Hospital Practices and Research

Abstract Background: Klebsiella pneumoniae (K. pneumoniae) is a major cause of hospital-acquired infections, where treatment options are restricted due to drug-resistant strains, including those producing extended-spectrum beta-lactamases (ESBLs) and carbapenemases.
Objectives: This study focuses on the molecular identification of beta-lactamase and carbapenemase genes in K. pneumoniae strains from Valiasr Hospital, Zanjan, to enhance infection control and antimicrobial strategies.
Methods: In this cross-sectional study, 50 K. pneumoniae clinical isolates were obtained from blood, urine, and wound samples of ICU patients in 2024. Phenotypic identification and antimicrobial susceptibility testing were performed using the Kirby-Bauer disk diffusion method. Genomic DNA extraction was performed using the phenol-chloroform method, followed by polymerase chain reaction (PCR) to identify resistance genes (blaCTX-M, blaTEM, blaSHV, blaIMP, blaVIM). The PCR products were analyzed via agarose gel electrophoresis, with data processed using SPSS version 26.
Results: The mean age of the patients was 58.90 years, and the isolates exhibited high resistance rates to ampicillin (90%), piperacillin (78%), and cefotaxime (72%). Genotypic testing indicated ESBL gene frequencies: blaTEM (46%), blaSHV (44%), and blaCTX-M (40%), along with carbapenemase genes blaVIM and blaIMP in 26% and 22% of isolates, respectively. A significant link was found between the blaTEM gene and urinary isolates (P = 0.037). Furthermore, the presence of the blaTEM, blaSHV, and blaCTX-M genes was associated with MDR, XDR, and PDR phenotypes (P < 0.05), with 100% of MDR isolates containing all three genes.
Conclusion: The study found a high prevalence of ESBL genes linked to multidrug resistance patterns among K. pneumoniae isolates in ICUs. The presence of carbapenemase genes (blaIMP and blaVIM) indicates a shift toward carbapenem resistance, underscoring the urgent need for better antibiotic surveillance and infection control in these settings.

Abstract Background: Low back pain is an important health problem and is one of the main symptoms in lumbar disc pathology. It is not known whether paraspinal muscular weakness is a cause or a result of low back pain.
Objectives: The current study was performed in order to investigate paraspinal muscles Cross-Section Area (CSA) and Fat Infiltration (FI) in chronic versus acute Low Back Pain (LBP) patients and their association with disc herniation.
Methods: 76 acute and 76 chronic LBP adult subjects who were candidates for magnetic resonance imaging in a referral hospital in Isfahan, Iran, were evaluated in terms of demographics, their pain and disability severity, FI (signal intensity index) of paraspinal muscles in five lumbar levels, CSA of paraspinal muscles in five lumbar levels and disk herniation degree in five lumbar levels.
Results: Overweight patients: 34 (45.9 %); obese: 12 (16.2 %); ODI score: 25.2 (6.7) and mean VAS score was: 6.44 (1.2). The longer the pain persisted, the higher its severity was felt. Similar numbers were found for females. Females had higher pain scores and higher FI in paraspinal muscles. Accordingly, FI was higher, and CSA was lower in chronic LBP than acute LBP (P<0.05). Women had smaller, and fattier paraspinal muscles (P<0.05).
Conclusion: Chronic LBP is associated with a decreased muscle volume in paraspinal muscles. Regular physical activity routines, weight loss meal plans, physiotherapy and corrective training programs might prevent chronicity of LBP, increase paraspinal CSA, decrease paraspinal FI, attenuate back pain severity and hence improve patients’ quality of life.