniae strains, MIC determination using E-test (company Liofilcheme-Italy) was performed. Results: According to the MIC results, 26 samples (34.6%) are resistant to cefotaxime 22 isolates are completely resistant to concentration of 256μg. Conclusion: Because of the importance of risk of becoming ESBL, further studies are needed to clarify the ESBL in the region. Keywords: ESBL, MIC, Klebsiella pneumoniae, Cephalosporin

---

Abstract Background and Objective: Bacterial colonization in upper respiratory airways is one of the major risk factors for the development of the ventilator–associated pneumonia (VAP), which is the most common and serious hospital-acquired infection in intensive care unit (ICU). The aim of this study was to determine the frequency of oropharyngeal microorganisms of patients with tracheal tube hospitalized in ICU. Material and Methods: Of 39 patients hospitalized in ICU of panje Azar Hospital, the oropharyngeal cultures were taken after admission. The samples were evaluated for growth of Staphylococcus aureus, Pneumococcus, Enterococcus, Pseudomonas, and E-coli. Results: The mean age of the patients (21 men, 18 women) was 43.64±15.01. The culture was positive in 28.2% and the most common isolate was Pseudomonas aeruginosa (10.3%). Conclusion: Pseudomonas, which is the main pathogen for ventilator- associated pneumonia, may be a potential threat for the patients hospitalized in intensive care units. Keywords: Microbial Colonization, Endotracheal Tube, Intensive Care Unit, Ventilator Associated Pneumonia

---

Abstract Background and Objective: Multiple drug resistance has increased in recent years in Klebsiella pneumoniae isolates. The Integrons are mobile genetic elements that carry antibiotics resistance genes. The aim of this study was to determine antibiotic susceptibility and the prevalence of class 1, 2, and 3 integrons in clinical Klebsiella pneumoniae isolated from clinical specimens. Material and Methods: A total of 108 K. pneumoniae isolates were collected between April and December 2011 from different clinical specimens of Loghman hospital in Tehran and identified by biochemical tests. Susceptibility of isolates to 14 antibiotic disks was determined by disk diffusion method. The template DNA was extracted by freeze-thaw method and the presence of class 1, 2, and 3 integrons was investigated by PCR method. Level of resistance to antibiotics in integron-positive and integron-negative isolates was determined. Results: The highest level of resistance was seen for cefotaxime, ceftriaxone, and amoxicillin-clavulanic acid (55.5%). In 79 isolates (73.14%) class 1 integron and in 57 of 79 isolates (72.15%) resistance to at least two classes of drugs were seen. The class 2 and 3 integrons were not detected. Among integron-negative isolates, 8 isolates (27.58%) had resistance to at least one antibiotic. Conclusion: The prevalence of class 1 integron in resistant K. pneumoniae is high therefore, the monitoring of drug resistance and limiting the use of antibiotics are necessary. Keywords: Klebsiella Pneumoniae, Integron, Multi-Drug Resistance

---

Abstract Background and Objective: Streptococcus pneumoniae is the most common cause of acquired bacterial infections in the respiratory system. In recent years, a high incidence of pneumococcal resistance to different antibiotics has also been appeared. This study was conducted to evaluate the in vivo and in vitro resistance of pneumococcal pneumonia to ceftriaxone, azithromycin and co-amoxiclave in clinical setting and laboratory. Material and Methods: In this single-blind clinical trial study, the participants were the patients with the diagnosis of pneumonia referred to infectious diseases clinic in Vali-e-Asr hospital of Birjand university of Medical Sciences, October 2012 - April 2014. The patients were randomly allocated to one of the three therapeutic regimes including azithromycin, ceftriaxone, and co-amoxiclave. After 48-72 hours that the infection was confirmed by paraclinical findings, the patients with pneumococcal pneumonia remained in the study and their in vivo and in vitro resistance to the above mentioned antibiotics were compared. Results: The most in vitro drug resistance was to co-amoxiclave (41.5%) and the least to ceftriaxone (20.8%) (P>0.05). For In vivo, the most resistance was to azithromycin (47.4%) and the least one to ceftriaxone (6.7%) (p<0.05). The agreement coefficient between the laboratory antibiogram test and the clinical responses to therapeutic regimes of azithromycin, co-amoxiclave and ceftriaxone was 0.25 (p=0.26), 0.46 (p=0.02) and 0.44 (p=0.04), respectively. Conclusion: With regard to the demographic characteristics of the patients in this study, the resistance of Streptococcus pneumoniae to ceftriaxone is less than that of co-amoxiclave and azithromycin in both clinical setting and laboratory. Keywords: Drug Resistance, Streptococcus Pneumonia, Azithromycin, Ceftriaxone, Co-Amoxiclave

