Search

Cerebrovascular events are linked to ankylosing spondylitis. Accelerated atherosclerosis and endothelial dysfunction against a backdrop of inflammation have been widely blamed for the increased cerebrovascular risk in ankylosing spondylitis. The absence of a comprehensive review encouraged us to consider the link between ankylosing spondylitis and cerebrovascular diseases. Web of Science, PubMed, Medline, Scopus, and EMBASE were searched to identify studies published from 2000 to June 10, 2023. All observational and cohort studies reporting myocardial infarction or stroke and considering classic cerebrovascular risk in ankylosing spondylitis patients and healthy controls were included. Most of the included studies reported that the risk of cerebrovascular disorders was greater in ankylosing spondylitis than in the general population. Also, most studies showed that for both sexes, the prevalence of cardiovascular illnesses rose with age, and this trend was consistent across all subgroups of cardiovascular disorders. Also, most studies reported that the rate of cerebrovascular accidents in ankylosing spondylitis patients was higher than in control groups. Some studies reported that the risk of developing an ischemic stroke was higher in young patients with ankylosing spondylitis, while others did not. Our systematic analysis found that most studies agreed that ankylosing spondylitis patients had a higher risk of cerebrovascular diseases than the general population. Still, this increased risk was influenced by several factors that need further research exploration.

Background: The alarming rise of resistant microorganisms is becoming a serious health threat today. Consequently, there is a pressing need to obtain novel compounds with antimicrobial properties. In this regard, lichens are promising substances with antimicrobial potential to control different microbial strains, including fungi, Gram-positive and Gram-negative bacteria, and viruses. Objectives: This study explored the efficacy of Dermatocarpon miniatum in treating burn wound infections. We examined twenty-four Methicillin-resistant Staphylococcus aureus (MRSA) isolated from patients admitted to Imam Moussa Kazem Hospital of Isfahan, Iran.Methods: In this interventional study, we assessed the antibacterial activity of D. miniatum against MRSA using the microdilution broth method. Biofilm inhibitory was evaluated through microtiter plate technique. Additionally, the effect of D. miniatum on the icaA gene expression was analyzed by real-time PCR. Results: The methanolic extract of D. miniatum exhibited significant antibacterial activity against MRSA strains. Additionally, at a concentration of ½ MIC, the extract demonstrated a 65% inhibition of biofilm formation. Moreover, a sub-MIC concentration (1/4) of D. miniatum was effective in reducing the expression of the icaA gene.Conclusion: The results of the present study reveal that D. miniatum extract can be used as a promising antibacterial agent against MRSA strains commonly found in wound biofilms.

Background and Aim: Understanding the antibiotic resistance profile of uropathogenic Escherichia coli in urinary tract infections (UTIs) across different populations and regions is crucial for appropriate antibiotic prescribing practices. This study aimed to assess the antibiotic resistance pattern of uropathogenic Escherichia coli isolated from UTIs in outpatients, focusing on gender and age demographics. Methods: This cross-sectional study analyzed 7365 urine culture samples obtained from patients consecutively referred to the Kashan Reference Laboratory between April 2021 and March 2022. Following sterile urine collection, bacterial cultures were grown on McConkey agar, blood agar, and specific media. Escherichia coli isolates were identified, and antibiotic resistance was determined using the disk diffusion method on Mueller Hinton agar, following National Committee for Clinical Laboratory Standards guidelines. Results: Among 401 positive urine cultures, 251 (62.5%) were attributed to E. coli, while 150 (37.4%) were related to other organisms. Of the E. coli cases, 226 isolates (90%) were from women and 25 (10%) from men. The E. coli strains exhibited the highest resistance (54.7%) to cefazolin and the lowest resistance (4.4%) to imipenem and nitrofurantoin. Antibiotic resistance in E. coli from men exceeded that of women across all antibiotics tested, with statistically significant differences observed in ceftriaxone, imipenem, ciprofloxacin, and nitrofurantoin (P

Background and Aim: The prevalence and patterns of antibiotic resistance among bacterial agents causing urinary tract infections (UTIs) can vary over time and across different geographical regions. This study aimed to evaluate the prevalence and antibiotic resistance patterns of bacterial agents isolated from urine cultures of outpatients referred to the Reference Laboratory in Kashan, Iran, during 2021-2022. Methods: This cross-sectional study analyzed 7365 urine culture samples collected from patients referred to the Reference Laboratory in Kashan, Iran, between April 2021 and March 2022. Urine samples were obtained using the mid-stream method under sterile conditions and cultured on MacConkey agar, blood agar, and specific bacterial media. The identified organisms were tested for antibiotic resistance using the disc diffusion method on Mueller Hinton agar medium following the guidelines of the National Committee for Clinical Laboratory Standards (CLSI 2020). Results: Among the 7365 patients with urine cultures, 401 individuals (5.4%) had positive culture results, with a predominance of women (88.8%). Escherichia coli (62.5%) and Klebsiella (24.6%) were the most frequently isolated organisms. Escherichia coli exhibited the highest resistance rates to cefazolin (54.7%), cotrimoxazole (51%), and ciprofloxacin (41%), while showing the lowest resistance to imipenem and nitrofurantoin (4.4%). Klebsiella showed the highest resistance to cefazolin (58.3%) and cotrimoxazole (41.4%), with the lowest resistance to imipenem (7.1%). Gram-positive bacteria demonstrated the highest resistance to clindamycin (71.4%) and cotrimoxazole (57.9%), while displaying the lowest resistance to gentamicin (14.7%) and nitrofurantoin (17.5%). Conclusion: Escherichia coli and Klebsiella were the predominant causative agents of UTIs, exhibiting similar antibiotic resistance patterns. Empirical antibiotic treatment based on these results may be considered before obtaining culture results.

