fa ﺑﺮﺭﺳﻲ ﻭﺟﻮﺩ ﮊﻥ ﻫﺎﻱ ﺑﺘﺎﻻﮐﺘﺎﻣﺎﺯﻱ ‪ blaSHV‬ﻭ‪ blaTEM‬ﺩﺭ ﺳﻮﻳﻪ ﻫﺎﻱ ﺍﺷﺮﻳﺸﻴﺎ ﮐﻠﻲ‬ ‫ﻣﻘﺎﻭﻡ ﺑﻪ ﺁﻧﺘﻲ ﺑﻴﻮﺗﻴﮏ ﺟﺪﺍ ﺷﺪﻩ ﺍﺯ ﻧﻤﻮﻧﻪ ﻫﺎﻱ ﮐﻠﻴﻨﻴﮑﻲ ﺍﺯ ﺑﻴﻤﺎﺭﺳﺘﺎﻥ ﻫﺎﻱ ﺗﻬﺮﺍﻥ باکتری شناسی پزشکی Medical Bacteriology مقاله پژوهشی Original Research Article <div align="right" style="direction: rtl"> ‫<b>ﺯﻣﻴﻨﻪ ﻭ ﺍﻫﺪﺍﻑ:</b> ﭘﻴﺪﺍﻳﺶ ﺳﻮﻳﻪ ﻫﺎ ﻣﻘﺎﻭﻡ ﺑﻪ ﺁﻧﺘﻲ ﺑﻴﻮﺗﻴﮏ ﺍﻣﺮﻭﺯﻩ ﺑﻌﻨﻮﺍﻥ ﻳﮑﻲ ﺍﺯ ﭼﺎﻟﺶ ﻫﺎ ﺩﺭﻣﺎﻥ ﺑﻴﻤﺎﺭﺍﻥ ﻣﺒـﺘﻼ ﺑـﻪ ﻋﻔﻮﻧـﺖ ﻫـﺎ‬ ‫ﻧﺎﺷﻲ ﺍﺯ ﺍﻳﻦ ﺳﻮﻳﻪ ﻫﺎ ﻣﻄﺮﺡ ﺍﺳﺖ ﻭ ﺗﺤﻘﻴﻘﺎﺕ ﺯﻳﺎﺩ ﺩﺭ ﺍﻳﻦ ﺭﺍﺑﻄﻪ ﺍﺯ ﺟﻤﻠﻪ ﺩﺭ ﻣﻮﺭﺩ ﺁﻧﺘﻲ ﺑﻴﻮﺗﻴﮏ ﻫـﺎ ﺑﺘﺎﻻﮐﺘـﺎﻡ ﺍﻧﺠـﺎﻡ ﺷـﺪﻩ ﺍﺳـﺖ.‬ ‫ﺗـﻮﻟﻴـﺪ ﺁﻧﺰﻳـﻢ ﻫﺎ ﺑﺘـﺎﻻﮐﺘـﺎﻣﺎﺯ ﺍﺯ ﺟﻤﻠﻪ ﺁﻧﺰﻳﻢ ﻫـﺎ ‪ SHV‬ﻭ ‪ TEM‬ﺩﺭ ﺑﺎﮐﺘـﺮ <i>ﺍﺷﺮﻳـﺸﻴﺎﮐﻠﻲ</i> ﺑﺎﻋــﺚ ﻣﻘــﺎﻭﻡ ﺷـﺪﻥ ﺁﻥ ﺩﺭ ﺑــﺮﺍﺑﺮ‬ ‫ﺁﻧﺘﻲ ﺑﻴﻮﺗﻴﮏ ﻫﺎ ﺑﺘﺎﻻﮐﺘﺎﻡ ﻣﺨﺘﻠﻒ ﺷﺪﻩ ﺍﺳﺖ. ﻫﻤﭽﻨﻴﻦ ﺍﻳﻦ ﺑﺎﮐﺘﺮ ﻗﺎﺩﺭ ﺑﻪ ﺗﻮﻟﻴﺪ ﺑﺘﺎﻻﮐﺘﺎﻣﺎﺯﻫﺎی ﻭﺳﻴﻊ ﺍﻟﻄﻴﻒ (‪ (ESBLs‬ﻧﻴـﺰ ﻫـﺴﺖ.‬ ‫ﻫﺪﻑ ﺍﺯ ﺍﻧﺠﺎﻡ ﺍﻳﻦ ﺗﺤﻘﻴﻖ ﺑﺮﺭﺳﻲ ﺍﻟﮕﻮﻫﺎی ﺣﺴﺎﺳﻴﺖ ﺁﻧﺘﻲ ﺑﻴﻮﺗﻴﮑﻲ ﻧﺴﺒﺖ ﺑﻪ ﺁﻧﺘﻲ ﺑﻴﻮﺗﻴﮏ ﻫﺎ ﺑﺘﺎﻻﮐﺘﺎﻡ ﻭ ﺗﺤﻘﻴﻖ ﭘﻴﺮﺍﻣﻮﻥ ﻭﺟـﻮﺩ ﮊﻥ ‫ﻫﺎی ﺑﺘﺎﻻﮐﺘﺎﻣﺎﺯ‬  ‬ ‫‪ bla_SHV‬ﻭ‪ bla_TEM‬ﺩﺭ ﻧﻤﻮﻧﻪ ﻫﺎ ﺑﺎﻟﻴﻨﻲ ‪ <i>E .coli‬</i> ﻣﻲ ﺑﺎﺷﺪ.