Teaching Hospitals In Ahvaz Research Articles

The application of the loop-mediated isothermal amplification method for rapid detection of methicillin-resistant Staphylococcus aureus

Methicillin-resistant Staphylococcus aureus (MRSA) is an important problem associated with significant mortality and morbidity and well known as a predominant bacterial pathogen. The aim of this study was to identify MRSA strains. In this study (June 2018 to June 2019) isolates of S. aureus were obtained from patients referred to teaching hospitals of Ahvaz, Iran. All isolates were confirmed by conventional microbiological methods. In following, antimicrobial susceptibility testing (AST), MRSA screening, PCR detection of MRSA and LAMP assay were performed. Out of a total of 156 staphylococcal isolates, 126 isolates were identified as MRSA. Seventy-two (57.1%) MRSA isolates were recovered from wound. All MRSA isolates were sensitive to vancomycin, linezolid, teicoplanin, quinupristin-dalfopristin, and tigecycline. The results of LAMP showed 100% agreement with PCR. Sensitivity and specificity of the LAMP assays for the mecA genes were 100% and 100%, respectively. The LAMP assay is a rapid and simple method for the identifications of MRSA. Because of its performance without the need for specific instrumentation, this method can be easily employed in medical centers for the detection of mecA.

Antimicrobial resistance patterns and prevalence of integrons in Shigella species isolated from children with diarrhea in southwest Iran

Objective: To investigate the antimicrobial resistance patterns and prevalence of integrons in Shigella species isolated from children with diarrhea in southwest Iran. Methods: In this study, 1 530 stool samples were collected from children under 15 years with diarrhea referred to teaching hospitals in Ahvaz and Abadan, southwest Iran. Shigella spp. were identified by standard biochemical tests and PCR. The antibiotic resistance pattern of all Shigella isolates was determined by the disk diffusion method and minimum inhibitory concentration (MIC) by E-test. Results: Of 1 530 stool samples, 91 (5.9%, 91/1 530) were positive for Shigella spp. the most common Shigella isolates were Shigella flexneri 47 (51.6%, 47/1 530). Antibiotic susceptibility tests showed that the highest antibiotic resistance was related to trimethoprim-sulfamethoxazole (87.9%, 80/91) and ampicillin (86.8%, 79/91). Multiplex PCR results revealed that 56% and 86.9% of Shigella isolates carried integron class I and integron class II genes, respectively. None of the isolates included the integron class III gene. Conclusions: The high prevalence of multi-drug resistance in Shigella isolates in our area increases the concerns about dissemination of the antibiotic-resistant isolates in this bacterium.

Antimicrobial resistance patterns and their encoding genes among clinical isolates of Acinetobacter baumannii in Ahvaz, Southwest Iran

Acinetobacter baumannii is one of the most important organisms in nosocomial infections. Antibiotic resistance in this bacterium causes many problems in treating patients. This study aimed to investigate antibiotic resistance patterns and resistance-related, genes in clinical isolates of Acinetobacter baumannii. This descriptive study was conducted on 124 isolates of Acinetobacter baumannii collected from clinical samples in two teaching hospitals in Ahvaz. The antibiotic resistance pattern was determined by disk diffusion. The presence of genes coding for antibiotic resistance was determined using the polymerase chain reaction method. Out of 124 isolates, the highest rate of resistance was observed for rifampin (96.8%). The resistance rate for imipenem, meropenem, colistin, and polymyxin-B were 78.2%, 73.4%, 0.8% and 0.8%, respectively. The distribution of qnrA, qnrB, qnrS, Tet A, TetB, and Sul1genes were 52.6%, 0%, 3.2%, 93.5% 69.2%, and 6.42%, respectively. High prevalence of tetA, tetB, and qnrA genes among Acinetobacter baumannii isolated strains in this study indicate the important role of these genes in multidrug resistance in this bacteria.• Acinetobacter baumannii is an important human pathogen that has attracted the attention of many researchers Antibiotic resistance in this bacterium causes many problems in treating patients.• The resistance rate for imipenem, meropenem, colistin, and polymyxin-B were 78.2%, 73.4%, 0.8% and 0.8%, respectively. The distribution of qnrA, qnrB, qnrS, Tet A, TetB, and Sul1genes were 52.6%, 0%, 3.2%, 93.5% 69.2%, and 6.42%, respectively.

