Methodology and early results of the first surveillance program on prevention and control of antimicrobial resistance in Isfahan, Iran: The IAS-I study

Abstract

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.

Antimicrobial Resistance in Hospitalized Patients with Community Acquired Urinary Tract Infection in Isfahan, Iran

“…Moreover, we recognized community source of the isolates with help from experienced infectious control nurses at the bed of patients in enrolled hospitals. 14 The sex pattern of patients in our study reveals relatively equal distribution in both sexes. Approximately 41% of admitted patients in our study were males.…”

“…They were recruited during the time period of March 2016 to March 2018 and participated in the IAS-1 project which is a cross-sectional study planned to investigate the antimicrobial susceptibility profile of clinically important microorganisms, conducted in Isfahan, Iran. 14 Indications for admission of the patients include hemodynamic instability, complicating factors (such as urinary stones), severe symptoms, intolerance of oral antibiotics, and poor adherence to medications. The IAS-1 study was planned to investigate the main microorganisms and antibiotic susceptibility profile of infections in cases who were admitted to three large medical centers in Isfahan city, Iran (Project No: 194042).…”

Antibiotic Susceptibility of Klebsiella pneumonia Isolates from Hospitalized Patients in Three Referral Medical Centers in Isfahan, Iran

“…Isfahan antimicrobial resistance surveillance-1aimed to determine the antibiotic susceptibility patterns of common bacteria isolated from inpatients with established infections in three large medical centers in Isfahan, Iran: Alzahra, Dr. Shariati, and Dr. Gharazi Hospitals, which collectively have more than 1,300 beds. Their laboratories are approved for quality by the Iranian Ministry of Health for microbiological tests and collaborate with the World Health Organization in the Global Antimicrobial Resistance Surveillance System (17).…”

“…If the K. pneumonia species was isolated from a site with no clinical or para-clinical manifestations of infection, it was considered a contaminant and excluded from the study. Samples were collected after 48 hours of hospitalization, and all samples obtained from internal devices were categorized as nosocomial isolates, while others were classified as community-acquired organisms (17).…”

Antimicrobial Susceptibility Patterns of Escherichia coli Isolates from Hospitalized Patients with Different Infections in Isfahan, Iran: Impact on Empiric Antibiotic Therapy in Associated Infections

“…For the detection of microbial agents, samples were collected using aseptic techniques from urine, bloodstream, cerebrospinal fluid, deep collections, draining surgical sites, or bronchoalveolar lavage (BAL) (8). Identification of isolates as E. coli was done by routine conventional tests such as gram staining and biochemical tests (catalase and oxidase tests), reactions on triple sugar iron (TSI) agar, Methyl Red (MR) and Voges-Proskauer (VP) tests, indole production, urease test, citrate utilization, lysine iron agar (LIA) test, and motility.…”