‫ﻣﺠﻠــﻪﻱ ﻋﻠﻤــﻲ‪ ،‬ﭘﮋﻭﻫﺸــﻲ ﺩﺍﻧﺸــﮕﺎﻩ ﻋﻠــﻮﻡ ﭘﺰﺷـﮑﻲ ﺯﻧﺠــﺎﻥ‬ ‫ﺩﻭﺭﻩﻱ ‪ ,٢٢‬ﺷﻤﺎﺭﻩﻱ ‪ ,٩١‬ﺧﺮﺩﺍﺩ ﻭ ﺗﻴﺮ ‪ ,١٣٩٣‬ﺻﻔﺤﺎﺕ ‪ ١٢١‬ﺗﺎ ‪١٣٠‬‬ ‫ﺑﺮﺭﺳﻲ ﻓﺮﺍﻭﺍﻧﻲ ﻣﻘﺎﻭﻣﺖ ﺑﻪ ﻭﻧﮑﻮﻣﺎﻳﺴﻴﻦ ﺩﺭ ﻣﻴﺎﻥ ﺳﻮﻳﻪﻫﺎﻱ ﺍﻧﺘﺮﻭﮐﻮﮐﻮﺱ ﻓﺴﻴﻮﻡ ﺟﺪﺍ ﺷﺪﻩ ﺍﺯ‬ ‫ﻋﻔﻮﻧﺖﻫﺎﻱ ﺍﺩﺭﺍﺭﻱ ﺩﺭ ﺑﻴﻤﺎﺭﺳﺘﺎﻥﻫﺎﻱ ﺗﻬﺮﺍﻥ‬ ‫‪۵‬‬ ‫ﻟﻴﻠﻲ ﺷﮑﻮﻫﻲ ﺯﺍﺩﻩ‪ ،۱‬ﺩﮐﺘﺮ ﺍﺷﺮﻑ ﻣﺤﺒﺘﻲ ﻣﺒﺎﺭﺯ‪ ،۲‬ﺩﮐﺘﺮ ﻣﺤﻤﺪ ﺭﺿﺎ ﺯﺍﻟﻲ‪ ،۳‬ﺩﮐﺘﺮ ﺭﺿﺎ ﺭﻧﺠﺒﺮ‪ ،۴‬ﺩﮐﺘﺮ ﻣﺴﻌﻮﺩ ﺍﻝ ﺑﻮﻳﻪ‬ ‫ﻧﻮﻳﺴﻨﺪﻩﻱ ﻣﺴﻮﻭﻝ‪ :‬ﺗﻬﺮﺍﻥ‪ ،‬ﺩﺍﻧﺸﮕﺎﻩ ﺗﺮﺑﻴﺖ ﻣﺪﺭﺱ‪ ،‬ﺩﺍﻧﺸﮑﺪﻩﻱ ﻋﻠﻮﻡ ﭘﺰﺷﮑﻲ‬ ‫ﺩﺭﻳﺎﻓﺖ‪۹۲/۴/۹ :‬‬ ‫‪mmmobarez@modares.ac.ir‬‬ ‫ﭘﺬﻳﺮﺵ‪۹۲/۷/۱۵ :‬‬ ‫ﭼﮑﻴﺪﻩ‬ ‫ﺯﻣﻴﻨﻪ ﻭ ﻫﺪﻑ‪ :‬ﺳﻮﻳﻪﻫﺎﻱ ﻣﻘﺎﻭﻡ ﺑﻪ ﻭﻧﮑﻮﻣﺎﻳﺴﻴﻦ ﺍﻧﺘﻮﮐﻮﮐﻮﺱ ﻓﺴﻴﻮﻡ )‪ (VRE‬ﺷﺎﻳﻊﺗﺮﻳﻦ ﻋﺎﻣﻞ ﺍﻳﺠﺎﺩ ﻋﻔﻮﻧﺖﻫﺎﻱ ﺍﺩﺭﺍﺭﻱ ﺩﺭ ﺑﻴﻤﺎﺭﺍﻥ ﺑﺴﺘﺮﻱ ﻣﻲﺑﺎﺷﻨﺪ‪.‬‬ ‫ﻫﺪﻑ ﺍﺯ ﺍﻳﻦ ﻣﻄﺎﻟﻌﻪ ﺑﺮﺭﺳﻲ ﻓﺮﺍﻭﺍﻧﻲ ﻋﻔﻮﻧﺖﻫﺎﻱ ﺍﺩﺭﺍﺭﻱ ﻧﺎﺷﻲ ﺍﺯ ﺍﻧﺘﺮﻭﮐﻮﮎ ﻓـﺴﻴﻮﻡ ﻭ ﻫﻤﭽﻨـﻴﻦ ﺗﻌﻴـﻴﻦ ﻣﻴـﺰﺍﻥ ﻣﻘﺎﻭﻣـﺖ ﺑـﻪ ﻭﻧﮑﻮﻣﺎﻳـﺴﻴﻦ ﻭ ﺩﻳﮕـﺮ‬ ‫ﺁﻧﺘﻲﺑﻴﻮﺗﻴﮏﻫﺎﻱ ﻣﻮﺛﺮ ﺩﺭ ﺩﺭﻣﺎﻥ ﺍﻳﻦ ﻋﻔﻮﻧﺖﻫﺎ ﺩﺭ ﺑﻴﻤﺎﺭﺍﻥ ﺑﺴﺘﺮﻱ ﺩﺭ ﭼﻬﺎﺭ ﺑﻴﻤﺎﺭﺳﺘﺎﻥ ﺁﻣﻮﺯﺷﻲ ﺩﺭ ﺷﻬﺮ ﺗﻬﺮﺍﻥ ﺑﻮﺩ‪.‬‬ ‫ﺭﻭﺵ ﺑﺮﺭﺳﻲ‪ :‬ﻧﻤﻮﻧﻪﮔﻴﺮﻱ ﺑﻪﻣﺪﺕ ‪ ۹‬ﻣﺎﻩ ﺍﺯ ﺷﻬﺮﻳﻮﺭ ﺳﺎﻝ ‪ ۱۳۹۰‬ﺗـﺎ ﺍﺭﺩﻳﺒﻬـﺸﺖ ‪ ۱۳۹۱‬ﺍﻧﺠـﺎﻡ ﭘـﺬﻳﺮﻓﺖ‪ .‬ﻧﻤﻮﻧـﻪﻫـﺎﻱ ﺍﺩﺭﺍﺭﻱ ﺍﺯ ﺑﻴﻤـﺎﺭﺍﻥ ﺑـﺴﺘﺮﻱ ﺩﺭ‬ ‫ﺑﻴﻤﺎﺭﺳﺘﺎﻥﻫﺎﻱ ﻃﺎﻟﻘﺎﻧﻲ‪ ،‬ﻟﻘﻤﺎﻥ‪ ،‬ﻣﻔﻴﺪ ﻭ ﻟﺒﺎﻓﻲ ﻧﮋﺍﺩ ﺩﺭ ﺗﻬﺮﺍﻥ ﺟﻤﻊﺁﻭﺭﻱ ﮔﺮﺩﻳﺪ‪ .‬ﺑﺮﺍﺳﺎﺱ ﺗﺴﺖﻫـﺎﻱ ﺑﻴﻮﺷـﻴﻤﻴﺎﻳﻲ ﻭ ﻣﻮﻟﮑـﻮﻟﻲ ﮔﻮﻧـﻪﻫـﺎﻱ ﺍﻧﺘﺮﻭﮐـﻮﮎ‬ ‫ﺷﻨﺎﺳﺎﻳﻲ ﺷﺪﻧﺪ‪ .‬ﺣﺴﺎﺳﻴﺖ ﺿﺪ ﻣﻴﮑﺮﻭﺑﻲ ﺳﻮﻳﻪﻫﺎﻱ ﺍﻧﺘﺮﻭﮐﻮﮐﻮﺱ ﻓﺴﻴﻮﻡ ﻭ ﻣﻴﺰﺍﻥ ﺣﺪﺍﻗﻞ ﻏﻠﻈـﺖ ﻣﻬـﺎﺭﻱ )‪ (MIC‬ﻭﻧﮑﻮﻣﺎﻳـﺴﻴﻦ ﺑـﻪ ﺭﻭﺵ ﺩﻳـﺴﮏ‬ ‫ﺩﻳﻔﻴﻮﺯﻥ ﻭ ﺁﮔﺎﺭ ﺩﻳﻠﻮﺷﻦ ﺗﻌﻴﻴﻦ ﮔﺮﺩﻳﺪ‪ .‬ﺣﻀﻮﺭ ﮊﻥﻫﺎﻱ ‪ vanA‬ﻭ ‪ vanB‬ﺩﺭ ﺳﻮﻳﻪﻫﺎﻱ ‪ VRE‬ﺗﻮﺳﻂ ﺗﺴﺖ ‪ PCR‬ﻣﻮﺭﺩ ﺑﺮﺭﺳﻲ ﻗﺮﺍﺭ ﮔﺮﻓﺖ‪.‬‬ ‫ﻳﺎﻓﺘﻪﻫﺎ‪ :‬ﺩﺭ ﻣﺠﻤﻮﻉ ‪ ۸۶‬ﺍﻳﺰﻭﻟﻪ ﺍﻧﺘﺮﻭﮐﻮﮐﻲ ﺍﺯ ﻧﻤﻮﻧﻪﻫﺎﻱ ﺍﺩﺭﺍﺭﻱ ﺟﺪﺍ ﮔﺮﺩﻳﺪ ﮐﻪ ﺷﺎﻣﻞ )‪ ۵۲‬ﺩﺭﺻﺪ( ‪ ۴۵‬ﺍﻳﺰﻭﻟﻪ ﺍﻧﺘﺮﻭﮐﻮﮐﻮﺱ ﻓﺴﻴﻮﻡ ﺑﻮﺩﻧﺪ‪ ۴۲/۲ .‬ﺩﺭﺻﺪ‬ ‫ﺍﺯ ﺳﻮﻳﻪﻫﺎﻱ ﺍﻧﺘﺮﻭﮐﻮﮐﻮﺱ ﻓﺴﻴﻮﻡ ﺑﻪ ﻭﻧﮑﻮﻣﺎﻳﺴﻴﻦ ﻣﻘﺎﻭﻡ ﺑﻮﺩﻩ ﻭ ﮊﻧﻮﺗﻴﭗ ‪ vanA‬ﺭﺍ ﻧﺸﺎﻥ ﻣﻲﺩﺍﺩﻧﺪ‪ .‬ﺗﻤﺎﻣﻲ ﺳﻮﻳﻪﻫﺎﻱ ‪ VRE‬ﻧﺴﺒﺖ ﺑﻪ ﺁﻧﺘﻲﺑﻴﻮﺗﻴﮏﻫﺎﻱ‬ ‫ﺁﻣﭙﻲﺳﻴﻠﻴﻦ‪ ،‬ﺟﻨﺘﺎﻣﻴﺴﻴﻦ‪ ،‬ﺳﻴﭙﺮﻭﻓﻠﻮﮐﺴﺎﺳﻴﻦ ﻭ ﺍﺭﻳﺘﺮﻭﻣﺎﻳﺴﻴﻦ ﻭ ‪ ۷۸‬ﺩﺭﺻﺪ ﺁﻥﻫﺎ ﺑﻪ ﻧﻴﺘﺮﻭﻓﻮﺭﺍﻧﺘﻮﺋﻴﻦ ﻣﻘﺎﻭﻡ ﻭ ﻫﻤﮕﻲ ﻧﺴﺒﺖ ﺑﻪ ﺁﻧﺘﻲﺑﻴﻮﺗﻴﮏﻫﺎﻱ ﻟﻴﻨﺰﻭﻻﻳﺪ‬ ‫ﻭ ﮐﻮﻳﻨﻮﭘﺮﻳﺴﺘﻴﻦ ‪ -‬ﺩﺍﻟﻔﻮﭘﺮﻳﺴﺘﻴﻦ ﺣﺴﺎﺱ ﺑﻮﺩﻧﺪ‪ .‬ﺩﺭ ﺳﻮﻳﻪﻫﺎﻱ ﻣﻘﺎﻭﻡ ﺑﻪ ﻭﻧﮑﻮﻣﺎﻳﺴﻴﻦ ‪ MIC50‬ﺑـﻴﺶ ﺍﺯ ‪۱۲۸‬ﻭ ‪ MIC90‬ﺑـﻴﺶ ﺍﺯ ‪ ۲۵۶‬ﻣﻴﻠـﻲﮔـﺮﻡ ﺩﺭ‬ ‫ﻣﻴﻠﻲﻟﻴﺘﺮ ﺗﻌﻴﻴﻦ ﮔﺮﺩﻳﺪ‪.‬‬ ‫ﻧﺘﻴﺠﻪ ﮔﻴﺮﻱ‪ :‬ﺍﻓﺰﺍﻳﺶ ﺳﻮﻳﻪﻫﺎﻱ ﻣﻘﺎﻭﻡ ﺑﻪ ﻭﻧﮑﻮﻣﺎﻳﺴﻴﻦ ﺍﻧﺘﺮﻭﮐﻮﮐﺲ ﻓﺴﻴﻮﻡ ﺑﺎ ﺍﻟﮕﻮﻫﺎﻱ ﻣﻘﺎﻭﻣﺘﻲ ﭘﺮ ﺧﻄﺮ ﺗﻬﺪﻳﺪﻱ ﺟﺪﻱ ﺩﺭ ﺑﻴﻤﺎﺭﺳﺘﺎﻥﻫﺎﻱ ﺍﻳﺮﺍﻥ ﺑﻮﺩﻩ‪،‬‬ ‫ﻣﻮﺟﺐ ﻣﺤﺪﻭﺩﻳﺖ ﺩﺭ ﮔﺰﻳﻨﻪﻫﺎﻱ ﺩﺭﻣﺎﻧﻲ ﺑﺮﺍﻱ ﺑﻴﻤﺎﺭﺍﻥ ﻣﺒﺘﻼ ﺑﻪ ﻋﻔﻮﻧﺖﻫﺎﻱ ﻧﺎﺷﻲ ﺍﺯ ﺍﻧﺘﺮﻭﮐﻮﮐﺲ ﻓﺴﻴﻮﻡ ﻣﻲ ﺷﻮﺩ‪.