Background: In recent years, the use of herbal medicine, as a complementary and effective medicine, is increasing worldwide. The aim of this study was to investigate the properties of Rosa damascene essential oil nanoemulsion in vitro. Materials and Methods: In this experimental study, rose flower was obtained from Barzok area of Kashan and its essential oil was prepared by steam distillation method. The components of the essential oil were identified by gas chromatography and mass spectrometry (GC-MS). After preparing essential oil nanoemulsion, the size and morphology of nanoemulsion were examined by zeta test and transmission electron microscope (TEM), respectively. Antioxidant activity and cytotoxicity were tested by DPPH (1,1-diphenyl-2-picryl-hydrazyl) and MTT (HeLa cancer cells) methods, respectively. Antimicrobial activities against Salmonella Typhimurium were evaluated by disc diffusion, minimum inhibitory concentration (MIC) and bactericidal (MBC) by microdilution methods and prevention of biofilm formation. Results: The most compounds of rose essential oil included Nonadecane (33.55%), Heneicosane (16.03%), Hexadecanal (7.78%) and Eicosane (3.39%). The stability of nanoemulsion was also equal to -47.5 mV. The size of nanoemulsion particles was also confirmed by TEM method. Essential oil nanoemulsion had no antioxidant activity. The MIC and MBC were 350 and 700 µg/ml, respectively. The percentage of biofilm reduction in MIC and MBC concentrations was 75 and 80%, respectively. The concentration of 5.47 µg/mL of nanoemulsion caused a decrease of 67% of living HeLa cells. Conclusion: With attention to the antibacterial and anticancer properties of rose essential oil nanoemulsion, this compound can be suggested in the treatment of bacterial infections and cancer cells.

Background: Mycobacterium tuberculosis affects the lungs in 85% of all cases and the remaining 15% through extra pulmonary affecting other parts of the body such as lymph nodes, pleura, and the genitourinary system. This study aimed to investigate extra-pulmonary tuberculosis (TB) associated factors, failure of treatment, and trends between 2004-2017 in Kashan, Iran. Materials and Methods: This study was conducted during 2004-2017 on newly registered extrapulmonary tuberculosis patients referred to TB Referral Center in Isfahan province, Kashan city, Iran. Information (demographic characteristics, related factors of the disease, and treatment status) of 197 extrapulmonary tuberculosis (EPTB) patients was extracted from Medical case records. Results: In total, 527 cases of Tuberculosis were reported, of which, 159 (30.17%) were confirmed extrapulmonary TB. Eighty-five (53.5%) and 74 (46.5%) were male and female, respectively. Also, 74 (46.5%), and 84 (53.5%) of EPTB were from Iran, and Afghanistan immigrants, respectively. The average age of patients was 41.9±2.18. Among underlying diseases in extrapulmonary TB positive, diabetes mellitus (DM) was predominant with a prevalence of 31 (19.5%), while, 128 (80.5%) cases did not show any underlying disease. Most of the patients were in the age group (21-40 years) with a frequency of 60 (37.7%), and the lowest of patients belonged to the age group (>80 years) with a frequency of 9 (5.7%). No correlation was found between related factors and infection with EPTB (p> 0.05). Conclusion: Our findings showed that the prevalence of EPTB in Kashan was relatively high, but, a relative decrease was shown during 2004-2017, which with preventative measures can be reduced the prevalence.

Abstract Background This study aimed to determine the prevalence and antibiotic resistance patterns in Staphylococcus aureus isolated from patients with cystic fibrosis in Middle Eastern countries. Methods A systematic search was conducted in the PubMed, Web of Science (ISI), and Scopus databases for studies presenting the prevalence of MRSA strains, antibiotic resistance pattern in S. aureus strains isolated from patients who suffered from cystic fibrosis in Middle Eastern countries from 1999 to 10 June 2020. The following terms were used; prevalence, antibiotic resistance, antimicrobial drug resistance, drug resistance, Staphylococcus aureus, S. aureus, Methicillin-resistant Staphylococcus aureus, MRSA, cystic fibrosis, CF, and the Middle East. The meta-analysis was performed using Comprehensive Meta-analysis software (Version 3.3.070). Results Patients’ age ranged from 1.6 to 18 years. Females were more than males. The prevalence of S. aureus was varied between 5.6 and 77.8%. The prevalence of S. aureus was varied between 5.6 and 77.8% in different countries. The combined prevalence of S. aureus in Middle East countries from 1999 to 2020 was reported by 40.9% (95% CI 29.6–53.1). The pooled prevalence of MRSA was reported at 18.6% (95% CI 1.1–82.6), Z = 0.9, I 2 = 98.6, Q = 146.7. The highest combined resistance in S. aureus strains was reported to Penicillin G (94%), followed by Ciprofloxacin (54.9%). Conclusion Regarding a quite prevalence of S. aureus and an intermediate prevalence of MRSA in CF patients, preventive measures and health policies should be implemented in the Middle East area to prevent the spread of infections caused by MRSA strains in CF patients.

Abstract Mediterranean type of visceral leishmaniasis (VL) is a zoonotic parasitic infection. Some provinces of Iran are endemic for VL while other parts are considered as sporadic areas. This study aimed to assess a combination of recombinant K26 and rK39 antigens as well as crude antigen (CA), derived from an Iranian strain of L. infantum, compared to direct agglutination test (DAT) for the detection of VL in humans and domestic dogs as animal reservoir hosts of the disease. A combination of rK26 and rK39 antigens and also CA was evaluated using indirect ELISA on serum samples of 171 VL confirmed humans (n = 84) and domestic dogs (n = 87) as well as 176 healthy humans (n = 86) and domestic dogs (n = 90). Moreover, 36 serum samples of humans (n = 20) and canines (n = 16) with other potentially infectious diseases were collected and tested for finding cross- reactivity. The results of ELISA were compared to DAT, currently considered as gold standard for the serodiagnosis of VL. The sensitivity and specificity, positive predictive and negative predictive values were calculated compared to DAT. The positive sera had previously shown a positive DAT titer ≥ 1:800 for humans and ≥ 1:80 for dogs. Analysis was done by MedCalc and SPSS softwares. Using the combination of rK26 and rK39 in ELISA, a sensitivity of 95.2% and a specificity of 93.0% % were found in human sera at a 1:800 (cut-off) titer when DAT-confirmed cases were compared with healthy controls; a sensitivity of 98.9% and specificity of 96.7%% were found at a 1:80 (cut-off) titer compared with DAT. A good degree of agreement was found between the combined rK39 and rK26-ELISA with DAT in human (0.882) and dog serum samples (0.955) by kappa analysis (p