Virulence determinants and biofilm formation in clinical isolates of Enterococcus: A cross-sectional study

Objective: To evaluate the relationship between biofilm formation and incidence of virulence determinants in clinical isolates of Enterococcus. Methods: In this cross-sectional study, the clinical isolates of Enterococcus strains were collected from the university teaching hospitals in Ahvaz, Iran from June 2017 to June 2018. Then, the prevalence of Enterococcus species, antibiotic resistance, virulence factors, and biofilm-producing ability were determined. Results: Of the 119 tested isolates, 17 (14.3%) were Enterococcus faecalis, 72 (60.5%) were Enterococcus faecium and 30 (25.2%) were other Enterococcus spp. Gelatinase was detected in 97 (81.5%) isolates, enterococcal surface protein in 41 (34.5%) isolates, serine protease in 39 (32.8%) cases, accessory colonization factor in 111 (93.3%) cases and pathogenicity islands in 17 (14.3%) cases. The biofilm formation ability was observed in 75 (63.0%) of all isolates and the association between the presence of enterococcal surface protein gene and biofilm formation was statistically significant. Higher resistance to vancomycin, gentamycin, and teicoplanin was indicated in Enterococcus faecium with 81.8%, 58.4%, and 85.7% resistance rate, respectively. All Enterococcus faecalis isolates were sensitive to teicoplanin and vancomycin. Conclusions: The presence of antibiotic-resistance with several virulence factors in Enterococcus spp has become a concern. High prevalence of enterococcal surface protein gene among biofilm- producing isolates suggests a potential relation between biofilm formation and the enterococcal surface protein gene, and further studies are needed to identify the mechanism of biofilm inhibition.

Loop-mediated isothermal amplification for detection of Legionella pneumophila in respiratory specimens of hospitalized patients in Ahvaz, southwest Iran.

BackgroundLegionnaires’ disease is an important public health problem that can cause substantial mortality and morbidity. Legionnaires’ disease-risk estimation may be compromised by uncertainties in Legionella-detection methods. The aim of this study was the detection of L. pneumophila in respiratory specimens of hospitalized patients with respiratory symptoms by culture, PCR, and loop-mediated isothermal amplification (LAMP) methods.MethodsSputum and bronchoalveolar lavage samples were obtained from patients with pneumonia admitted to teaching hospitals in Ahvaz, Iran from June 2016 to March 2017. Isolation of Legionella spp. was done by culturing the samples directly onto buffered charcoal–yeast extract and modified Wadowsky–Yee agar medium. Then, PCR and LAMP assays were performed for detection of L. pneumophila via its mip gene in respiratory specimens.ResultsA total of 100 respiratory specimens were collected. Our results showed that 1% of the samples were culture positive for Legionella spp., and 3% and 7% of samples were positive for L. pneumophila using the mip gene on PCR and LAMP assays, respectively.ConclusionLegionnaires’ disease should be considered in the diagnosis of pulmonary infectious diseases. Also, the LAMP assay is a faster method with higher sensitivity and specificity than conventional methods, such as PCR and culture, for laboratory diagnosis of Legionnaires’ disease.

Pattern and extent of off-label and unlicensed drug use in neonatal intensive care units in Iran

BackgroundMany newborns may need to be hospitalized and receive drugs during the first days of their lives. These drugs are fundamentally prescribed as off-label and unlicensed. This study aimed to investigate the amount of these kinds of drugs administered in the Neonatal Intensive Care Units (NICUs) of Abuzar and Imam Khomeini Teaching Hospitals in Ahvaz, Iran.MethodsThis was a 3-month descriptive, cross-sectional study with retrospective nature in which 193 hospitalized newborns were studied. Demographic data were extracted from the patients’ files. The drugs were classified as off-label, unlicensed or licensed according to the Pediatric & Neonatal Dosage Handbook (Lexicomp®, 22nd Edition).ResultsIn total, 1049 prescriptions were registered for the 193 hospitalized newborns (term and preterm). For each newborn, the mean numbers of prescriptions and drugs received were 5.4 and 4.5, respectively. The mean numbers of prescriptions and drugs were greater for preterm newborns.Of the total 1049 prescriptions, 38.1% were off-label and 1.9% were unlicensed. Of the 193 newborns, 85% received at least one off-label or unlicensed prescription. Off-label prescriptions were mostly related to dose (44.8%) and dosing interval (36.5%). Most off-label drugs were antibiotics (mainly Gentamicin). Albuterol was used off-label in 100% of the cases.ConclusionsThe results of the present study show that the prescription of off-label and unlicensed drugs in NICUs is as high in Iran as in other countries. This suggests that it is necessary to provide information to neonatologists to decrease the prescription of off-label and unlicensed drugs.