‬‬ ‫ﻭﺍﮊﮔﺎﻥ ﮐﻠﻴﺪﻱ‪ :‬ﺍﻧﺘﺮﻭﮐﻮﮐﻮﺱ ﻓﺴﻴﻮﻡ‪ ،‬ﻋﻔﻮﻧﺖ ﺍﺩﺭﺍﺭﻱ‪ ،‬ﻣﻘﺎﻭﻣﺖ‪ ،‬ﻭﻧﮑﻮﻣﺎﻳﺴﻴﻦ‬ ‫ﻣﻘﺪﻣﻪ‬ ‫ﻋﻔﻮﻧـــﺖﻫـــﺎﻱ ﻣﺠـــﺎﺭﻱ ﺍﺩﺭﺍﺭﻱ ‪ ۳۰‬ﺗـــﺎ ‪ ۴۰‬ﺩﺭﺻـــﺪ ﺍﺯ‬ ‫ﻣﺠﻤﻮﻉ ﻋﻔﻮﻧﺖﻫﺎﻱ ﺍﮐﺘﺴﺎﺑﻲ ﺑﻴﻤﺎﺭﺳﺘﺎﻧﻲ ﺭﺍ ﺗـﺸﮑﻴﻞ ﻣـﻲﺩﻫﻨـﺪ‬ ‫ﻭ ﺷﺎﻳﻊﺗﺮﻳﻦ ﻋﻔﻮﻧﺖ ﺍﻳﺠﺎﺩ ﺷﺪﻩ ﻧﺎﺷﻲ ﺍﺯ ﺍﻧﺘﺮﻭﮐﻮﮎﻫﺎ ﻣﻲﺑﺎﺷﺪ‪.‬‬ ‫ﺍﻧﺘﺮﻭﮐﻮﮎﻫﺎ ﻋﺎﻣـﻞ ﺷـﺎﻳﻊ ﺳﻴـﺴﺘﻴﺖ‪ ،‬ﭘﺮﻭﺳـﺘﺎﺗﻴﺖ ﻭ ﺍﭘﻴـﺪﻣﻴﺖ‬ ‫‪ - ۱‬ﺩﺍﻧﺸﺠﻮﻱ ﺩﻛﺘﺮﺍﻱ ﺑﺎﻛﺘﺮﻱ ﺷﻨﺎﺳﻲ‪ ،‬ﺩﺍﻧﺸﻜﺪﻩﻱ ﻋﻠﻮﻡ ﭘﺰﺷﻜﻲ‪ ،‬ﺩﺍﻧﺸﮕﺎﻩ ﺗﺮﺑﻴﺖ ﻣﺪﺭﺱ ﺗﻬﺮﺍﻥ‬ ‫‪ - ۲‬ﺩﻛﺘﺮﺍﻱ ﺗﺨﺼﺼﻲ ﻣﻴﻜﺮﻭﺏ ﺷﻨﺎﺳﻲ‪ ،‬ﺩﺍﻧﺸﻴﺎﺭ ﮔﺮﻭﻩ ﺑﺎﻛﺘﺮﻱ ﺷﻨﺎﺳﻲ‪ ،‬ﺩﺍﻧﺸﻜﺪﻩﻱ ﻋﻠﻮﻡ ﭘﺰﺷﻜﻲ‪ ،‬ﺩﺍﻧﺸﮕﺎﻩ ﺗﺮﺑﻴﺖ ﻣﺪﺭﺱ ﺗﻬﺮﺍﻥ‬ ‫‪ - ٣‬ﻓﻮﻕ ﺗﺨﺼﺺ ﮔﻮﺍﺭﺵ ﻭ ﻛﺒﺪ‪ ،‬ﺍﺳﺘﺎﺩ ﻣﺮﮐﺰ ﺗﺤﻘﻴﻘﺎﺕ ﮔﻮﺍﺭﺵ ﻭﮐﺒﺪ‪ ،‬ﺩﺍﻧﺸﮕﺎﻩ ﻋﻠﻮﻡ ﭘﺰﺷﮑﻲ ﺷﻬﻴﺪ ﺑﻬﺸﺘﻲ‪ ،‬ﺗﻬﺮﺍﻥ‬ ‫‪ - ٤‬ﺩﻛﺘﺮﺍﻱ ﺗﺨﺼﺼﻲ ﺑﺎﻛﺘﺮﻱ ﺷﻨﺎﺳﻲ‪ ،‬ﺩﺍﻧﺸﻴﺎﺭ ﻣﺮﮐﺰ ﺗﺤﻘﻴﻘﺎﺕ ﺑﻴﻮﻟﻮﮊﻱ ﻣﻮﻟﮑﻮﻟﻲ ﺩﺍﻧﺸﮕﺎﻩ ﻋﻠﻮﻡ ﭘﺰﺷﮑﻲ ﺑﻘﻴﻪ ﺍﻟﻪ‪ ،‬ﺗﻬﺮﺍﻥ‬ ‫‪ - ٥‬ﺩﻛﺘﺮﺍﻱ ﺗﺨﺼﺼﻲ ﺑﺎﻛﺘﺮﻱ ﺷﻨﺎﺳﻲ‪ ،‬ﻣﺮﻛﺰ ﺗﺤﻘﻴﻘﺎﺕ ﮔﻮﺍﺭﺵ‪ ،‬ﺩﺍﻧﺸﮕﺎﻩ ﻋﻠﻮﻡ ﭘﺰﺷﻜﻲ ﺷﻬﻴﺪ ﺑﻬﺸﺘﻲ‬ ‫‪122‬‬ ‫ﻓﺮﺍﻭﺍﻧﻲ ﻣﻘﺎﻭﻣﺖ ﺑﻪ ﻭﻧﮑﻮﻣﺎﻳﺴﻴﻦ ﺩﺭ ﻋﻔﻮﻧﺖﻫﺎﻱ ﺍﺩﺭﺍﺭﻱ‬ ‫ﺩﺭ ﺍﻓﺮﺍﺩ ﻣﺴﻦ ﻣﻲﺑﺎﺷﻨﺪ ﮐﻪ ﺩﺭ ﺍﻳﻦ ﺍﻓﺮﺍﺩ‪ ،‬ﻋﻔﻮﻧﺖﻫـﺎﻱ ﺩﺳـﺘﮕﺎﻩ‬ ‫)ﺩﻱ ﺁﻻﻧـﻴﻦ ‪ -‬ﺩﻱ ﺁﻻﻧـﻴﻦ( ﺩﺭ ﻣﺮﺣﻠـﻪﻱ ﺁﺧـﺮ ﭘـﻴﺶ ﺳــﺎﺯﻫﺎﻱ‬ ‫ﺍﺩﺭﺍﺭﻱ ﻓﻮﻗﺎﻧﻲ ﻣﻲﺗﻮﺍﻧـﺪ ﻣﻨﺠـﺮ ﺑـﻪ ﺑـﺎﮐﺘﺮﻳﻤﻲ ﺷـﺪﻩ‪ ،‬ﺩﺭ ﺯﻧـﺎﻥ‬ ‫ﭘﻨﺘﺎﭘﭙﺘﻴﺪﻱ ﭘﭙﺘﻴﺪ ﻭ ﮔﻠﻴﻜﺎﻥ ﻛﻤـﭙﻠﻜﺲﻫـﺎﻳﻲ ﺗـﺸﻜﻴﻞ ﻣـﻲﺩﻫﻨـﺪ‬ ‫ﺟــﻮﺍﻥ ﻋﺎﻣــﻞ ﺳﻴــﺴﺘﻴﺖ ﻣــﺰﻣﻦ ﻏﻴــﺮ ﺷــﺎﻳﻊ ﻣــﻲﺑﺎﺷــﺪ )‪.(۱‬‬ ‫ﺑﺎﻋﺚ ﺍﺯ ﺑﻴﻦ ﺭﻓﺘﻦ ﺍﺳﺘﺤﻜﺎﻡ ﺳﺎﺧﺘﺎﺭﻱ ﺩﻳـﻮﺍﺭﻩﻱ ﺳـﻠﻮﻟﻲ ﻭ ﺩﺭ‬ ‫ﺍﻧﺘﺮﻭﮐﻮﮎﻫﺎ‪ ،‬ﮐﻮﮐﺴﻲﻫﺎﻱ ﮔﺮﻡ ﻣﺜﺒﺘﻲ ﻫﺴﺘﻨﺪ ﮐﻪ ﺑﺨﺸﻲ ﺍﺯ ﻓﻠﻮﺭ‬ ‫ﻧﺘﻴﺠﻪ ﻣﺮﮒ ﺳﻠﻮﻝ ﻣﻲ ﺷﻮﺩ‪ .‬ﺑﺮ ﺍﺳﺎﺱ ﺧـﺼﻮﺻﻴﺎﺕ ﻓﻨـﻮﺗﻴﭙﻲ ﻭ‬ ‫ﺗﻨﻔﺴﻲ ﻓﻮﻗﺎﻧﻲ‪ ،‬ﻣﺠﺎﺭﻱ ﺻﻔﺮﺍﻭﻱ‪ ،‬ﺣﻔﺮﻩ ﻱ ﺩﻫﺎﻥ‪ ،‬ﻣﺜﺎﻧﻪ‪ ،‬ﻭﺍﮊﻥ ﻭ‬ ‫)‪ (vanA, vanB, vanD, vanE, vanG, vanL, vanM, vanN‬ﻭ‬ ‫ﺩﻳﮕﺮ ﻧﻘﺎﻁ ﻧﻴـﺰ ﮐﻠـﻮﻧﻴﺰﻩ ﺷـﻮﻧﺪ‪ .‬ﻓﻠـﻮﺭ ﮐﻮﻣﻨـﺴﺎﻝ ﺧـﻮﺩ ﺑﻴﻤـﺎﺭ‬ ‫ﻳـﮏ ﻧـﻮﻉ ﻣﻘﺎﻭﻣــﺖ ﺫﺍﺗـﻲ ‪ vanC‬ﮔــﺰﺍﺭﺵ ﮔﺮﺩﻳـﺪﻩ ﺍﺳــﺖ‪.‬‬ ‫ﻣﻬﻢﺗﺮﻳﻦ ﻣﻨﺒﻊ ﻋﻔﻮﻧﺖﻫﺎﻱ ﺍﻧﺘﺮﻭﮐﻮﮐﻲ ﻣﺤﺴﻮﺏ ﻣـﻲﮔـﺮﺩﺩ )‪(۲‬‬ ‫ﻣﻘﺎﻭﻣـﺖ ﻧـﻮﻉ ‪ vanA‬ﻭ ‪ vanB‬ﻏﺎﻟـﺐﺗـﺮﻳﻦ ﻧـﻮﻉ ﻣﻘﺎﻭﻣـﺖ‬ ‫ﻣﻴﮑﺮﻭﺑﻲ ﺭﻭﺩﻩ ﻱ ﺍﻧﺴﺎﻥ ﻭ ﺣﻴﻮﺍﻧﺎﺕ ﺑﻮﺩﻩ‪ ،‬ﻣﻲﺗﻮﺍﻧﻨﺪ ﺩﺭ ﺩﺳـﺘﮕﺎﻩ‬ ‫ﮊﻧﻮﺗﻴﭙﻲ ﺗﺎ ﮐﻨﻮﻥ ﻫﻔﺖ ﻧﻮﻉ ﻣﻘﺎﻭﻣﺖ ﺍﮐﺘﺴﺎﺑﻲ ﺑـﻪ ﻭﻧﮑﻮﻣﺎﻳـﺴﻴﻦ‬ ‫ﺩﻭ ﮔﻮﻧﻪ ﺍﻧﺘﺮﻭﮐﻮﮐﻮﺱ ﻓﺴﻴﻮﻡ ﻭ ﺍﻧﺘﺮﻭﮐﻮﮐﻮﺱ ﻓﮑﺎﻟﻴﺲ ﺑـﻴﺶ ﺍﺯ‬ ‫ﺩﺭ ﺍﻳﺠﺎﺩ ﻣﻘﺎﻭﻣﺖ ﺑـﻪ ﻭﻧﮑﻮﻣﺎﻳـﺴﻴﻦ ﻣـﻲﺑﺎﺷـﻨﺪ‪ ،‬ﺩﺳـﺘﻪﻱ ﮊﻧـﻲ‬ ‫ﺳﺎﻳﺮ ﮔﻮﻧﻪﻫﺎﻱ ﺍﻧﺘﺮﻭﮐﻮﮎ ﺩﺭ ﺍﻳﺠـﺎﺩ ﻋﻔﻮﻧـﺖﻫـﺎﻱ ﺍﻧﺘﺮﻭﮐـﻮﮐﻲ‬ ‫‪ vanA‬ﻣﻘﺎﻭﻣــﺖ ﺳــﻄﺢ ﺑــﺎﻻ ﻭ ﻗﺎﺑــﻞ ﺍﻟﻘــﺎ ﺑــﻪ ﻭﻧﻜﻮﻣﺎﻳــﺴﻴﻦ‬ ‫ﺩﺧﻴﻞ ﻣﻲﺑﺎﺷﻨﺪ )‪ .(۳‬ﻣﻬـﻢﺗـﺮﻳﻦ ﺩﻟﻴـﻞ ﺍﻫﻤﻴـﺖ ﺍﻧﺘﺮﻭﮐـﻮﮎﻫـﺎ‬ ‫)‪ (MIC ≥ 64 -1000 µg/ml‬ﻭ ﺗﻴﻜـﻮﭘﻼﻧﻴﻦ‪MIC ≥ 16-‬‬ ‫ﻣﻘﺎﻭﻣﺖ ﺫﺍﺗﻲ ﺁﻥﻫـﺎ ﺑـﻪ ﺁﻧﺘـﻲﺑﻴﻮﺗﻴـﮏﻫـﺎﻱ ﻣﻌﻤـﻮﻝ ﻭ ﮐـﺴﺐ‬ ‫)‪ (512 µg/ml‬ﺭﺍ ﺍﻳﺠــﺎﺩ ﻣــﻲﻛﻨــﺪ ﻛــﻪ ﻣﻌﻤــﻮﻻﹰ ﺍﺯ ﻃﺮﻳــﻖ‬ ‫ﻣﻘﺎﻭﻣﺖ ﺩﺭ ﺑﺮﺍﺑﺮ ﺗﻘﺮﻳﺒﺎ ﺗﻤﺎﻣﻲ ﺁﻧﺘﻲﺑﻴﻮﺗﻴـﮏﻫـﺎﻱ ﺩﺭ ﺩﺳـﺘﺮﺱ‬ ‫ﺗﺮﺍﻧﺴﭙﻮﺯﻭﻥ ‪ Tn1546‬ﻣﻨﺘﻘـﻞ ﻣـﻲﮔـﺮﺩﺩ‪ .