---

Abstract Background and Objective: Klebsiella pneumoniae is an opportunistic nosocomial pathogen causing a variety of infections including urinary tract infections, pneumonia, septicemia, wound infections and infections in the intensive care units. Since the ESBL producing Klebsiella pneumoniae strains are increasingly causing urinary tract infections, we aim to assess antibiotic resistance pattern and evaluate the prevalence of ESBL in Klebsiella pneumoniae isolated from urinary tract infections. Material and Methods: this cross-sectional study was conducted on 122 Klebsiella pneumoniae strains collected from Zahedan hospitals. After final identification of isolates, antibiotic susceptibility tests were carried out by using disk diffusion in agar method for 16 antibiotics and ESBL production was determined by the combined disk method. Results: The Klebsiella pneumoniae strains showed susceptibility to imipenem and amikacin ( 94.3%) ,chloramphenicol (88.5%) , gentamicin (81.1%) , ciprofloxacin (80.3%) , cefepime (73%) ,streptomycin (72.1%), nalidixic acid (68%) , tetracycline (65.6%), and cefotaxime, ceftazidime, cefpodoxime (62.3%) . The resistance of strains was seen to nitrofurantoin (53.3%), cotrimoxazole (39.3%), Cefpodoxime (37.7%), cefotaxime (36.9%), ceftriaxone (36.1%), aztreonam (34.4%), ceftazidime (32.8%). Thirty-eight isolates (31.1%) were shown to produce ESBLs. Conclusion: A high rate of resistance was observed to most of the antibiotics among ESBL producing strains therefore, it is important to be careful about the use of antibiotics and identification of ESBL using phenotypic methods. Keywords: Antibiotic Resistance, Extended Spectrum Beta-Lactamases,KlebsiellaPneumoniae, Urinary Tract Infection, Isolate

---

Abstract Background and Objective: Klebsiella pneumoniae is one of the agents causing nosocomial infection therefore, we decided to report the prevalence of Klebsiella pneumoniae caused infection. Material and methods: The frequency of Klebsiella in culture media samples of Panje Azar hospital was studied in 2011-2012. After determination of the species with biochemical methods and determination of resistance to third generation cephalosporins, the existence of responsible genes for this resistance was investigated using specific primers. The PCR product for CTX-M gene was sequenced. Results: During the study, 70 isolates of Klebsiella were isolated in that 51 (72.8%) related to three months of November, December and January. Except for the one related to November, other ESBL cases belonged to these three months. Based on molecular investigation of ESBL genes, these isolates at least were in 3 types and had a high frequency in Internal, female and Emergency wards. Conclusion: The present report implied a sudden prevalence of Klebsiella pneumoniae that detected and controlled by a correct monitoring. Keyword: Klebsiella Pneumoniae, ESBL, CTX-M

---

Abstract Background and Objective: Increased antibiotic resistant strains and inadequacy of current vaccines against pneumococcal infections necessitate the study of novel protein antigens. It seems that minor autolysin of Streptococcus pneumoniae may have antigenicity. Thus, we aimed at cloning its gene for the first time. Material and Methods: After DNA extraction of Streptococcus pneumoniae (ATCC 49619), Specific primers were designed for amplifying minor autolysin gene fragment, using PCR. The purified gene fragment was inserted into pET21a vector and was transformed into bacterial competent cells by heat shock technique. The presence of gene and absence of mutation in the recombinant vector were checked out with sequencing and enzymatic digestion methods. The gene sequence was finally analyzed by bioinformatic tools. Results: The gene of minor autolysin was cloned successfully and the result of enzymatic digestion was the indication of complete isolation of this gen from plasmid. . Bioinformatics studies revealed that the mature protein was lacking signal peptide and the gene encoded 318 amino acids with a molecular weight of 36.4 kDa. Conclusion: The presentation and characterization of novel antigens such as minor autolysin could help us with finding new approaches for preventing and controlling pneumococcal infection. Keywords: Streptococcus Pneumoniae, Minor Autolysin, Cloning

---

         Keywords: Streptococcus Pneumoniae, Pharyngeal Carriers, lytA.

         Keywords: Streptococcus Pneumoniae, Pharyngeal Carriers, lytA.

         Keywords: Streptococcus Pneumoniae, Pharyngeal Carriers, lytA.