Assessing Knowledge, Attitude, and Practices of Parents Towards Physical Activity of Children with Asthma Referring to Ahvaz Teaching Hospitals

Background: Parents are the primary caregivers and their positive knowledge, attitude, and practices play an important role in children’s future vision. Objectives: This study aimed to determine knowledge, attitude, and practices of parents of asthmatic children about physical activities in patients referred to teaching hospitals in Ahvaz during 2016. Methods: In this cross-sectional study, 118 parents of children with asthma, admitted to the pediatric wards of teaching hospitals in Ahvaz, were selected by non-randomized consecutive method according to the inclusion criteria (P = 0.5, and d = 0.09). A researcher-made questionnaire (demographic information, knowledge, attitude, and practices of parents) was given to 20 parents after calculating cvr, cvi, and reliability confirmation through test-retest method by 10 professors. The data were analyzed using descriptive statistics, and ANOVA. Management and data analysis was performed using the SPSS statistical software. Results: The results showed that the knowledge of 61.01% of parents was ideal and 38.13% intermediate, attitude of 51.69% was ideal and 48.30% neutral, and practices of 53.38% was ideal and 46.61% was intermediate towards physical activity in children with asthma. There was a significant association between the level of knowledge and attitude of parents with educational level (P = 0.0001), severity of asthma (P = 0.049), and duration of asthma (P = 0.049). Conclusion: Overall, knowledge, attitude, and practices of parents on physical activities, such as swimming and gymnastics, was poor and it is suggested that parents be advised towards more allowed sports activities in children with asthma.

Drug Supply Chain Management and Implementation of Health Reform Plan in Teaching Hospital Pharmacies of Ahvaz, Iran

Background: Drugs play a strategic role as a health commodity. Thus, the supply chain management of drugs is an important issue to reducing costs and thereby improving patient health. Objective: This study evaluated the status of drug supply chain management and health reform in the pharmaceutical sector of teaching hospitals in Ahvaz, Iran. Methods: This cross-sectional study was carried out in pharmacies of teaching hospitals in Ahwaz, Iran in 2015. Data was collected through a checklist extracted from the Evaluation Checklist of the Food and Drug Deputy and related articles. The study checklist examined six dimensions of the Evaluation Checklist, including drug storage, administrative regulations, preparation of medicines, drug distribution, taking medication, and implementation of health reforms in the pharmaceutical sector. The content validity of the checklist was confirmed by experts and pharmaceutical specialists. Data was analyzed for descriptive characteristics such as frequency and percentage using EXCEL version 2010 software. Results: The findings show that hospitals met standards for administrative regulations with 78.5% and preparation of medicines with 77.25%. The dimensions of drug storage with 74.75%, taking medication with 74.25%, implementation of health reforms with 71.5%, and drug distribution with 62.5% were in a near-standard state. Conclusion: Supply chain management systems of medicines in teaching hospitals are near-standard. To improve hospitals, offering proper training to employees, using the fixed-rate shopping system, and providing facilities to patients are recommended.

Survey of CTX-M Gene Frequency in Extended-Spectrum Beta-Lactamase-Producing Enterobacteriaceae Isolates Using the Combination Disk and PCR Methods in Ahvaz, Iran.

