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Int J Entric Pathog. 2014 January; 1(2): 76-8. Published Online 2014 January 1.
First CTX-M type ß–lactamase-Producing and Ciprofloxacin Resistant
Infection Acquired by a Child in IRANFarzaneh Firoozeh 1, Fereshteh Shahcheraghi 2,*, Taghi Zahraei-Salehi 3, Mohammad Mehdi Aslani 2, Reihaneh Banisaeed 31 Department of Microbiology and Immunology, School of Medicine, Kashan University of Medical Sciences, Kashan, IR Iran
2 Department of Microbiology and Microbiology Research Center, Pasteur Institute, Tehran, IR Iran
3 Department of Microbiology, Faculty of Veterinary Medicine, University of Tehran, Tehran, IR Iran* Corresponding author: Fereshteh Shahcheraghi, Department of Microbiology and Microbiology Research Center, Pasteur Institute, Tehran, IR Iran. Tel: +98-2166405535, Fax: +98-
2166405535, E-mail: email@example.com
August 23, 2013; Revised:
August 25, 2013; Accepted:
August 31, 2013
The frequency of multidrug-resistance (MDR) among Salmonella
isolates has increased dramatically. Here we report the first case of CTX-M
type ß–lactamase producing ciprofloxacin-resistant Salmonella
infection as a child in Iran. Antimicrobial resistance profile was determined
according to the Clinical and Laboratory Standards Institute. A double disk synergy test was used in the production of extended-spectrum
β-lactamases (ESBLs). PCR assays were carried out to detect blaTEM, blaSHV and blaCTX-M beta lactamase genes. The presence of class 1
integrons was investigated by PCR assays. The Salmonella Enteritidis
isolate from the child was ciprofloxacin and extended-spectrum
cephalosporins resistant and found to carry the blaCTX-M beta-lactamase gene and class 1 integrons, suggests that antimicrobial resistance
determinants may be located on the same genetic unit of the class 1 integrons identified here. Resistance to ciprofloxacin and extended-
spectrum cephalosporins, the drugs of choice for treating invasive salmonellosis, especially in children is a public health problem.
Ciprofloxacin; blaCTX-M; Extended Spectrum β-lactamase; Multidrug Resistance; Salmonella Enteritidis
pain, fulminant diarrhea, nausea, vomiting and fever ad-
is a common cause of the food borne
mitted to the pediatric infection diseases' ward due to
gastroenteritis. Though non-typhoidal salmonellosis is
gastroenteritis. The stool and blood specimens for culture
self-limiting, but antibiotic therapy can be life saving in
were sent to the Microbiology Laboratory in Pasteur Insti-
children, elderly, and immune compromised personals
tute of Iran. Direct microscopic examination of the stool
with systemic infections (1). Fluoroquinolones and third-
specimens showed leukocytes. Culture of the stool was
generation cephalosporins are major antibiotics used for
performed, and on the 3rd day of hospitalization identi-
treatment of invasive salmonellosis (2). Increasing occur-
fied as Salmonella
species, was isolated from the two con-
rence of antimicrobial resistant Salmonella
secutive stool cultures. The identification of the isolated
complicated the treatment process. In particular, detec-
enterica was confirmed by conventional
tion of fluoroquinolon and expanded spectrum cepha-
standard biochemical and serological tests (4). The iso-
losporin's resistant Salmonella
strains is a newly emerg-
late from the child was serotyped by multiplex PCR assays
ing threat in many countries (3). In this study, we report
and confirmed using commercial antisera as described
a ciprofloxacin and expanded spectrum cephalosporin's
previously and found to be Salmonella enterica
resistant Salmonella Enteritidis
isolated from a child with
Enteritidis (5). The antimicrobial resistance of Salmonella
severe gastroenteritis. Resistance to the drugs of choice
Enteritidis isolate to twenty-one antimicrobial agents
for severe salmonellosis, especially in children is of major
was determined by agar disk diffusion, and the mini-
clinical concern. This is the first report of emerging CTX-
mum inhibitory concentrations (MICs) of ciprofloxacin
M type ß–lactamase-producing ciprofloxacin resistant and ceftriaxone were evaluated by the broth-microdilu-
isolated from a human clinical specimens.
tion methods' accordance with the standards of the Clini-
cal and Laboratory Standards Institute. The strain was
2. Case Report
found to be resistant to ampicillin, streptomycin, oxytet-
racycline, doxycycline, trimethoprim-sulfamethoxazole,
In April 2010, a one-year-old boy with acute abdominal
chloramphenicol, cephalothin, ceftazidime, ceftriaxone,
Implication for health policy/practice/research/medical education:
In the present study, we described the first report of ciprofloxacin resistant Salmonella
infection acquired by a child in Iran.