---

---

---

---

---

 Background: Rampant and irrational use of antibiotics led to antimicrobial resistance in intensive care units, directly influencing the clinical outcome. The prior introduction of antibiotics, especially broad-spectrum antibiotics, has been identified as a leading cause of hospital-acquired pneumonia. The present study aims to examine the existing scenario of antibiotic resistance due to multidrug-resistant organisms that are detected in mechanically ventilated patients.
Methods: This cross-sectional study was conducted in the department of Microbiology of a tertiary care hospital in Central India. A total of 410 endotracheal secretions were collected. The endotracheal aspirate of adult patients admitted to the medicine intensive care unit and on mechanical ventilation was received at the microbiology laboratory for processing by standard bacteriological techniques. Drug susceptibility testing was done using the Kirby-Bauer disc diffusion method according to the indications mentioned in Clinical and Laboratory Standards Institute 2021.
Results: Out of 410 collected endotracheal secretion samples, 332 (81 %) samples demonstrated bacterial growth. A total of 265 (80%) cases fulfilled the inclusion criteria. From 265 samples, 92 (34.7 %) patients were clinically and microbiologically confirmed as cases of ventilator-associated pneumonia. Over eighty percent of gram-negative bacilli were multidrug-resistant strains (Acinetobacter baumannii, Klebsiella pneumoniae, and Pseudomonas aeruginosa).
Conclusion: Real understanding of multidrug-resistant pathogens, early isolation as well as avoiding long-term antibiotic intake can reduce mortality levels currently linked with late-onset ventilator-associated pneumonia.

---

---

Background: Carbapenems are broad-spectrum β-lactam antibiotics, often reserved as last-line treatment for infections caused by multidrug-resistant (MDR) Gram-negative bacteria. Carbapenemase producing organisms (CPOs) pose a serious public health threat, contributing to severe healthcare-associated infections and increased mortality rates. This study aimed to determine the prevalence of CPOs and their antibiotic resistance patterns in isolates from burn and wound infections.
Methods: A total of 250 clinical samples (140 wound swabs and 110 burn swabs) were collected from hospitalized patients in Kirkuk and Sulaimaniyah hospitals between January and July 2023. Specimens were cultured on MacConkey agar and cetrimide agar and incubated at 37°C for 18–24 hours. Bacterial identification and antimicrobial susceptibility testing were performed using the BD Phoenix™ M50 system, while carbapenemase production was confirmed using the BD RAPIDEC® CARBA NP assay.
Results: Among the isolates, 27 (38.02%) were confirmed as carbapenemase-producing and exhibited multidrug resistance. The distribution was as follows: Pseudomonas aeruginosa (44.44%, 12 isolates), Escherichia coli (33.33%, 9 isolates), Enterobacter cloacae (18.51%, 5 isolates), and Klebsiella pneumoniae (3.7%, 1 isolate). Notably, CP-P. aeruginosa and CP-K. pneumoniae showed the highest resistance, being resistant to 15 antibiotics across seven different classes.
Conclusion: This study reveals a high prevalence of MDR CPOs in burn and wound infections, likely due to antibiotic misuse or overuse. The findings highlight the urgent need for novel therapeutic strategies to combat carbapenem-resistant pathogens, which are associated with increased global morbidity and mortality.

---

Background: Burkholderia pseudomallei is a saprophytic, aerobic, non-sporing, nonfermenting, facultative intracellular motile gram-negative bacilli found in tropical and subtropical regions. Melioidosis can range from asymptomatic infections to life-threatening illnesses affecting the internal organs, particularly when the host's immunity is compromised. Delayed clinical presentation and a lack of access to critical care resources in high-prevalence areas significantly contribute to this death burden. This disease has a high case fatality rate in endemic areas. The written consent was obtained from the patient after explained them about this study. To increase physician awareness of melioidosis in high-risk patients presenting with diverse clinical symptoms, thereby enhancing diagnostic accuracy and ensuring timely, appropriate treatment. Case descriptions:Case series: Case 1: 40-year-old male with septic pulmonary emboli; Case 2: 72-year-old female with chronic obstructive pulmonary disease and Type II respiratory failure; Case 3: 25-year-old female with septic arthritis; Case 4: 69years-old male with pneumonia and bacteraemia; Case 5: 54-year-old male with diabetic nephropathy and chronic kidney disease. The appropriate samples were collected from all the cases, and the identification of the isolated organisms and antibiotic susceptibility tests were performed using Vitek 2 automated compact system. The patients were treated with appropriate supportive measures. Among the five cases, three had a better outcome, and two cases had deteriorated. Conclusion:This case series emphasis that the Clinicians should be aware of the risk of melioidosis, particularly during the rainy season, Diagnostic tests should be enhanced to ensure timely exploration and treatment.