‬ﺩﺳـﺘﻪ ﮊﻧـﻲ ‪vanB‬‬ ‫ﺍﻧﺘﺮﻭﮐــﻮﮎﻫــﺎ ﺑـﻪﺧــﺼﻮﺹ ﺍﻧﺘﺮﻭﮐــﻮﮎﻫــﺎﻱ ﻣﻘــﺎﻭﻡ ﺩﺭ ﺑﺮﺍﺑــﺮ‬ ‫)‪ (MIC= 4 -16 µg/ml‬ﻣﻲﺷﻮﺩ ﻭ ﺑﻪ ﺗﻴﻜـﻮﭘﻼﻧﻴﻦ ﺣـﺴﺎﺱ‬ ‫ﻭﻧﮑﻮﻣﺎﻳــﺴﻴﻦ )‪ (VRE‬ﺑﻴﻤــﺎﺭﻱﺯﺍﻱ ﻋﻤــﺪﻩ ﺩﺳــﺘﮕﺎﻩ ﺍﺩﺭﺍﺭﻱ‬ ‫ﺍﺳﺖ ﮐﻪ ﻣﻌﻤﻮﻻﹰ ﺑﺮ ﺭﻭﻱ ﻛﺮﻭﻣﻮﺯﻭﻡ ﻗـﺮﺍﺭ ﺩﺍﺭﻧـﺪ ﻭﻟـﻲ ﻣﻤﻜـﻦ‬ ‫ﻣﻲﺑﺎﺷﻨﺪ‪ .‬ﻃﺒﻖ ﻣﻄﺎﻟﻌﺎﺕ ﻭ ﻧﺘﺎﻳﺞ ﻣﻨﺘﺸﺮ ﺷـﺪﻩ ﺍﮐﺜـﺮ ‪ VRE‬ﻫـﺎ‬ ‫ﺍﺳﺖ ﺑﺮ ﺭﻭﻱ ﭘﻼﺳﻤﻴﺪ ﻧﻴﺰ ﺣﻤـﻞ ﺷـﻮﺩ )‪ (۷- ۱۲‬ﺍﻭﻟـﻴﻦ ﻣـﻮﺭﺩ‬ ‫ﻇﻬﻮﺭ ﺳـﻮﻳﻪﻫـﺎﻱ ‪ VRE‬ﮐﻨﺘـﺮﻝ ﻭ ﺩﺭﻣـﺎﻥ ﻋﻔﻮﻧـﺖ ﻧﺎﺷـﻲ ﺍﺯ‬ ‫ﺑﻌﺪ ﺍﺯ ﺍﻳﺎﻻﺕ ﻣﺘﺤﺪﻩ ﻭ ﺗﺎ ﺑﻪ ﺍﻣﺮﻭﺯ ﻇﻬﻮﺭ ‪ VRE‬ﺩﺭ ﺑﺴﻴﺎﺭﻱ ﺍﺯ‬ ‫ﺍﻧﺘﺮﻭﮐﻮﮐﻮﺱ ﻓﺴﻴﻮﻡ ﺭﺍ ﺩﭼﺎﺭ ﻣﺸﮑﻞ ﮐﺮﺩﻩ ﺍﺳﺖ‪ ،‬ﭼﺮﺍ ﮐـﻪ ﺍﻳـﻦ‬ ‫ﮐﺸﻮﺭﻫﺎ ﺍﺯ ﺟﻤﻠﻪ ﺍﻳـﺮﺍﻥ ﮔـﺰﺍﺭﺵ ﺷـﺪﻩ ﺍﺳـﺖ‪ .‬ﺑـﻪﻃـﻮﺭﻱﮐـﻪ‬ ‫ﻧﻮﻉ ﺳﻮﻳﻪﻫـﺎ ﻋـﻼﻭﻩ ﺑـﺮ ﻣﻘﺎﻭﻣـﺖ ﺫﺍﺗـﻲ ﺩﺭ ﺑﺮﺍﺑـﺮ ﺑـﺴﻴﺎﺭﻱ ﺁﺯ‬ ‫ﺍﻣﺮﻭﺯﻩ ﺑﻪ ﻋﻨﻮﺍﻥ ﻳﮏ ﭘﺎﺗﻮﮊﻥ ﻣﻬـﻢ ﺑﻴﻤﺎﺭﺳـﺘﺎﻧﻲ ﺩﺭ ﻧﻈـﺮ ﮔﺮﻓﺘـﻪ‬ ‫ﺁﻧﺘﻲﺑﻴﻮﺗﻴﮏﻫﺎﻱ ﻣﻮﺟﻮﺩ ﻣﻲﺷﻮﻧﺪ )‪۵‬ﻭ ‪ .(۴‬ﻣﻨﺎﺳﺐﺗﺮﻳﻦ ﺩﺭﻣـﺎﻥ‬ ‫ﻫﺰﻳﻨﻪﻫﺎﻱ ﺩﺭﻣﺎﻧﻲ ﻧﺎﺷﻲ ﺍﺯ ﺳﻮﻳﻪﻫﺎﻱ ‪ VRE‬ﺩﺭ ﺑﻴﻤﺎﺭﺳﺘﺎﻥﻫـﺎ‪،‬‬ ‫ﺑــﺮﺍﻱ ﻋﻔﻮﻧــﺖﻫــﺎﻱ ﺍﻧﺘﺮﻭﮐــﻮﮐﻲ ﺗﺮﮐﻴ ـﺐ ﻳ ـﮏ ﺁﻧﺘ ـﻲﺑﻴﻮﺗﻴ ـﮏ‬ ‫ﺍﻃﻼﻉ ﺍﺯ ﻧﻮﻉ ﭘﺎﺗﻮﮊﻥﻫﺎﻱ ﺩﺧﻴﻞ ﺩﺭ ﺍﻳﺠﺎﺩ ﻋﻔﻮﻧـﺖﻫـﺎﻱ ﺍﺩﺭﺍﺭﻱ‬ ‫ﮔﻠﻴﮑﻮﭘﭙﺘﻴﺪ ﻣﺎﻧﻨﺪ ﻭﻧﮑﻮﻣﺎﻳﺴﻴﻦ ﻳـﺎ ﻳـﮏ ﺁﻧﺘـﻲﺑﻴﻮﺗﻴـﮏ ﺑﺘﺎﻻﮐﺘـﺎﻡ‬ ‫ﻭ ﻫﻤﭽﻨﻴﻦ ﺍﻟﮕﻮﻫﺎﻱ ﻣﻘـﺎﻭﻣﺘﻲ ﺁﻥﻫـﺎ ﺩﺭ ﮐﻨﺘـﺮﻝ ﻭ ﺩﺭﻣـﺎﻥ ﺍﻳـﻦ‬ ‫ﻣﺎﻧﻨــﺪ ﺟﻨﺘﺎﻣﻴــﺴﻴﻦ ﻣــﻲﺑﺎﺷــﺪ‪ .‬ﮐــﻪ ﺍﮐﺜــﺮ ﺳــﻮﻳﻪﻫــﺎﻱ ‪VRE‬‬ ‫ﻣﻄﺎﻟﻌﻪ ﺑﺮﺭﺳﻲ ﻓﺮﺍﻭﺍﻧﻲ ﻣﻘﺎﻭﻣﺖ ﺑﻪ ﻭﻧﮑﻮﻣﺎﻳـﺴﻴﻦ ﻭ ﻫﻤﭽﻨﻴﻨـﻴﻦ‬ ‫ﺑــﻪ ﻏﻠﻈــﺖﻫــﺎﻱ ﺑــﺎﻻﻱ ﻭﻧﮑﻮﻣﺎﻳــﺴﻴﻦ‪ ،‬ﺁﻣﻴﻨﻮﮔﻠﻴﮑﻮﺯﻳــﺪﻫﺎ ﻭ‬ ‫ﻣﻘﺎﻳــﺴﻪ ﺍﻟﮕﻮﻫــﺎﻱ ﻣﻘﺎﻭﻣــﺖ ﺁﻧﺘــﻲﺑﻴــﻮﺗﻴﮑﻲ ﺩﺭ ﺳــﻮﻳﻪﻫــﺎﻱ‬ ‫ﺑﺘﺎﻻﮐﺘﺎﻡﻫﺎ ﻣﻘﺎﻭﻣﺖ ﻧﺸﺎﻥ ﻣﻲﺩﻫﻨﺪ )‪ .(۶‬ﮔﻠﻴﻜﻮﭘﭙﺘﻴـﺪﻫﺎ ﺑـﺎ ﻣﻬـﺎﺭ‬ ‫ﺍﻧﺘﺮﻭﮐﻮﮐﻮﺱ ﻓﺴﻴﻮﻡ ﺟﺪﺍ ﺷﺪﻩ ﺍﺯ ﻋﻔﻮﻧﺖﻫـﺎﻱ ﺍﺩﺭﺍﺭﻱ ﺑﻴﻤـﺎﺭﺍﻥ‬ ‫ﺳﻨﺘﺰ ﺩﻳﻮﺍﺭﻩ ﺳﻠﻮﻟﻲ ﺑﺮ ﺑﺎﻛﺘﺮﻱﻫﺎﻱ ﮔﺮﻡ ﻣﺜﺒﺖ ﺗﺎﺛﻴﺮ ﻣﻲﮔﺬﺍﺭﻧـﺪ‪.‬‬ ‫ﺑﺴﺘﺮﻱ ﺩﺭ ﺑﺨﺶﻫﺎﻱ ﻣﺨﺘﻠﻒ ﭼﻬﺎﺭ ﺑﻴﻤﺎﺭﺳﺘﺎﻥ ﺁﻣﻮﺯﺷﻲﺩﺭ ﺷﻬﺮ‬ ‫ﻣ ـﻲﺑﺎﺷــﺪ )‪ .(۴‬ﺩﺭ ﺑﺨــﺶﻫــﺎﻱ ﭘــﺮ ﺧﻄــﺮﻱ ﻫﻤﭽــﻮﻥ ‪ICU‬‬ ‫ﻣﺘﻌﻠﻖ ﺑﻪ ﺍﻧﺘﺮﻭﮐﻮﮐﻮﺱ ﻓﺴﻴﻮﻡ ﻣﻲﺑﺎﺷﻨﺪ )‪.(۱‬‬ ‫ﺁﻧﺘــﻲﺑﻴﻮﺗﻴــﮏﻫــﺎ ﻗــﺎﺩﺭ ﺑــﻪ ﮐــﺴﺐ ﮊﻥﻫــﺎﻱ ﻣﻘﺎﻭﻣــﺖ ﺑــﻪ‬ ‫ﻣﺎﻧﻨﺪ ﺁﻣﭙﻲﺳﻴﻠﻴﻦ ﺑﻪﻫﻤﺮﺍﻩ ﻳﮏ ﺁﻧﺘـﻲﺑﻴﻮﺗﻴـﮏ ﺁﻣﻴﻨﻮﮔﻠﻴﮑﻮﺯﻳـﺪﻱ‬ ‫ﮔﻠﻴﻜﻮﭘﭙﺘﻴــﺪﻫﺎ ﺭﻭﻱ ﺳــﻄﺢ ﺧــﺎﺭﺟﻲ ﺳــﻠﻮﻝ ﺑــﺎ ﺍﻧﺘﻬﺎﻫــﺎﻱ‬ ‫ﺑﺎﻋﺚ ﻳﻚ ﻣﻘﺎﻭﻣﺖ ﻗﺎﺑﻞ ﺍﻟﻘﺎ ﺳﻄﺢ ﭘﺎﻳﻴﻦ ﺗﺎ ﺑﺎﻻ ﺑﻪ ﻭﻧﻜﻮﻣﺎﻳﺴﻴﻦ‬ ‫ﻣﻘﺎﻭﻣﺖ ﺑﻪ ﻭﻧﮑﻮﻣﺎﻳﺴﻴﻦ ﺍﺯ ﺍﺭﻭﭘﺎ ﮔﺰﺍﺭﺵ ﮔﺮﺩﻳـﺪ ﻭ ﻳـﮏ ﺳـﺎﻝ‬ ‫ﻣ ـﻲﺷــﻮﻧﺪ )‪۱۴‬ﻭ ‪ .(۱۳‬ﺑــﺎ ﺗﻮﺟــﻪ ﺑــﻪ ﺍﻓــﺰﺍﻳﺶ ﻣــﺮﮒ ﻭﻣﻴ ـﺮ ﻭ‬ ‫ﻋﻔﻮﻧﺖﻫﺎ ﺍﻫﻤﻴﺖ ﺑﺴﻴﺎﺭ ﺣﺎﻳﺰ ﺍﻫﻤﻴﺖ ﻣﻲﺑﺎﺷـﺪ‪ .‬ﻫـﺪﻑ ﺍﺯ ﺍﻳـﻦ‬ ‫ﺗﻬﺮﺍﻥ ﺑﻮﺩ‪.