Changes in 4-Year Antimicrobial Resistance Pattern of Gram-Positive Bacteria at the Main Referral Teaching Hospital, Tehran, Iran
AbstractInfectious diseases are one of the most common causes of morbidity and mortality and the spread of resistant microorganisms is playing a significant role in this regard. The purpose of this study was to assess the trend in antimicrobial resistance of gram-positive bacteria at the main referral teaching hospital in Tehran during a 4-year period. All patients' biological isolates such as blood, urine, wound drainage, synovial fluid, sputum, and cerebrospinal fluid sent to the central laboratory of the hospital from 2007 to 2010 for identification and subsequently, antimicrobial susceptibility testing by Kirby-Bauer disc diffusion method were considered. All isolates (100%) of S. aureus were sensitive to vancomycin and linezolid and resistant to amoxicillin. The rate of S. aureus resistance to oxacillin increased from 60.78% in 2007 to 72% in 2010. All isolates of Streptococci in 2007 and 2008 were sensitive to vancomycin; while, 3.33% and 4.76% of Streptococci isolates were reported to be vancomycin-resistant in 2009 and 2010, respectively. Enterococci isolated from the entire specimens were identified to be sensitive to teicoplanin and linezolid and resistant to cloxacillin and oxacillin. The rates of Enterococci sensitivity to vancomycin were 90.91%, 81.25%, 86.67%, and 93.3% in 2007, 2008, 2009, and 2010, respectively. Changes of antibiotics sensitivity against g positive pathogens were significant during four years in this study. To minimize the spread of resistant gram positive pathogens, periodic and regular surveillance of antimicrobial resistance pattern is highly recommended.
World Health Organization (WHO). The top 10 causes of death. [Internet] 2011 June [cited 2012 May 15]; Available from: http://www.who.int/mediacentre/factsheets/fs310/en/index. html
Rossolini GM, Mantengoli E, Montagnani F, Pollini S. Epidemiology and clinical relevance of microbial resistance determinants versus anti-Gram-positive agents. Curr Opin Microbiol 2010;13(5):582-8.
Rossolini GM, Thaller MC. Coping with antibiotic resistance: contributions from genomics. Genome Med 2010;2(2):15.
Felmingham D, Washington J. Trends in the antimicrobial susceptibility of bacterial respiratory tract pathogens: findings of the Alexander Project 1992-1996. J Chemother 1999;11 Suppl 1:5-21.
Thuong M, Shortgen F, Zazempa V, Girou E, Soussy CJ, Brun-Buisson C. Appropriate use of restricted antimicrobial agents in hospitals: the importance of empirical therapy and assisted re-evaluation. J Antimicrob Chemother 2000;46(3):501-8.
U.S. Food and Drug Administration (FDA). Battle of the Bugs: Fighting Antibiotic Resistance. [Internet] 2011 Aug 17 [cited 2012 May 15]; Available from: http://www.fda.gov/drugs/resourcesforyou/consumers/ucm 143568.htm
Weinstein MP, Towns ML, Quartey SM, Mirrett S, Reimer LG, Parmigiani G, Reller LB. The clinical significance of positive blood cultures in the 1990s: a prospective comprehensive evaluation of the microbiology, epidemiology, and outcome of bacteremia and fungemia in adults. Clin Infect Dis 1997;24(4):584-602.
Emori TG, Gaynes RP. An overview of nosocomial infections, including the role of the microbiology laboratory. Clin Microbiol Rev 1993;6(4):428-42.
National Center of Rational Use Drug. Available at: http://www.ncrud.ir/Files/Report/report-%20keshvari- 89.pdf [Accessed 10/12/2011].
Naber CK. Staphylococcus aureus bacteremia: epidemiology, pathophysiology, and management strategies. Clin Infect Dis 2009;48 Suppl 4:S231-7.
Japoni A, Farshad S, Alborzi A, Kalani M, Rafaatpour N, Oboodi B, Pourabbas B. Epidemiology and antibacterial susceptibility patterns of bloodstream infections, 2001- 2004: an experience with BACTEC 9240 in Southern Iran. Pak J Biol Sci 2008;11(3):422-7.
Japoni A, Vazin A, Davarpanah MA, Afkhami Ardakani M, Alborzi A, Japoni S, Rafaatpour N. Ventilatorassociated pneumonia in Iranian intensive care units. J Infect Dev Ctries 2011;5(4):286-93.
Rahbar M, Gra-Agaji R, Hashemi S. Nosocomial blood stream infections in Imam Khomeini Hospital, Urmia, Islamic Republic of Iran, 1999-2001. East Mediterr Health J 2005;11(3):478-84.
Kp P, Arora V, Pp G. Bloodstream Bacterial Pathogens and their Antibiotic Resistance Pattern in Dhahira Region, Oman. Oman Med J 2011;26(4):240-79.
Woodford N, Livermore DM. Infections caused by Grampositive bacteria: a review of the global challenge. J Infect 2009;59 Suppl 1:S4-16.
