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The goal of this study was to attempt to determine the rate of contamination of health-care workers' (HCWs) hands and environmental surfaces in intensive care units (ICU) by the main bacteria associated with hospital acquired infections (HAIs) in Tehran, Iran. A total of 605 and 762 swab samples were obtained from six ICU environments and HCWs' hands. Identification of the bacterial isolates was performed according to standard biochemical methods, and their antimicrobial susceptibility was determined based on the guidelines recommended by clinical and laboratory standards institute (CLSI). The homology of the resistance patterns was assessed by the NTSYSsp software. The most frequent bacteria on the HCWs' hands and in the environmental samples were Acinetobacter baumannii (1.4% and 16.5%, respectively), Staphylococcus aureus (5.9% and 8.1%, respectively), S. epidermidis (20.9% and 18.7%, respectively), and Enterococcus spp. (1% and 1.3%, respectively). Patients' oxygen masks, ventilators, and bed linens were the most contaminated sites. Nurses' aides and housekeepers were the most contaminated staff. Imipenem resistant A. baumannii (94% and 54.5%), methicillin-resistant S. aureus (MRSAs, 59.6% and 67.3%), and vancomycin resistant Enterococci (VREs, 0% and 25%) were detected on the hands of ICU staff and the environmental samples, respectively. Different isolates of S. aureus and Enterococcus spp. showed significant homology in these samples. These results showed contamination of the ICU environments and HCWs with important bacterial pathogens that are the main risk factors for HAIs in the studied hospitals.

Bacterial infection is considered a predisposing factor for disorders of the biliary tract. This study aimed to determine the diversity of bacterial communities in bile samples and their involvement in the occurrence of biliary tract diseases. A total of 102 bile samples were collected during endoscopic retrograde cholangiopancreatography (ERCP). Characterization of bacteria was done using culture and polymerase chain reaction-denaturing gradient gel electrophoresis (PCR-DGGE) methods. Antimicrobial susceptibility of the isolates was determined based on the Clinical and Laboratory Standards Institute (CLSI) guidelines and identity of the nucleotide sequences of differentiated bands from the DGGE gels was determined based on GenBank data. In total, 41.2 % (42/102) of the patients showed bacterial infection in their bile samples. This infection was detected in 21 % (4/19), 45.4 % (5/11), 53.5 % (15/28), and 54.5 % (24/44) of patients with common bile duct stone, microlithiasis, malignancy, and gallbladder stone, respectively. Escherichia coli showed a significant association with gallstones. Polymicrobial infection was detected in 48 % of the patients. While results of the culture method established coexistence of biofilm-forming bacteria (Pseudomonas aeruginosa, E. coli, Klebsiella pneumoniae, Enterococcus spp., and Acinetobacter spp.) in different combinations, the presence of Capnocytophaga spp., Lactococcus spp., Bacillus spp., Staphylococcus haemolyticus, Enterobacter or Citrobacter spp., Morganella spp., Salmonella spp., and Helicobacter pylori was also characterized in these samples by the PCR-DGGE method. Multidrug resistance phenotypes (87.5 %) and resistance to third- and fourth-generation cephalosporins and quinolones were common in these strains, which could evolve through their selection by bile components. Ability for biofilm formation seems to be a need for polymicrobial infection in this organ.

Device-associated health care-acquired infections (DA-HAIs) pose a threat to patient safety, particularly in the intensive care unit (ICU). However, few data regarding DA-HAI rates and their associated bacterial resistance in ICUs from Iran are available. A DA-HAI surveillance study was conducted in six adult and pediatric ICUs in academic teaching hospitals in Tehran using CDC/NHSN definitions. We collected prospective data regarding device use, DA-HAI rates, and lengths of stay from 2584 patients, 16,796 bed-days from one adult ICU, and bacterial profiles and bacterial resistance from six ICUs. Among the DA-HAIs, there were 5.84 central line-associated bloodstream infections (CLABs) per 1000 central line-days, 7.88 ventilator-associated pneumonias (VAPs) per 1000 mechanical ventilator-days and 8.99 catheter-associated urinary tract infections (CAUTIs) per 1000 urinary catheter-days. The device utilization ratios were 0.44 for central lines, 0.42 for mechanical ventilators and 1.0 for urinary catheters. The device utilization ratios of mechanical ventilators and urinary catheters were higher than those reported in the ICUs of the INICC and the CDC's NHSN reports, but central line use was lower. The DA-HAI rates in this study were higher than the CDC's NHSN report. However, compared with the INICC report, the VAP rate in our study was lower, while the CLAB rate was similar and the CAUTI rate was higher. Nearly 83% of the samples showed a mixed-type infection. The most frequent pathogens were Acinetobacter baumannii, Staphylococcus aureus and Pseudomonas aeruginosa, followed by Klebsiella pneumoniae and Enterococcus spp. In the S. aureus isolates, 100% were resistant to oxacillin. Overall resistances of A. baumannii and K. pneumonia to imipenem were 70.5% and 76.7%, respectively. A multiple drug resistance phenotype was detected in 68.15% of the isolates. The DA-HAI rates in Iran were shown to be higher than the CDC-NHSN rates and similar to the INICC rates. Resistance to oxacillin and imipenem was higher as well. Comparing device use, DA-HAI rates, and bacterial resistance for the primary isolated bacteria indicated a direct association between urinary catheter use and the rates of CAUTI.

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There are ambiguous results about the involvement of Helicobacter species in production of hepatobiliary diseases. This study was aimed to investigate any possible association between the presences of Helicobacter spp., their genotypes and occurrence of different biliary diseases. Cultures of 102 bile samples for Helicobacter spp. did not show any growth, but the presence of Helicobacter genus specific DNA (16s rRNA gene) was detected in 3.92% of them. No significant association was found between development of the diseases and presence of the bacteria. All the Helicobacter genus positive samples belonged to H. pylori species and showed vacA+ (s1/m2), cagA- genotypes.

Background: Detection of the cause of diarrhoeal diseases is important for the management of the outbreaks. Aims: This study investigated the prevalence of Shiga toxin-producing bacteria in stool samples of patients with diarrhoea associated with outbreaks of foodborne illness in the Islamic Republic of Iran. Methods: A total of 532 stool and rectal swab samples from 70 sporadic outbreaks during May 2014 to August 2015 were examined for infection with Shiga toxin-producing bacteria. The isolates were examined for carriage of the virulence genes stx 1 and stx 2 in all isolates and eae/ehxA in Escherichia coli.Results: E. coli, Shigella spp., Citrobacter spp., Enterobacter spp., Klebsiella spp. and other enteric bacteria were detected in 77.7% (376/484), 5.0% (24/484), 3.9% (19/484), 0.4% (2/484), 3.7% (18/484) and 9.3% (45/484) of the samples respectively. Of the 196 sorbitol-negative E. coli strains, 3 (1.5%) carried the stx 1 gene as did 2 of the 19 (10.5%) Citrobacter strains. Conclusion: Shiga toxin-producing Citrobacter spp. strains should be considered as a newly emerging foodborne pathogen in outbreaks.