Journal title
عنوان نشریه
Technology and Research Information System
Literature & Humanities
http://newresearch.medilam.ac.ir
1
admin
doi
fa
jalali
1401
12
1
gregorian
2023
3
1
5
4
online
1
fulltext
fa
بررسی الگوی میکروبیولوژی و مقاومت دارویی نمونه های BAL( لاواژ برونکوآلوئولار) گرفته شده از بیماران بستری در بیمارستان های مصطفی خمینی و امام خمینی (ره) شهر ایلام طی دوره ی یک ساله
Title: Study of Microbiological and drug resistance pattern of BAL (bronchoalveolar lavage) samples of patients Hospitalized of Imam Khomaini and Shahid Mostafa University Hospitals during one year
میکروب شناسی پزشکی
سایر......
<span style="font-size:11pt"><span style="line-height:normal"><span style="direction:rtl"><span style="unicode-bidi:embed"><span style="font-family:Calibri,sans-serif"><b><u><span lang="AR-SA" style="font-size:12.0pt"><span b="" style="font-family:" titr="">زمینه و هدف</span></span></u></b> <span lang="AR-SA" style="font-size:14.0pt"><span b="" nazanin="" style="font-family:">:</span></span> <span lang="AR-SA" style="font-size:12.0pt"><span b="" nazanin="" style="font-family:">بیماری های ریوی یکی از علل شایع مرگ و میر زودرس و ناراحتی های آزاردهنده و جدی در بین مردم می باشد.</span></span> <span lang="AR-SA" style="font-size:12.0pt"><span b="" nazanin="" style="font-family:">از آن جایی که میزان بروز پنومونی و عفونت باکتریایی دستگاه تنفس تحتانی می تواند به عنوان معیاری برای ارزیابی چگونگی اقدامات درونی و مداخله ای و هم چنین سیستم کنترل عفونت بیمارستانی باشد، و باتوجه به اینکه مطالعه ای مشابه مطالعه ما در استان ایلام صورت نگرفته ، ضرورت دانستیم مطالعه حاضر را انجام دهیم.</span></span><span dir="LTR" style="font-size:12.0pt"><span new="" roman="" style="font-family:" times=""><span style="color:#a53010"></span></span></span></span></span></span></span></span><br>
<span style="font-size:12pt"><span style="direction:rtl"><span style="unicode-bidi:embed"><span style="font-family:Arial,sans-serif"><b><u><span b="" lang="AR-SA" nazanin="" style="font-family:">موادوروشها</span></u></b><span b="" lang="AR-SA" nazanin="" style="font-family:"> :</span><span b="" lang="AR-SA" nazanin="" style="font-family:"> نمونه </span><span dir="LTR" new="" roman="" style="font-family:" times="">BAL</span><span b="" lang="AR-SA" nazanin="" style="font-family:">(برونکوآلوئولار لاواژ)</span><span b="" lang="AR-SA" nazanin="" style="font-family:"> از بیماران با مشکلات تنفسی بستری در بیمارستان به روش برونکوسکوپی گرفته شد. نمونه ها بر روی محیط های کشت روتین باکتریایی کشت داده شد، سپس </span><span dir="LTR" lang="FY" new="" roman="" style="font-family:" times="">cfu</span><span b="" lang="FA" nazanin="" style="font-family:"> کلی آنها شمارش و</span><span b="" lang="AR-SA" nazanin="" style="font-family:"> باکتری ها شناسایی گردیدند. و حساسیت آنتی بیوتیکی به روش دیسک دیفیوژن مطابق با پروتکل </span><span dir="LTR" new="" roman="" style="font-family:" times="">CLSI</span><span b="" lang="AR-SA" nazanin="" style="font-family:"> انجام گردید . برای تشخیص باکتری های سخت رشد از روش </span><span dir="LTR" new="" roman="" style="font-family:" times="">PCR</span><span b="" lang="AR-SA" nazanin="" style="font-family:"> با استفاده از پرایمرهای اختصاصی ژن </span><i>16</i><i><span dir="LTR" lang="FY" new="" roman="" style="font-family:" times="">srRNA</span></i><span b="" lang="AR-SA" nazanin="" style="font-family:"> به ترتیب برای مایکوپلاسما پنومونیه، کلامیدیا پنومونیه و ژن</span><i> </i><i><span dir="LTR" lang="FY" new="" roman="" style="font-family:" times="">mip</span></i> <span b="" lang="AR-SA" nazanin="" style="font-family:"> برای لژیونلا پنوموفیلا </span><span b="" lang="FA" nazanin="" style="font-family:">استفاده شد.