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Khaledi M, Afkhami H, Matouri RN, Dezfuli AAZ, Bakhti S. Effective Strategies to Deal With Infection in Burn Patient. J Burn Care Res 2021; 43:931-935. [PMID: 34935044 DOI: 10.1093/jbcr/irab226] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Treatment of bacterial infection is difficult. Treatment protocol of burned patient is hard. Furthermore, treatment in burned patients is accompanied with problems such as complexity in diagnosis of infection's agent, multiple infections, being painful, and involving with different organelles. There are different infections of Gram-positive and Gram-negative bacteria in burned patients. From important bacteria can be noted to Pseudomonas aeruginosa, Acinetobacter baumannii, and Staphylococcus aureus that have high range of morbidity and mortality. Treatment of those bacterial infections is extremely important. Hence, many studies about methods of treatment of bacterial infections have published. Herein, we have suggested practical methods for example ant virulence therapies, nanotechnology, vaccine, and photodynamic therapy in treatment of bacterial infections. Those methods have been done in many researches and had good effect.
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Affiliation(s)
- Mansoor Khaledi
- Department of Microbiology, Faculty of Medicine, Shahed University, Tehran, Iran
| | - Hamed Afkhami
- Department of Microbiology, Faculty of Medicine, Shahed University, Tehran, Iran
| | - Raed Nezhad Matouri
- Department of Medical Library and Information Sciences, School of Health Management and Information Sciences, Iran University of Medical Sciences, Tehran, Iran
| | | | - Shahriar Bakhti
- Department of Microbiology, Faculty of Medicine, Shahed University, Tehran, Iran
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Rahimi E, Asgari A, Azimi T, Soleiman-meigooni S. Molecular Detection of Carbapenemases and Extended-Spectrum β-Lactamases-Encoding Genes in Clinical Isolates of Pseudomonas aeruginosa in Iran. Jundishapur J Microbiol 2021; 14. [DOI: 10.5812/jjm.115977] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
Background: Pseudomonas aeruginosa is a unique Gram-negative opportunistic pathogen that is the leading cause of nosocomial infections. Objectives: This study aimed to investigate the prevalence of the main carbapenemase and extended-spectrum β-lactamases encoding genes in P. aeruginosa clinical isolates. Methods: In the present study, we collected 85 P. aeruginosa clinical isolates from different wards of three military hospitals in Tehran, Iran. We used disk diffusion and agar dilution methods to determine resistance to 12 different antibiotics in these isolates. Also, we assessed the blaIMP, blaVIM, blaSHV, blaTEM, and blaCTX genes by polymerase chain reaction methods among all isolates. Results: Our results revealed that all isolates were resistant to two antibiotics, and 76 (89.4%) of isolates were multidrug-resistant. We observed maximum and minimum resistance rates against ticarcillin (n = 77; 90.5%) and colistin (n = 7; 8.2%), respectively. The blaVIM, blaIPM, blaTEM, blaSHV, and blaCTX genes were harbored by 44 (51.8%), 20 (23.5%), 41 (48.2%), 24 (28.2%), and 16 (18.8%) isolates, respectively. Conclusions: The resistance rate among P. aeruginosa strains is significantly increasing that causes nosocomial infections due to different mechanisms, including the high frequency of metallo-β-lactamases and extended-spectrum β-lactamases genes.
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Bazgir ZN, Ahanjan M, Goli HR, Gholami M, Ghasemian R, Hashemi-Soteh MB. Frequency of bla IMP and bla SPM Metallo-β-Lactamase Genes among Carbapenem-Resistant Pseudomonas aeruginosa Clinical Isolates in Sari, North of Iran. Recent Adv Antiinfect Drug Discov 2021; 16:148-156. [PMID: 34961433 DOI: 10.2174/2772434416666210607141520] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/17/2020] [Revised: 04/03/2021] [Accepted: 04/07/2021] [Indexed: 12/31/2022]
Abstract
INTRODUCTION Metallo-β-lactamases (MBLs) play a major role in the resistance of Pseudomonas aeruginosa to carbapenems. We investigated the antibiotic susceptibility patterns and frequency of MBLs genes (blaIMP and blaSPM) in carbapenem-resistant P. aeruginosa clinical isolates in Sari, Iran. MATERIALS AND METHODS The isolates were identified using standard microbiological tests, and their antibiotic susceptibility pattern was determined by the disk agar diffusion method according CLSI criteria. Phenotypic identification of MBL-producing strains assessed by the combined disk test (CDT). Then, polymerase chain reaction (PCR) was used to detect the presence of blaIMP and blaSPM genes. RESULTS The highest and lowest levels of antibiotic resistance were observed against gentamicin (40%) and piperacillin-tazobactam (13%), respectively. Besides, 40 isolates (40%) had the multi-drug resistant (MDR) phenotype, while 5 (12.5%) MDR isolates were resistant to all antibiotics tested. The results of the CDT showed that among 43 carbapenem non-susceptible clinical isolates of P. aeruginosa, 33 (76.74%) isolates were MBL-producing strains. Also, the frequency of the blaIMP gene among 43 carbapenem non susceptible isolates was determined to be 6.97%, while none of these isolates carried the blaSPM gene. CONCLUSION Due to the high prevalence of carbapenem-resistant and MDR P. aeruginosa in this study, routine antibiotic susceptibility testing and phenotypic identification of carbapenemase production by this bacterium are necessary for the proper selection of antibiotics.
