Background: Acinetobacter baumannii is a gram-negative pathogen that is highly resistant to antibiotics. This bacterium can cause severe systemic infections, especially in hospitalized patients. Recently, antimicrobial-resistant Acinetobacter baumannii has become a lifethreatening pathogen in Iran and around the world. Materials & Methods: In this study, several Iranian and English databases were systematically searched to find all original and review articles investigating the prevalence of imipenem resistance in their sample size, while mentioning the source of clinical isolates, as well as the prevalence of antimicrobial resistance genes. Findings: Among genes, bla OXA-23 with a prevalence of 31% to 100% was responsible for global outbreaks of imipenem-resistant Acinetobacter baumannii and was presented in most of the hospital isolates. Our meta-analysis also revealed that 74.2% of Acinetobacter baumannii were resistant to imipenem in 122 clinical studies. Conclusion:Our study highlighted a rapid increase in the rate of imipenem resistance in clinical isolates of Acinetobacter baumannii in Iran. The need for periodic antibiotic care system programs to monitor the administration and use of antibiotics

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.