Pasteur Institute of Iran

---

Introduction: Pseudomonas aeruginosa is one of the leading causes of nosocomial infections, and antibiotic resistance of this pathogen is an important concern in treating such infections. The current work was conducted to investigate the prevalence of bla-IMP, and bla-VIM metallo-beta-lactamase (MBL) among clinical and environmental P. aeruginosa isolates obtained from ICUs of different hospitals in Rasht, Iran. Methods: A total number of 35 P. aeruginosa strains including 20 clinical and 15 environmental strains were isolated from ICUs. The isolated bacteria were screened for MBL production using Combined Disc Synergy Testing (CDST) assay. The frequency of bla-IMP and bla-VIM among MBL producing P. aeruginosa (MBL-PA) was investigated using Polymerase Chain Reaction (PCR). Also, the antibiotic susceptibility of all isolates was determined. Results: According to the results, 51% of isolates were regarded as MBL-PA while bla-IMP or bla-VIM genes were detected in 37% of isolates. The environmental isolates showed higher resistance to the majority of antibiotics compared to the clinical isolates, and MBL genes were more prevalent among environmental isolates. Conclusion: Higher resistance of environmental P. aeruginosa strains in ICUs shows a need to pursue newer approaches, including novel cleaning methods and surveillance programs, to reduce nosocomial infections.

---

Introduction: Burkholderia cepacie complex (Bcc) is an emerging multidrug-resistant gram-negative bacteria frequently isolated from health care facilities worldwide. The present study investigated the prevalence of Bcc in health care settings in Sebha, Libya. Methods: Two hundred swabs were initially collected. Forty-seven nosocomial Bcc isolates were identified from three medical care facilities, i.e., 40 (20%) from Sebha Medical Center, five from the Sebha Infertility Treatment Center, and two from Althanweya Clinic. The isolates were identified using a combination of biochemical tests and USP chapter <60> Microbiological Examination of Non-Sterile Products Tests for Burkholderia Cepacia Complex guidelines. A UPGMA dendrogram was used to examine the biochemical relationship of isolates. Some of the putative virulence factors contributing to the pathogenicity of the isolates were also explored. Results:  Of the 47 isolates, 29.79% were B. cepcia, 23.40% B. cenocepcia, 12.77% B. thailandensis, 8.51% B. vietnamiensis,  6.38% B. ambifaria, B. pyrrocinia, and B. stabilis each,  4.26% B. anthina, and 2.13% B. arboris. A variation in virulence factors was observed among isolates; all (100%) isolates produced siderophore, 91% had capsules, 91% produced lipase, 89% formed a biofilm, and 49% produced alkaline protease. The UPGMA dendrogram revealed that Bcc species shared substantial phenotypical identity among themselves. Conclusion: In developing countries with limited resources, diagnostic challenges in identifying Bcc species can be resolved using selective media and USP chapter <60> guidelines.

---

The term "Nosocomial" is attributed to the diseases acquired by the patient under medical care. Various microorganisms, including bacteria, viruses, and fungi, may contribute to developing nosocomial infections (NIs). Urinary tract infections (UTI), surgical-site infections (SSI), bloodstream infections (BSI), and pneumonia are the most well-known instances. We investigated various aspects of NIs and the main causative agents of NIs, particularly bacteria, antibiotic resistance, crucial viral infections in hospitals, and a brief survey of fungal infections. It was concluded that specific human body tissues such as those in the lungs and urinary tract are more likely to be a target for nosocomial pathogens. The fatalities associated with these infections, particularly in the intensive care unit (ICU), are serious concerns, and transmission by health facilities has become a primary medical issue because of its spread into the community. Another medical point is antibiotic resistance which is a leading cause of prolonged periods of hospitalization and makes the treatment procedure harder and costlier. Additionally, measures to prevent the spread of NIs and minimize the economic loss are discussed. All physicians and medical students must be updated about different kinds of these infections, their causative agents, challenges, and how to deal with them to reduce the consequences and improve public health.

---

Introduction: Nosocomial respiratory infections are a significant cause of mortality in hospitalized patients in Middle East countries. This study assesses the prevalence of nosocomial respiratory infection and associated factors as a tool for early diagnosis among intensive care unit (ICU) patients at risk for mortality. Methods: From January to November 2021, 357 patients with more than 72 h hospitalization in ICU were monitored. Respiratory samples were examined for the presence of microbial isolates using clinical microbiology procedures based upon microscopic morphology, cultural and PCR methods. Demographic data were collected, including age, gender, date of hospitalization, underlying diseases, date of death, and laboratory data. Results: Out of fifty-three positive cultures, 18 samples (34%) were positive for fungal isolates, and the rest were positive for bacterial isolates. The most common bacterial and fungal isolates were Streptocossus Pyogenes (17.9%) and Candida albicans (22.5%). Of the infected patients, 67.9% were male, 39.62 % had kidney diseases, and 15.09% died due to nosocomial infections. The results also showed that the tumor necrosis factor α and complement component 3 levels were significantly associated with the incidence of respiratory fungal or bacterial infections (P<0.05). Conclusions: The rate of respiratory nosocomial infection in ICU patients was high. It is essential to implement control measures such as managing the length of hospital stay and examining the patient's immune factors to reduce the risk of these infections in ICU patients. Also, ICU patients should be prescribed appropriate antibiotics to prevent respiratory infections.

---

Introduction: Infections caused by ESBL-producing bacteria are a growing concern worldwide, especially in developing countries like Nigeria. Hence, this study aimed to isolate, screen, and identify ESBL-producing Escherichia coli from clinical samples and analyze their antibiotic resistance patterns. Methods: 200 clinical samples were collected, consisting of 60 stool, 88 urine, and 52 wound pussamples. We used the pour-plate method on MaCconkey agar (MAC) for isolation. After suspected E. coli was isolated, we sub-cultured it on eosin methylene blue (EMB) agar. To confirm E. coli identification, we used cultural and biochemical assays. Disc and double disc diffusion methods were employed to screen and confirm ESBL-producing E. coli. Antimicrobial susceptibility testing was conducted by disc diffusion technique, and the results were interpreted using CLSI standards. Results: A total of 47 E. coli isolates were obtained, with 48.5% of the isolates originating from urine samples. These isolates were among six different genera of bacteria. Among the E. coli isolates, 16 were confirmed to be ESBL producers. The ESBL-producing E. coli demonstrated high resistance to amoxicillin-clavulanic acid (87.5%), ampicillin (75.0%), and cefotaxime (50.0%). Before plasmid curing, the bacteria demonstrated a high susceptibility to chloramphenicol (81.3%) and amikacin (56.3%). However, varying antibiotic resistance and susceptibility degrees were observed after plasmid curing. Conclusion: ESBL-producing E. coli showed a high resistance level (34.0%) against most discs used. However, chloramphenicol and amikacin showed promise as potential treatments for ESBL-producing E. coli infections. In addition, it is recommended that clinical laboratories should include routine ESBL detection methods for ongoing surveillance of antibiotic-resistant isolates. This will serve as a helpful guide for empirically treating bacterial infections.