‬ <br>‫<b>ﺭﻭﺵ ﺑﺮﺭﺳﻲ:</b> ﺑﺮﺍی ﺍﻧﺠﺎﻡ ﺍﻳﻦ ﺗﺤﻘﻴﻖ 200 ﺳﻮﻳﻪ <i>ﺍﺷﺮﻳﺸﻴﺎﮐﻠﻲ</i> ﺍﺯ ﻧﻤﻮﻧﻪ ﻫﺎی ﻣﺨﺘﻠﻒ ﺷﺎﻣﻞ ﺍﺩﺭﺍﺭ، ﺧﻠﻂ، ﺯﺧﻢ، ﻣﺎﻳﻊ ﻣﻐـﺰ ﻧﺨـﺎﻋﻲ، ﺍﺯ‬ ‫۵ ﺑﻴﻤـﺎﺭﺳﺘﺎﻥ ﺗﻬـﺮﺍﻥ ﺍﻳﺰﻭﻟـﻪ ﻭﺟﻤﻊ ﺁﻭﺭ ﺷﺪ ﺑـﺮﺍی ﺗﻌﻴﻴــﻦ ﻣﻘــﺎﻭﻣﺖ ﻧﻤﻮﻧـﻪ ﻫـﺎ، ﺗـﺴﺖ ﺁﻧﺘـﻲ ﺑﻴـﻮﮔﺮﺍﻡ ﺑـﺎ ﺭﻭﺵ ‪Disk diffusion‬‬ ‫ﺻﻮﺭﺕ ﮔﺮﻓﺖ. ﺁﻧﺘﻲ ﺑﻴﻮﺗﻴﮏ ﻫﺎی ﺗﺤـﺖ ﺑﺮﺭﺳـﻲ ﻋﺒـﺎﺭﺕ ﺑﻮﺩﻧـﺪ ﺍﺯ: ﺳـﻔﺘﺎﺯﻳﺪﻳﻢ، ﺳﻔﻮﺗﺎﻛـﺴﻴﻢ، ﺳـﻔﺘﺮیاﻛـﺴﻮﻥ، ﺳﻴﭙﺮﻭﻓﻠﻮﻛـﺴﺎﺳﻴﻦ،‬ ‫ﺳﻔﺘﻴـﺰﻭﻛﺴﻴﻢ، ﺍﻳﻤﻲ ﭘﻨﻢ، ﻛﺮﺑﻨـﻲ ﺳـﻴﻠﻴﻦ، ﺁﻣﻴﻜــﺎﺳﻴﻦ، ﺟﻨﺘـﺎﻣـﺎﻳـﺴﻴﻦ، ﭘﻴﭙﺮﺍﺳﻴﻠﻴــﻦ ﻭ ﭘﻴﭙﺮﺍﺳـﻴﻠﻴﻦ/ﺗﺎﺯﻭﺑﺎﻛﺘـﺎﻡ (‪ .(BBL‬ﺳـﭙﺲ ‪MIC‬‬ ‫ﺳﻮﺵ ﻫﺎ ﺟﺪﺍ ﺷﺪﻩ ﻧﺴﺒﺖ ﺑـﻪ ﺁﻧﺘﻲ ﺑﻴـﻮﺗﻴﮏ ﻫـﺎ ﺳﻔﺘـﺎﺯﻳﺪﻳﻢ ﻭ ﺍﻳﻤﻲ ﭘﻨﻢ ﺑـﻪ ﺭﻭﺵ ‪ Micro dilution‬ﺗﻌﻴﻴـﻦ ﺷــﺪ. ﻃﺒــﻖ ﭘﺮﻭﺗﮑـﻞ‬(‫‪ .(NCCLS‬ﺑﺮﺍی ﺑﺮﺭﺳـﻲ ﻭﺟــﻮﺩ ‪ ESBLs‬ ﺩﺭ ﺳـﻮﻳﻪ ﻫـﺎی ﺍﻳﺰﻭﻟـﻪ ﺷـﺪﻩ ﺍﺯ ﺭﻭﺵ ‪ Disk diffusion‬ ﺑـﺎ ﺍﺳـﺘﻔﺎﺩﻩ ﺍﺯ ﺗـﺴﺖ ﻓﻨـﻮﺗﻴﭙﻲ‬ ‫ﺗﺄﻳﻴﺪ (‪ (Phenotypic Confirmatory Test=PCT‬ﺍﺳﺘﻔﺎﺩﻩ ﮔﺮﺩﻳـﺪ ﻭ ﺑـﺎ ﺍﺳـﺘﻔﺎﺩﻩ ﺍﺯ ﺭﻭﺵ ‪ PCR‬ ﮊﻥ ﻫـﺎی‬ ‫‪ bla_SHV‬ﻭ‪ bla_TEM‬ﺩﺭ‬ ‫ﺳﻮﻳﻪ ﻫﺎ ﺍﻳﺰﻭﻟﻪ ﺷﺪﻩ ﻣﻮﺭﺩ ﺑﺮﺭﺳﻲ ﻗﺮﺍﺭ ﮔﺮﻓﺘﻨﺪ.‬ <br>‫<b>ﻳﺎﻓﺘﻪ ﻫﺎ:</b> ﺩﺭ ﺍﻳﻦ ﺗﺤﻘﻴﻖ ﺑﺨﺶ ﺍﻋﻈﻢ ﻧﻤﻮﻧﻪ ﻫﺎ ﻣﺮﺑﻮﻁ ﺑﻪ ﻋﻔﻮﻧﺖ ﻫﺎی ﺍﺩﺭﺍﺭی ﺑـﻮﺩ ۸۷۱=‪ .(۸۹%) n‬ﻫﻤﭽﻨـﻴﻦ ﺑﻴـﺸﺘﺮﻳﻦ ﻣﻴـﺰﺍﻥ ﻣﻘﺎﻭﻣـﺖ‬ ‫ﺳﻮﺵ ﻫﺎ ﺩﺭ ﺑﺮﺍﺑﺮ ﮐﺮﺑﻨﻲ ﺳﻴﻠﻴﻦ۷۴۱=‪ ( ۷۳/۵% )n‬ﻭ ﺑﻴﺸﺘﺮﻳﻦ ﻣﻴﺰﺍﻥ ﺣﺴﺎﺳﻴﺖ ﺁﻧﻬـﺎ ﺩﺭ ﺑﺮﺍﺑـﺮ ﺍﻳﻤـﻲ ﭘـﻨﻢ ﺩﻳـﺪﻩ ﺷـﺪ 200=‪.