title: Nosocomial Infections: Multicenter surveillance of antimicrobial resistance profile of Staphylococcus aureus and Gram negative rods isolated from blood and other sterile body fluids in Iran.
abstract: OBJECTIVE
  Antibiotic resistance is increasing, especially in healthcare-associated infections causing significant public health concerns worldwide. National information is required to make appropriate policies, update list of essential drugs for treatment, and evaluate the effects of intervention strategies. A nationwide surveillance of antimicrobial resistant bacteria in nosocomial infections was established in Iran in 2008, so that the data obtained through the surveillance would enable us to construct a database.
  
  
  METHODS
  Seven major teaching hospitals in Shiraz, Tabriz, Sari, Mashhad, Sanandaj, Ahwaz and Isfahan participated in this study. A total of 858 strains isolated from blood and other sterile body fluids were tested. Identification at the species level was performed with conventional biochemical methods and the API system. Susceptibility tests were done using disk diffusion method. The methicillin-resistance in S. aureus (MRSA) was determined by the oxacillin agar screen plate and respective MIC values were assessed using the E-test strips. The confirmatory disk diffusion methods were applied for phenotypic identification of extended-spectrum β- lactamase (ESBL) production for E. coli and K. pneumoniae, according to CLSI guidelines.
  
  
  RESULTS
  Cultivation and re-identification of the strains yielded 858 isolates, consisting of 224 S. aureus, 148 Klebsiella spp., 105 Serratia spp., 146 E. coli, 67 Acinetobacter spp., 38 Enterobacter spp., 95 Pseudomonas spp., 71 P.aeruginosa. 35 Stenotrophomonas sp., and 8 other organisms. MRSA was detected in 37.5% of the isolates. No vancomycin-resistant or vancomycin-intermediate resistant S. aureus was detected. With the exception of Acinetobacter and Stenotrophomonas, 85% of the Gram-negative isolates were found to be susceptible in vitro to imipenem. Overall, about 61% of K. pneumoniae and 35% of E. coli isolates were ESBL producing.
  
  
  CONCLUSIONS
  Multidrug resistant isolates of Gram-negative organisms and methicillin-resistant strains of S. aureus have been detected in many hospitals in this study.
authors.affiliation: Professor Alborzi Clinical Microbiology Research Center, Nemazee Hospital, Shiraz University of Medical Sciences, Shiraz, IR Iran.
authors.forename: Bahman
authors.initials: B
authors.lastname: Poorabbas
authors.affiliation: Professor Alborzi Clinical Microbiology Research Center, Nemazee Hospital, Shiraz University of Medical Sciences, Shiraz, IR Iran.
authors.forename: Jalal
authors.initials: J
authors.lastname: Mardaneh
authors.affiliation: Professor Alborzi Clinical Microbiology Research Center, Nemazee Hospital, Shiraz University of Medical Sciences, Shiraz, IR Iran.
authors.forename: Zahra
authors.initials: Z
authors.lastname: Rezaei
authors.affiliation: Professor Alborzi Clinical Microbiology Research Center, Nemazee Hospital, Shiraz University of Medical Sciences, Shiraz, IR Iran.
authors.forename: Mehdi
authors.initials: M
authors.lastname: Kalani
authors.affiliation: Professor Alborzi Clinical Microbiology Research Center, Nemazee Hospital, Shiraz University of Medical Sciences, Shiraz, IR Iran.
authors.forename: Gholamreza
authors.initials: G
authors.lastname: Pouladfar
authors.affiliation: Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, IR Iran.
authors.forename: Mohammad Hasan
authors.initials: MH
authors.lastname: Alami
authors.affiliation: Department of Pediatrics, Faculty of Medicine, Kurdistan University of Medical Sciences, Sanandaj, IR Iran.
authors.forename: Jafar
authors.initials: J
authors.lastname: Soltani
authors.affiliation: Infectious Diseases and Tropical Medicine Research Center, Jundishapur University of Medical Sciences, Ahvaz, IR Iran.
authors.forename: Ahmad
authors.initials: A
authors.lastname: Shamsi-Zadeh
authors.affiliation: Pediatric Health Research Center, Tabriz University of Medical Sciences, Tabriz, IR Iran.
authors.forename: Shahram
authors.initials: S
authors.lastname: Abdoli-Oskooi
authors.affiliation: Mazandaran University of Medical Sciences, Sari, IR Iran.
authors.forename: Mohammed Jafar
authors.initials: MJ
authors.lastname: Saffar
authors.affiliation: Professor Alborzi Clinical Microbiology Research Center, Nemazee Hospital, Shiraz University of Medical Sciences, Shiraz, IR Iran.
authors.forename: Abdolvahab
authors.initials: A
authors.lastname: Alborzi
keywords: Antimicrobial resistance; Blood; Gram negative bacteria; Iran; Staphylococcus aureus; Sterile body fluids