</span><span b="" lang="AR-SA" nazanin="" style="font-family:"> برای تحلیل داده ها از</span> <span b="" lang="AR-SA" nazanin="" style="font-family:"> آزمون </span><span dir="LTR" new="" roman="" style="font-family:" times="">chi square</span> <span b="" lang="AR-SA" nazanin="" style="font-family:">و نرم</span> <span b="" lang="AR-SA" nazanin="" style="font-family:">افزار</span> <span dir="LTR" new="" roman="" style="font-family:" times="">SPSS</span><span b="" nazanin="" style="font-family:"> استفاده شد.</span> <span b="" lang="AR-SA" nazanin="" style="font-family:">در</span> <span b="" lang="AR-SA" nazanin="" style="font-family:">تمام</span> <span b="" lang="AR-SA" nazanin="" style="font-family:">موارد</span> <span dir="LTR" lang="FY" new="" roman="" style="font-family:" times="">p </span><span dir="LTR" new="" roman="" style="font-family:" times="">values </span>< 0.05)<span b="" lang="AR-SA" nazanin="" style="font-family:">)</span> <span b="" lang="AR-SA" nazanin="" style="font-family:">معنی</span> <span b="" lang="AR-SA" nazanin="" style="font-family:">دار</span> <span b="" lang="AR-SA" nazanin="" style="font-family:">در</span> <span b="" lang="AR-SA" nazanin="" style="font-family:">نظر</span> <span b="" lang="AR-SA" nazanin="" style="font-family:">گرفته</span> <span b="" lang="AR-SA" nazanin="" style="font-family:">شد</span>.<span lang="AR-SA" style="font-family:"B Nazanin""></span></span></span></span></span><br>
<span style="font-size:11pt"><span style="line-height:normal"><span style="text-autospace:none"><span style="direction:rtl"><span style="unicode-bidi:embed"><span style="font-family:Calibri,sans-serif"><b><u><span lang="AR-SA" style="font-size:12.0pt"><span b="" nazanin="" style="font-family:">نتایج</span></span></u></b><b><u><span lang="AR-SA" style="font-size:14.0pt"><span b="" nazanin="" style="font-family:">:</span></span></u></b> <span lang="AR-SA" style="font-size:12.0pt"><span b="" nazanin="" style="font-family:">از بین 44 نمونه</span></span> <span dir="LTR" style="font-size:12.0pt"><span new="" roman="" style="font-family:" times="">BAL</span></span><span lang="AR-SA" style="font-size:12.0pt"><span b="" nazanin="" style="font-family:"> در بیماران با روش کشت، </span></span><span lang="FA" style="font-size:12.0pt"><span b="" nazanin="" style="font-family:">100 جدایه تشخیص داده شد که شامل :</span></span><span lang="AR-SA" style="font-size:12.0pt"><span b="" nazanin="" style="font-family:">استافیلوکوکوس اورئوس (24)</span></span><span dir="LTR" style="font-size:12.0pt">31.2</span><span lang="AR-SA" style="font-size:12.0pt"><span b="" nazanin="" style="font-family:">%، استرپتوکوکوس گروه </span></span><span dir="LTR" style="font-size:12.0pt"><span new="" roman="" style="font-family:" times="">A</span></span><span style="font-size:12.0pt"><span b="" nazanin="" style="font-family:"> (18)</span></span><span dir="LTR" style="font-size:12.0pt">23.4</span><span lang="AR-SA" style="font-size:12.0pt"><span b="" nazanin="" style="font-family:">%، انتروکوکوس (</span></span><span arial="" lang="AR-SA" style="font-family:">11</span><span lang="AR-SA" style="font-size:12.0pt"><span b="" nazanin="" style="font-family:">)</span></span><span dir="LTR" style="font-size:12.0pt">14.3</span><span lang="AR-SA" style="font-size:12.0pt"><span b="" nazanin="" style="font-family:">%، آسینتوباکتر بومانی، سودوموناس آئروژینوزا (11)</span></span><span