Investigation of antimicrobial resistance patterns and molecular typing of Pseudomonas aeruginosa isolates among Coronavirus disease-19 patients

BACKGROUND

Pseudomonas aeruginosa is a common co-infecting pathogen recognized among COVID-19 patients. We aimed to investigate the antimicrobial resistance patterns and molecular typing of Pseudomonas aeruginosa isolates among Coronavirus disease-19 patients.

METHODS

Between December 2020 and July 2021, 15 Pseudomonas aeruginosa were isolated from COVID-19 patients in the intensive care unit at Sina Hospital in Hamadan, west of Iran. The antimicrobial resistance of the isolates was determined by disk diffusion and broth microdilution methods. The double-disk synergy method, Modified Hodge test, and polymerase chain reaction were utilized to detect Pseudomonas aeruginosa extended spectrum beta-lactamase and carbapenemase producers. Microtiter plate assay was performed to evaluate the biofilm formation ability of the isolates. The isolates phylogenetic relatedness was revealed using the multilocus variable-number tandem-repeat analysis method.

RESULTS

The results showed Pseudomonas aeruginosa isolates had the most elevated resistance to imipenem (93.3%), trimethoprim-sulfamethoxazole (93.3%), ceftriaxone (80%), ceftazidime (80%), gentamicin (60%), levofloxacin (60%), ciprofloxacin (60%), and cefepime (60%). In the broth microdilution method, 100%, 100%, 20%, and 13.3% of isolates showed resistance to imipenem, meropenem, polymyxin B, and colistin, respectively. Ten (66.6%) isolates were identified as multiple drug resistance. Carbapenemase enzymes and extended spectrum beta-lactamases were identified in 66.6% and 20% of the isolates, respectively and the biofilm formation was detected in 100% of the isolates. The blaOXA-48, blaTEM, blaIMP, blaSPM, blaPER, blaVEB, blaNDM, blaSHV, and blaCTX-M genes were detected in 100%, 86.6%, 86.6%, 40%, 20%, 20%, 13.3%, 6.6%, and 6.6% of the isolates, respectively. The blaVIM, blaGIM, blaGES, and blaMCR-1 genes were not identified in any of the isolates. The MLVA typing technique showed 11 types and seven main clusters and most isolates belong to cluster I, V and VII.

CONCLUSION

Due to the high rate of antimicrobial resistance, as well as the genetic diversity of Pseudomonas aeruginosa isolates from COVID-19 patients, it is indispensable to monitor the antimicrobial resistance pattern and epidemiology of the isolates on a regular basis.

Seroprevalence of Brucellosis in Butchers, Veterinarians and Slaughterhouse Workers in Hamadan, Western Iran

BACKGROUND

Brucellosis is a zoonotic disease caused by Brucella species via infected domestic animals. In endemic areas, certain occupations such as veterinarians, butchers, and slaughterhouse workers are considered high risk regarding brucellosis. We evaluated the seroprevalence of brucellosis in high-risk occupations in Hamadan, West of Iran.

STUDY DESIGN

a cross-sectional study.

METHODS

Overall, 218 participants from 2014 to 2015 were enrolled. A questionnaire including demographic data, length of employment, and using personal protective equipment was completed for each of them. Then, blood samples were taken and sent to Hamadan Health Center to be tested by Wright or standard tube agglutination (STA). In addition, samples with positive Wright test were examined by 2-mercaptoethanol (2ME) test. Then, seropositive participants were evaluated for clinical manifestations of brucellosis. All collected data were analyzed by SPSS ver. 16.

RESULTS

The mean age of the participants was 42.79±11.16 yr and all seropositive cases were male. Based on Wright ≥1/80 and 2ME ≥1/40, seroprevalence of brucellosis was 13.3% and 12.3%, respectively. The use of personal protective equipment was low among individuals with or without brucellosis. Myalgia, fatigue, back pain, joint pain, night sweats, fever, malaise, and headache were common symptoms in seropositive cases. Moreover, 20.6% of the seropositive participants were asymptomatic.

CONCLUSIONS

High prevalence of brucellosis in these occupational groups and symptomatic disease in significant numbers of them, so periodic clinical examinations in these groups seems to be essential for brucellosis surveillance system.

Prevalence and incidence rates of latent tuberculous infection in a large prison in Iran

BACKGROUND

Prisons can act as reservoirs of tuberculous infection. Previous studies have shown that the prevalence of latent tuberculous infection (LTBI) is high in prisons.

OBJECTIVE

To investigate the prevalence and incidence rates of LTBI and contributing factors in a prison population in Iran.

METHODS

In March 2013, inmates at the Hamadan Central Prison were invited to participate in a voluntary two-stage screening programme using the tuberculin skin test (TST). In the first stage, the standard TST was administered and read, and was repeated in negative cases to identify cases with delayed TST reactivity and boosted reaction. In the second stage, inmates with a true-negative TST underwent repeat screening 6 months later to identify incident LTBI. Information about risk factors was obtained using structured interviews.

