Background: Device-associated nosocomial infections (DA-NIs), due to MDR Enterobacteriaceae, are a major threat\nto patient safety in ICUs. We investigated on Extended-spectrum Ã?²-lactamases (ESBL) producing Enterobacteriaceae\nand incidence of integrons in these bacteria isolated from ventilator-associated pneumonia (VAP) and catheter-associated\nurinary tract infections (CAUTIs) in 18 governmental hospitals in the north of Iran.\nMethods: In this cross-section study, the antibiotic susceptibility test was performed using the MIC method; also,\nphenotypically detection of ESBL-producing bacteria was carried out by the double-disk synergy (DDS) test. Presence\nof ESBL-related genes and integron Classes 1 and 2 was evaluated by the PCR method.\nResults: Out of a total of 205 patients with DA-NIs, Enterobacteriaceae were responsible for (72.68%) of infections.\nThe most common DA-NIs caused by Enterobacteriaceae were VAP (77.18%), CAUTI (19.46%), and sepsis due to\nVAP (3.35%). The most frequently Enterobacteriaceae were; Klebsiella pneumoniae 75 (24; 32% ESBL positive), E. coli\n69 (6; 8.69% ESBL positive) and Enterobacter spp. 5 (5; 100% ESBL positive). Distribution of ESBL-related genes was as\nfollows: bla-SHV (94.3%), bla-CTX (48.6%), bla-VEB (22.9%) and bla-GES (17.14%). The incidence rate of integron class 1\nand class 2 was (82.92%) and (2.9%) respectively. Eight types of ESBL-producing bacteria were observed.\nConclusions: Due to the fact that the emergence rate of ESBL Enterobacteriaceae is increasing in DA-NIs, co-incidence\nof different types of ESBL genes with integrons in 75ââ?¬â??100% of strains in our study is alarming for clinicians and\nhealthcare safety managers. Therefore, regional and local molecular level estimations of ESBLs that are agents of\nDA-NIs are critical for better management of empiric therapy, especially for patients in ICUs.
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