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Affiliation(s)
- Zahra Norouzi Bazgir
- Molecular and Cell Biology Research Centre, Faculty of Medicine, Mazandaran University of Medical Sciences, Sari, Iran
| | - Mohammad Ahanjan
- Pediatric Infectious Disease Research Center, Communicable Disease Institute, Mazandaran University of Medical Sciences, Sari, Iran
| | - Hamid Reza Goli
- Molecular and Cell Biology Research Centre, Faculty of Medicine, Mazandaran University of Medical Sciences, Sari, Iran
| | - Mehrdad Gholami
- Department of Microbiology and Virology, Faculty of Medicine, Mazandaran University of Medical Sciences, Sari, Iran
| | - Roya Ghasemian
- Antimicrobial Resistance Research Center, Mazandaran University of Medical Sciences, Sari, Iran
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Rabiei MM, Asadi K, Shokouhi S, Nasiri MJ, Alavi Darazam I. Antipseudomonal β-Lactams Resistance in Iran. Int J Microbiol 2020; 2020:8818315. [PMID: 33488724 DOI: 10.1155/2020/8818315] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2020] [Accepted: 12/07/2020] [Indexed: 11/17/2022] Open
Abstract
Over the last years, the mortality rate of Pseudomonas aeruginosa, which is one of the major reasons for severe infections, has been significantly increasing. This bacterium is highly resistant to many antibiotics, especially carbapenems, thanks to its complicated mechanism by which it can acquire exogenous genes. The purpose of this research is to have a review of empirical studies surveying the P. aeruginosa resistance to beta-lactams in Iran in order to investigate the most reliable methods by which the incidence of P. aeruginosa infections can be decreased and controlled. We performed a systematic review of all articles published from 2008 until 2018. Studies which did not address P. aeruginosa resistance to beta-lactams were excluded from the analysis. Studies with less than 10 cases were also excluded. Studies with more than ten cases, which did not have repetitive information, were taken into account for the final selection; 133 out of 893 articles were chosen. The resistance rate of P. aeruginosa among the articles was as follows: more than 72% of studies revealed >50% level of resistance to cefepime, followed by aztreonam (53.2%), ceftazidime (61%), piperacillin/tazobactam (54.5%), meropenem (48.3%), and imipenem (42.4%). The selection of empiric antipseudomonal antibiotics is absolutely uncertain and hazardous, and the risk of clinical failure may be more among cephalosporins and piperacillin-tazobactam as well as aztreonam. The results of this study illustrate that the methods enabling clinics to identify the bacterium resistance pattern and its genetic basis and to have the opportunity of empiric therapies through access to updated local data of antimicrobial susceptibility pattern are the most effective methods. However, the widespread usage of these approaches undoubtedly needs reliable molecular and nucleic acid-based devices, which are both affordable and available.