(۱۰۰%) n‬‬ ‫ﻫﻤﭽﻨﻴﻦ۵۰۱=‪ (۵۲/۵%) n‬ﺍﺯ ﻧﻤﻮﻧﻪ ﻫﺎ ﺗﺤﺖ ﺑﺮﺭﺳﻲ، ﺩﺍﺭﺍ ﮊﻥ ﻫﺎ ‪ ESBL‬ ﺑﻮﺩﻧﺪ ﮐﻪ ﺑﻴﺸﺘﺮﻳﻦ ﻣﻴﺰﺍﻥ ﻣﻘﺎﻭﻣﺖ ﺩﺭ ﺍﻳﻦ ﻧﻤﻮﻧﻪ ﻫـﺎ ﻧﻴـﺰ‬ ‫ﺩﺭ ﺑﺮﺍﺑﺮ ﮐﺮﺑﻨﻲ ﺳﻴﻠﻴﻦ ﺩﻳﺪﻩ ﺷﺪ(%۵۹). ﻫﻤﭽﻨﻴﻦ ۸۴ =‪ (%۲۴) n‬ﺍﺯ ﺳﻮﻳـﻪ ﻫــﺎ ﻣـﻮﺭﺩ ﺑﺮﺭﺳـﻲ ﺣـﺎﻭی ﮊﻥ ‪ bla_TEM‬ ﻭ۲۱ =‪ (%۶) n‬ﺍﺯ‬ ‫ﺳﻮﻳﻪ ﻫﺎ ﺣﺎﻭی ﮊﻥ ‪ bla_SHV‬ ﺑﻮﺩﻧﺪ.‬ <br>‫<b>ﻧﺘﻴﺠﻪ ﮔﻴﺮﻱ:</b> ﺑﺎ ﺗﻮﺟﻪ ﺑﻪ ﺩﺭﺻﺪ ﺑﺎﻻی ﻣﻘﺎﻭﻣﺖ ﺑﻪ ﺳﻔﺘﺎﺯﻳﺪﻳﻢ ﻭ ﻣﻴﺰﺍﻥ ﺑﺎﻻی ﺗﻮﻟﻴﺪ ‪  ESBLs‬ﺑﺎﻳﺪ ﺩﺭ ﻣﺼﺮﻑ ﺳﻔﺎﻟﻮﺳﭙﻮﺭﻳﻦ ﻫﺎ ﻧـﺴﻞ‬ ‫ﺳﻮﻡ ﺩﻗﺖ ﻧﻤـﻮﺩ. ﻫﻤﭽﻨﻴـﻦ ﺑـﻪ ﻣﻨﻈـﻮﺭ ﺩﺭﻣـﺎﻥ ﻭ ﺟﻠﻮﮔﻴﺮی ﺍﺯ ﮔﺴﺘﺮﺵ ﻋﻔﻮﻧﺖ ﻫﺎ ﻧﺎﺷـﻲ ﺍﺯ ﺍﺭﮔﺎﻧﻴـﺴﻢ ﻫـﺎی ⁺‪ ،ESBL‬ﺍﻧﺠـﺎﻡ ﺩﻗﻴـﻖ‬ ‫ﺗﺴﺖ ﻫﺎی ﺁﻧﺘﻲ ﺑﻴﻮﮔﺮﺍﻡ ﻗﺒﻞ ﺍﺯ ﺗﺠﻮﻳﺰ ﺁﻧﺘـﻲ ﺑﻴﻮﺗﻴـﮏ ﻭ ﭘﺮﻫﻴـﺰ ﺍﺯ ﻣـﺼﺮﻑ ﺑـﻲ ﺭﻭﻳـﻪ ﻭ ﺧﻮﺩﺳـﺮﺍﻧﻪ ﺩﺍﺭﻭ ﺑـﻮﻳﮋﻩ ﺁﻧﺘـﻲ ﺑﻴﻮﺗﻴـﮏ ﻫـﺎ‬ی ‫ﺳﻔﺎﻟﻮﺳﭙﻮﺭﻳﻨﻲ ﺿﺮﻭﺭ ﺍﺳﺖ.‬ </div> <b>Background and Objectives:</b> The pathogenic strains of <i>Escherichia coli</i> cause severe septicemia, urinary tract infection and wound sepsis. Resistance of this organism to the expanded-spectrum cephalosporins occurs via the production of extended-spectrum β-lactamases (ESBLs) such as TEM and SHV. These enzymes hydrolyze oxyimino cephalosporins (cefotaxime, ceftazidime) and monobactams (aztreonam). This study was conducted to determine the drug susceptibility and prevalence of ESBL phenotypes of <i>E. coli</i> isolates at Tehran hospitals. <br><b>Material and Methods:</b> collectively, 200 isolates of<i> E. coli</i> were obtained from 5 hospitals in Tehran. The antibiotic susceptibility patterns of all clinical specimens were determined using disk diffusion method. Phenotypic confirmatory test was used to detect ESBL producing isolates. The MICs of ceftazidime and imipenem were determined using Microbroth dilution assay. Isolates with MIC≥2µg/ml were screened by PCR to detect bla_TEM and bla_SHV genes. <br><b>Results:</b> Resistance to ceftazidime and cefotaxime were 30.1% and 32.1% respectively. All isolates were susceptible to imipenem. 52.5% of them (n=105) were positive in phenotypic confirmatory test. Resistance to ciprofloxacin among ESBL positive strains was 41%. The bla_TEM and bla_SHV genes were found among 24% (n=48) and 6% (n=12) of isolates respectively. Six isolates (3%) contained both genes. <br><b>Conclusion:</b>At Tehran hospitals, the rate of resistance to ceftazidime and prevalence of ESBL phenotype among the isolates of <i>E. coli</i> are high. It is necessary to seek a remedy for monitoring the ESBLs in these health settings. TEM is the dominant enzyme among the ESBL producing strains of <i>E. coli</i> in Iran. ﺍﺷﺮﻳﺸﻴﺎﮐﻠﻲ، ﻣﻘﺎﻭﻣﺖ ﺁﻧﺘﻲ ﺑﻴﻮﺗﻴﮑﻲ، ‪blaSHV,blaTEM‬‬ E.coli, antimicrobial resistant, blaTEM, blaSHV 1 8 http://ijmm.ir/browse.php?a_code=A-10-1-64&slc_lang=fa&sid=1 Fereshteh Shahcheraghi ﻓﺮﺷـﺘﻪ ﺷـﺎﻫﭽـﺮﺍﻏﻲ feresh100@yahoo.com 1003194753284600405 1003194753284600405 Yes Department of Microbiology, Pasteur Institute of Iran, Tehran ﺑﺨﺶ ﺑﺎﻛﺘﺮ ﺷﻨﺎﺳﻲ، ﺍﻧﺴﺘﻴﺘﻮ ﭘﺎﺳﺘﻮﺭ ﺍﻳﺮﺍﻥ Haniye Noveiri ﻫﺎﻧﻴﻪ ﻧﻮﻳﺮ 1003194753284600406 1003194753284600406 No Islamic Azad University, Lahijan Branch, Lahijan دانشگاه ازاد اسلامی واحد لاهیجان Siavash Nasiri ﺳﻴﺎﻭﺵ ﻧﺼﻴﺮ 1003194753284600407 1003194753284600407 No Department of Microbiology, Pasteur Institute of Iran, Tehran ﺑﺨﺶ ﺑﺎﻛﺘﺮ ﺷﻨﺎﺳﻲ، ﺍﻧﺴﺘﻴﺘﻮ ﭘﺎﺳﺘﻮﺭ ﺍﻳﺮﺍﻥ