title: Assessment of extended-spectrum β-lactamases and integrons amongEnterobacteriaceaein device-associated infections: multicenter study in north of Iran.
abstract: BACKGROUND
  Device-associated nosocomial infections (DA-NIs), due to MDREnterobacteriaceae, are a major threat to patient safety in ICUs. We investigated on Extended-spectrum β-lactamases (ESBL) producingEnterobacteriaceaeand incidence of integrons in these bacteria isolated from ventilator-associated pneumonia (VAP) and catheter-associated urinary tract infections (CAUTIs) in 18 governmental hospitals in the north of Iran.
  
  
  METHODS
  In this cross-section study, the antibiotic susceptibility test was performed using the MIC method; also, phenotypically detection of ESBL-producing bacteria was carried out by the double-disk synergy (DDS) test. Presence of ESBL-related genes and integron Classes 1 and 2 was evaluated by the PCR method.
  
  
  RESULTS
  Out of a total of 205 patients with DA-NIs,Enterobacteriaceaewere responsible for (72.68%) of infections. The most common DA-NIs caused byEnterobacteriaceaewere VAP (77.18%), CAUTI (19.46%), and sepsis due to VAP (3.35%). The most frequentlyEnterobacteriaceaewere;Klebsiella pneumoniae75 (24; 32% ESBL positive),E. coli69 (6; 8.69% ESBL positive) andEnterobacter spp. 5 (5; 100% ESBL positive). Distribution of ESBL-related genes was as follows: bla-SHV (94.3%), bla-CTX (48.6%), bla-VEB (22.9%) and bla-GES (17.14%). The incidence rate of integron class 1 and class 2 was (82.92%) and (2.9%) respectively. Eight types of ESBL-producing bacteria were observed.
  
  
  CONCLUSIONS
  Due to the fact that the emergence rate of ESBLEnterobacteriaceaeis increasing in DA-NIs, co-incidence of different types of ESBL genes with integrons in 75-100% of strains in our study is alarming for clinicians and healthcare safety managers. Therefore, regional and local molecular level estimations of ESBLs that are agents of DA-NIs are critical for better management of empiric therapy, especially for patients in ICUs.
authors.affiliation: Infection Diseases Research Center with Focus on Nosocomial Infection, Mazandaran University of Medical Sciences, Sari, Iran.
authors.forename: Masoumeh
authors.initials: M
authors.lastname: Bagheri-Nesami
authors.affiliation: Molecular and Cell Biology Research Center, Department of Immunology, Faculty of Medicine, Mazandaran University of Medical Sciences, Sari, Iran.
authors.forename: Alireza
authors.initials: A
authors.lastname: Rafiei
authors.affiliation: Department of Clinical Pharmacy, Faculty of Pharmacy, Mazandaran University of Medical Sciences, Sari, Iran.
authors.forename: Gohar
authors.initials: G
authors.lastname: Eslami
authors.affiliation: Student Research Committee, Antimicrobial Resistance Research Center, Mazandaran University of Medical Sciences, Sari, Iran.
authors.forename: Fatemeh
authors.initials: F
authors.lastname: Ahangarkani
authors.affiliation: Infection Diseases Research Center with Focus on Nosocomial Infection, Mazandaran University of Medical Sciences, Sari, Iran.
authors.forename: Mohammad Sadegh
authors.initials: MS
authors.lastname: Rezai
authors.affiliation: Traditional and Complementary Medicine Research Center, Mazandaran University of Medical Sciences, Sari, Iran.
authors.forename: Attieh
authors.initials: A
authors.lastname: Nikkhah
authors.affiliation: Infection Diseases Research Center with Focus on Nosocomial Infection, Mazandaran University of Medical Sciences, Sari, Iran.
authors.forename: Azin
authors.initials: A
authors.lastname: Hajalibeig