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Al-Khudhairy MK, Al-Shammari MMM. Prevalence of metallo-β-lactamase-producing Pseudomonas aeruginosa isolated from diabetic foot infections in Iraq. New Microbes New Infect 2020; 35:100661. [PMID: 32194966 PMCID: PMC7076140 DOI: 10.1016/j.nmni.2020.100661] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2019] [Revised: 01/14/2020] [Accepted: 02/10/2020] [Indexed: 12/03/2022] Open
Abstract
Metallo-β-lactamase (MBL)-producing Pseudomonas aeruginosa is a major cause of nosocomial infections. However, there is little information in Iraq regarding its prevalence in patients with diabetic foot ulcer. Carbapenems are efficient antibiotics against extended-spectrum β-lactamase–producing P. aeruginosa. However, there are many potential health risks associated with carbapenem-resistant P. aeruginosa. We aimed to determine MBL-producing P. aeruginosa isolated from diabetic foot ulcer infections. A total of 97 P. aeruginosa isolates were isolated from pus and deep tissue swabs of 282 patients admitted to Al-Sader hospital, Najaf City, Iraq, with diabetic foot infections from October 2017 to January 2018. All P. aeruginosa isolates were tested by the Kirby-Bauer disc diffusion method for evaluating 13 antibiotics. Phenotypic carbapenem resistance was confirmed by the combined disc test, double-disc synergy test, modified Hodge test and CHROMagar KPC agar. All phenotypic MBL-producing P. aeruginosa isolates were screened for blaIMP, blaNDM, blaSIM, blaSPM and blaVIM genes by multiplex PCR. Of the 97 P. aeruginosa isolates, combined disc test and modified Hodge test revealed 12 isolates (12.4%) to be MBL producers, and ten (10.3%) displayed MBL production as accessed by CHROMagar KPC agar test. Nine isolates (9.3%) were carbapenemase producers by the imipenem and ceftizoxime double-disc synergy test. Of 12 phenotypic MBL-producing P. aeruginosa, PCR amplification confirmed 4 (33.3%) and 3 (25%) isolates harbouring blaVIM and blaIMP gene respectively, but none carried the blaNDM, blaSIM or blaSPM genes. The steady and rapid increase of MBL production is worrisome and needs to be controlled through extensive studies and more judicious selection of antibiotics, especially carbapenems.
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Affiliation(s)
- M K Al-Khudhairy
- Department of Community Health, College of Health and Medical Techniques, Al-Furat Al-Awsat Technical University, Kufa, Iraq
| | - M M M Al-Shammari
- College of Medicine, Jabir Ibn Hayyan Medical University, Al-Najaf, Iraq
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Vivas R, Barbosa AAT, Dolabela SS, Jain S. Multidrug-Resistant Bacteria and Alternative Methods to Control Them: An Overview. Microb Drug Resist 2019; 25:890-908. [DOI: 10.1089/mdr.2018.0319] [Citation(s) in RCA: 96] [Impact Index Per Article: 19.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023] Open
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Abril D, Marquez-Ortiz RA, Castro-Cardozo B, Moncayo-Ortiz JI, Olarte Escobar NM, Corredor Rozo ZL, Reyes N, Tovar C, Sánchez HF, Castellanos J, Guaca-González YM, Llanos-Uribe CE, Vanegas Gómez N, Escobar-Pérez J. Genome plasticity favours double chromosomal Tn4401b-bla KPC-2 transposon insertion in the Pseudomonas aeruginosa ST235 clone. BMC Microbiol 2019; 19:45. [PMID: 30786858 PMCID: PMC6381643 DOI: 10.1186/s12866-019-1418-6] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2017] [Accepted: 02/12/2019] [Indexed: 01/04/2023] Open
Abstract
Background Pseudomonas aeruginosa Sequence Type 235 is a clone that possesses an extraordinary ability to acquire mobile genetic elements and has been associated with the spread of resistance genes, including genes that encode for carbapenemases. Here, we aim to characterize the genetic platforms involved in resistance dissemination in blaKPC-2-positive P. aeruginosa ST235 in Colombia. Results In a prospective surveillance study of infections in adult patients attended in five ICUs in five distant cities in Colombia, 58 isolates of P. aeruginosa were recovered, of which, 27 (46.6%) were resistant to carbapenems. The molecular analysis showed that 6 (22.2%) and 4 (14.8%) isolates harboured the blaVIM and blaKPC-2 genes, respectively. The four blaKPC-2-positive isolates showed a similar PFGE pulsotype and belonged to ST235. Complete genome sequencing of a representative ST235 isolate shows a unique chromosomal contig of 7097.241 bp with eight different resistance genes identified