Objective(s): Klebsiella pneumoniae is the common cause of pneumonia in hospitalized patients, particularly in intensive care units (ICU). The infection can transfer by medical equipment such as mechanical ventilators. This study aimed to investigate the molecular typing of the extended-spectrum beta-lactamase-producing K. pneumoniae isolates recovered from Beheshti Hospital, Kashan, Iran. Materials and Methods: K. pneumoniae isolates producing ESBLs have been collected from the samples obtained from Shahid Beheshti hospital, Kashan, Iran. Antimicrobial susceptibility was determined using the Kirby Bauer disk diffusion method. The presence of ESBLs was evaluated using CLSI for ESBL screening by the double-disk diffusion method. Molecular typing was conducted by pulsed-field gel electrophoresis (PFGE). In total, 89 K. pneumoniae isolates were recovered, of which 47.1% were ESBL producers.Results: Results showed that all of the clinical and environmental isolates were resistant to ceftriaxone, meropenem, cefazolin, cefotaxime, cephalothin, and piperacillin-tazobactam. All isolates were grouped under four clusters (A-D). The major cluster was related to the C cluster with 22 isolates (19 clinical and 3 environmental). Seventy-two percent of isolates were from the ICU ward. There was no correlation between antibiotic resistance patterns and PFGE clusters (P=0.2).Conclusion: We observed a common molecular signature among both clinical and environmental K. pneumoniae isolates, indicating a similar genotype and likely a common origin for ESBL producer isolates found in different hospital wards. Therefore, hospitals need to implement an effective infection control system to decrease the spreading of ESBL strains within the hospitals and subsequently the transmission of the infection to patients.

Aims: This study aimed to investigate class 1 integrons and biofilm formation in multi-drug resistance (MDR) Uropathogenic Escherichia coli (UPEC) isolated from patients with urinary tract infection (UTI). Materials and Methods: Three hundred and eighty positive cultures were collected from patients with UTI referred to Shohadaye Qom hospital from 2018 to 2019. Suitable tests were done to diagnose UPEC, and confirmed by usp gene polymerase chain reaction (PCR). Antibiotic susceptibility testing was performed using Kirby Bauer disk diffusion. Analysis of biofilm production was conducted using microtiter plate assay. Next, the presence of Class 1 integrons and dfr-17 gene was surveyed by PCR. Data analyzed using Chi-squared and Fisher's exact tests in SPSS software, P < 0.05 was considered statistically significant. Findings: In total, 166 isolates of UPEC were retrieved. Among them, 120 isolates were MDR. The highest resistance of MDRs was observed against ampicillin. Among MDRs, 71, 18, 15, and 16 isolates were negative, weak, moderate, and strong biofilm producers, respectively. Meanwhile, 47.5% of the isolates were positive for int-1 gene and 25.8% of the isolates were positive for dfr-17-gene cassette. Out of 57 int-1 positive MDRs, 15 isolates (26.3%) showed strong biofilm which indicated a significant correlation (P < 0.001). Furthermore, among 31 MDRs with the positive dfr-17, 8 isolates (25.8%) had strong biofilm which statistically was significant (P < 0.001). Conclusion: The present study reported a significant correlation between cassettes genes, Class 1 integrons, and biofilm formation with antibiotic resistance pattern. Hence, continuous screening for antibiotics resistance is vital for infection control and prevention.

Nowadays, consumers are pushing for the use of natural preservatives such as essential oils (EOs) in the fresh and processed foods, including meat. However, this action is related to a variety of challenges that are associated with essential oils, including low solubility in water, high volatility, and limited long-term stability. These factors collectively reduce their effective utilization in this application. Therefore, the objective of this research was to investigate the morphology and stability of the Rosa damascena essential oil nanoemulsion (RDNE), as well as its antibacterial and anticancer properties. Also, we examined its effects on the quality characteristics of ground sheep meat during the refrigerated storage. The zeta potential and particle size of RDNE were −47.5 mV and 100 nm, respectively. The minimum inhibitory concentration (MIC) and minimum bactericidal concentration (MBC) of the RDNE against Salmonella typhimurium were 375 and 750 µg/mL, respectively. The most inhibition of biofilm formation (80%) was observed for RDNE at 2 MIC. The RDNE had an inhibitory effect on the expression of the Salmonella enterotoxin gene (stn). The obtained IC50 of RDNE against colon and cervical cancer cell lines (HCT 116 and HeLa cells) were 3.31 and 4.6 µg/mL, respectively. Adding RDNE at a concentration of 250 µg/g to fresh ground meat resulted in the total bacterial count (TBC) remaining below 8 log CFU/g during storage. Moreover, the samples coated with RDNE (250 µg/g) had the fewest coliforms, lactic acid bacteria (LAB), S. typhimurium, pH, and total volatile basic nitrogen (TVB-N) content. RDNE coating improved the flavor and overall acceptability of the samples. Therefore, RDNE is recommended as a natural preservative agent to enhance the bacterial and chemical stability of sheep meat.

Background: Efflux pumps such as MexEF-OprN and mexXY-OprM play an important role in the resistance of Pseudomonas aeruginosa (P. aeruginosa) to antibiotics. The present study aimed to assess the reduced expression of efflux pump genes of P. aeruginosa with Satureja khuzistanica essential oil (SKEO).Methods: The present cross-sectional study was conducted in 2016 at the Microbiology Laboratory of Baqiyatallah University of Medical Sciences, Tehran, Iran. The disk diffusion method was used for susceptibility testing of gentamicin and norfloxacin. Minimum inhibitory concentration (MIC) was determined for gentamicin and norfloxacin. The antibacterial efficacy of SKEO was defined by determining the MIC values using the microdilution method. In vitro, the synergistic interaction of SKEO combined with gentamicin or norfloxacin was examined via checkerboard assay and defined as a fractional inhibitory concentration index. The reverse transcription-polymerase chain reaction technique was used to measure changes in the expression of the efflux pump genes. The data were analyzed using SPSS software version 16.0, and p Results: The MIC values of SKEO were in the range of 6 to 12 µg/mL. In the presence of sub-inhibitory concentrations (1.16 to 2 MIC) of SKEO, synergistic effects were revealed using the checkerboard method. The effect of norfloxacin and gentamicin increased up to 8-fold. The expression of mexY and mexE was reduced after treatment with SKEO.Conclusion: SKEO reduced the expression of efflux pumps and the MIC values of norfloxacin and gentamicin in vitro.