‬‬ ‫ﻣﺠﻠﻪﻱ ﻋﻠﻤﻲ‪ ،‬ﭘﮋﻭﻫﺸﻲ ﺩﺍﻧﺸﮕﺎﻩ ﻋﻠﻮﻡ ﭘﺰﺷﮑﻲ ﻭ ﺧﺪﻣﺎﺕ ﺑﻬﺪﺍﺷﺘﻲ‪ ،‬ﺩﺭﻣﺎﻧﻲ ﺯﻧﺠـﺎﻥ‪ ،‬ﺩﻭﺭﻩﻱ ‪ ,٢٢‬ﺷﻤﺎﺭﻩﻱ ‪ ,٩١‬ﺧﺮﺩﺍﺩ ﻭ ﺗﻴﺮ ‪١٣٩٣‬‬ ‫ﻟﻴﻠﻲ ﺷﻜﻮﻫﻲ ﺯﺍﺩﻩ ﻭ ﻫﻤﻜﺎﺭﺍﻥ‬ ‫ﺭﻭﺵ ﺑﺮﺭﺳﻲ‬ ‫ﻧﻤﻮﻧﻪﮔﻴﺮﻱ ﻭ ﺷﻨـﺎﺳـﺎﻳﻲ ﮔﻮﻧﻪﻫﺎﻱ ﺍﻧﺘﺮﻭﮐﻮﮎ‪ :‬ﻧﻤــﻮﻧﻪﻫﺎﻱ‬ ‫ﺍﺩﺭﺍﺭﻱ ﺍﺯ ﺑﻴﻤﺎﺭﺍﻥ ﺑﺴﺘﺮﻱ ﺩﺭ ﺑﺨـﺶﻫـﺎﻱ ﻣﺨﺘﻠـﻒ ﺍﺯ ﺟﻤﻠـﻪ‬ ‫‪123‬‬ ‫ﺩﺭﺟــــﻪﻱ‪ ۴۵ ،‬ﺛﺎﻧﻴــــﻪ‪ ۳۵ ،‬ﺳــــﻴﮑﻞ؛ ﺗﮑﺜﻴــــﺮ ﻧﻬــــﺎﻳﻲ‪:‬‬ ‫‪ ۷۲‬ﺩﺭﺟﻪ ‪ ۵‬ﺩﻗﻴﻘﻪ‪ ،‬ﻳﮏ ﺳﻴﮑﻞ ﺍﺳﺘﻔﺎﺩﻩ ﮔﺮﺩﻳﺪ )‪.(۱۵‬‬ ‫ﺑﺮﺭﺳ ﻲ ﺣﺴﺎﺳﻴﺖ ﺁﻧﺘـ ﻲﻣﻴ ﮑﺮﻭﺑـ ﻲ ﻭ ﮊﻧﻮﺗﻴـﭗ ﻣﻘﺎﻭﻣـﺖ ﺑـﻪ‬ ‫‪ ،ICU‬ﻧﻔﺮﻭﻟﻮﮊﻱ‪ ،‬ﭘﻴﻮﻧﺪ ﮐﻠﻴﻪ‪ ،‬ﭘﻴﻮﻧﺪ ﮐﺒﺪ‪ ،‬ﻫﻤﺎﺗﻮﻟﻮﮊﻱ‪ ،‬ﮔﻮﺍﺭﺵ‪،‬‬ ‫ﻭﻧﮑﻮﻣﺎﻳﺴﻴﻦ‪ :‬ﺣﺴﺎﺳﻴﺖ ﺁﻧﺘﻲﺑﻴـﻮﺗﻴﮑﻲ ﺩﺭ ﺑﺮﺍﺑـﺮ ﺩﻳـﺴﮏﻫـﺎﻱ‬ ‫)ﻃﺎﻟﻘﺎﻧﻲ‪ ،‬ﻣﻔﻴﺪ‪ ،‬ﻟﻘﻤﺎﻥ ﻭ ﻟﺒﺎﻓﻲ ﻧﮋﺍﺩ( ﺩﺭ ﺷﻬﺮ ﺗﻬﺮﺍﻥ ﺩﺭ ﻓﺎﺻﻠﻪﻱ‬ ‫ﺁﻣﭙﻲ ﺳﻴﻠﻴﻦ )‪ ۱۰‬ﻣﻴﮑﺮﻭﮔﺮﻡ(‪ ،‬ﺟﻨﺘﺎﻣﻴـﺴﻴﻦ )‪ ۱۲۰‬ﻣﻴﮑﺮﻭﮔـﺮﻡ(‪،‬‬ ‫ﺟﺮﺍﺣﻲ‪ ،‬ﺍﺭﺗﻮﭘﺪﻱ‪ ،‬ﻗﻠﺐ ﻭﺍﻧﮑﻮﻟﻮﮊﻱ ﭼﻬﺎﺭ ﺑﻴﻤﺎﺭﺳﺘﺎﻥ ﺁﻣﻮﺯﺷـﻲ‬ ‫ﺷﻬﺮﻳﻮﺭ ﺳﺎﻝ ‪ ۹۰‬ﺗﺎ ﺧـﺮﺩﺍﺩ ﺳـﺎﻝ ‪ ۹۱‬ﺟﻤـﻊ ﺁﻭﺭﻱ ﺷـﺪ‪ .‬ﺍﻳـﻦ‬ ‫ﻭﻧﮑﻮﻣﺎﻳﺴﻴﻦ )‪ ۳۰‬ﻣﻴﮑﺮﻭﮔـﺮﻡ(‪ ،‬ﺗﻴﮑـﻮﭘﻼﻧﻴﻦ )‪ ۳۰‬ﻣﻴﮑﺮﻭﮔـﺮﻡ(‪،‬‬ ‫ﻧﻴﺘﺮﻭﻓﻮﺭﺍﻧﺘــــﻮﺋﻴﻦ )‪ ۳۰۰‬ﻣﻴﮑﺮﻭﮔــــﺮﻡ(‪ ،‬ﺳﻴﭙﺮﻭﻓﻠﻮﮐــــﺴﺎﺳﻴﻦ‬ ‫ﻧﻤﻮﻧﻪﻫﺎ ﺍﺯ ﺁﺯﻣﺎﻳﺸﮕﺎﻩﻫﺎﻱ ﻣﻴﮑﺮﻭﺏﺷﻨﺎﺳﻲ ﺑﻴﻤﺎﺭﺳﺘﺎﻥﻫﺎﻱ ﻣﻮﺭﺩ‬ ‫)‪ ۵‬ﻣﻴﮑﺮﻭﮔــﺮﻡ( ﺍﺭﻳﺘﺮﻭﻣﺎﻳـﺴﻴﻦ)‪ ۱۵‬ﻣﻴﮑﺮﻭﮔــﺮﻡ(‪ ،‬ﺗﺘﺮﺍﺳــﺎﻳﮑﻠﻴﻦ‬ ‫ﺍﻧﺘﺮﻭﮐـﻮﮎ ﺗﺤـﺖ ﻋﻨـﻮﺍﻥ )‪Enterococcosel (BBL, USA‬‬ ‫ﺩﺍﻟﻔﻮﭘﺮﻳـــﺴﺘﻴﻦ )ﺳﻴﻨﺮﺳـــﻴﺪ( )‪ ۱۵‬ﻣﻴﮑﺮﻭﮔـــﺮﻡ(‪ ،‬ﻟﻴﻨﺰﻭﻻﻳـــﺪ‬ ‫ﻣﻄﺎﻟﻌﻪ ﺟﻤﻊﺁﻭﺭﻱ ﺷﺪﻧﺪ‪ .‬ﺳـﭙﺲ ﺑـﺮ ﺭﻭﻱ ﻣﺤـﻴﻂ ﺍﺧﺘـﺼﺎﺻﻲ‬ ‫ﻛﺸﺖ ﺩﺍﺩﻩ ﺷﺪﻩ‪ ،‬ﭘﺲ ﺍﺯ ‪ ۲۴‬ﺳﺎﻋﺖ ﺍﻧﻜﻮﺑﺎﺳﻴﻮﻥ ﺩﺭ ‪ ۳۵‬ﺩﺭﺟﻪﻱ‬ ‫ﺳﺎﻧﺘﻲﮔﺮﺍﺩ‪ ،‬ﺗﻐﻴﻴﺮ ﺭﻧﮓ ﻣﺤﻴﻂ ﺍﺯ ﺯﺭﺩ ﺑﻪ ﻗﻬﻮﻩﺍﻱ ﺗﻴـﺮﻩ ﺗـﺎ ﺳـﻴﺎﻩ‬ ‫)‪ ۳۰‬ﻣﻴﮑﺮﻭﮔﺮﻡ( ﮐﻠﺮﺍﻣﻔﻨﻴﮑﻞ )‪ ۳۰‬ﻣﻴﮑﺮﻭﮔﺮﻡ(‪ ،‬ﮐﻮﻳﻨﻮﭘﺮﻳﺴﺘﻴﻦ ‪-‬‬ ‫)‪ ۱۵‬ﻣﻴﮑﺮﻭﮔﺮﻡ( ﺑﻪ ﺭﻭﺵ ﺩﻳﺴﮏ ﺩﻳﻔﻴﻮﮊﻥ ﻭ ﻫﻤﭽﻨﻴﻦ ﺣـﺪﺍﻗﻞ‬ ‫ﻏﻠﻈــﺖ ﻣﻬــﺎﺭﻱ )‪ (MIC‬ﻭﻧﮑﻮﻣﺎﻳــﺴﻴﻦ ﺑــﻪ ﺭﻭﺵ ﻣﻴﮑــﺮﻭ‬ ‫ﻧﺸﺎﻥ ﺩﻫﻨﺪﻩﻱ ﻫﻴﺪﺭﻭﻟﻴﺰ ﺍﺳـﻜﻮﻟﻴﻦ ﺑـﻮﺩ‪ .‬ﺍﻧﺘﺮﻭﻛـﻮﻙﻫـﺎ ﻭ ﻏﻴـﺮ‬ ‫ﺁﮔﺎﺭ ﺩﺍﻳﻠﻮﺷﻦ ﻣﻄﺎﺑﻖ ﻣﻌﻴﺎﺭﻫـﺎﻱ ‪ CLSI ۲۰۱۱‬ﺗﻌﻴـﻴﻦ ﮔﺮﺩﻳـﺪ‬ ‫ﺟﻬﺖ ﺗﺸﺨﻴﺺ ﺁﻥ ﺩﻭ ﺍﺯ ﻳﻜـﺪﻳﮕﺮ ﺍﺯ ﺭﺷـﺪ ﺩﺭ ﺑـﺮﺍﺙ ﺣـﺎﻭﻱ‬ ‫ﺳــﻮﻳﻪﻫــﺎﻱ ‪ VRE‬ﺑــﺎ ﺍﺳــﺘﻔﺎﺩﻩ ﺍﺯ ﭘﺮﺍﻳﻤﺮﻫــﺎﻱ ﺍﺧﺘــﺼﺎﺻﻲ‬ ‫ﺍﻧﺘﺮﻭﻛﻮﻙﻫﺎ ﻭ ﻫﺮ ﺩﻭ ﻗﺎﺩﺭ ﺑﻪ ﺗﺠﺰﻳﻪﻱ ﺍﺳﻜﻮﻟﻴﻦ ﻣﻲﺑﺎﺷـﻨﺪ ﻛـﻪ‬ ‫‪ %۶/۵‬ﻛﻠﺮﻳﺪ ﺳﺪﻳﻢ ﺑﺮﺭﺳﻲ ﮔﺮﺩﻳﺪ‪ .‬ﺳﭙﺲ ﺑﻪ ﻣﻨﻈـﻮﺭ ﺗـﺸﺨﻴﺺ‬ ‫ﮔﻮﻧﻪﻫﺎﻱ ﺍﻧﺘﺮﻭﮐﻮﮎ ﺑﺮ ﺍﺳﺎﺱ ﺗﺴﺖﻫﺎﻱ ﺑﻴﻮﺷﻴﻤﻴﺎﻳﻲ ﻫﻤﭽـﻮﻥ‬ ‫ﺗﺨﻤﻴﺮ ﻗﻨﺪ‪ ،‬ﺑﺮﺭﺳﻲ ﺣﺮﮐﺖ ﻭ ﺗﻮﻟﻴﺪ ﭘﻴﮕﻤﺎﻥ ﺑـﻪ ﻣﻨﻈـﻮﺭ ﺍﻓﺘـﺮﺍﻕ‬ ‫ﺑﻬﺘﺮ ﺩﻭ ﮔﻮﻧﻪ ﺍﻧﺘﺮﻭﮐﻮﮐـﻮﺱ ﻓـﺴﻴﻮﻡ ﻭ ﺍﻧﺘﺮﻭﮐﻮﮐـﻮﺱ ﻓﮑـﺎﻟﻴﺲ‬ ‫)‪ .