Author/Authors :
Rafiei Alireza نويسنده , Ahangarkani Fatemeh نويسنده Antimicrobial Resistance Research Center, Department of Infectious Diseases, Mazandaran University of Medical Sciences, Sari, IR Iran Ahangarkani Fatemeh , Rezai Mohammad Sadegh نويسنده Mazandaran Pediateric Infectious Disease Research Center (MPIDRC), Bouali Sina Hospital,Mazandaran University of Medical Sciences,Sari,Iran , Bagheri-Nesami Masoumeh نويسنده Mazandaran Pediateric Infectious Disease Research Center (MPIDRC),Department of Medical- Surgical Nursing,Mazandaran University of Medical Sciences,Sari,Iran , Eslami Gohar نويسنده Faculty of Pharmacy, Phramaceutical Resaerch Center,Department of Clinical Pharmacy,Mazandaran University of Medical Sciences,Sari,Iran , Nikkhah Attieh نويسنده Infectious Diseases Research Center with Focus on
Nosocomial Infection, Mazandaran University of Medical Sciences,
Sari, Iran , Shafahi Khaironesa نويسنده Fatemeh Zahra Hospital, Mazandaran University of Medical
Sciences, Sari, Iran , Hajalibeig Azin نويسنده Infectious Diseases Research Center with Focus on
Nosocomial Infection, Mazandaran University of Medical Sciences,
Sari, Iran , Khajavi Rezvan نويسنده Molecular and Cell Biology Research Center, Department of
Immunology, Faculty of Medicine, Mazandaran University of Medical
Sciences, Sari, Iran
Abstract :
Background Acinetobacter
baumannii has increasingly become one of
the most common pathogens causing ventilator-associated pneumonia (VAP).
Objectives In the present study, we aimed to assess the presence of
extended-spectrum beta-lactamase (ESBL) and integron genes in
A. baumannii isolates from VAP patients in the
intensive care units (ICUs) of 18 hospitals in North of Iran. Methods
All patients, who were ventilated for at least 48 hours, were assessed
daily for VAP. The minimum inhibitory concentrations were determined
according to the standard protocol by the clinical and laboratory
standards institute (CLSI). ESBL-producing A.
baumannii was detected, using the double-disk synergy test.
ESBL-positive A. baumannii isolates were screened for
CTX, VEB, GES,
SHV, int1, and
int2 genes, using polymerase chain reaction (PCR)
amplification. Results In total, 29 out of 205 patients with nosocomial
infections, admitted to ICUs during 2014 - 2015, showed VAP caused by
ESBL-producing A. baumannii. A total of 19 (65.51%)
strains were extensively drug resistant (XDR). As the findings revealed,
the rates of imipenem and colistin resistance were 55.2% and 34.5%,
respectively. The prevalence of CTX,
VEB, and SHV genes in
ESBL-producing A. baumannii was 34.5%, 17.2%, and
96.6%, respectively. Also, 79.3% of the isolates had class 1 integrons,
while 10.3% contained class 2 integrons. Conclusions Presence of
integrons in A. baumannii has been considerably
associated with ESBL genes. The high rate of SHV and
int1 genes highlights the necessity of avoiding
aminoglycosides for empirical therapy. Although colistin was the most
sensitive antibiotic in XDR strains in our region, due to the presence
of patients with A. baumannii in ICUs, colistin
resistance screening should be performed before empirical therapy for
VAP, even for those without prior exposure to this antibiotic.