Copyright 2014, Alborz University of Medical Sciences.; Published by Safnek. This is an Open Access article distributed under the terms of the Creative Commons
Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
cefixime, cefotaxime, aztreonam, ciprofloxacin, and nor-
selection of ciprofloxacin resistance genes that trans-
floxacin. Ciprofloxacin and ceftriaxone minimum inhibi-
ferred into the human. It is probable that ciprofloxacin
tory concentrations (MICs) values were 4 μg/mL and 128
and extended spectrum β-lactam resistant Salmonella
μg/mL, respectively. The isolate was investigated for ESBL
strain identified here are transmitted to a child via con-
production using the double disk synergy test according
to published methods (3). The genes responsible for the
Quinolone resistance in gram-negative bacteria is
ESBL phenotype (blaTEM, blaSHV, blaCTX-M) were identi-
commonly due to mutations in quinolone target genes,
fied by PCR assay using primers and conditions reported
DNA gyrase (gyrA) and topoisomerase IV (parC) and/or
previously (3). By PCR assays the Salmonella Enteritidis
regulatory genes of outer membrane proteins or efflux
isolate was found to carry class 1 integrons (Figure 1). PCR
pumps (8). Plasmid mediated quinolone/fluoroquinolon
amplification conditions and primers described previ-
resistance determinants qnrA, qnrB1-8, qnrS1-2 have since
been described (9). In most studies was shown that qnr
genes were accompanied by genes encoding extended-
PCR amplification of Class 1 Integrons intI and Sul1 Genes in
spectrum β-lactamases and often embedded in complex
Salmonella Enteritidis Isolated From an one-year-old Boy.
sul1 type integrons (ESBLs). Here, the ciprofloxacin-resis-
tant Salmonella Enteritidis
strain, found to carry sul1-asso-
ciated class-1 integrons and the blaCTX-M beta-lactamase
gene. Thus, the fluoroquinolon and extended-spectrum
cephalosporins resistance determinants may be locat-
ed on the same genetic unit of the class 1 integrons de-
It is obvious that the use of antimicrobials will result
in the selection of resistance strains. Accordingly, efforts
must be made to reduce the use of certain antibiotics in
animals, to delay the transmission of antibiotic-resistant
Salmonella strains to human via food products.
(A) Lane M: 1 kbp DNA ladder as the molecular size marker; lane 1: PCR
mix with no template; lane 2: positive control; lane 3: the intI gene was
All authors have participated equally in the study.
detected in Salmonella isolate from child. (B) Lane M: 1 kbp DNA ladder
as the molecular size marker; lane 1: PCR mix with no template; lane 2:
positive control; lane 3: the sul1 gene was detected in Salmonella isolate
Fluoroquinolones and extended-spectrum cephalospo-
rins are commonly used to treat Salmonella
Bacterial resistance to these important drugs has dra-
1. Rayamajhi N, Kang SG, Kang ML, Lee HS, Park KY, Yoo HS. Assess-
matically increased. Animals and animal products are
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significant sources of resistant bacteria for the human
monella enterica serovar Typhimurium isolated from swine. J
Vet Med Sci.
2. Firoozeh F, Zahraei-Salehi T, Shahcheraghi F, Karimi V, Aslani MM.
In this study, we have isolated a ciprofloxacin-resistant
Characterization of class I integrons among Salmonella enterica
Salmonella Enteritidis from clinical specimens of a child
serovar Enteritidis isolated from humans and poultry. FEMS Im-
with invasive salmonellosis. Previous study has reported
munol Med Microbiol.
ciprofloxacin-resistant in Salmonella strains isolated
3. Ranjbar R, Giammanco GM, Aleo A, Plano MR, Naghoni A, Owlia
P, et al. Characterization of the first extended-spectrum beta-
from poultry in our country (7). The enrofloxacin is main
lactamase-producing nontyphoidal Salmonella strains isolated
prescribed fluoroquinolon in treatment of bacterial
in Tehran, Iran. Foodborne Pathog Dis.
infections in poultry in Iran (2). It is probable that the
4. Winn WC, Koneman EW. Koneman's Color Atlas and Textbook of Di-
widely use of fluoroquinolones such as enrofloxacin in
5. Firoozeh F, Shahcheraghi F, Zahraei Salehi T, Karimi V, Aslani MM.
poultry, led to cross resistance against ciprofloxacin and
Antimicrobial resistance profile and presence of class I integrongs
among Salmonella enterica serovars isolated from human clinical
8. Garnier F, Raked N, Gassama A, Denis F, Ploy MC. Genetic
specimens in Tehran, Iran. Iran J Microbiol.
environment of quinolone resistance gene qnrB2 in a com-
6. Fey PD, Safranek TJ, Rupp ME, Dunne EF, Ribot E, Iwen PC, et al.
plex sul1-type integron in the newly described Salmonella
Ceftriaxone-resistant salmonella infection acquired by a child
enterica serovar Keurmassar. Antimicrob Agents Chemother.
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7. Morshed R, Peighambari SM. Drug resistance, plasmid profile
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and random amplified polymorphic DNA analysis of Iranian
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isolates of Salmonella enteritidis. New Microbiol.
Central Union High School District Health and Welfare Benefits 2010-2011 All Benefit Eligible Classified Employees (and COBRA Enrollees) Carol Moreno, Director of Human Resources HEALTH AND WELFARE BENEFITS EFFECTIVE OCTOBER 1, 2010 The annual open enrollment for making medical, dental, vision and life insurance plan changes is from Tuesday, August 10, 2010 through Friday, Se
Alle R Copyright orbehalt Evaluation of Tobacco Use Cessation (TUC) CounsellingIan Needlemana/Saman Warnakulasuriyab/Gay Sutherlandc/Michael M. Bornsteind/Elias Casalse/Thomas Dietrichf/Jean SuvanaAbstract: Tobacco use cessation (TUC) in dentistry is critical to reducing the effect of a major risk factor for both oral andsystematic diseases. The effect of TUC interventions has been widely