Background: The use of antibiotics is common, but its excessive or improper use leads to antibiotic resistance. Consequently, scientists have been interested in exploring traditional medicine to identify a new source of anti-bacterial agents. The present study aimed to conduct a systematic review to determine the anti-bacterial activity of Satureja khuzestanica Jamzad (SKJ) and Zataria multiflora Boiss (ZM) essential oils against Pseudomonas aeruginosa in vitro.Methods: A comprehensive literature search for studies published on SKJ and ZM was carried out. Various keywords (S. Khuzestanica, Marzeh-e-Khuzestani, Z. Multiflora, Z. Multiflora Boiss; avishan-e-shirazi, shirazi thyme, thymol, carvacrol; P. aeruginosa, Iran, antibacterial effect; traditional medicine, phytomedicine, herbal medicine) were used to search both international and Iranian databases (Google Scholar, Science Direct, Web of Science, MEDLINE; PubMed, Scopus, Cochrane Library, Academic Search; Journal Storage, Magiran, Irandoc, Scientific Information Database (SID), and IranMedex). The selected articles were published during 2000-2017 and were written in English or Persian.Results: Seventeen articles were included in the review. The main ingredients of SKJ and ZM plants were carvacrol and thymol. The potential anti-bacterial activity of essential oils from these plants was confirmed. The carvacrol content, as the major active ingredient of SKJ was between 38.33-97.89%. The major ingredients of ZM were carvacrol (16.8-82.7%) followed by thymol (25.70-64.87%). The minimum inhibitory concentration (MIC) value of SKJ and ZM essential oils against bacterial strains was in the range of 0.31-450 and 2-8,000 μg/mL, respectively. Conclusion: The present review study confirmed the anti-bacterial activity of SKJ and ZM, particularly against Pseudomonas in vitro.

Abstract Objective This study aimed to evaluate the phenotypic and genotypic characterization of biofilm formation and spa and ica genes among clinical isolates of methicillin-resistant Staphylococcus aureus. Result This cross-sectional study was performed on 146 Staphylococcus aureus isolates from hospitalized patients in Isfahan Province Hospitals. MRSA isolates were confirmed using disk diffusion test with oxacillin disk and amplification of mecA gene by PCR assays. Ability of biofilm production was evaluated targeting the icaA and icaD genes. Of 146 Staphylococcus aureus isolates, 24 (16.4%) carried mecA genes and identified as MRSA strains. Strong ability of biofilm production was seen among 76.02% (111/146) S. aureus isolates and 87.5% (21/24) MRSA strains, respectively. Also, 75.0% (18/24) MRSA isolates carried icaA and icaD was not detected in these strains. Analysis of spa gene showed 70.83% (17/24) MRSA strains were spa positive. From which 14 and 3 strains identified with one band (150, 270, 300, 360, 400 bp) and two bands (150–300 bp), respectively. According to data obtained, the prevalence of MRSA isolates from Isfahan Province Hospitals is relatively high and a remarkable percentage of them show strong power in biofilm production. Also analysis of spa gene showed a fairly large diversity among MRSA strains.

Background: Different virulence factors are involved in the pathogenesis of urinary tract infection (UTI) caused by Uropathogenic Escherichia coli (UPEC); hence, this study aimed to study the prevalence of biofilm formation, virulence factors, and phylogenetic groups and their correlation with biofilm formation among UPEC isolates through a systematic review and meta-analysis. Materials and Methods: A literature search was conducted from 1, 2000, to the end of 2021 in different databases for studies that reported biofilm together with virulence genes or phylogenetic groups in UPEC isolates from patients with UTI according to PRISMA protocol. Data were analyzed by Comprehensive meta-analysis software. Results: The pooled prevalence of biofilm formers was 74.7%. The combined prevalence of phylogenetic Groups A, B1, B2, and D (s) were reported at 19.6%, 11%, 50.7%, and 20.5%, respectively. The most common virulence genes reported worldwide were fimA, ecpA, and fimH, with a combined prevalence of 90.3%, 86.6%, and 64.9%, respectively. The pooled prevalence of biofilm formation in UPEC isolates with phylogenetic Groups A, B1, B2, D, C, and F were 12.4%, 8.7%, 33.7%, 12.4%, 2.6%, and 2.65%, respectively. Several studies showed a correlation between biofilm production and virulence genes, or phylogenetic groups. Conclusion: Regarding data obtained, the high level of combined biofilm formation (74.7%) and the presence of a positive correlation between biofilm production and virulence genes, or phylogenetic groups as reported by the most studies included in the present review, indicates an important role of biofilm in the persistence of UPEC in the UTI.

Background: Urinary tract infection (UTI) is one of the most commonly problematic bacterial infections, especially among women. Increasing drug resistance requires the determination of an antibiotic resistance pattern for proper treatment. Therefore, this study aimed to investigate the prevalence and antibiotic resistance against bacterial agents isolated from urinary tract infections in women referred to Ghaem Hospital, Mashhad, Iran. Materials and Methods: This descriptive cross-sectional study was performed in 2800 urine samples acquired from outpatient women referred to Ghaem Hospital in Mashhad between 2015 and 2016. Sampling method was as simple random sampling, and data collection method was field sampling. Detection of the bacteria was performed using routine microbiological and biochemical methods. Susceptibility testing was performed using a disk diffusion method (Kirby-Bauer) on the Muller Hinton Agar medium. The results were analyzed using SPSS software version 22, through Chi-square and Wilcoxon signed-rank tests. Results: Among 6500 of urine samples, 1155 samples were positive for bacteria. The highest prevalence belonged to Escherichia coli with 640 isolates (55.4%), and the lowest prevalence belonged to Pseudomonas aeruginosa with 35 isolates (3%). The highest resistance was reported against ampicillin (84.2%) and the lowest resistance to ciprofloxacin (27.7%), followed by ampicillin (28.2%). Conclusion: In this study, the antibiotic resistance was high for antibiotics routinely used to treat urinary tract infection. Therefore, due to the rapid increase in antibiotic resistance, an accurate assessment of antibiotic resistance pattern is needed.