dir="LTR" style="font-size:12.0pt">14.3</span><span lang="AR-SA" style="font-size:12.0pt"><span b="" nazanin="" style="font-family:">% ، انتروباکتر (10)</span></span> <span dir="LTR" style="font-size:12.0pt">13</span><span lang="AR-SA" style="font-size:12.0pt"><span b="" nazanin="" style="font-family:">%، میکروکوکوس، استافیلوکوکوس اپیدرمیدیس و کلبسیلا پنومونیه (5) 6.5% بودند. و با روش</span></span> <span dir="LTR" style="font-size:12.0pt"><span new="" roman="" style="font-family:" times="">PCR</span></span><span lang="AR-SA" style="font-size:12.0pt"><span b="" nazanin="" style="font-family:"> (4 مورد) 9.1% برای کلامیدیا پنومونیه مثبت گردید و هیچ باندی برای مایکوپلاسما پنومونیه و لژیونلا پنوموفیلا یافت نشد. آسینتوباکترها</span></span> <span lang="AR-SA" style="font-size:12.0pt"><span b="" nazanin="" style="font-family:">بیشترین مقاومت 81.8% </span></span> <span lang="AR-SA" style="font-size:12.0pt"><span b="" nazanin="" style="font-family:">به</span></span> <span lang="AR-SA" style="font-size:12.0pt"><span b="" nazanin="" style="font-family:">آزترونام و سفتازیدیم</span></span> <span lang="AR-SA" style="font-size:12.0pt"><span b="" nazanin="" style="font-family:">را</span></span> <span lang="AR-SA" style="font-size:12.0pt"><span b="" nazanin="" style="font-family:">نشان</span></span> <span lang="AR-SA" style="font-size:12.0pt"><span b="" nazanin="" style="font-family:">دادند. 75%</span></span> <span lang="AR-SA" style="font-size:12.0pt"><span b="" nazanin="" style="font-family:">ایزوله</span></span> <span lang="AR-SA" style="font-size:12.0pt"><span b="" nazanin="" style="font-family:">های</span></span> <span lang="AR-SA" style="font-size:12.0pt"><span b="" nazanin="" style="font-family:">استافیلوکوکوس اورئوس</span></span> <span lang="AR-SA" style="font-size:12.0pt"><span b="" nazanin="" style="font-family:">مقاوم به سفوکسیتین (</span></span><span dir="LTR" style="font-size:12.0pt"><span new="" roman="" style="font-family:" times="">MRSA</span></span><span lang="AR-SA" style="font-size:12.0pt"><span b="" nazanin="" style="font-family:">) و 83.3% دارای ژن </span></span><i><span dir="LTR" style="font-size:12.0pt"><span new="" roman="" style="font-family:" times="">mec A</span></span></i><span style="font-size:12.0pt"><span b="" nazanin="" style="font-family:"> بودند و</span></span> <span lang="AR-SA" style="font-size:12.0pt"><span b="" nazanin="" style="font-family:">مقاومت</span></span> <span lang="AR-SA" style="font-size:12.0pt"><span b="" nazanin="" style="font-family:">به</span></span> <span lang="AR-SA" style="font-size:12.0pt"><span b="" nazanin="" style="font-family:">ونکومایسین</span></span><span dir="LTR" style="font-size:12.0pt"><span new="" roman="" style="font-family:" times="">(<i>VRE</i></span></span><span dir="LTR" style="font-size:12.0pt">)</span><span lang="AR-SA" style="font-size:12.0pt"><span b="" nazanin="" style="font-family:"> در 27.3% از</span></span> <span lang="AR-SA" style="font-size:12.0pt"><span b="" nazanin="" style="font-family:">گونه</span></span> <span lang="AR-SA" style="font-size:12.0pt"><span b="" nazanin="" style="font-family:">های</span></span> <span lang="AR-SA" style="font-size:12.0pt"><span b="" nazanin="" style="font-family:">انتروکوکوس</span></span> <span lang="AR-SA" style="font-size:12.0pt"><span b="" nazanin="" style="font-family:">مشاهده</span></span> <span lang="AR-SA" style="font-size:12.0pt"><span b="" nazanin="" style="font-family:">گردید. مقاومت</span></span> <span lang="AR-SA" style="font-size:12.0pt"><span b="" nazanin="" style="font-family:">به