title: Health care associated infections, antibiotic resistance and clinical outcome: A surveillance study from Sanandaj, Iran.
abstract: OBJECTIVE
  To study the antibiotic susceptibility patterns of gram-negative healthcare associated bacterial infections at two tertiary hospitals in the Sanandaj city, Kurdistan Province, Iran.
  
  
  METHODS
  From January 2012 to December 2012, all positive cultures from potentially sterile body fluids were gathered. They sent to professor Alborzi clinical microbiology center in Shiraz for further analysis and susceptibility testing. The antibiotic susceptibility was determined using the Kirby-Bauer method (disk diffusion technique). The Results were interpreted according to Clinical and Laboratory Standards Institute guidelines against a series of antimicrobials. World Health Organization definitions for Healthcare associated infections were followed.
  
  
  RESULTS
  Seven hundred and thirty-two positive cultures were reported from both hospitals. Seventy-nine isolates/patients fulfilled the study criteria for health-care associated gram-negative infections. The most frequent bacterial cultures were from the pediatric wards (52%). Serratia marcescens (S. marcescens) (38%) Escherichia coli (E. coli) (19%), Klebsiella pneumoniae (K. pneumoniae) (19%), Acinetobacter baumannii (6%), Enterobacter species (6%), Serratia odorifera (4%) and Pseudomonas species (5%) were the most frequently isolated organisms. The susceptibility pattern of common isolates i.e., S. marcescens, E. coli and K. pneumoniae for commonly used antibiotics were as follows: Ampicillin 3.3%, 6.7%, 20%; gentamicin 73.3%, 73.3%, 46.7%; ceftazidim 80%, 73.3%, 33.3%; cefepim 80%, 86.7%, 46.7%; piperacillin/tazobactam 90%, 66.7%, 86.7%; ciprofloxacin 100%, 73.3%, 86.7%; imipenem 100%, 100%, 100%, respectively.
  
  
  CONCLUSIONS
  The most effective antibiotics against gram-negative healthcare associated infections are imipenem followed by ciprofloxacin. The resistance rate is high against ampicillin and cephalothin. The high mortality rate (46.1%) associated with S. marcescens is alarming.
authors.affiliation: Jafar Soltani, Department of Pediatrics, Faculty of Medicine, Kurdistan University of Medical Sciences, Sanandaj 6617713446, Iran.
authors.forename: Jafar
authors.initials: J
authors.lastname: Soltani
authors.affiliation: Jafar Soltani, Department of Pediatrics, Faculty of Medicine, Kurdistan University of Medical Sciences, Sanandaj 6617713446, Iran.
authors.forename: Bahman
authors.initials: B
authors.lastname: Poorabbas
authors.affiliation: Jafar Soltani, Department of Pediatrics, Faculty of Medicine, Kurdistan University of Medical Sciences, Sanandaj 6617713446, Iran.
authors.forename: Neda
authors.initials: N
authors.lastname: Miri
authors.affiliation: Jafar Soltani, Department of Pediatrics, Faculty of Medicine, Kurdistan University of Medical Sciences, Sanandaj 6617713446, Iran.
authors.forename: Jalal
authors.initials: J
authors.lastname: Mardaneh
keywords: Antibiotic susceptibility; Escherichia coli; Extended-spectrum beta-lactamase; Klebsiella pneumoniae; Nosocomial infections; Serratia marcescens