Abstract Background Antibiotic-resistant pathogens are an emerging threat in this century. Epinecidin-1 is a multi-functional Antimicrobial Peptide (AMP) produced by Orange-spotted grouper (Epinephelus coioides) has been shown to have extensive potentials as an alternative for current antibiotics. Due to the huge costs for the study and the production of a new drug, if an antimicrobial peptide has other beneficial functions in addition to antimicrobial activities, it would be preferred. Methods In this study, properties and applications of Epinecidin-1 were investigated and addressed comprehensively. To achieve this, the Google Scholar search engine and three databases of PubMed, Scopus, and Web of Science were used. Results Epinecidin-1 is a cationic AMP with an alpha-helical structure. Seven functional usages of this peptide have been reported in the literature including antibacterial, antifungal, antiviral, antiprotozoal, anticancer, immunomodulatory, and wound healing properties. Moreover, this peptide has high potential to be used as an active ingredient in cleaning solutions as well as application in vaccine production. Conclusion Due to significant antimicrobial activities tested on bacteria such as Staphylococcus aureus and Helicobacter pylori and also wound healing properties, Epi-1 has high potential to be considered as an important candidate for the production of new drugs and treatment of various infections including diabetic foot ulcer and peptic ulcer. Moreover, adjuvant-like properties of Epi-1 make it a suitable candidate for the studies related to an adjuvant. Other attractive properties such as anticancer effects have also been reported for this peptide which encourages further studies on this peptide.

ABSTRACT Background and Objectives: Pseudomonas aeruginosa is a gram negative opportunistic pathogen and an important cause of wound infections and nosocomial infections. The purpose of this study was to study inhibitory effects of a new ointment prepared from medicinal plants against P. aeruginosa isolates. Methods: In this study, an ointment called ZOUSH was prepared from mixing alcoholic extracts of Satureja khuzestaniea, Zataria multiflora, Mentha mozaffariani Jamzad, honey and polyurethane. Minimal inhibitory concentration of ZOUSH and its compositions alone or combined was determined using the disk diffusion method. Results: S. khuzestaniea, Z. multiflora and Mentha mozaffariani Jamzad had inhibitory effects against P. aeruginosa. The ZOUSH ointment had greater antibacterial effects than the any of its compositions used solely or combined. The diameter of inhibition zone had a direct relationship with the concentration of the extracts. Moreover, the antibacterial effect of the ZOUSH ointment was identical to that of polymyxine B (300 µg). Conclusion: We demonstrated that the ZOUSH ointment has inhibitory effects against P. aerugionosa. The inhibition zone diameter is directly correlated with the concentration of the extracts. Our results suggest that the ointment could be useful for treatment of burn wounds and skin infections.

No Abstract

None.

Background: Legionella species are ubiquitous and naturally found in lakes, rivers, streams and hot springs, and other water resources. The present study aimed to investigate the prevalence of Legionella species in water resources of Iran by a systematic review and meta-analysis. Methods: In search of papers relevant to the prevalence of Legionella in water resources of Iran, the scientific information database in both English and Persian languages was used. The search was limited to studies between the year 2000 and end of July 2016. Each cohort and cross-sectional study that reported the contamination of water with Legionella was included in the present study. For data analysis, comprehensive meta-analysis software with Cochran’s Q and I2 tests were used. P values less than 0.05 were considered statistically significant. Results: The prevalence of Legionella species in water resources of Iran was 27.3% (95% CI: 25.3-29.3). The prevalence of Legionella spp. in hospital water, dental settings water, and other water resources were 28.8% (95% CI: 26.4-31.2), 23.6% (95% CI: 16.1-33.2), and 29.6% (95% CI: 25.6-33.8), respectively. The most common Legionella species was L. pneumophila with a prevalence of 60.5% (95% CI: 53.3-67.2) and the prevalence of all other species was 52.5% (95% CI: 44.7-60.2). The highest prevalence was reported in Isfahan with 55.7% (95% CI: 48.0-63.0). Conclusion: Based on the results, the prevalence rate of Legionella species in water resources of Iran was high and the most common Legionella species was L. pneumophila.

ABSTRACT Background and Objectives: Acinetobacter baumannii is an opportunistic pathogen that affects different groups of people, especially intensive care unit (ICU) patients. The prevalence of infections caused by this bacterium is very high. Today, prevalence of infections caused by multidrug-resistant (MDR) and extreme-drug resistant (XDR) strains is increasing. This study aimed to determine the antibiotic susceptibility pattern of A. baumannii isolates from ICU patients. Methods: This cross-sectional study was conducted from October 2014 to March 2015 on patients admitted to ICU of Imam Khomeini hospital in Tehran, Iran. Clinical samples of various sources were collected from patients. Isolates were detected and identified via microbiological and biochemical tests as well as PCR amplification of the blaOxa51 gene. Then, susceptibility testing was performed using the Kirby-Bauer disk diffusion test. Statistical analysis was performed with SPSS (version 22, Chicago, IL, USA) using Chi-square and Fisher’s exact tests. Results: Of the total of 62 clinical samples, 24 (39%) were respiratory samples and only three (6%) were cerebrospinal fluid samples. Most MDR and XDR strains were isolated from respiratory samples. The highest resistance rate was against ceftriaxone, ticarcillin and erythromycin (100%), while the lowest resistance rate was against to minocycline (20%). Conclusion: Owing to detection of high multi-drug resistance isolates in the present study, and importance of multi-drug resistance in A. baumannii, the identification of multi-drug resistance genes and their reporting to health care/treatment centers is important. Thus, it is recommended to perform susceptibility testing to help determine the most effective antibiotic(s) for the treatment of infections in ICU patients. Keywords: Acinetobacter baumannii, MDR, XDR, ICU.