پیپراسیلین، سفوتاکسیم، سیپروفلوکساسین و ایمیپنم در ایزوله های سودوموناس آئروژینوزا با شیوع 54.5%،45.5%، و 36.4% دیده شد. </span></span><span lang="FA" style="font-size:12.0pt"><span b="" nazanin="" style="font-family:">فراوانی </span></span><span lang="AR-SA" style="font-size:12.0pt"><span b="" nazanin="" style="font-family:">ارگانیسم ها در بخش </span></span><span dir="LTR" style="font-size:12.0pt"><span new="" roman="" style="font-family:" times="">ICU</span></span><span lang="FA" style="font-size:12.0pt"><span b="" nazanin="" style="font-family:">(46%)</span></span><span lang="AR-SA" style="font-size:12.0pt"><span b="" nazanin="" style="font-family:"> بیشتر از سایر بخش ها بود.</span></span></span></span></span></span></span></span><br>
<span style="font-size:11pt"><span style="line-height:normal"><span style="text-autospace:none"><span style="direction:rtl"><span style="unicode-bidi:embed"><span style="font-family:Calibri,sans-serif"><span lang="FA" style="font-family:"B Nazanin""></span></span></span></span></span></span></span><br>
<span style="font-size:11pt"><span style="line-height:normal"><span style="direction:rtl"><span style="unicode-bidi:embed"><span style="font-family:Calibri,sans-serif"><b><u><span lang="AR-SA" style="font-size:12.0pt"><span b="" style="font-family:" titr="">بحث و نتیجه گیری</span></span></u></b><span lang="AR-SA" style="font-size:14.0pt"><span b="" nazanin="" style="font-family:">: </span></span><span lang="AR-SA" style="font-size:12.0pt"><span b="" nazanin="" style="font-family:">وجود </span></span><span dir="LTR" style="font-size:12.0pt"><span new="" roman="" style="font-family:" times="">MRSA</span></span><span lang="AR-SA" style="font-size:12.0pt"><span b="" nazanin="" style="font-family:">، انتروباکتریاسه های مقاوم به سفالوسپورین های نسل سوم و پسودوموناس و آسینتوباکتر مقاوم به پیپراسیلین،ایمیپنم،سفوتاکسیم،آزترونام و سیپروفلوکساسین در میان بخش های مورد مطالعه و به ویژه بخش </span></span><span dir="LTR" style="font-size:12.0pt"><span new="" roman="" style="font-family:" times="">ICU</span></span><span lang="AR-SA" style="font-size:12.0pt"><span b="" nazanin="" style="font-family:"> از نگرانی های بزرگ هستند. به</span></span> <span lang="AR-SA" style="font-size:12.0pt"><span b="" nazanin="" style="font-family:">این</span></span> <span lang="AR-SA" style="font-size:12.0pt"><span b="" nazanin="" style="font-family:">علت رعایت اصول</span></span> <span lang="AR-SA" style="font-size:12.0pt"><span b="" nazanin="" style="font-family:">کنترل</span></span> <span lang="AR-SA" style="font-size:12.0pt"><span b="" nazanin="" style="font-family:">بیماری های عفونی باکتری</span></span> <span lang="AR-SA" style="font-size:12.0pt"><span b="" nazanin="" style="font-family:">های</span></span> <span lang="AR-SA" style="font-size:12.0pt"><span b="" nazanin="" style="font-family:">مقاوم</span></span> <span lang="AR-SA" style="font-size:12.0pt"><span b="" nazanin="" style="font-family:">ضروری</span></span> <span lang="AR-SA" style="font-size:12.0pt"><span b="" nazanin="" style="font-family:">می</span></span> <span lang="AR-SA" style="font-size:12.0pt"><span b="" nazanin="" style="font-family:">باشد</span></span><span dir="LTR" style="font-size:12.0pt">.</span><span lang="FA" style="font-size:14.0pt"><span style="font-family:"B Nazanin""></span></span></span></span></span></span></span> <div style="text-align: left;"></div>
