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      Analysis of the Frequency, Antibiotic Susceptibility, and Related Genes among Foodborne Pathogenic Bacteria Isolated from Hospital Refrigerators in Tehran, Iran

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          Abstract

          Background:

          Hospital refrigerators as essential food storage can be important source of food contamination. We aimed to investigate the frequency and antibiotic susceptibility of the pathogenic bacteria in three hospital refrigerators in Tehran.

          Methods:

          This study was performed on 254 samples, collected from 60 refrigerators of the various wards of three hospitals, A, B, and C, in Tehran, Iran from 2020 to 2021. Following isolation and identification of isolates, the antibiotic susceptibility pattern was determined. PCR-based assays were used to screen the presence of antibiotic resistance genes of resistant isolates.

          Results:

          From 254 collected samples, 236 samples (92.9%) were contaminated. Most strains were isolated from refrigerators with poorly cleaned, temperatures above 8 °C in non-critical wards. Most bacteria belonging to Enterobacteriaceae (68.8%), followed by Staphylococcus (11.9%), and Enterococcus (10.6%), while the frequency of non-Enterobacteriaceae isolates was 8.9%. The highest antibiotic resistant bacteria were in extended spectrum beta-lactamase (ESBL) 9.7%, vancomycin-resistant enterococci (VRE) 5.3%, methicillin-resistant S. epidermidis (MRSE) 0.4%, and methicillin-resistant S. aureus (MRSA) 0.4%, respectively. The bla OXA-48, bla CTX, and bcla TEM genes were found only in 10% of Enterobacteriaceae isolates. The bla OXA-51 gene was found in all non-Enterobacteriaceae isolates. The vanA and mecA genes were detected in antibiotic-resistant Enterococcus and Staphylococcus.

          Conclusion:

          Our findings suggests major concern about cross-contamination and the emergence of antibiotic-resistant isolates as a potential health threat with hospital refrigerators origin. More attention to hospital refrigerators cleaning is necessary to prevent foodborne diseases and nosocomial infections.

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          Most cited references40

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          Horizontal transfer of antibiotic resistance genes in clinical environments

          A global medical crisis is unfolding as antibiotics lose effectiveness against a growing number of bacterial pathogens. Horizontal gene transfer (HGT) contributes significantly to the rapid spread of resistance, yet the transmission dynamics of genes that confer antibiotic resistance are poorly understood. Multiple mechanisms of HGT liberate genes from normal vertical inheritance. Conjugation by plasmids, transduction by bacteriophages, and natural transformation by extracellular DNA each allow genetic material to jump between strains and species. Thus, HGT adds an important dimension to infectious disease whereby an antibiotic resistance gene (ARG) can be the agent of an outbreak by transferring resistance to multiple unrelated pathogens. Here, we review the small number of cases where HGT has been detected in clinical environments. We discuss differences and synergies between the spread of plasmid-borne and chromosomal ARGs, with a special consideration of the difficulties of detecting transduction and transformation by routine genetic diagnostics. We highlight how 11 of the top 12 priority antibiotic-resistant pathogens are known or predicted to be naturally transformable, raising the possibility that this mechanism of HGT makes significant contributions to the spread of ARGs. HGT drives the evolution of untreatable "superbugs" by concentrating ARGs together in the same cell, thus HGT must be included in strategies to prevent the emergence of resistant organisms in hospitals and other clinical settings.
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            Antimicrobial resistance and virulence: a successful or deleterious association in the bacterial world?

            Hosts and bacteria have coevolved over millions of years, during which pathogenic bacteria have modified their virulence mechanisms to adapt to host defense systems. Although the spread of pathogens has been hindered by the discovery and widespread use of antimicrobial agents, antimicrobial resistance has increased globally. The emergence of resistant bacteria has accelerated in recent years, mainly as a result of increased selective pressure. However, although antimicrobial resistance and bacterial virulence have developed on different timescales, they share some common characteristics. This review considers how bacterial virulence and fitness are affected by antibiotic resistance and also how the relationship between virulence and resistance is affected by different genetic mechanisms (e.g., coselection and compensatory mutations) and by the most prevalent global responses. The interplay between these factors and the associated biological costs depend on four main factors: the bacterial species involved, virulence and resistance mechanisms, the ecological niche, and the host. The development of new strategies involving new antimicrobials or nonantimicrobial compounds and of novel diagnostic methods that focus on high-risk clones and rapid tests to detect virulence markers may help to resolve the increasing problem of the association between virulence and resistance, which is becoming more beneficial for pathogenic bacteria.
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              Overview of Changes to the Clinical and Laboratory Standards Institute Performance Standards for Antimicrobial Susceptibility Testing, M100, 31st Edition.

              The Clinical and Laboratory Standards Institute (CLSI) Subcommittee on Antimicrobial Susceptibility Testing (AST) develops and publishes standards and guidelines for AST methods and results interpretation in an annual update to the Performance Standards for Antimicrobial Susceptibility Testing (M100). This minireview will discuss changes to M100 for the 31st edition, including new and revised breakpoints and testing recommendations. New MIC and disk diffusion breakpoints are described for azithromycin (Shigella spp.), imipenem-relebactam (Enterobacterales, Pseudomonas aeruginosa, and anaerobes), and lefamulin (Staphylococcus aureus, Haemophilus influenzae, and Streptococcus pneumoniae), and disk breakpoints are described for azithromycin and Neisseria gonorrhoeae. The rationale behind revised oxacillin MIC breakpoints for select staphylococci is discussed. Updates to test methods include a method for disk diffusion using positive blood culture broth and use of linezolid to predict tedizolid susceptibility. There is clarification on which drugs to suppress on bacteria isolated from the cerebrospinal fluid and clarification on the use of a caret symbol attached to the intermediate category ("I^") to indicate those antimicrobials that concentrate in the urine.
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                Author and article information

                Journal
                Iran J Public Health
                Iran J Public Health
                IJPH
                Iranian Journal of Public Health
                Tehran University of Medical Sciences
                2251-6085
                2251-6093
                March 2024
                : 53
                : 3
                : 680-690
                Affiliations
                [1. ]Department of Hygiene, Science and Research Branch, Islamic Azad University, Tehran, Iran
                [2. ]Department of Food Industry, School of Nutrition Sciences & Food Technology, Shahid Beheshti University of Medical Sciences, Tehran, Iran
                [3. ]Department of Pathology and Laboratory Medicine, Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran
                Author notes
                [* ] Corresponding Author: Email: abbasalimotallebi@ 123456gmail.com
                Article
                IJPH-53-680
                10.18502/ijph.v53i3.15150
                11194645
                773e442e-7939-4f57-adfa-8e9fdea09712
                Copyright© 2024 Soltanzadeh et al. Published by Tehran University of Medical Sciences.

                This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International license. ( https://creativecommons.org/licenses/by-nc/4.0/). Non-commercial uses of the work are permitted, provided the original work is properly cited

                History
                : 10 December 2022
                : 14 March 2023
                Categories
                Original Article

                Public health
                foodborne diseases,antibiotic resistance,hospital refrigerators,food safety
                Public health
                foodborne diseases, antibiotic resistance, hospital refrigerators, food safety

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