Background: Urinary tract infection (UTI) is a major complication in patients who receive the kidney transplant. We aimed to evaluate the prevalence and antimicrobial resistance of bacterial uropathogens isolated from Iranian kidney transplant recipients. Methods: We searched according to Prisma protocol for UTI infection, prevalence, occurrence and distribution of bacteria and their pattern of antibiotic resistance among Iranian patients who receive kidney transplant through online electronic databases with MeSh terms and text words in published references in both Persian and English languages during 1990-2017. Data analysis was performed using Comprehensive meta-analysis software (CMA) by Cochrane Q and I2 Random Effects Model. Results: Eleven studies met the eligible inclusion criteria. The prevalence of UTI among kidney transplant patients varied from 11.7% to 67.5%. The combined prevalence of UTI was 32.6%. Among Gram-negative pathogens causing UTI, E. coli was the most dominant followed by Klebsiella pneumonia with prevalence 41.3% and 11.9%, respectively. Also, amongst Gram-positive bacteria, the highest prevalence belonged to Enterococcus spp. (9.8%) and coagulase-negative Staphylococci (9.4%). Also in Gram-negative pathogens, the most resistance was to ampicillin (91.2%), followed by ceftazidime (89.5%). The minimum resistance was against imipenem with prevalence 14.3%. Conclusion: The combined prevalence of UTI was 32.6%. Gram-negative pathogens especially E. coli were the most agents of UTI in Iranian patients who receive kidney transplant. Also, in gram-negative pathogens, the most resistance was to ampicillin that it needs a new strategy for prophylaxis and treatment of UTI after the kidney transplant.

Background: We aimed to evaluate the diagnosis of acute toxoplasmosis by IgG avidity test in pregnant women. Methods: In this cross-sectional study, 250 blood samples were collected from pregnant women with the first month of their pregnancy referring to health centers of University in Mashhad during 2016. Samples were centrifuged at 3000 rpm for 5 min for separation of serum and were kept in the -20 until use. To detection of acute and chronic toxoplasmosis, anti-Toxoplasma antibodies (IgG and IgM, and IgG avidity tests were performed using ELISA. Then, data analyzed using SPSS software by Frequency, Pearson Chi-Square, Likelihood Ratio, and Exact tests. And P

Background: Staphylococcus aureus and Pseudomonas aeruginosa are the most important bacteria causing the nosocomial infections, which are resistant to most of the antibiotics. The aim of this study was to evaluate the drug resistance of S. aureus and P. aeruginosa strains isolated from environmental samples of Hamedan educational hospitals using disk diffusion and minimum inhibitory concentration (MIC) methods. Materials and Methods: In this descriptive cross-sectional study, 400 samples were collected from Hamedan educational hospitals. To assess the antibiotic susceptibility of 10 common antibiotics, the agar dilution (Kirby-Bauer) method was used. Also, to determine the MIC of S. aureus and P. aeruginosa, vancomycin and ciprofloxacin antibiotics were used. Results: From a total of 400 samples, 39 (9.7%) isolates were P. aeruginosa and 28 (7%) were S. aureus. Staphylococcus aureus showed the highest resistance to ofloxacin (82.1%) and the highest drug resistance to P. aeruginosa was related to meropenem (82%). Also, the highest MIC and maximum bactericidal concentration (MBC) for S. aureus to vancomycin were 128 and 256, respectively. In P. aeruginosa, the highest MIC and MBC to ciprofloxacin were 128 and 256, respectively. Conclusion: Staphylococcus aureus and P. aeruginosa showed the highest resistance to ofloxacin and meropenem, respectively. Considering the rapid increase of antibiotic resistance, accurate evaluation of the antibiotic resistance pattern of the bacteria is required.

Background: Catheter-associated (CA) bacteriuria is a result of the extensive usage of urinary catheterization. Once a catheter is placed, many patients achieve bacteriuria, even with the use of greatest consideration and care of the catheter. In this study, we decided to evaluate the prevalence of Catheter-associated bacteriuria in patients who received short-term catheterization in the northeast of Iran.Materials and Methods: In this cross-sectional study during one year (among 2014-2015) 275 patients who have admitted recently and have no history of catheterization and drug consumption were included. Three samples were taken from patients before, one day after catheterization and after removal of the catheter. The urine samples were analyzed and cultured on the suitable media. Antibiotics susceptibility testing was performed by disk diffusion method. Then, data analyzed using SPSS software by Student t-test. In addition, the p values less than 0.05 were considered as significant.Results: In general, the rate of catheter-associated bacteriuria in these hospitals was 68% (187 cases of 275). The mean age of the participants and patients with bacteriuria were 41±1.2 and 24.8±6.2 years old, respectively. The most common isolated bacteria were Escherichia coli (50.6%) followed by Staphylococcus aureus and Klebsiella pneumonia (21.6%). The highest sensitivity was reported against kanamycin (68.9%) and highest resistance was observed against ampicillin with a rate of 96.3%.Conclusion: For prevention of healthcare-associated UTI, correct catheterization and use of the closed catheter system is recommended. In addition, before prescribing any antibiotics it should be paying attention to the antibiotics susceptibility testing results.

Acinetobacter baumannii is an important opportunistic pathogen that mainly infects critically patients in intensive care units (ICU). The production of plasmid-mediated extended-spectrum b-lactamases (ESBLs) is one of the most important mechanisms of resistance against b-lactam antibiotics. This study aimed to evaluate the prevalence of ESBLs in A. baumannii isolated from ICU of Ghaem hospital, Mashhad, Iran. A total of 140 A. baumannii isolates recovered from hospitalized patients in ICU of Ghaem hospital in Mashhad city from December 2014 to March 2015. Identification of A. baumannii isolates carried out using biochemical laboratory methods and then confirmed by OXA-51 PCR screening. Susceptibility testing performed using disk diffusion (Kirby-Bauer) method as recommended by CLSI guidelines. A. baumannii isolates screened for production of ESBLs using combination disk test. blaPER, blaGES, blaTEM, blaSHV, blaCTX, blaVEB and blaOXA-10 beta-lactamase genes detected using conventional PCR. The most antibacterial resistance was against cefuroxime (­99.3%) and colistin was the most effective antibiotic. None of the isolates were ESBL producer by combination disk test. However, results of PCR revealed that the prevalence of blaPER, blaGES and blaTEM genes were 7.1%, 4.3% and 27.1%, respectively. blaCTX, blaVEB, and blaOXA-10 were not found in any of isolates. According to the results, the high resistance was seen against selected antibiotics and the phenotypic tests are not sufficient alone for determination of ESBLs producer of A. baumannii isolates. So, molecular tests are also necessary for detection of these enzymes.