(۱۶‬ﺣـــﻀﻮﺭ ﮊﻥﻫـــﺎﻱ ﻣﻘﺎﻭﻣـــﺖ ﺑـــﻪ ﻭﻧﮑﻮﻣﺎﻳـــﺴﻴﻦ ﺩﺭ‬ ‫)‪, 5′-CTTTTTCCGGCTCGACTTCCT-3′‬‬ ‫‪(vanA: 5ʹ- TACTGTTTGGGGGTTGCTC-3′‬‬ ‫ﺑـــــــــﻪ ﻃـــــــــﻮﻝ ‪ ۷۳۴‬ﺟﻔـــــــــﺖ ﺑـــــــــﺎﺯ ﻭ‬ ‫‪(vanB: GGGGGGGAGGATGGTGGGATAGAG‬‬ ‫)‪ ,GGAAGATACCGTGGCTCAAAC-3฀‬ﺑـﻪ ﻃـﻮﻝ‬ ‫ﻛﻪ ﻧـﺴﺒﺖ ﺑـﻪ ﺩﻳﮕـﺮ ﮔﻮﻧـﻪﻫـﺎ ﺍﺯ ﻓﺮﺍﻭﺍﻧـﻲ ﺑـﺎﻻﺗﺮﻱ ﺩﺭ ﺍﻳﺠـﺎﺩ‬ ‫‪ ۴۲۰‬ﺟﻔﺖ ﺑﺎﺯ ﺑﻪ ﺭﻭﺵ ‪ deblex PCR‬ﻃﺒﻖ ﺷﺮﺍﻳﻄﻲ ﮐـﻪ ﺩﺭ‬ ‫ﺍﺳﺎﺱ ﻭﺟﻮﺩ ﮊﻥﻫﺎﻱ ﺍﺧﺘﺼﺎﺻﻲ ﺍﻳﻦ ﺩﻭ ﮔﻮﻧـﻪ ﻳﻌﻨـﻲ ﮊﻥ ‪ddl‬‬ ‫ﺳـــﻮﻳﻪﻫـــﺎﻱ ﺍﻧﺘﺮﻭﮐﻮﮐـــﻮﺱ ﻓـــﺴﻴﻮﻡ ‪ ATCC 51559‬ﻭ‬ ‫ﻋﻔﻮﻧﺖﻫﺎ ﻭ ﺩﺭ ﻣﺤـﻴﻂ ﺑﺮﺧـﻮﺭﺩﺍﺭ ﻫـﺴﺘﻨﺪ ﺍﺯ ﺭﻭﺵ ‪ PCR‬ﺑـﺮ‬ ‫ﺍﺧﺘﺼﺎﺻﻲ ﺍﻧﺘﺮﻭﻛﻮﻛﻮﺱ ﻓـﺴﻴﻮﻡ ﻭ ﺍﺧﺘـﺼﺎﺻﻲ ﺍﻧﺘﺮﻭﻛﻮﻛـﻮﺱ‬ ‫ﻓﻜﺎﻟﻴﺲ ‪GAGGCAGACCAGATTGACG -3′, 5฀-‬‬ ‫)‪TATGACAGCGACTCCGATTC-3′‬‬ ‫‪E. faecium:‬‬ ‫‪( ddl‬‬ ‫ﺑـــــــــﻪ ﻃـــــــــﻮﻝ ‪ ۶۵۸‬ﺟﻔـــــــــﺖ ﺑـــــــــﺎﺯ ﻭ‬ ‫) ‪5฀- ATCAAGTACAGTTAGTCT-3′,‬‬ ‫‪E. faecalis:‬‬ ‫‪(ddl‬‬ ‫‪ 5฀- ACGATTCAAAGCTAACTG -3′‬ﺑﻪ ﻃﻮﻝ ‪ ۹۴۱‬ﺟﻔـﺖ‬ ‫ﺑﺎﺯ ﺑﺎ ﺷﺮﺍﻳﻂ ﺩﻧﺎﺗﻮﺭﺍﺳﻴﻮﻥ ﺍﻭﻟﻴﻪ‪ :‬ﺩﺭ ﺩﻣﺎﻱ ‪ ۹۴‬ﺩﺭﺟﻪ‪ ،‬ﭘﻨﺞ ﺩﻗﻴﻘـﻪ‬ ‫ﻭ ﻳﮏ ﺳﻴﮑﻞ؛ ﺩﻧﺎﺗﻮﺭﺍﺳﻴﻮﻥ‪ :‬ﺩﺭ ﺩﻣﺎﻱ ‪ ۹۴‬ﺩﺭﺟﻪ‪ ،‬ﻳﮏ ﺩﻗﻴﻘﻪ‪۳۵ ،‬‬ ‫ﺳﻴﮑﻞ؛ ﺍﺗﺼﺎﻝ‪ ۵۰ :‬ﺩﺭﺟﻬﻲ ﻳﮏ ﺩﻗﻴﻘﻪ‪ ۳۵ ،‬ﺳـﻴﮑﻞ؛ ﺗﮑﺜﻴـﺮ‪۷۲ :‬‬ ‫ﺁﺯﻣﺎﻳﺶ ‪ PCR‬ﻗﺒﻠﻲ ﺫﮐﺮ ﺷﺪ‪ ،‬ﻣﻮﺭﺩ ﺑﺮﺭﺳﻲ ﻗﺮﺍﺭ ﮔﺮﻓﺖ )‪.(۱۵‬‬ ‫ﺍﻧﺘﺮﻭﮐﻮﮐﻮﺱ ﻓﮑﺎﻟﻴﺲ ‪ ATCC 512999‬ﺑﻪ ﻋﻨﻮﺍﻥ ﺳﻮﻳﻪﻫﺎﻱ‬ ‫ﺍﺳﺘﺎﻧﺪﺍﺭﺩ ﺑـﻪﺗﺮﺗﻴـﺐ ﺟﻬـﺖ ﺗﻌﻴـﻴﻦ ﮊﻥﻫـﺎﻱ ‪ vanA‬ﻭ ‪vanB‬‬ ‫ﻣﻮﺭﺩ ﺍﺳﺘﻔﺎﺩﻩ ﻗﺮﺍﺭ ﮔﺮﻓﺖ‪.‬‬ ‫ﻳﺎﻓﺘﻪﻫﺎ‬ ‫ﻓﺮﺍﻭﺍﻧـ ـ ﻲ ﮔﻮﻧـــﻪﻫـــﺎﻱ ﺍﻧﺘﺮﻭﮐـــﻮﮎ‪ :‬ﺩﺭ ﻣﺠﻤـــﻮﻉ ‪۱۴۴‬‬ ‫ﺍﻳﺰﻭﻟﻪ ﺍﻧﺘﺮﻭﮐﻮﮐﻲ ﺍﺯ ﻧﻤﻮﻧﻪﻫﺎﻱ ﺑﺎﻟﻴﻨﻲ ﺟﻤـﻊﺁﻭﺭﻱ ﮔﺮﺩﻳـﺪ ﮐـﻪ‬ ‫)‪ ۶۰(۸۶‬ﺩﺭﺻﺪ ﺳﻮﻳﻪ ﺍﺯ ﻧﻤﻮﻧـﻪﻫـﺎﻱ ﺍﺩﺭﺍﺭﻱ ﺟـﺪﺍ ﺷـﺪﻧﺪ‪ .‬ﮐـﻪ‬ ‫‪ ۴۵‬ﺍﻧﺘﺮﻭﮐﻮﮐــﻮﺱ ﻓــﺴﻴﻮﻡ )‪ ۵۲‬ﺩﺭﺻــﺪ(‪ ۳۹ ،‬ﺍﻧﺘﺮﻭﮐﻮﮐــﻮﺱ‬ ‫ﻣﺠﻠﻪﻱ ﻋﻠﻤﻲ‪ ،‬ﭘﮋﻭﻫﺸﻲ ﺩﺍﻧﺸﮕﺎﻩ ﻋﻠﻮﻡ ﭘﺰﺷﮑﻲ ﻭ ﺧﺪﻣﺎﺕ ﺑﻬﺪﺍﺷﺘﻲ‪ ،‬ﺩﺭﻣﺎﻧﻲ ﺯﻧﺠـﺎﻥ‪ ،‬ﺩﻭﺭﻩﻱ ‪ ,٢٢‬ﺷﻤﺎﺭﻩﻱ ‪ ,٩١‬ﺧﺮﺩﺍﺩ ﻭ ﺗﻴﺮ ‪١٣٩٣‬‬ ‫‪124‬‬ ‫ﻓﺮﺍﻭﺍﻧﻲ ﻣﻘﺎﻭﻣﺖ ﺑﻪ ﻭﻧﮑﻮﻣﺎﻳﺴﻴﻦ ﺩﺭ ﻋﻔﻮﻧﺖﻫﺎﻱ ﺍﺩﺭﺍﺭﻱ‬ ‫ﻓﮑﺎﻟﻴﺲ )‪ ۴۵/۳‬ﺩﺭﺻﺪ( ﻭ ‪ ۱) ۱/۶‬ﺩﺭﺻﺪ( ﺭﺍ ﺩﻳﮕﺮ ﮔﻮﻧـﻪﻫـﺎﻱ‬ ‫ﺍﻧﺘﺮﻭﮐــﻮﮎ ﺗــﺸﮑﻴﻞ ﻣــﻲﺩﺍﺩﻧــﺪ‪ ۱۸ .‬ﺍﻳﺰﻭﻟــﻪ )‪ ۴۰/۶‬ﺩﺭﺻــﺪ(‬ ‫ﺍﺩﺭﺍﺭﻱ ﺍﻧﺘﺮﻭﮐﻮﮐــــﻮﺱ ﻓــــﺴﻴﻮﻡ ﺍﺯ ﺯﻧــــﺎﻥ ﻭ ‪ ۲۷‬ﺍﻳﺰﻭﻟــــﻪ‬ ‫)‪ ۵۹/۳‬ﺩﺭﺻﺪ( ﺍﺯ ﻣﺮﺩﺍﻥ ﺟﺪﺍ ﮔﺮﺩﻳﺪ‪ .‬ﻓﺮﺍﻭﺍﻧـﻲ ‪ VRE‬ﺍﺯ ﻣﻴـﺎﻥ‬ ‫‪ ۴۵‬ﺳــﻮﻳﻪ ﺍﻧﺘﺮﻭﮐﻮﮐــﻮﺱ ﻓــﺴﻴﻮﻡ ‪ ۱۹‬ﺳــﻮﻳﻪ )‪ ۴۲/۲‬ﺩﺭﺻــﺪ(‬ ‫ﻧﺴﺒﺖ ﺑﻪ ﻭﺍﻧﮑﻮﻣﺎﻳﺴﻴﻦ ﻣﻘﺎﻭﻡ ﺑﻮﺩﻧﺪ ﺩﺭ ﺣـﺎﻟﻲ ﮐـﻪ ﻫـﻴﭻ ﮐـﺪﺍﻡ‬ ‫ﺑﻪ ﺗﺮﺗﻴـﺐ ﺩﺍﺭﺍﻱ ﺑﻴـﺸﺘﺮﻳﻦ ﻣﻴـﺰﺍﻥ ‪ VRE‬ﺑﻮﺩﻧـﺪ )ﺟـﺪﻭﻝ ‪.(۲‬‬ ‫ﺟﺪﻭﻝ ‪ :١‬ﺍﻟﮕﻮﻫﺎﻱ ﻣﻘﺎﻭﻣﺖ ﺁﻧﺘﻲﺑﻴﻮﺗﻴﮑﻲ ﺩﺭ ﺳﻮﻳﻪﻫﺎﻱ ﻣﻘﺎﻭﻡ‬ ‫ﺑﻪ ﻭﻧﮑﻮﻣﺎﻳﺴﻴﻦ ﺍﻧﺘﺮﻭﮐﻮﮐﻮﺱ ﻓﺴﻴﻮﻡ‬ ‫ﺍﻟﮕﻮﻫﺎﻱ ﻣﻘﺎﻭﻣﺖ ﺁﻧﺘﻲﺑﻴﻮﺗﻴﮑﻲ‬ ‫)‪ (%‬ﺗﻌﺪﺍﺩ‬ ‫ﺍﺯ ﺳـــﻮﻳﻪﻫـــﺎﻱ ﺍﻧﺘﺮﻭﮐﻮﮐـــﻮﺱ ﻓﮑـــﺎﻟﻴﺲ ﻭ ﺍﻧﺘﺮﻭﮐﻮﮐـــﻮﺱ‬ ‫)‪٣ (%١٥/٧‬‬ ‫‪Am/Gm/Cip/Te/E/Chl/Ni‬‬ ‫)‪١ (%٢/٥‬‬ ‫‪Am/Gm/Cip/Te/E/Chl‬‬ ‫ﺗﻤـﺎﻣﻲ ‪VRE‬ﻫـﺎ ﺩﺍﺭﺍﻱ ﮊﻥ ﻣﻘﺎﻭﻣـﺖ ﺑـﻪ ﻭﻧﮑﻮﻣﺎﻳـﺴﻴﻦ ﻧـﻮﻉ‬ ‫)‪٨ (%٤٢‬‬ ‫ﮔﺎﻟﻴﻨــﺎﺭﻭﻡ ﺑــﻪ ﺍﻳــﻦ ﺁﻧﺘــﻲﺑﻴﻮﺗﻴــﮏ ﻣﻘــﺎﻭﻣﺘﻲ ﻧــﺸﺎﻥ ﻧﺪﺍﺩﻧــﺪ‪.‬‬ ‫‪ (vanA)A‬ﺑﻮﺩﻧﺪ )ﺷﮑﻞ ‪ .