and five transposons: a Tn6162-like with ant(2″)-Ia, two Tn402-like with ant(3″)-Ia and blaOXA-2 and two Tn4401b with blaKPC-2. All transposons were inserted into the genomic islands. Interestingly, the two Tn4401b copies harbouring blaKPC-2 were adjacently inserted into a new genomic island (PAGI-17) with traces of a replicative transposition process. This double insertion was probably driven by several structural changes within the chromosomal region containing PAGI-17 in the ST235 background. Conclusion This is the first report of a double Tn4401b chromosomal insertion in P. aeruginosa, just within a new genomic island (PAGI-17). This finding indicates once again the great genomic plasticity of this microorganism. Electronic supplementary material The online version of this article (10.1186/s12866-019-1418-6) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Deisy Abril
- Bacterial Molecular Genetics Laboratory, Universidad El Bosque, Carrera 9 N°131A-02, Bogotá D.C, Colombia
| | | | - Betsy Castro-Cardozo
- Bacterial Molecular Genetics Laboratory, Universidad El Bosque, Carrera 9 N°131A-02, Bogotá D.C, Colombia
| | - José Ignacio Moncayo-Ortiz
- Grupo de Investigación en Enfermedades Infecciosas- GRIENI, Facultad de Ciencias de la Salud, Universidad Tecnológica de Pereira, Pereira, Colombia
| | | | - Zayda Lorena Corredor Rozo
- Bacterial Molecular Genetics Laboratory, Universidad El Bosque, Carrera 9 N°131A-02, Bogotá D.C, Colombia
| | - Niradiz Reyes
- Grupo de Genética y Biología Molecular, Universidad de Cartagena, Cartagena, Colombia
| | - Catalina Tovar
- Grupo de Investigación en Enfermedades Tropicales y Resistencia Bacteriana, Universidad del Sinú, Montería, Colombia
| | | | - Jaime Castellanos
- Grupo de Patogénesis Infecciosa, Universidad Nacional de Colombia, Bogotá D.C, Colombia
| | - Yina Marcela Guaca-González
- Grupo de Investigación en Enfermedades Infecciosas- GRIENI, Facultad de Ciencias de la Salud, Universidad Tecnológica de Pereira, Pereira, Colombia
| | | | - Natasha Vanegas Gómez
- Bacterial Molecular Genetics Laboratory, Universidad El Bosque, Carrera 9 N°131A-02, Bogotá D.C, Colombia.,The i3 institute, Faculty of Science University of Technology, Sydney, Australia
| | - Javier Escobar-Pérez
- Bacterial Molecular Genetics Laboratory, Universidad El Bosque, Carrera 9 N°131A-02, Bogotá D.C, Colombia.
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Azimi A, Peymani A, Pour PK. Phenotypic and molecular detection of metallo-β-lactamase-producing Pseudomonas aeruginosa isolates from patients with burns in Tehran, Iran. Rev Soc Bras Med Trop 2018; 51:610-615. [DOI: 10.1590/0037-8682-0174-2017] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2018] [Accepted: 08/10/2018] [Indexed: 01/10/2023] Open
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Jabalameli F, Taki E, Emaneini M, Beigverdi R. Prevalence of metallo-β-lactamase-encoding genes among carbapenem-resistant Pseudomonas aeruginosa strains isolated from burn patients in Iran. Rev Soc Bras Med Trop 2018; 51:270-276. [DOI: 10.1590/0037-8682-0044-2018] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2018] [Accepted: 06/08/2018] [Indexed: 11/22/2022] Open
Affiliation(s)
| | - Elahe Taki
- Tehran University of Medical Sciences, Iran
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10
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Abstract
Background: Multidrug-resistant Pseudomonas aeruginosa (MDR P. aeruginosa) is known as a serious threat to human health worldwide. Limited information is available concerning the prevalence of MDR P. aeruginosa in Iran. The aim of the present study was to investigate the relative frequency of MDR P. aeruginosa in different parts of Iran. Materials and Methods: Using appropriate keywords and well-known English and Persian database, available data about MDR P. aeruginosa in Iran were retrieved. After applying predefined criteria, relevant studies were selected. Results: By using random-effect models, the pooled incidence of MDR P. aeruginosa was estimated 58% (95% confidence interval [CI]; 0.54–0.61). The highest and lowest prevalence of MDR P. aeruginosa were observed in Tehran (100%) (95% CI; 0.94–1.00) and Zahedan (16%) (95% CI; 0.10–0.24), respectively. The highest resistance rate was against ceftazidime (50%) (95% CI; 0.46–0.54) and amikacin (50%) (95% CI; 0.46–0.54). Conclusion: Our findings are of concern since they demonstrate the high prevalence rate of MDR P. aeruginosa in the majority of Iranian hospitals.