Background and purpose: Lung diseases are one of the common causes of premature death and annoying and serious ailments among people. Since the incidence rate of pneumonia and bacterial infection of the lower respiratory tract can be used as a criterion for evaluating the internal and interventional measures as well as the hospital infection control system, and considering that a study similar to ours has not been conducted in Ilam province, We found it necessary to conduct the present study.<br>
Materials and methods: BAL (bronchoalveolar lavage) samples were taken from hospitalized patients with respiratory problems by bronchoscopy. The samples were cultured on routine bacterial culture media, then their total cfu were counted and bacteria were identified. And antibiotic sensitivity was done by disc diffusion method according to CLSI protocol. PCR method using specific primers of 16srRNA gene for Mycoplasma pneumoniae, Chlamydia pneumoniae and mip gene for Legionella pneumophila was used to detect hard-to-grow bacteria. Chi square test and SPSS software were used for data analysis. In all cases, p values < 0.05) were considered significant.<br>
Results: Out of 44 BAL samples in patients by culture method, 100 isolates were detected, including: Staphylococcus aureus (24) 31.2%, Streptococcus group A (18) 23.4%, Enterococcus (11) 14.3%, Acinetobacter baumannii, Pseudomonas aeruginosa (11) 14.3%, Enterobacter (10) 13%, Micrococcus, Staphylococcus epidermidis and Klebsiella pneumoniae (5) 6.5%. And by PCR method (4 cases), 9.1% was positive for Chlamydia pneumoniae and no band was found for Mycoplasma pneumoniae and Legionella pneumophila. Acinetobacter showed the highest resistance of 81.8% to azetronam and ceftazidime. 75% of Staphylococcus aureus isolates resistant to cefoxitin (MRSA) and 83.3% had mec A gene, and resistance to vancomycin (VRE) was observed in 27.3% of enterococcus species. Resistance to piperacillin, cefotaxime, ciprofloxacin, and imipenem was seen in Pseudomonas aeruginosa isolates with a prevalence of 54.5%, 45.5%, and 36.4%. The frequency of organisms in the ICU department (46%) was higher than other departments.<br>
<br>
Discussion and conclusion: The presence of MRSA, Enterobacteriaceae resistant to third generation cephalosporins and Pseudomonas and Acinetobacter resistant to piperacillin, imipenem, cefotaxime, azetronam and ciprofloxacin among the studied departments and especially the ICU department are major concerns. For this reason, it is necessary to observe the principles of controlling infectious diseases of resistant bacteria.
BAL , مقاومت دارویی, بیماران بستری, PCR
BAL, drug resistance, hospitalized patients, PCR
0
0
http://newresearch.medilam.ac.ir/browse.php?a_code=A-10-2391-2&slc_lang=fa&sid=1
iraj
pakzad
ایرج
پاکزاد
pakzadi2006@gmail.com
4539274457
100319475328460067760
Yes
Medical School
دانشکده پزشکی
zahra
tahmasebi
زهرا
طهماسبی
zahratahmasebi67@gmail.com
4549958359
100319475328460067761
No
Medical School
دانشکده پزشکی
parisa
asadollahi
پریسا
اسدللهی
asadolahi.p@gmail.com
4501241586
100319475328460067762
No
Medical School
دانشکده پزشکی
behroz
sadeghi kalani
بهروز
صادقی کلانی
behroz.sadeghi@gmail.com
6169982527
100319475328460067763
No
Medical School
دانشکده پزشکی
sobhan
ghafurian
سبحان
غفوریان
sobhan.ghafurian@gmail.com
4500169504
100319475328460067764
No
Medical School
دانشکده پزشکی
Nourkhoda
Sadeghifard
نورخدا
صادقی فرد
sadeghifard@gmail.com
5819703741
100319475328460067765
No
Medical School
دانشکده پزشکی
esmail
ghasemi pasha kalaei
اسماعیل
قاسمی پاشا کلایی
smaeilghasemi@yahoo.com
2091931993
100319475328460067766
No
Medical School
دانشکده پزشکی