(۱‬ﺑﺨـﺶﻫـﺎﻱ ﭘﻴﻮﻧـﺪ ﮐﻠﻴـﻪ )‪۷۷/۷‬‬ ‫ﺩﺭﺻــﺪ(‪ ۶۶/۶) ICU ،‬ﺩﺭﺻــﺪ( ﻭ ﻧﻔﺮﻭﻟــﻮﮊﻱ )‪ ۵۵/۵‬ﺩﺭﺻــﺪ(‬ ‫)‪٧ (%٣٦/٨‬‬ ‫‪Am/Gm/Cip/Te/E/Ni‬‬ ‫‪Am/Gm/Cip/Te/E‬‬ ‫‪ ،Am‬ﺁﻣﭙﻲ ﺳﻴﻠﻴﻦ‪ , Gm:‬ﺟﻨﺘﺎﻣﻴﺴﻴﻦ ‪, Cip:‬ﺳﻴﭙﺮﻭﻓﻠﻮﮐﺴﺎﺳﻴﻦ‪, Te:‬‬ ‫ﺗﺘﺮﺍﺳﻴﮑﻠﻴﻦ ‪ , E:‬ﺍﺭﻳﺘﺮﻭﻣﺎﻳﺴﻴﻦ ‪ , Chl:‬ﮐﻠﺮﺍﻣﻔﻨﻴﮑﻞ‪ , Ni:‬ﻧﻴﺘﺮﻭﻓﻮﺭﺍﻧﺘﻮﺋﻴﻦ‬ ‫ﺷﮑﻞ ‪ :۱‬ﺗﺼﻮﻳﺮ ﮊﻝ ﺁﮔﺎﺭﺯ ﺍﺯ ﻧﺘﺎﻳﺞ ﺗﮑﺜﻴﺮ ﮊﻥﻫﺎﻱ ‪ vanA‬ﻭ ‪ vanB‬ﺑﻪ ﺭﻭﺵ ‪ ،Duplex PCR‬ﭼﺎﻫﮏ ﺷﻤﺎﺭﻩ ‪ ;۱‬ﻣﺎﺭﮐﺮ‪) 2 kb‬ﻓﺮﻣﻨﺘﺎﺯ(‪ ،‬ﭼﺎﻫﮏ‬ ‫ﺷﻤﺎﺭﻩ ‪ ;۲‬ﻧﻤﻮﻧﻪ ﮐﻨﺘﺮﻝ ﻣﻨﻔﻲ‪ ،‬ﭼﺎﻫﮏ ﺷﻤﺎﺭﻩ ‪ ;۳‬ﻧﻤﻮﻧﻪ ﮐﻨﺘﺮﻝ ﻣﺜﺒﺖ ﮊﻥ ‪ vanA‬ﺳﻮﻳﻪ ﺍﻧﺘﺮﻭﮐﻮﮐﻮﺱ ﻓﺴﻴﻮﻡ )‪ ( ATCC51559‬ﺑﻪ ﻃﻮﻝ‪ 734 bp‬ﻭ‬ ‫ﮐﻨﺘﺮﻝ ﻣﺜﺒﺖ ﮊﻥ ‪ :vanB‬ﺳﻮﻳﻪ ﺍﻧﺘﺮﻭﮐﻮﮐﻮﺱ ﻓﮑﺎﻟﻴﺲ )‪ (ATTCC 29212‬ﺑﻪ ﻃﻮﻝ ‪ ،420 bp‬ﭼﺎﻫﮏ ﺷﻤﺎﺭﻩ ‪ ;۴‬ﻧﻤﻮﻧﻪ ﺗﺴﺖ ﻣﻨﻔﻲ‪،‬‬ ‫ﭼﺎﻫﮏﻫﺎﻱ ﺷﻤﺎﺭﻩ ‪ ۸ ،۶،۷ ،۵‬ﻭ ‪ ۹‬ﻧﻤﻮﻧﻪﻫﺎﻱ ﺗﺴﺖ ﻣﺜﺒﺖ ﺩﺍﺭﺍﻱ ﮊﻥ ‪.vanA‬‬ ‫ﻣﺠﻠﻪﻱ ﻋﻠﻤﻲ‪ ،‬ﭘﮋﻭﻫﺸﻲ ﺩﺍﻧﺸﮕﺎﻩ ﻋﻠﻮﻡ ﭘﺰﺷﮑﻲ ﻭ ﺧﺪﻣﺎﺕ ﺑﻬﺪﺍﺷﺘﻲ‪ ،‬ﺩﺭﻣﺎﻧﻲ ﺯﻧﺠـﺎﻥ‪ ،‬ﺩﻭﺭﻩﻱ ‪ ,٢٢‬ﺷﻤﺎﺭﻩﻱ ‪ ,٩١‬ﺧﺮﺩﺍﺩ ﻭ ﺗﻴﺮ ‪١٣٩٣‬‬ ‫ﻟﻴﻠﻲ ﺷﻜﻮﻫﻲ ﺯﺍﺩﻩ ﻭ ﻫﻤﻜﺎﺭﺍﻥ‬ ‫ﻣﻘﺎﻭﻣﺖ ﺁﻧﺘ ﻲﺑﻴﻮﺗﻴ ﮑ ﻲ‪ :‬ﺗﻤﺎﻣﻲ ﺳـﻮﻳﻪﻫـﺎﻱ ‪ VRE‬ﻧـﺴﺒﺖ ﺑـﻪ‬ ‫ﺁﻧﺘــﻲﺑﻴﻮﺗﻴﮑﻬــﺎﻱ ﺗﻴﮑــﻮﭘﻼﻧﻴﻦ‪ ،‬ﺁﻣﭙــﻲﺳــﻴﻠﻴﻦ‪ ،‬ﺟﻨﺘﺎﻣﻴــﺴﻴﻦ‪،‬‬ ‫‪125‬‬ ‫ﻣــﺸﺎﻫﺪﻩ ﮔﺮﺩﻳـﺪ ‪ MIC50 ≥۱۲۸‬ﻣﻴﮑﺮﻭﮔــﺮﻡ ﺩﺭ ﻣﻴﻠـﻲﻟﻴﺘــﺮ ﻭ‬ ‫‪ MIC90 ≥ ۲۵۶‬ﻣﻴﮑــﺮﻭ ﮔــﺮﻡ ﺩﺭ ﻣﻴﻠـﻲ ﻟﻴﺘــﺮ ﺗﻌﻴــﻴﻦ ﮔﺮﺩﻳ ـﺪ‪.‬‬ ‫ﺍﺭﻳﺘﺮﻭﻣﺎﻳــﺴﻴﻦ‪ ،‬ﺳﻴﭙﺮﻭﻓﻠﻮﮐــﺴﺎﺳﻴﻦ ﻣﻘــﺎﻭﻡ ﺑﻮﺩﻧــﺪ‪ .‬ﺑﻴــﺸﺘﺮﻳﻦ‬ ‫ﺍﻟﮕﻮﻫﺎﻱ ﻣﻘﺎﻭﻣﺘﻲ ﻏﺎﻟﺐ ﺩﺭ ﺳـﻮﻳﻪﻫـﺎﻱ ‪ VRE‬ﺑـﻪﺗﺮﺗﻴـﺐ ﺑـﻪ‬ ‫ﻣﻘﺎﻭﻣــﺖ ﭘــﺲ ﺍﺯ ﺁﻧﺘــﻲﺑﻴﻮﺗﻴــﮏﻫــﺎﻱ ﺫﮐــﺮ ﺷــﺪﻩ ﺩﺭ ﺑﺮﺍﺑــﺮ‬ ‫ﺻــﻮﺭﺕ ﻣﻘﺎﻭﻣــﺖ ﻫﻤﺰﻣــﺎﻥ ﺑــﻪ ﺁﻣﭙــﻲﺳــﻴﻠﻴﻦ‪ /‬ﺟﻨﺘﺎﻣﻴــﺴﻴﻦ‪/‬‬ ‫ﻧﻴﺘﺮﻭﻓﻮﺭﺍﻧﺘﻮﺋﻴﻦ ﺩﺭ ﻳﺎﺯﺩﻩ )‪ ۷۸‬ﺩﺭﺻﺪ( ﺳـﻮﻳﻪ ﻣـﺸﺎﻫﺪﻩ ﮔﺮﺩﻳـﺪ‪.‬‬ ‫ﺳﺴﭙﺮﻭﻓﻠﻮﮐﺴﺎﺳﻴﻦ‪ /‬ﺗﺘﺮﺍﺳﻴﮑﻠﻴﻦ‪ /‬ﺍﺭﻳﺘﺮﻭﻣﺎﻳﺴﻴﻦ ﺩﺭ ‪ ۴۲‬ﺩﺭﺻـﺪ‬ ‫ﭘﻨﺞ ﺳﻮﻳﻪ )‪ ۲۸/۵‬ﺩﺭﺻﺪ( ﺳﻮﻳﻪ ﻧﺴﺒﺖ ﺑﻪ ﮐﻠﺮﺍﻣﻔﻨﻴﮑﻞ ﻣﻘـﺎﻭﻡ ﻭ‬ ‫ﻣــﻮﺍﺭﺩ ﻭ ﻣﻘﺎﻭﻣــﺖ ﻫﻤﺰﻣــﺎﻥ ﺑــﻪ ﺁﻣﭙــﻲﺳــﻴﻠﻴﻦ‪ /‬ﺟﻨﺘﺎﻣﻴــﺴﻴﻦ‪/‬‬ ‫ﺗﻤﺎﻣﻲ ﺁﻥﻫﺎ ﺑـﻪ ﮐﻮﻳﻨﻮﭘﺮﻳـﺴﺘﻴﻦ ‪ -‬ﺩﺍﻟﻔﻮﭘﺮﻳـﺴﺘﻴﻦ )ﺳﻴﻨﺮﺳـﻴﺪ( ﻭ‬ ‫ﺳﺴﭙﺮﻭﻓﻠﻮﮐـــــﺴﺎﺳﻴﻦ‪ /‬ﺗﺘﺮﺍﺳـــــﻴﮑﻠﻴﻦ‪ /‬ﺍﺭﻳﺘﺮﻭﻣﺎﻳـــــﺴﻴﻦ‪/‬‬ ‫ﻟﻴﻨﺰﻭﻻﻳــﺪ ﺣــﺴﺎﺱ ﺑﻮﺩﻧــﺪ‪ .‬ﻣﻴــﺰﺍﻥ ‪ MIC‬ﻭﻧﮑﻮﻣﺎﻳــﺴﻴﻦ ﺍﺯ‬ ‫ﻧﻴﺘﺮﻭﻓﻮﺭﺍﻧﺘـــﻮﺋﻴﻦ ﺩﺭ ‪ ۳۹‬ﺩﺭﺻـــﺪ ﻣـــﻮﺍﺭﺩ ﻣـــﺸﺎﻫﺪﻩ ﮔﺮﺩﻳـ ـﺪ‬ ‫‪ ۶۴‬ﺗــﺎ ‪ ۵۱۲‬ﻣﻴﮑﺮﻭﮔــﺮﻡ ﺩﺭ ﻣﻴﻠ ـﻲﻟﻴﺘــﺮ ﺩﺭ ﺳــﻮﻳﻪﻫــﺎﻱ ‪VRE‬‬ ‫)ﺟﺪﻭﻝ ‪.(۱‬‬ ‫ﺟﺪﻭﻝ ‪ :٢‬ﻣﻴﺰﺍﻥ )ﺩﺭﺻﺪ( ﻣﻘﺎﻭﻣﺖ ﺑﻪ ﻭﻧﮑﻮﻣﺎﻳﺴﻴﻦ ﺩﺭﻣﻴﺎﻥ ﺳﻮﻳﻪﻫﺎﻱ ﺍﻧﺘﺮﻭﮐﻮﮐﻮﺱ ﻓﺴﻴﻮﻡ ﺟﺪﺍ ﺷﺪﻩ ﺍﺯ ﻋﻔﻮﻧﺖﻫﺎﻱ ﺍﺩﺭﺍﺭﻱ ﺑﻴﻤﺎﺭﺍﻥ‬ ‫ﺑﺴﺘﺮﻱ ﺩﺭ ﺑﺨﺶﻫﺎﻱ ﻣﺨﺘﻠﻒ ﺑﻴﻤﺎﺭﺳﺘﺎﻥﻫﺎﻱ ﻣﻮﺭﺩ ﻣﻄﺎﻟﻌﻪ‬ ‫ﺑﺨﺶﻫﺎﻱ ﺑﻴﻤﺎﺭﺳﺘﺎﻥ‬ ‫‪E. faecium‬‬ ‫‪VRE‬‬ ‫ﺳﺎﻳﺮ ﺑﺨﺶﻫﺎ‬ ‫ﻧﻔﺮﻭﻟﻮﮊﻱ‬ ‫ﭘﻴﻮﻧﺪ ﮐﻠﻴﻪ‬ ‫ﮔﻮﺍﺭﺵ‬ ‫‪ICU‬‬ ‫)‪٦ (%١٣/٣‬‬ ‫)‪٩ (%٢٠‬‬ ‫)‪٩ (%٢٠‬‬ ‫)‪١٢ (%٢٦/٦‬‬ ‫)‪٩ (%٢٠‬‬ ‫‪٠‬‬ ‫)‪٥ (%٥٥/٥‬‬ ‫)‪٧ (%٧٧/٧‬‬ ‫)‪٣ (%٢٥‬‬ ‫)‪٦ (%٦٦/٦‬‬ ‫ﺑﺤﺚ‬ ‫ﻋﻔﻮﻧﺖﻫﺎﻱ ﺍﺩﺭﺍﺭﻱ ﺷﺎﻳﻊﺗﺮﻳﻦ ﻋﻔﻮﻧﺖ ﺑﻴﻤﺎﺭﺳـﺘﺎﻧﻲ ﺍﻳﺠـﺎﺩ‬ ‫ﻳﮏ ﺑﻮﺩﻩ ﻭﻟﻲ ﺍﻣﺮﻭﺯﻩ ﺍﻳﻦ ﻧﺴﺒﺖ ﺩﺭ ﺣﺎﻝ ﮐـﺎﻫﺶ ﻣـﻲ ﺑﺎﺷـﺪ ﻭ‬ ‫ﺷﺪﻩ ﺗﻮﺳﻂ ﺍﻧﺘﺮﻭﮐﻮﮎﻫﺎ ﻣﻲﺑﺎﺷـﻨﺪ‪ .