No Abstract####

Background and Objectives: Leptospirosis is a zooanthroponosis caused by the genus of Leptospira. It is an emerging public health problem due to its increasing incidence. The achievement to a vaccine that prevent from entrance of Leptospira interrogans to the deeper tissues of the host is needed. This study aimed to investigate the immunogenicity of LcpA (rLcpA) and LenA (rLenA) recombinant proteins in combination with LTB (rLTB) recombinant protein as an adjuvant against leptospiral infection in hamsters. Materials and Methods: The genes encoding these proteins were cloned into pGH cloning vector and then lenA, lcpA and ltb genes subcloned into pET-15b and pET-28a expression vectors, respectively. The hamsters were immunized with the purified recombinant proteins and challenged with Leptospira interrogans for evaluation of their survival. The antibody responses to the recombinant proteins were determined by ELISA. Then, data entered into SPSS software. Statistical Kruskal–Wallis test was used to compare the significant differences among different groups. The groups with significant differences were further analyzed by post hoc tests. The p value < 0.05 statistically was considered significant. Results: Immunized hamsters with rLenA-plus-rLTB, rLcpA-plus-rLTB and rLenA-plus-rLcpA-plus-rLTB proteins showed 60%, 74%, and 80% survival rates, respectively. A significant amount of interleukin-17 (IL-17), interleukin-4 (IL-4) and gamma interferon (IFNγ) cytokines were produced in immunized hamsters. Conclusion: Based on our findings, rLcpA and rLenA proteins in combination with rLTB can protect the hamsters against L. interrogans and effectively induce a protective antibody response. Thus, these proteins can be used as an additional prophylactic tool against leptospira.

Background: Urinary tract infection (UTI) is a mainly common infection in kidney transplant recipients. This study decided to investigate UTI, bacterial agents, and antibiotic resistance pattern in kidney transplant recipients from Iran. Materials and Methods: Search process was conducted for UTI, bacterial agents, and antibiotic resistance pattern in kidney transplant recipients from Iran via electronic databases (Scopus, PubMed, Web of Science, etc.,) with Mesh terms in either Persian and English languages without limited time to May 31, 2020. Data were analyzed by comprehensive meta-analysis software. Results: The combined prevalence of UTI in renal transplant recipients was reported by 31.1%. The combined prevalence of Gram-negative bacteria was 69%. The most common pathogens among Gram negatives were E. coli followed by Klebsiella pneumoniae with frequency 43.4% and 13%, respectively. Subgroup analysis for Gram-positive bacteria showed the combined prevalence of 31%. The most common microorganism among Gram positives belonged to coagulase-negative Staphylococci and Enterococci with a prevalence of 10.2% and 9%, respectively. Subgroup meta-analysis of antibiotic resistance for Gram-negative showed the most resistance to cephalexin followed by carbenicillin with a prevalence of 89.1% and 87.3%, respectively. Conclusion: Our review showed a noticeable rate of UTI (31.1%) among renal transplant recipients in Iran and a high prevalence of Gram-negative (69%) and Gram-positive (13%) microorganisms. A high resistance rate was seen against almost all antibiotics used for the treatment of UTI. Therefore, empirical prescription of antibiotics should be avoided, and it should be based on data obtained from antibiogram tests.

Background: Although, nontuberculous mycobacteria can cause disease in different organisms, theyusually are not reported in most countries because scientists in general consider them as non-pathogens.But, increasing nontuberculous mycobacteria diseases occurrence has changed this belief. Nevertheless,there is no meta-analysis review about prevalence of nontuberculous mycobacteria in Iran.Methods: Any data about prevalence of nontuberculous mycobacteria in clinical specimens in Iranwere retrieved by searching data bases such as Pub Med, MEDLINE, and Iranian data bases. Then themeta-analysis was performed by comprehensive meta-analysis software (CMA).Results: The meta-analysis showed that the prevalence of nontuberculous mycobacteria in the clinicalspecimens in Iran was 1.3%. In the studies that had sample size less than 300, and in studies conductedafter 2004, the prevalence was higher. Also, the prevalence of nontuberculous mycobacteria was higherin the West of Iran. In this study, the most prevalent rapid-growing mycobacterium was Mycobacterium.fortuitum and most prevalent slow-growing mycobacterium was M. simiae with the prevalence 44.2%and 14.3%, respectively.Conclusion: M. simiae is the most prevalent nontuberculous mycobacteria in the clinical specimensin Iran. As this species of nontuberculous mycobacteria has similar clinical and radiologicalmanifestations with tuberculosis, it is often treated as tuberculosis. Unfortunately, M. simiae is resistantagainst first-line anti-TB drugs resulting in treatment failure after using routine anti-TB medication.Therefore, there is an urgent need for application of new diagnostic strategy for identification ofnontuberculous mycobacteria species.

Summary: The spa gene occurs in all strains of Staphylococcus aureus (S. aureus), can function as a genetic marker and might be used distinguish strains at the species level. Hence, due to these advantages, we used spa typing and the Based Upon Repeat Pattern (BURP) to assign the clonal and phylogenetic relationships of S. aureus strains. The sensitivity of S. aureus strains to methicillin was determined using agar disk diffusion. The extracted DNA from 56 isolates of S. aureus was subjected to PCR to detect the spa gene with specific primers. The spa typing method was performed for each of the isolates, and then, BURP was used to cluster spa types (spa-CCs). Finally, using relevant software, the phylogenic tree was drawn. The results of this study showed that 25 out of 56 (44.6%) isolates were resistant to methicillin. The typing of S. aureus isolates revealed 24 different spa types among 56 isolates, and BURP analysis clustered the 24 spa types into 5 spa clonal complexes (CCs) and 12 singletons. The process of spa typing, in combination with BURP analysis, provides an efficient method for investigating phylogenetic and clonal relationships among clinical isolates and can be useful for monitoring bacterial spread between hospitals and communities as well as between and within hospitals. Keywords: Staphylococcus aureus, spa gene, BURP, Phylogenetic relationships