BackgroundA common mechanism of resistance to beta-lactam antibiotics is the production of beta-lactamase by Gram-negative bacteria. Recently, nonderivative extended-spectrum beta-lactamases (ESBLs) from the TEM and SHV enzymes, such as CTX-M, that were related to different geographical regions have been recognized.ObjectivesThe aim of this study was to determine the frequency of the CTX-M gene in ESBL-producing Enterobacteriaceae isolates in hospitalized patients in the teaching hospitals of Ahvaz, Iran.MethodsEnterobacteriaceae isolates from clinical specimens (other than stool), such as wounds, blood, urine, trachea, discharge, and abscess, were collected and examined. All the isolates were identified using standard biochemical tests. The combination test was carried out based on CLSI criteria for the phenotypic detection of ESBL-producing isolates. After DNA extraction, the CTX-M and CTX-M-1 genes were amplified using PCR among phenotypically positive ESBL isolates.ResultsAmong 240 Enterobacteriaceae isolates, Escherichia coli and Enterobacter were the most common isolates with 171 (71.3%) and 65 (27.1%), respectively. The combination test results also showed that 108 (45%) Enterobacteriaceae isolates were phenotypic ESBL producers, but 104 (96%) isolates were positive for the blaCTX-M gene and 99 (92%) were positive for the blaCTX-M-1 gene according to the PCR method.ConclusionsThe results of this study phenotypically and genotypically confirmed the high frequency of ESBL-producing strains, such as the CTX-M and CTX-M-1 genes, among Enterobacteriaceae isolates in our region. Therefore, use of antibiotic susceptibility testing for the detection of ESBL isolates prior to the prescription of beta-lactam antibiotics is recommended. This could help prevent the spread of bacteria strains that are resistant to beta-lactam antibiotics.

Current Status of the Fetography: Preventing of the Future Radiation Induced Cancer

Background: Fetography has named the radiography of the fetus in utero. Due to the potential risk of radiation-induced cancers and other malignant effects, this procedure has avoided and has completely replaced by ultrasonography. However it has observed that this invasive procedure has still followed in some clinical departments. Objectives: The aim of this study was to assess the current status of the fetography and its prevalence as an un-recommended diagnostic procedure in teaching hospitals of Ahvaz, Iran. Methods: The radiology and ultrasonography reception systems of two teaching hospitals of Ahvaz have investigated to identify pregnant patients who has undergone fetal presentation imaging (cephalic or breech) between 21 March 2013 and 21 March 2015. Results: In general 3741 pregnant women who have undergone fetal-presentation imaging during two past years have identified. There was significant statistically differences between X-ray and ultrasonography examinations (2528 vs. 1213; P value < 0.05), as those have accounted for 67.5% and 32.5% of the performed examinations, respectively. Women younger than 30 years, who were more sensitive to radiation, accounted for 51.2% of the X-ray examinations. The number of fetographies has increased as much as 2.2 fold during 2013 to 2015. Discussion: Women of the investigated hospital have received avoidable fetal irradiation due to fetography then it was a reason for concern. Ultrasonography should be the first-line imaging modality for pregnant women, especially in the case of fetal-presentation.

Molecular characterization of Staphylococcus aureus isolates from southwest of Iran using spa and SCCmec typing methods

Staphylococcus aureus remains a major cause of nosocomial infection worldwide. Characterization of S. aureus isolates circulating in the southwest of Iran will contribute to understand and control the spread of the strains in this area. spa and SCCmec typing methods were used for genotyping of 125 S. aureus isolates obtained from two teaching hospitals in Ahvaz. Drug susceptibility testing was performed by using disk diffusion method.Frequency of the methicillin resistant S. aureus (MRSA) isolates was 39% (n = 34) and 27% (n = 10) in Emam Khomeini and Golestan hospitals, respectively. Except for Erythromycin, MRSA strains showed high rate of resistance to antimicrobial agents including penicillin (100%), norfloxacine (80%), azitromycin (80%), ciprofloxacin (80%), gentamycin (77%), cotrimoxazole (75%), cephotaxime. All isolates were sensitive to vancomycin. Out of 44 MRSA strains, 39 (88.5%) were SCCmec III, three (7%) were IVc and two (4.5%) of them were nontypeable. spa types t037 (26 isolates; 59%), and t1149 (25 isolates; 31%) were the most dominant types found in MRSA and methicillin sensitive S. aureus (MSSA) strains, respectively.We found SCCmec type III as the most prominent type indicating that most of the studied bacterial population had hospital origin. spa type t037, the most frequent genotype in this study were significantly (100%) associated with MRSA. For the first time we are reporting spa types t692, t706 and t018 from Iran and t342, t704, t2622, t5598, t11270 and t2864 from Asia. Moreover we are reporting types t6871 and t2684 for the second time in the world.