‬ﺩﺭ ﺑﻴـﺸﺘﺮ ﻣـﻮﺍﺭﺩ ﻧﻴـﺎﺯ ﺑـﻪ‬ ‫ﺣﺎﻝ ﺍﻓﺰﺍﻳﺶ ﻣﻲﺑﺎﺷﺪ )‪ .(۱۷‬ﺩﺭ ﺑﺮﺧﻲ ﺍﺯ ﻧﺘﺎﻳﺞ ﮔﺰﺍﺭﺵ ﺷﺪﻩ ﺍﺯ‬ ‫ﺷـﺮﻭﻉ ﺩﺭﻣـﺎﻥ ﺍﻳـﻦ ﻋﻔﻮﻧـﺖﻫـﺎ ﻗﺒــﻞ ﺍﺯ ﻧﺘـﺎﻳﺞ ﺁﺯﻣـﺎﻳﺶﻫــﺎﻱ‬ ‫ﻣﻴﮑــﺮﻭﺏﺷﻨﺎﺳ ـﻲ ﻣـﻲﺑﺎﺷــﺪ‪ ،‬ﻟــﺬﺍ ﺗﺠــﻮﻳﺰ ﺻــﺤﻴﺢ ﻭ ﻣﻨﻄﻘ ـﻲ‬ ‫ﺁﻧﺘﻲﺑﻴﻮﺗﻴﮏﻫﺎ ﺩﺭ ﺍﻳﻦﮔﻮﻧﻪ ﻣﻮﺍﺭﺩ ﺑﺴﻴﺎﺭ ﺣﺎﻳﺰ ﺍﻫﻤﻴﺖ ﻣﻲﺑﺎﺷـﺪ‪.‬‬ ‫ﺩﺭ ﺳﺎﻝﻫﺎﻱ ﺍﺧﻴﺮ ﻣﻄﺎﻟﻌﺎﺕ ﻓﺮﺍﻭﺍﻧـﻲ ﺩﺭ ﻣـﻮﺭﺩ ﺍﭘﻴـﺪﻣﻴﻮﻟﻮﮊﻱ ﻭ‬ ‫ﻣﻘﺎﻭﻣﺖﻫﺎﻱ ﺁﻧﺘﻲﺑﻴﻮﺗﻴﮑﻲ ﺩﺭ ﻋﻔﻮﻧﺖﻫﺎﻱ ﺍﻧﺘﺮﻭﮐﻮﮐﻲ ﺩﺭ ﺍﻳـﺮﺍﻥ‬ ‫ﺻﻮﺭﺕ ﮔﺮﻓﺘﻪ ﺍﺳﺖ‪ .‬ﺍﻣﺮﻭﺯﻩ ﺑﺎ ﺗﻮﺟﻪ ﺑﻪ ﺍﻓﺰﺍﻳﺶ ﺍﻧﺘﺮﻭﮐﻮﮎﻫﺎﻱ‬ ‫ﻧﺴﺒﺖ ﻋﻔﻮﻧﺖﻫﺎﻱ ﺑﻴﻤﺎﺭﺳﺘﺎﻧﻲ ﻧﺎﺷﻲ ﺍﺯ ﺍﻧﺘﺮﻭﮐﻮﮐﻮﺱ ﻓﺴﻴﻮﻡ ﺩﺭ‬ ‫ﺍﻳ ـﺮﺍﻥ ﻧﻴ ـﺰ ﺷــﺎﻫﺪ ﮐــﺎﻫﺶ ﻧﻘــﺶ ﺍﻧﺘﺮﻭﮐﻮﮐــﻮﺱ ﻓﮑــﺎﻟﻴﺲ ﺩﺭ‬ ‫ﻋﻔﻮﻧﺖﻫﺎﻱ ﺑﻴﻤﺎﺭﺳﺘﺎﻧﻲ ﻧﺎﺷﻲ ﺍﺯ ﺍﻧﺘﺮﻭﮐﻮﮎﻫﺎ ﻫـﺴﺘﻴﻢ‪ .‬ﺩﺭ ﻳـﮏ‬ ‫ﻣﻄﺎﻟﻌﻪ ﮐﻪ ﺗﻮﺳﻂ ﺍﻣﺎﻧﻴﻨﻲ ﻭ ﻫﻤﮑﺎﺭﺍﻥ ﺩﺭ ﺍﻳـﺮﺍﻥ ﺩﺭ ﺳـﺎﻝ ‪۲۰۰۸‬‬ ‫ﺍﻧﺠﺎﻡ ﮔﺮﻓﺖ ﻧﺴﺒﺖ ﻋﻔﻮﻧﺘﻬﺎﻱ ﻧﺎﺷﻲ ﺍﺯ ﺍﻧﺘﺮﻭﮐﻮﮐـﻮﺱ ﻓﮑـﺎﻟﻴﺲ‬ ‫ﺑﻪ ﺍﻧﺘﺮﻭﮐﻮﮐﻮﺱ ﻓﺴﻴﻮﻡ ‪ ۱/۸‬ﺑﻪ ‪ ۱‬ﮔﺰﺍﺭﺵ ﺷﺪﻩ ﺍﺳـﺖ )‪ .(۱۸‬ﺩﺭ‬ ‫ﻳ ـﮏ ﻣﻄﺎﻟﻌــﻪ ﺩﻳﮕــﺮ ﮐــﻪ ﺩﺭ ﺑﻴﻤﺎﺭﺳــﺘﺎﻥﻫــﺎﻱ ﺗﻬــﺮﺍﻥ ﺗﻮﺳــﻂ‬ ‫ﭼﻨﺪ ﻣﻘﺎﻭﻣﺘﻲ ﺑﻪﻭﻳﮋﻩ‪ ،‬ﺳﻮﻳﻪﻫﺎﻱ ﺍﻧﺘﺮﻭﮐـﻮﮎ ﻓـﺴﻴﻮﻡ ﻣﻘـﺎﻭﻡ ﺑـﻪ‬ ‫ﺳﻠﻄﺎﻥﺩﻻﻝ ﻭ ﻫﻤﮑﺎﺭﺍﻥ ﺩﺭ ﻫﻤﺎﻥ ﺳﺎﻝ ﺻـﻮﺭﺕ ﮔﺮﻓـﺖ ﺩﺭ ‪۳۰‬‬ ‫ﺑﻴﺶ ﺍﺯ ﺳﺎﻳﺮ ﮔﻮﻧﻪﻫﺎﻱ ﺍﻧﺘﺮﻭﮐﻮﮎ ﻣﻲﺑﺎﺷـﺪ‪ .‬ﻫـﺮ ﭼﻨـﺪ ﮐـﻪ ﺩﺭ‬ ‫)‪ .(۱۹‬ﻧﺘﺎﻳﺞ ﺣﺎﺻﻞ ﺍﺯ ﺍﻳﻦ ﺗﺤﻘﻴﻖ ﺣﺎﺿﺮ ﻧﻴﺰ ﭼﻨـﻴﻦ ﻣﻄﻠﺒـﻲ ﺭﺍ‬ ‫ﻭﻧﮑﻮﻣﺎﻳﺴﻴﻦ ﻣﻴﺰﺍﻥ ﻋﻔﻮﻧﺖﻫﺎﻱ ﻧﺎﺷﻲ ﺍﺯ ﺍﻧﺘﺮﻭﮐﻮﮐـﻮﺱ ﻓـﺴﻴﻮﻡ‬ ‫ﮔﺬﺷﺘﻪ ﻧﺴﺒﺖ ﻋﻔﻮﻧﺖﻫﺎﻱ ﻧﺎﺷﻲ ﺍﺯ ﺍﻧﺘﺮﻭﮐﻮﮐﻮﺱ ﻓﮑﺎﻟﻴﺲ ﺑﻴﺶ‬ ‫ﺍﺯ ﺍﻧﺘﺮﻭﮐﻮﮐﻮﺱ ﻓﺴﻴﻮﻡ ﺑﻮﺩﻩ ﺍﺳﺖ ﺑﻪﻃﻮﺭﻱ ﮐﻪ ﻧﺴﺒﺖ ﺁﻥ ﺩﻩ ﺑـﻪ‬ ‫ﺻﺪ ﻋﻔﻮﻧﺖﻫﺎﻱ ﺍﺩﺭﺍﺭﻱ‪ ،‬ﺍﻧﺘﺮﻭﮐﻮﮐﻮﺱ ﻓﺴﻴﻮﻡ ﺟﺪﺍ ﺷﺪﻩ ﺍﺳـﺖ‬ ‫ﺗﺎﻳﻴـﺪ ﻣـﻲﮐﻨـﺪ ﻭ ﺳـﻬﻢ ﺍﻧﺘﺮﻭﮐﻮﮐـﻮﺱ ﻓـﺴﻴﻮﻡ ﺣﺘـﻲ ﺑـﻴﺶ ﺍﺯ‬ ‫ﺍﻧﺘﺮﻭﮐﻮﮐﻮﺱ ﻓﮑﺎﻟﻴﺲ ﺩﺭ ﺍﻳﺠﺎﺩ ﻋﻔﻮﻧﺖﻫﺎﻱ ﺍﺩﺭﺍﺭﻱ ﻣـﻲﺑﺎﺷـﺪ‬ ‫ﻣﺠﻠﻪﻱ ﻋﻠﻤﻲ‪ ،‬ﭘﮋﻭﻫﺸﻲ ﺩﺍﻧﺸﮕﺎﻩ ﻋﻠﻮﻡ ﭘﺰﺷﮑﻲ ﻭ ﺧﺪﻣﺎﺕ ﺑﻬﺪﺍﺷﺘﻲ‪ ،‬ﺩﺭﻣﺎﻧﻲ ﺯﻧﺠـﺎﻥ‪ ،‬ﺩﻭﺭﻩﻱ ‪ ,٢٢‬ﺷﻤﺎﺭﻩﻱ ‪ ,٩١‬ﺧﺮﺩﺍﺩ ﻭ ﺗﻴﺮ ‪١٣٩٣‬‬ ‫‪126‬‬ ‫ﻓﺮﺍﻭﺍﻧﻲ ﻣﻘﺎﻭﻣﺖ ﺑﻪ ﻭﻧﮑﻮﻣﺎﻳﺴﻴﻦ ﺩﺭ ﻋﻔﻮﻧﺖﻫﺎﻱ ﺍﺩﺭﺍﺭﻱ‬ ‫ﺑﻪﻃﻮﺭﻱ ﮐﻪ ﻧـﺴﺒﺖ ﻋﻔﻮﻧـﺖ ﺍﺩﺭﺍﺭﻱ ﺣﺎﺻـﻞ ﺍﺯ ﺍﻧﺘﺮﻭﮐﻮﮐـﻮﺱ‬ ‫ﺩﺭ ﺑﻴﻤﺎﺭﺳــﺘﺎﻥﻫــﺎﻱ ﺗﻬــﺮﺍﻥ ﭘﺮﺩﺍﺧﺘــﻪﺍﻧــﺪ ﻧﻤﻮﻧــﻪﻫــﺎﻱ ﺍﺩﺭﺍﺭﻱ‬ ‫ﻓﺴﻴﻮﻡ ﺑﻪ ﺍﻧﺘﺮﻭﮐﻮﮐﻮﺱ ﻓﮑﺎﻟﻴﺲ ‪۱/۱۵‬ﺑـﻪ ‪ ۴۵) ۱‬ﺩﺭ ﺑﺮﺍﺑـﺮ ‪(۳۹‬‬ ‫‪ ۸۹‬ﺩﺭﺻﺪ ﺍﺯ ﻧﻤﻮﻧﻪﻫﺎ ﺭﺍ ﺗﺸﮑﻴﻞ ﻣﻲﺩﺍﺩﻧﺪ ﻭ ﺗﻨﻬﺎ ‪ ۴/۶‬ﺩﺭﺻـﺪ ﺍﺯ‬ ‫ﻣﺸﺎﻫﺪﻩ ﮔﺮﺩﻳﺪ‪ .‬ﻭ ﺩﺭ ﻭﺍﻗـﻊ ﺍﻭﻟـﻴﻦ ﮔﺰﺍﺭﺷـﻲ ﺍﺳـﺖ ﮐـﻪ ﺩﺭ ﺁﻥ‬ ‫ﺍﻳﻦ ﺳﻮﻳﻪﻫﺎ ﺑﻪ ﻭﻧﮑﻮﻣﺎﻳﺴﻴﻦ ﻣﻘﺎﻭﻡ ﺑﻮﺩﻧـﺪ‪ .‬ﺗﻤـﺎﻣﻲ ﺳـﻮﻳﻪﻫـﺎﻱ‬ ‫ﻧﺴﺒﺖ ﻋﻔﻮﻧـﺖﻫـﺎﻱ ﺍﻧﺘﺮﻭﮐﻮﮐـﻮﺱ ﻓـﺴﻴﻮﻡ ﺑﻴـﺸﺘﺮ ﻣـﻲﺑﺎﺷـﺪ‪.