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Affiliation(s)
- Hamid Vaez
- Department of Microbiology, School of Medicine, Zabol University of Medical Sciences, Zabol, Iran
| | - Amin Salehi-Abargouei
- Nutrition and Food Security Research Center, Yazd, Iran.,Department of Nutrition, Faculty of Health, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
| | - Zahra Rashki Ghalehnoo
- Department of Microbiology, School of Medicine, Zabol University of Medical Sciences, Zabol, Iran
| | - Farzad Khademi
- Department of Microbiology, School of Medicine, Ardabil University of Medical Sciences, Ardabil, Iran
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Pirii LE, Friedrich AW, Rossen JWA, Vogels W, Beerthuizen GIJM, Nieuwenhuis MK, Kooistra-Smid AMD, Bathoorn E. Extensive colonization with carbapenemase-producing microorganisms in Romanian burn patients: infectious consequences from the Colectiv fire disaster. Eur J Clin Microbiol Infect Dis 2017; 37:175-183. [PMID: 29063446 PMCID: PMC5748401 DOI: 10.1007/s10096-017-3118-1] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2017] [Accepted: 10/09/2017] [Indexed: 02/07/2023]
Abstract
Health care of severe burn patients is highly specialized and may require international patient transfer. Burn patients have an increased risk of developing infections. Patients that have been hospitalized in countries where carbapenemase-producing microorganisms (CPMO) are endemic may develop infections that are difficult to treat. In addition, there is a risk on outbreaks with CPMOs in burn centers. This study underlines that burn patients may extensively be colonized with CPMOs, and it provides best practice recommendations regarding clinical microbiology and infection control. We evaluated CPMO-carriage and wound colonization in a burn patient initially treated in Romania, and transported to the Netherlands. The sequence types and acquired beta-lactamase genes of highly-resistant microorganisms were derived from next generation sequencing data. Next, we searched literature for reports on CPMOs in burn patients. Five different carbapenemase-producing isolates were cultured: two unrelated OXA-48-producing Klebsiella pneumoniae isolates, OXA-23-producing Acinetobacter baumanii, OXA-48-producing Enterobacter cloacae, and NDM-1-producing Providencia stuartii. Also, multi-drug resistant Pseudomonas aeruginosa isolates were detected. Among the sampling sites, there was high variety in CPMOs. We found 46 reports on CPMOs in burn patients. We listed the epidemiology of CPMOs by country of initial treatment, and summarized recommendations for care of these patients based on these reports and our study.
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Affiliation(s)
- L E Pirii
- Department of Medical Microbiology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.
| | - A W Friedrich
- Department of Medical Microbiology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - J W A Rossen
- Department of Medical Microbiology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - W Vogels
- Department of Medical Microbiology, Certe, Groningen, The Netherlands.,Department of Medical Microbiology, Martini Hospital, Groningen, The Netherlands
| | | | - M K Nieuwenhuis
- Association of Dutch Burn Centers, Burn Centre, Martini Hospital Groningen, Groningen, The Netherlands
| | - A M D Kooistra-Smid
- Department of Medical Microbiology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.,Department of Medical Microbiology, Certe, Groningen, The Netherlands
| | - E Bathoorn
- Department of Medical Microbiology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
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Abstract
INTRODUCTION Imipenem-resistant Pseudomonas aeruginosa (IRPA), due to resistance to different classes of antibiotics and its remarkable capacity to survive in harsh and adverse conditions such as those in the hospital environment, is considered a serious threat to the healthcare system. Given the great impact of IRPA on patients' outcome and in order to possibly improve antibiotic prescription, this study was conducted to determine the prevalence of clinical isolates of IRPA in different parts of Iran. METHODS A systematic literature search was performed in PubMed, Web of Science, Google Scholar and Scopus, as well as in two Iranian domestic search engines, i.e., Iranian Scientific Information Database and Magiran. Finally, after applying exclusion and inclusion criteria 37 articles with full-texts describing the prevalence of imipenem-resistant P. aeruginosa were selected for meta-analysis and systematic review. RESULTS The pooled estimation of 5227 P. aeruginosa isolates in this analysis showed that the percentage of imipenem-resistant P. aeruginosa is about 54% in the Iranian population (95%CI: 0.47-0.62, logit event rate=0.19, 95%CI: -0.12,0.49). CONCLUSION The findings of this analysis show that in the majority of Iranian hospitals the relative frequency of IRPA is high, therefore, in order to prevent further dissemination of IRPA, more appropriate antibiotic prescription and infection control policies must be implemented by decision-makers.
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Affiliation(s)
- Hamid Vaez
- PhD, Department of Microbiology, School of Medicine, Zabol University of Medical Sciences, Shahid Rajaei Street, P.O. code 9861663335, Zabol, Iran
| | - Amin Salehi-Abargouei
- PhD, Department of Nutrition, Faculty of Health, Shahid Sadoughi University of Medical Sciences, Bahonar Square, PO code 8915173160, Yazd, Iran
| | - Farzad Khademi
- PhD, Department of Microbiology, School of Medicine, Ardabil University of Medical Sciences, Daneshgah Street, PO code 5618985991, Ardabil, Iran
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