Panlilio AL, Culver DH, Gaynes RP, Banerjee S, Henderson TS, Tolson JS, Martone WJ. Methicillinresistant Staphylococcus aureus in U.S. hospitals, 1975- 1991. Infect Control Hosp Epidemiol 1992;13(10):582-6.
Reynolds R, Potz N, Colman M, Williams A, Livermore D, MacGowan A; BSAC Extended Working Party on Bacteraemia Resistance Surveillance. Antimicrobial susceptibility of the pathogens of bacteraemia in the UK and Ireland 2001-2002: the BSAC Bacteraemia Resistance Surveillance Programme. J Antimicrob Chemother 2004;53(6):1018-32.
Mohammadtaheri Z, Pourpaki M, Mohammadi F, Namdar R, Masjedi MR. Surveillance of antimicrobial susceptibility among bacterial isolates from intensive care unit patients of a tertiary-care university hospital in Iran: 2006-2009. Chemotherapy 2010;56(6):478-84.
Khorvash F, Mostafavizadeh K, Mobasherizadeh S, Behjati M, Naeini AE, Rostami S, Abbasi S, Memarzadeh M, Khorvash FA. Antimicrobial susceptibility pattern of microorganisms involved in the pathogenesis of surgical site infection (SSI); A 1 year of surveillance. Pak J Biol Sci 2008;11(15):1940-4.
Centers for Disease Control and Prevention (CDC). Staphylococcus aureus resistant to vancomycin--United States, 2002. MMWR Morb Mortal Wkly Rep 2002;51(26):565-7.
Sievert DM, Rudrik JT, Patel JB, McDonald LC, Wilkins MJ, Hageman JC. Vancomycin-resistant Staphylococcus aureus in the United States, 2002-2006. Clin Infect Dis 2008;46(5):668-74.
Saha B, Singh AK, Ghosh A, Bal M. Identification and characterization of a vancomycin-resistant Staphylococcus aureus isolated from Kolkata (South Asia). J Med Microbiol 2008;57(Pt 1):72-9.
Aligholi M, Emaneini M, Jabalameli F, Shahsavan S, Dabiri H, Sedaght H. Emergence of high-level vancomycin-resistant Staphylococcus aureus in the Imam Khomeini Hospital in Tehran. Med Princ Pract= 2008;17(5):432-4.
Askarian M, Assadian O, Safaee G, Golkar A, Namazi S, Movahed MR. Vancomycin use in a large teaching hospital in Shiraz, Islamic Republic of Iran, 2003. East Mediterr Health J 2007;13(5):1195-201.
Jenkins SG, Brown SD, Farrell DJ. Trends in antibacterial resistance among Streptococcus pneumoniae isolated in the USA: update from PROTEKT US Years 1-4. Ann ClinMicrobiol Antimicrob 2008;7:1.
Kohanteb J, Sadeghi E. Penicillin-resistant Streptococcus pneumoniae in Iran. Med Princ Pract 2007;16(1):29-33.
DeLisle S, Perl TM. Vancomycin-resistant enterococci: a road map on how to prevent the emergence and transmission of antimicrobial resistance. Chest 2003;123(5 Suppl):504S-18S.
Centers for Disease Control and Prevention (CDC).Summary of notifiable diseases, United States, 1997. MMWR Morb Mortal Wkly Rep 1998;46(54):ii-vii, 3-87.
Jones RN, Ross JE, Castanheira M, Mendes RE. United States resistance surveillance results for linezolid (LEADER Program for 2007). Diagn Microbiol Infect Dis 2008;62(4):416-26.
Hasibi M, Rezaii J, Mohajer Iravani B, Moslemi SB, Rahimi Haji-Abadi M, Taghavi SM, Haji-Nouri M. Hospital-acquired vancomycin-resistant enterococci: a report of 2-year experience. Acta Med Iran 2009;47(6):469-72.
Nateghian A, Robinson JL, Arjmandi K, Vosough P, Karimi A, Behzad A, Navidnia M. Epidemiology of vancomycin-resistant enterococci in children with acute lymphoblastic leukemia at two referral centers in Tehran, Iran: a descriptive study. Int J Infect Dis 2011;15(5):e332-5.
National Center of Rational Use Drug. Available at: http://www.ncrud.ir/Files/Report/Amar%2087%20(total).pdf [Accessed 10/12/2011].
Askarian M, Zeinalzadeh A, Japoni A, Alborzi A, Memish ZA. Prevalence of nasal carriage of methicillin-resistant Staphylococcus aureus and its antibiotic susceptibility pattern in healthcare workers at Namazi Hospital, Shiraz, Iran. Int J Infect Dis 2009;13(5):e241-7.
Sharifi Y, Hasani A, Ghotaslou R, Varshochi M, Hasani A, Soroush MH, Aghazadeh M, Milani M. Vancomycinresistant enterococci among clinical isolates from Northwest Iran: identification of therapeutic surrogates. J Med Microbiol 2012;61(Pt 4):600-2.
Farrell DJ, Mendes RE, Ross JE, Jones RN. Linezolid surveillance program results for 2008 (LEADER Program for 2008). Diagn Microbiol Infect Dis 2009;65(4):392-403.