Relationship between Outpatients’ Visit Time and Physicians’ Prescription Quality in Teaching Hospitals of Ahvaz: 2015

&lt;p&gt;&lt;strong&gt;BACKGROUND: &lt;/strong&gt;Examination time is a key factor determining the relative value of clinical physicians’ examination and care quality. Whereas commitment &lt;strong&gt;‎&lt;/strong&gt;to standard prescription principles by physicians increases the likelihood of proper treatment, its effectiveness and patients’ improvement. This study aimed to determine the relationship between outpatients’ examination time and physicians prescribing quality in teaching hospitals of Ahvaz.&lt;strong&gt;&lt;/strong&gt;&lt;/p&gt;&lt;p&gt;&lt;strong&gt;METHODS: &lt;/strong&gt;This cross-sectional study was conducted in 550 outpatients who visited teaching hospitals of Ahvaz in 2015.&lt;strong&gt; &lt;/strong&gt;The quality of the prescriptions was assessed by WHO checklist&lt;strong&gt;.&lt;/strong&gt; Each prescription was scored with a score range from 0 to 21, they were divided into four equal score categories including low (0–5.25), low intermediate (5.26–10.5), high intermediate (10.5–15.75) and good (15.76–21) and using correlation and regression was analyzed.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;RESULTS:&lt;/strong&gt; The total mean of examination time and commitment to prescription principles was 4.88±0.12 min and 15.92±1.14, respectively. Correlation coefficients between outpatients’ examination time and dimensions of “legibility”, “pharmaceutical form” and “medical orders”, and the total quality of prescription were significant (p˂0.005). The relationship between examination time and prescription quality confirmed with the fitting linear regression model. Increase per minute in patient’s examination by a physician, which is about 0.33 points, was added to the basic quality scores of prescription.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;CONCLUSION: &lt;/strong&gt;There was&lt;strong&gt; &lt;/strong&gt;a relationship between Examination time and dimensions of legibility, pharmaceutical form, and medical order. Considering commitment &lt;strong&gt;‎&lt;/strong&gt;to standard prescription principles,&lt;strong&gt; &lt;/strong&gt;examination time, which was declared by the Health Sector Evolution Guideline, improve physicians’ prescription quality and quality of provided services of hospitals. Therefore, providing an internet schedule for examination will be extremely helpful in organizing physicians’ examination.&lt;/p&gt;

Characterization of Oxacillinase and Metallo-β-Lactamas Genes and Molecular Typing of Clinical Isolates of Acinetobacter baumannii in Ahvaz, South-West of Iran.

Background:Carbapenem resistant Acinetobacter baumannii is an important nosocomial pathogen associated with a variety of infections.Objectives:The current study aimed to characterize the antimicrobial susceptibility, analyze the prevalence of oxacillinase and metallo-β-lactamase (MBL) genes and molecular typing of clinical isolates of A. baumannii.Materials and Methods:A total of 124 non-repetitive isolates of A. baumannii were collected from various clinical specimens in two teaching hospitals in Ahvaz, south-west of Iran. Antimicrobial susceptibility test was carried out by disk diffusion method. The minimum inhibitory concentrations (MICs) of imipenem, meropenem, colistin and tigecycline were determined using E-test. To screen for MBL production, double disk synergy (DDs) test and MBL E-test were performed. The presence of blaOXA-23-like, blaOXA-24-like, blaOXA-51-like, blaOXA-58-like, blaVIM, blaIMP and blaSPM genes was assessed by polymerase chain reaction (PCR). To identify clonal relatedness, all isolates were subjected to repetitive sequence-based PCR (rep-PCR)Results:Based on disk diffusion results, the highest rate of resistance was observed in rifampin (96.8%). Colistin and polymyxin-B were the most effective agents in vitro. According to the MIC results, the rate of resistance to imipenem, meropenem, colistin and tigecycline were 78.2%, 73.4%, 0.8% and 0, respectively. Metallo-β-lactamase production was positive in 42.3% and 79.4% of the isolates by DDs test and E-test, respectively. All isolates (100%) carried blaOXA-51-like gene. According to the results of multiplex PCR, blaOXA-23-like and blaOXA-24-like genes were detected in 85.6% and 6.2% of carbapenem resistant isolates, respectively. No blaOXA-58- like, blaVIM, blaIMP and blaSPM were detected. By rep-PCR, carbapenem resistant isolates were separated into six genotypes (A to F). Genotype A (30.9%) was the most prevalent (P value < 0.001). Genotypes B and C were found in 28.9% and 26.8% of the isolates, respectively.Conclusions:The rate of carbapenem resistant A. baumannii isolates were high in this study. Since, blaOXA-58-like or MBL genes were not detected, it seems that resistance to carbapenems is related to blaOXA-23-like and blaOXA-24-like. Moreover, blaOXA-23-like was the most prevalent oxacillinase (OXA) gene. Most of the isolates belonged to one of the four dominant genotypes indicating clonal dissemination in the hospitals under study. In order to control the spread of carbapenem-resistant A. baumannii, infection- control strategies are needed.