RESULTS

Among 1208 screened inmates, TST positivity was recorded in 756 cases (prevalence 62.6%). HIV-positive inmates and cigarette smokers were also more likely to have LTBI. In 380 inmates returning for a follow-up visit, the 6-month incidence rate was 7.6%. Two cases of pulmonary tuberculosis were identified during the period of study.

CONCLUSIONS

LTBI prevalence and incidence rates among Iranian prisoners are high. Comprehensive plans are needed to for effective TB control among prisoners.

Needlestick and sharp object injuries among health care workers in Hamadan Province, Iran

INTRODUCTION

Exposure to septic fluids through mucus and needlestick injuries is of great concern among health care workers (HCWs). The purpose of this study was to acquire epidemiological data, including occupation, level of education, and mode of exposure, in HCWs.

METHODS

The data on this group was gathered during 6 months and analyzed using SPSS version 16.

RESULTS

In this study, we detected 89 cases of needlestick injuries and exposure to septic body fluids in the health care centers. Nurses were the most exposed group (39.3%). The most exposed age group was 25-34 years (51.6%). Of those injured, 51.7% were evaluated for antibody titration after vaccination, and of them, 47.2% had titration above 10 mIU/mL and the remaining had titration below 10 mIU/mL.

DISCUSSION

Numerous educational programs on care are still necessary to inform active workers in the health system about the warning trends and consequences in this part of Iran.

Five-year Evaluation of Chronic Diseases in Hamadan, Iran: 2005-2009

BACKGROUND

Now the increasing growth of chronic diseases is the major health challenge worldwide. This survey was conducted to assess noncommunicable diseases related risk factors.

METHODS

A population-based cross sectional study was conducted in 2005 and repeated annually by 2009 in Hamadan province, the west of Iran using two-stage cluster sampling method. A total sample of 6500 subjects 15 to 64 years old were enrolled.

RESULTS

The total prevalence of cigarette smoking was 18% [95% CI 17% to 19%], 35.1% in men versus 1.1% in women. The smokers consumed on average 15 cigarettes per day. Almost 26.3% [95% CI 24.8% to 27.7%] of the target population eat five or more servings of fruits and vegetables per day; 52.8% [95% CI 51.2% to 54.3%] had work related physical activity; 28.1% [95% CI 26.7% to 29.4%] had physical activity during leisure time; 80.3% [95% CI 79.0% to 81.5%] had transportation related physical activity; 47.2% [95% CI 46.0% to 48.4%] were either overweight or obese; 8.1% [95% CI 7.1% to 9.2%] had impaired fasting blood sugar or were confirmed diabetes; 33.7% [95% CI 31.9% to 35.5%] had hypercholesterolemia; and 15.6% [95% CI 13.0% to 18.3%] had hypertriglyceridemia. There was a statistically significant association of age and gender with body mass index, systolic and diastolic hypertension, hyperglycemia, hypercholesterolemia and hypertriglyceridemia.

CONCLUSIONS

The evidences of the present survey promise a silent progressive epidemic of chronic diseases among Iranian citizens that may lead to an increasing growth of noncommunicable diseases in the next decade.

Comparison of doxycycline-streptomycin, doxycycline-rifampin, and ofloxacin-rifampin in the treatment of brucellosis: a randomized clinical trial

BACKGROUND

Traditional regimens for the treatment of brucellosis are associated with significant relapse rates. The aim of this study was to compare the efficacy of ofloxacin plus rifampin (OFX-RIF) versus doxycycline plus streptomycin (DOX-STR) and doxycycline plus rifampin (DOX-RIF) regimens in the treatment of brucellosis.

METHODS

Two hundred and nineteen patients with brucellosis were enrolled in a randomized clinical trial; 28 cases were withdrawn because they did not attend the follow-up. Out of 191 patients with brucellosis, 64 received OFX-RIF, 62 received DOX-RIF, and 65 patients received DOX-STR regimens. All patients were assessed during the period of therapy in the second, fourth, and sixth weeks by clinical course and were also followed up clinically and serologically for 6 months after the cessation of therapy.

RESULTS

The highest clinical response (95.4%) was observed in the DOX-STR group (p=0.009). The results of multivariate analysis indicate that treatment with DOX-STR had the least therapeutic failures among the three groups (p=0.033). Adverse reactions were seen in 16.8% of patients, but there was no significant difference among the three groups (p=0.613). The lowest relapse rate (4.6%) was observed in the DOX-STR group (p=0.109).

CONCLUSIONS

We conclude that the DOX-STR combination should remain the first-line regimen for the treatment of brucellosis in our region; we recommend DOX-RIF and OFX-RIF combinations as the second-line regimens.