The Prevalence of virB2 and 16SrRNA Genes of Brucella Isolated from Clinical Samples of Hospitals, Western Iran

Background: Although, nontuberculous mycobacteria can cause disease in different organisms, they usually are not reported in most countries because scientists in general consider them as non-pathogens. But, increasing nontuberculous mycobacteria diseases occurrence has changed this belief. Nevertheless, there is no meta-analysis review about prevalence of nontuberculous mycobacteria in Iran. Methods: Any data about prevalence of nontuberculous mycobacteria in clinical specimens in Iran were retrieved by searching data bases such as Pub Med, MEDLINE, and Iranian data bases. Then the meta-analysis was performed by comprehensive meta-analysis software (CMA). Results: The meta-analysis showed that the prevalence of nontuberculous mycobacteria in the clinical specimens in Iran was 1.3%. In the studies that had sample size less than 300, and in studies conducted after 2004, the prevalence was higher. Also, the prevalence of nontuberculous mycobacteria was higher in the West of Iran. In this study, the most prevalent rapid-growing mycobacterium was Mycobacterium. fortuitum and most prevalent slow-growing mycobacterium was M. simiae with the prevalence 44.2% and 14.3%, respectively. Conclusion: M. simiae is the most prevalent nontuberculous mycobacteria in the clinical specimens in Iran. As this species of nontuberculous mycobacteria has similar clinical and radiological manifestations with tuberculosis, it is often treated as tuberculosis. Unfortunately, M. simiae is resistant against first-line anti-TB drugs resulting in treatment failure after using routine anti-TB medication. Therefore, there is an urgent need for application of new diagnostic strategy for identification of nontuberculous mycobacteria species.

Background and Objectives: Klebsiella pneumoniae, one of the important causes of nosocomial infections, is the most common extended spectrum β-lactamases (ESBLs) producing organism. ESBLs are defined as the enzymes capable of hydrolyzing oxyimino-cephalosporins, monobactams and carbapenems. The aims of this study were to identify ESBL-producing K. pneumoniae isolates and detect their antibiotic susceptibility pattern. Materials and Methods: This cross-sectional study was conducted from December 2012 to May 2013 in teaching hospitals in Shiraz. Clinical specimens from the urine, sputum, wound, blood, throat, and body fluids were isolated and identified as K. pneumoniae. Antibacterial susceptibility testing was performed for 14 antibiotics using disk diffusion method according to CLSI guidelines. Isolates showing resistant to at least one of the β-lactam antibiotics were then evaluated for production of β-lactamase enzymes using E-test ESBL and combined disk Method. Also, MICs for ceftazidime and imipenem were determined using E-test. The presence of the blaSHV, blaTEM٫ blaPER and blaCTX-M genes was assessed by PCR. Results: Of 144 K. pneumoniae isolates from different specimens, 38 (26.3 %) was identified as ESBL producer by phenotypic confirmatory test. All ESBL producing isolates were susceptible to imipenem and meropenem and resistant to aztreonam. The highest rate of resistance belonged to amoxicillin (100%), cefotaxime (50%) and gentamicin (42.3%) and the lowest rates were seen for meropenem (11.8%), imipenem and amikacin (both 15.9%). Sixty-two isolates had MICs≥ 4 μg/ mL for ceftazidime, of which 38 were positive for ESBLs in phenotypic confirmatory tests (PCT). The prevalence of blaSHV, blaCTX-M, and blaTEM genes among these isolates were 22.2%, 19% and 16%. blaPER was not detected in the studied isolates. Conclusions: Due to the relatively high prevalence of ESBLs-producing K. pneumoniae isolates in the studied population, it seems that screening of infections caused by ESBL producers can lead to the most effective antibiotics therapies.

Background: One of the main causes of adverse complications following kidney transplantation is urinary tract infection (UTI). This study was done to define the incidence rate, clinical profiles, causative microorganisms, and UTI risk factors among kidney transplant recipients in Mashhad city. Materials and Methods: In this retrospective study, we perused medical files of 247 kidney recipients who underwent transplant surgery at Mashhad University Montaserie Hospital, during 2012–2014. All patients were followed for UTI during the 1st year after surgery. Results: 75 episodes of UTI developed by 152 pathogens in 56 (22.7%) of patients during 1-year follow-up. 26.6% of total UTIs were diagnosed within the 1st month after transplantation. The most frequently isolated uropathogens were Escherichia coli (55.3%, n = 84). The high rate of candiduria (8.5%) was observed, too. Conclusion: UTI is known as one of the hospitalization reasons in kidney transplantation recipients. Defining appropriate antibiotic prophylaxis against bacterial and fungal agents and early removal of urethral catheter are suggested to decrease posttransplantation complications.

Background: While the most nontuberculous mycobacteria (NTMs) species are considered as opportunistic pathogens, some of them are related to several human infections. It is believed that environment is the main source for these infections. Distribution and scattering pattern of NTMs has not been well studied in Iran and a few studies about this subject have been done, so the aim of this study was to determine prevalence of NTMs in environmental samples from Iran. Materials and Methods: Data about prevalence of NTMs in environmental samples from Iran were obtained by searching databases. The studies presenting cross-sectional or cohort and the papers with sample size ≥30 were included. Then, the meta-analysis was performed using Comprehensive Meta-Analysis software and Cochran′s Q and I2 tests. The strategy search was based PRISMA protocol is available online (PRISMA, http://www.prisma-statement.org). Results : The results of this meta-analysis showed that overall combined prevalence of NTMs in environmental samples from Iran was 38.3%. The frequency of NTM was higher in the north of Iran (73.2%). The most prevalent rapid-growing mycobacterium was Mycobacterium fortuitum (19.8%), and the most dominant slow-growing mycobacterium was Mycobacterium flavescens (16.8%). Conclusion: In regard to increasing incidence of disease in immunocompromised patients and existence of different types of mycobacteria species in environmental samples, efforts should be focused on measures that will specifically remove NTMs from habitats where susceptible individuals are exposed.