Radiation Protection in Radiology Departments of Ahvaz University of Medical Sciences Teaching Hospitals, Ahvaz, Iran, 2015

Background: Application of ionizing radiation in many fields especially in medicine is growing, and can cause adverse health effects. Objectives: The current study aimed to evaluate the radiation protection principles in radiology departments, based on national standards. Materials and Methods: The current study was conducted in all radiology departments of the teaching hospitals in Ahvaz, Iran, and their radiation protection status was investigated using Audit technique. For this purpose Audit checklist was prepared and essential information gathered by observation, interview with radiology department managers, and documentary surveying. At the end, standard situations were classified in three levels: poor ( ˂ 50%), medium (50 - 75%), and good (75 - 100%). Results: The mean of radiation protection in the studied radiology departments was 70.53%. The highest and lowest levels of radiation protection were in quality control and suitable ventilation, respectively. Radiation protection was evaluated as medium in 71.4% and good in 28.6% of the studied radiology departments. Conclusions: The state of observed radiation protection principles was relatively in the weak level in the studied radiology departments especially in facilities such as ventilation system, radiography entrance, and darkroom situation. More important reason was usage changing of sections as radiology billet from related organizations.

Detection of Metallo-Beta Lactamases Among Carbapenem-Resistant Pseudomonas aeruginosa.

Background:Carbapenems are important drugs used for the treatment of Pseudomonas aeruginosa infections, however metallo-β-lactamases (MBL) are able to efficiently hydrolyze these classes of drugs. Immediate detection of the MBL-producing P. aeruginosa is necessary in order to accurately treat infections caused by this organism.Objectives:To determine the prevalence of MBL producing P. aeruginosa in burn and non-burn patients by two phenotypic tests and polymerase chain reaction (PCR) and to compare phenotypic tests with PCR.Materials and Methods:A total of 223 non-duplicate strains of P. aeruginosa were collected from three teaching hospitals of Ahvaz, Iran. Antimicrobial susceptibility and minimum inhibitory concentrations (MICs) of carbapenems (imipenem, meropenem, doripenem and ertapenem) were determined by the Kirby-Bauer and E-test methods. Combined disk (CD) test, MBL E-test and PCR were performed for carbapenem-resistant P. aeruginosa isolates.Results:Amongst all the P. aeruginosa isolates, 58.7% were resistant to imipenem while 31.8%, 13.5% and 74.4% were resistant to meropenem, doripenem and ertapenem, respectively. Amongst all the P. aeruginosa isolates, 44.4% were multidrug resistant and 13.45% were resistant to all of the carbapenems. The CD test with doripenem disk / 750 μg ethylene diamine tetra acetic acid (EDTA) had the highest efficiency compared to the other phenotypic tests. blaIMP and blaVIM genes were detected in 11.7% and 0.4% of isolates, respectively. blaSPM and blaNDM genes were not observed.Conclusions:Epidemiological and regional evaluation of MBL-producing P. aeruginosa through simple and inexpensive methods should be considered for effective treatment of carbapenem-resistant P. aeruginosa infections.