Background:VAP is defined as pneumonia in patients who use ventilators. The acute physiology and chronic health evaluation (APACHE II) scoring system was originally developed for predicting mortality in patients who were admitted to the intensive care unit. Due to the complexity, a simpler score called IBMP-10 was developed. We designed the study to confirm and further investigate these two methods.Materials and Methods:This cross-sectional and analysis-descriptive study was done at the moment of VAP diagnosis on 60 patients in intensive care units. APACHE II and the IBMP-10 scores were calculated. ROC curves were generated to compare the new prediction rule with the APACHE II score. Results were reported as adjusted odds ratios with 95% confidence intervals (CIs). Analyses were performed using SPSS, version 20 and P values of 0.05 were considered to be statistically significant.Results:APACHE II Score means (P < 0.001) and IBMP-10 score (P < 0.001) means had significant increase in Non-survivor patient than in patients who survived. APACHE II can be used as a good prediction measure for mortality rate. In IBMP-10 method, specificity and PPV were greater than APACHE II, but in mc-nemar test, there was no significant difference between the two methods (P = 0.55). Both prediction rules had high NPV. In our study, survivors’ prediction value in APACHE II was 46.7%, and in IBMP-10, it was 46.7%.Conclusion:IBMP-10, compared to APACHE II, has greater sensitivity, specificity, and AUC to predict mortality. So the consequence of the use of IBMP-10 was better than APACHE II.

Introduction: It has been proposed that oxidative stress plays a crucial role in vancomycin-induced nephrotoxicity (VIN). Objectives: The present study aimed to investigate the nephroprotective effects of lycopene, as a powerful antioxidant, on VIN. Patients and Methods: In the present study, individuals who received vancomycin (VCM) for any indication were assigned to drug (n=28) and control (n=30) groups. The individuals in the drug group received 25 mg of oral lycopene daily for 10 days started concurrently with VCM and the patients in the placebo group received placebo tablets with VCM. Serum levels of creatinine (SCr) and blood urea nitrogen (BUN) as well as creatinine clearance (CrCl) were determined and recorded before the start of interventions, every other day during therapy, and 12 hours after the last dose of VCM in 10th day of treatment for all participants. Finally, the mean values of the measured parameters were compared between the groups. Results: The mean values of SCr were significantly lower in drug group compared to placebo at the 4th (0.85 ± 0.18 vs. 0.98 ± 0.22, P=0.016) and 6th (0.83 ± 0.18 vs. 0.95 ± 0.21, P=0.029) days. Also, CrCl was significantly higher in the drug group at the 4th day compared to placebo (105.82 ± 20.09 vs. 94.67 ± 20.53, P=0.041). Regarding VCM-induced AKI, no case was reported in any group. Conclusion: Lycopene has the potential for diminution of VCM-induced nephrotoxicity (VIN). However, more investigations with larger sample size are necessary to confirm this effect.

Background: Isfahan Antibiotic Resistance Surveillance System-1 has been instituted in Isfahan, Iran to construct a project for surveillance of clinically significant bacteria, and to help raise a logic regional stewardship program for prevention and control of disseminating-resistant organisms. Methods: During March 2016 to March 2018, an antibiotic resistance surveillance system was designed and implemented by Isfahan Infectious Diseases and Tropical Medicine Research Center. The surveillance program was implemented in three general hospitals in Isfahan. In addition to the routine microbiology data, clinical data (differentiation between true infections and contamination, healthcare-associated infections (HCAI) and community-acquired infections (CAI), as well as determination of the infection site) were obtained and analyzed by WHONET software. Results: During a 2-year period, from 7056 samples that revealed growth of bacteria, 3632 (51.5%) isolates were detected as contamination and 3424 (48.5%) true bacterial isolates were identified. Of these, about 32% of isolates were recognized as HCAI. Totally, the most recognized infections were urinary tract infection, bloodstream infection and skin and soft tissue infections. In patients with HCAIs, 70% of isolates were gram negative and in patients with CAIs 73% isolates were gram negative bacteria. Conclusions: The strength of the project is gathering enough clinical information in addition to microbiologic data, which would increase application of the results for empiric treatment and prevention of the infectious diseases in clinical settings.

Background: Antibiotic resistance against uro-pathogens is a worldwide health concern. The aim of this study was to determine the causative bacteria and antibiotic susceptibility patterns among hospitalized patients with community acquired urinary tract infection (UTI). Methods: This cross-sectional study was performed in 2016-2018 in Isfahan, Iran. Urine samples were examined for strain identification and antimicrobial resistance pattern using standard tests. Stratification was done based on gender and age (<20 and >20 years) groups. Chi-square and Fisher exact tests were applied to assess differences in etiology and susceptibility rates between groups. Results: Among 1180 patients, Escherichia coli was the commonest pathogen (68.1%) followed by Enterococcus spp. (8.8%) and Klebsiella pneumonia (8.0 %). Non-E. coli pathogens were more frequent among males (41.8% versus 24.8% in females, P < 0.01) and in those aged under 20 years (61.0% versus 22.2% in older than 20 years, P < 0.01). Isolated bacteria revealed high susceptibility to imipenem (94.9%), meropenem (92.2%), and amikacin (91.9%); moderate sensitivity to gentamicin (64.4%), cefepime (52.6%) and ceftazidime (47.2%); and low susceptibility to ceftriaxone (41.8%), cefotaxime (40.0%), ciprofloxacin (38.6%) and trimethoprim-sulfamethoxazol (31.3%). The sensitivity of isolates to ceftriaxone, ceftazidime, cefepime, imipenem, meropenem, amikacin and ciprofloxacin was significantly higher in females. Compared to the older age group, uro-pathogens were more susceptible to ciprofloxacin, ceftazidime and gentamicin in patients aged under 20 years. Conclusion:We found that imipenem, meropenem and amikacin were good choices for empiric therapy of complicated or severe hospitalized patients with community acquired UTI; and gentamicin, cefepime and ceftazidime were acceptable as initial choices in non-severe infections in the area.

Background: Urinary tract infection (UTI) is a common disease in hospitalized patients with indwelling devices especially in the intensive care units (ICUs). Candida species are the etiologic agents of 20%-25% of UTI in ICUs, and the most common organisms after Escherichia coli. Although fungal UTIs are clearly rare in comparison with bacterial UTIs, however there has been an increase in the prevalence of Candida species since 1980s. Despite Candida albicans being a main etiologic agent of fungal UTI, non-albicans Candida species (NACs) such as C. krusei, and C. glabrata, are repeatedly isolated from clinical samples. Identification of Candida to the species level is crucial due to expanding resistance of NACs to the antifungal agents. Objectives: The present study aimed to identify the causative agents of fungal UTI among hospitalized patients at the ICU ward of Al-Zahra university hospital in Isfahan, Iran. Methods: From March 2017 to October 2018, 100 ICU patients with positive urine cultures of Candida species were registered in Isfahan, Iran. All clinical isolates were sub-cultured on sabouraud dextrose agar, and CHROMagar Candida media and incubated at 37°C for 48 hours. Molecular identification was performed by polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP) technique using specific primers. Results: Candida albicans was the most prevalent species among clinical isolates (94%) followed by Candida tropicalis (4%), Candida glabrata (1%), and Candida parapsilosis (1%). Most patients belonged to the age range of 71-80. Diabetes mellitus and neutropenia were the main risk factors among patients. Conclusions: Since Candida albicans was the most prevalent species in the present study, and due to its various sensitivities to antifungal agents, antifungal susceptibility testing for clinical isolates is recommended for better management of Candida UTI.

Background: Chlamydia trachomatis (CT) has been considered as a major health problem worldwide given the high incidence of the infection, estimated to be 131 million new cases annually. The aim of the current study was to determine the prevalence of CT infection in female sex workers (FSWs) living in Isfahan, Iran and risks associated with its prevalence.Methods: This was a cross-sectional study, which was conducted on 99 FSWs recruited from two drop-in centers (DIC) in Isfahan during 2012-2014. The attendees were recruited consecutively. Vaginal, rectal, saliva and urine samples were tested for CT using Real-time PCR. The demographic data were gathered by face to face interview.Results: Prevalence of Chlamydia infection was 20.2% (20/99). The number of people who had more than one sexual partner in the CT-positive group was significantly higher than CT-negative (P= 0.042). The percentage of women whose duration of intimate relationship lasted more than three years was higher in the Chlamydia-positive population compared to Chlamydia-negative (70% vs 35.4%, p=0.005). Furthermore, Chlamydia-negative and Chlamydia-positive FSWs differed from one another in the history of imprisonment (11.4 % in Chlamydia-negative vs 35% in Chlamydia-positive group, p=0.017). Conclusion:The prevalence of CT infection was high among FSWs. Our findings showed that prison experience, the number of sexual partners and duration of intimate relationship were statistically significant among those affected by chlamydia infection.

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