‬‬ ‫‪ VRE‬ﺩﺍﺭﺍﻱ ‪ vanA‬ﺑﻮﺩﻧـــﺪ ﻭ ﻣﻘﺎﻭﻣـــﺖ ﻫﻤﺰﻣـــﺎﻥ ﺑـــﻪ‬ ‫ﻧــﺴﺒﺖ ﺑــﻪ ﺁﻧﺘــﻲﺑﻴﻮﺗﻴــﮏﻫــﺎﻱ ﻭﻧﮑﻮﻣﺎﻳــﺴﻴﻦ‪ ،‬ﺁﻣﭙــﻲﺳــﻴﻠﻴﻦ‪،‬‬ ‫ﺍﺭﻳﺘﺮﻭﻣﺎﻳﺴﻴﻦ ﺍﻟﮕـﻮﻱ ﻣﻘـﺎﻭﻣﺘﻲ ﻏﺎﻟـﺐ ﺑـﻮﺩﻩ ﻭ ﺩﺭ ‪ ۴۷‬ﺩﺭﺻـﺪ‬ ‫ﺟﻨﺘﺎﻣﻴﺴﻴﻦ‪ ،‬ﻧﻴﺘﺮﻭﻓﻮﺭﺍﻧﺘـﻮﺋﻴﻦ‪ ،‬ﺳﻴﭙﺮﻭﻓﻠﻮﮐـﺴﺎﺳﻴﻦ‪ ،‬ﮐـﻪ ﻣﻌﻤـﻮﻻ‬ ‫ﺳﻮﻳﻪﻫﺎﻱ ‪ VRE‬ﻣﺸﺎﻫﺪﻩ ﮔﺮﺩﻳـﺪ )‪ .(۳۱‬ﺩﺭ ﻣﻄﺎﻟﻌـﻪﻱ ﺣﺎﺿـﺮ‬ ‫ﺗﻮﺳﻂ ﭘﺰﺷﮑﺎﻥ ﺟﻬﺖ ﺩﺭﻣﺎﻥ ﻋﻔﻮﻧﺖﻫـﺎﻱ ﺍﺩﺭﺍﺭﻱ ﺍﻧﺘﺮﻭﮐـﻮﮐﻲ‬ ‫ﻣﻨﻄﺒﻖ ﺑﺎ ﺍﻳﻦ ﺗﺤﻘﻴﻖ ﺍﺯ ﺍﻳﺮﺍﻥ‪ vanA ،‬ﮊﻧﻮﺗﻴﭗ ﻏﺎﻟـﺐ ﺩﺭ ﻣﻴـﺎﻥ‬ ‫ﻃﺒﻖ ﺗﺤﻘﻴﻖ ﮐـﻪ ﺗﻮﺳـﻂ ﺭﻫﺒـﺮ ﻫﻤﮑـﺎﺭﺍﻥ ﺍﻧﺠـﺎﻡ ﺩﺍﺩﻧـﺪ ﻧﻴﺘـﺮﻭ‬ ‫ﻫﻤﺰﻣـــﺎﻥ ﺑـــﻪ ﻭﻧﮑﻮﻣﺎﻳـ ـﺴﻴﻦ‪ ،‬ﺟﻨﺘﺎﻣﻴـ ـﺴﻴﻦ‪ ،‬ﺁﻣﭙـ ـﻲﺳـ ـﻴﻠﻴﻦ‪،‬‬ ‫ﻓﻮﺭﺍﻧﺘﻮﺋﻴﻦ ﺁﻧﺘﻲﺑﻴﻮﺗﻴﮏ ﻧﺴﺒﺘﺎ ﻣﻮﺛﺮﻱ ﺑﺮﺍﻱ ﺩﺭﻣﺎﻥ ﻋﻔﻮﻧـﺖﻫـﺎﻱ‬ ‫ﺳﻴﭙﺮﻭﻓﻠﻮﮐﺴﺎﺳﻴﻦ ﻭ ﺍﺭﻳﺘﺮﻭﻣﺎﻳﺴﻴﻦ ﺩﺭ ‪ ۴۲‬ﺩﺭﺻﺪ ﻣﻮﺍﺭﺩ‪ ،‬ﺍﻟﮕﻮﻱ‬ ‫ﺍﺩﺭﺍﺭﻱ ﻧﺎﺷ ـﻲ ﺍﺯ ﺳــﻮﻳﻪﻫــﺎﻱ ‪ VRE‬ﺑــﻮﺩﻩ ﺍﺳــﺖ ﻭ ﻣﻘﺎﻭﻣــﺖ‬ ‫ﻣﻘﺎﻭﻣﺘﻲ ﻏﺎﻟﺐ ﺑﻮﺩﻩ ﻭ ﻣﻘﺎﻭﻣﺖ ﻫﻤﺰﻣﺎﻥ ﺑﻪ ﺁﻧﺘﻲﺑﻴﻮﻳﮏﻫﺎﻱ ﺫﮐﺮ‬ ‫ﻫﻤﺰﻣﺎﻥ ﺑﻪ ﻭﻧﮑﻮﻣﺎﻳﺴﻴﻦ ﻭ ﻧﻴﺘﺮﻭﻓﻮﺍﻧﺘـﻮﺋﻴﻦ ﺩﺭ ﺑﻴﻤـﺎﺭﺍﻥ ﺑـﺴﺘﺮﻱ‬ ‫ﺷــﺪﻩ ﻭ ﻧﻴﺘﺮﻭﻓﻮﺭﺍﻧﺘــﻮﺋﻴﻦ ﺩﺭ ‪ ۳۶‬ﺩﺭﺻــﺪ ﺳــﻮﻳﻪﻫــﺎﻱ ‪VRE‬‬ ‫ﻧﺘﺎﻳﺞ ﺣﺎﺻﻞ ﺍﺯ ﺍﻳﻦ ﻣﻄﺎﻟﻌﻪ ﺣﺎﮐﻲ ﺍﺯ ﻓﺮﺍﻭﺍﻧـﻲ ﺑـﺎﻻﻱ ﻣﻘﺎﻭﻣـﺖ‬ ‫ﺗﺠﻮﻳﺰ ﻣﻲﮔﺮﺩﻧﺪ )‪.(۲۰‬‬ ‫ﻭﻧﮑﻮﻣﺎﻳﺴﻴﻦ‪ ،‬ﺟﻨﺘﺎﻣﻴﺴﻴﻦ‪ ،‬ﺁﻣﭙـﻲ ﺳـﻴﻠﻴﻦ‪ ،‬ﺳﻴﭙﺮﻭﻓﻠﻮﮐـﺴﺎﺳﻴﻦ ﻭ‬ ‫ﺳــﻮﻳﻪﻫــﺎﻱ ‪ VRE‬ﺍﻧﺘﺮﻭﮐــﻮﮐﺲ ﻓــﺴﻴﻮﻡ ﻣــﻲﺑﺎﺷــﺪ‪ .‬ﻣﻘﺎﻭﻣــﺖ‬ ‫ﺑـﻴﺶ ﺍﺯ ﺑﻴﻤـﺎﺭﺍﻥ ﺳـﺮ ﭘـﺎﻳﻲ ﺑـﻮﺩﻩ ﺍﺳـﺖ )‪ ۴۲ .(۲۱‬ﺩﺭﺻــﺪ ﺍﺯ‬ ‫ﻣﺸﺎﻫﺪﻩ ﺷﺪﻩ ﺍﺳﺖ‪.‬‬ ‫ﺳﻮﻳﻪﻫﺎﻱ ﺍﻧﺘﺮﻭﮐﻮﮐﻮﺱ ﻓﺴﻴﻮﻡ ﻧﺴﺒﺖ ﺑـﻪ ﻭﻧﮑﻮﻣﺎﻳـﺴﻴﻦ ﻣﻘـﺎﻭﻡ‬ ‫ﺩﺭ ﺗﺤﻘﻴﻘﻲ ﮐـﻪ ﺗﻮﺳـﻂ ﮊﺍﻧـﻞ ﻭ ﻫﻤﮑـﺎﺭﺍﻥ ﺩﺭ ﺍﻳـﺎﻻﺕ ﻣﺘﺤـﺪﻩ‬ ‫ﺑﻮﺩﻧﺪ ﮐﻪ ﺍﻳﻦ ﺭﻗﻢ ﺑﻴﺶ ﺍﺯ ﺍﺭﻗﺎﻡ ﮔﺰﺍﺭﺵ ﺷﺪﻩ ﺩﺭ ﺍﻳﺮﺍﻥ ﻭ ﺑﺮﺧﻲ‬ ‫ﺻﻮﺭﺕ ﮔﺮﻓﺖ ﺁﻧﺘـﻲﺑﻴﻮﺗﻴـﮏﻫـﺎﻱ ﻟﻴﻨﺰﻭﻻﻳـﺪ‪ ،‬ﻧﻴﺘﺮﻭﻓﻮﺍﻧﺘـﻮﺋﻴﻦ‪،‬‬ ‫ﮐﺸﻮﺭﻫﺎﻱ ﺁﺳﻴﺎﻳﻲ ﻭ ﺍﺭﻭﭘﺎﻳﻲ ﻭﻟﻲ ﭘﺎﻳﻴﻦﺗـﺮ ﺍﺯ ﻧﺘـﺎﻳﺞ ﺁﻣﺮﻳﮑـﺎﻱ‬ ‫ﮐﻠﺮﺍﻣﻔﻨﻴﮑــﻞ‪ ،‬ﮐﻮﻳﻨﻮﭘﺮﻳــﺴﻴﺘﻴﻦ ‪ -‬ﺩﺍﻟﻔــﻮ ﭘﺮﻳــﺴﺘﻴﻦ ﻣــﻮﺛﺮﺗﺮﻳﻦ‬ ‫ﻻﺗﻴﻦ )‪ ۴۸‬ﺩﺭﺻﺪ( ﻭ ﺁﻣﺮﻳﮑﺎﻱ ﺷﻤﺎﻟﻲ )‪ ۷۶‬ﺩﺭﺻﺪ( ﻣﻲﺑﺎﺷﺪ‪ .‬ﺩﺭ‬ ‫ﺁﻧﺘﻲﺑﻴﻮﺗﻴﮏ ﺩﺭ ﺩﺭﻣﺎﻥ ﻋﻔﻮﻧﺖﻫﺎﻱ ﺍﺩﺭﺍﺭﻱ ﻧﺎﺷﻲ ﺍﺯ ﺳـﻮﻳﻪﻫـﺎﻱ‬ ‫ﻭﺍﻗﻊ ﻓﺮﺍﻭﺍﻧﻲ ‪ VRE‬ﺩﺭ ﺁﺳﻴﺎ ﮐﻤﺘﺮ ﺍﺯ ﺁﻣﺮﻳﮑﺎ ﻣﻲﺑﺎﺷﺪ ﻭ ﻳﮑﻲ ﺍﺯ‬ ‫ﻣﻘﺎﻭﻡ ﺑﻪ ﻭﻧﮑﻮﻣﺎﻳﺴﻴﻦ ﺍﻧﺘﺮﻭﮐﻮﮐﻮﺱ ﻓﺴﻴﻮﻡ ﺑﺎ ‪ ۲/۴ ،۰/۶ ،۰/۳‬ﻭ‬ ‫ﺩﻻﻳﻞ ﺁﻥ ﻇﻬﻮﺭ ﺩﻳﺮﺗﺮ ﺍﻳﻦ ﺳـﻮﻳﻪﻫـﺎ ﺩﺭ ﻗـﺎﺭﻩ ﺁﺳـﻴﺎ ﻣـﻲﺑﺎﺷـﺪ‬ ‫‪ ۱۳/۶‬ﺩﺭﺻـــﺪ ﻣﻘﺎﻭﻣـــﺖ ﺑـــﻪ ﺗﺮﺗﻴـــﺐ ﻭ ﺁﻣﭙـــﻲﺳـــﻴﻠﻴﻦ ﻭ‬ ‫)‪ .(۲۲- ۲۸‬ﺩﺭ ﻣﻄﺎﻟﻌﻪﺍﻱ ﮐﻪ ﺩﺭ ﺍﻳﺎﻻﺕ ﻣﺘﺤـﺪﻩ ﺻـﻮﺭﺕ ﮔﺮﻓﺘـﻪ‬ ‫ﺳﻴﭙﺮﻭﻓﻠﻮﮐﺴﺎﺳﻴﻦ ﺑﺎ ‪ ۹۶‬ﻭ ‪ ۱۰۰‬ﺩﺭﺻـﺪ ﻣﻘﺎﻭﻣـﺖ ﺍﺛـﺮ ﺑﺨـﺸﻲ‬ ‫‪ ۸۰‬ﺩﺭﺻﺪ ﺳﻮﻳﻪﻫـﺎﻱ ﺍﻧﺘﺮﻭﮐﻮﮐـﻮﺱ ﻓـﺴﻴﻮﻡ ﺑـﻪ ﻭﻧﮑﻮﻣﺎﻳـﺴﻴﻦ‬ ‫ﺿﻌﻴﻔﻲ ﻋﻠﻴﻪ ﺍﻳﻦ ﺳﻮﻳﻪﻫﺎ ﺩﺍﺷﺘﻨﺪ )‪ .(۳۲‬ﮐﻪ ﺩﺭ ﺗﺤﻘﻴـﻖ ﺣﺎﺿـﺮ‬ ‫ﻣﻘﺎﻭﻡ ﺑﻮﺩﻧﺪ )‪ ،(۲۹‬ﺗﻨﻬﺎ ﻣﻮﺭﺩﻱ ﮐﻪ ﺩﺭ ﺍﻳﺮﺍﻥ ﻧـﺴﺒﺖ ‪ VRE‬ﻫـﺎ‬ ‫ﺗﺎﺛﻴﺮ ﻧﻴﺘﺮﻭﻓﻮﺭﺍﻧﺘﻮﺋﻴﻦ ﺑﺴﻴﺎﺭ ﭘﺎﻳﻴﻦ ﺑﺎ ﻣﻘﺎﻭﻣﺖ ‪ %۷۸‬ﻭ ﮐﻠﺮﺍﻣﻔﻨﻴﮑﻞ‬ ‫ﺑﻴﺶ ﺍﺯ ﻧﺘﺎﻳﺞ ﺣﺎﺻﻞ ﺍﺯ ﺍﻳﻦ ