Background:Klebsiella pneumoniae is among the most frequently recovered etiologic agents from nosocomial infections. This opportunistic pathogen can generate a thick layer of biofilm as one of its important virulence factors, enabling the bacteria to attach to living or abiotic surfaces, which contributes to drug resistance.Objectives:The resistance of biofilm-mediated infections to effective chemotherapy has adverse effects on patient outcomes and survival. Therefore, the aim of the present study was to evaluate the biofilm-formation capacity of clinical K. pneumoniae isolates and to perform a molecular characterization using enterobacterial repetitive intergenic consensus-polymerase chain reaction (ERIC-PCR) to determine the dominant biofilm-producing genotype.Patients and Methods:In the present study, 94 K. pneumoniae isolates were obtained from two hospitals in Tehran, Iran. Biofilm formation was assayed by a modified procedure, then ERIC-PCR was carried out.Results:The distributions of the clinical specimens used in this study were 61.7% from urine, 18.1% from wounds, 11.7% from sputum, and 8.5% from blood. Among these isolates, 33% formed fully established biofilms, 52.1% were categorized as moderately biofilm-producing, 8.5% formed weak biofilms, and 6.4% were non-biofilm-producers. Genotyping of K. pneumoniae revealed 31 different ERIC types. Biofilm-formation ability in a special ERIC type was not observed.Conclusions:Our results indicated that an enormous proportion of K. pneumoniae isolated from sputum and surgical-wound swabs produced fully established biofilms. It is reasonable to assume the existence of a relationship between the site of infection and the formation of biofilm. A high level of genetic diversity among the K. pneumoniae strains was observed.
This study indicated that the 13-valent pneumococcal conjugate vaccine (PCV13) could cover the majority of the invasive pneumococcal isolates. Drug-resistant and multidrug-resistant Streptococcus pneumoniae strains are circulating in Iran. Therefore, public immunization of infants using PCV13 is recommended to reduce the incidence of pneumococcal disease and pneumococcal-resistant strains in Teheran.
Background: In the setting of impaired liver function, estimation of glomerular filtration rate (GFR) using common creatinine based equations is inaccurate. Recently, Glomerular Filtration Rate Assessment in Liver Disease (GRAIL) model has been introduced for estimating GFR in liver transplantation. This study was conducted to compare vancomycin dose adjustment in liver transplant patients using Cockcroft-Gault (C-G) versus GRAIL method.Methods: In this pilot, randomized clinical trial, adult liver transplant recipients who were candidate to receive intravenous vancomycin were enrolled. GFR and creatinine clearance were estimated using GRAIL model and C-G equation in the intervention and control arms, respectively and vancomycin maintenance doses were adjusted accordingly. At the steady state , peak and trough serum concentrations of vancomycin were collected for pharmacokinetic comparisons.Results: Fifteen patients were enrolled in each arm of the study. Mean daily dose of vancomycin was estimated insignificantly lower for individuals in GRAIL arm than C-G group (1500.00±544.45 versus 1750.00± 389.60mg). The rate of patients who achieved the target vancomycin trough concentration was similar between the two study arms (20%). Compared with C-G group, higher rate of patients in GRAIL arm experienced below-target vancomycin trough concentrations (40% versus 13.3%) and lower rate showed above target trough concentration (40% versus 66.7%), although these differences did not reach statistical significance. Higher rates of patients with at target and above target vancomycin AUC/MIC were seen in the C-G group compared with GRAIL group (40% versus 26.7% and 53.3% versus 26.7%, respectively), while individuals in the GRAIL arm represented significantly higher rate of below target vancomycin AUC/MIC than C-G arm (46.7% versus 6.7%) (P=0.049). No differences in clinical outcomes were observed between the two groups.Conclusion: Using GRAIL model for vancomycin dose selection may result in less percent of patients with at target AUC/MIC exposure compared to C-G method and expose more percent of patients at risk of vancomycin under dosing.
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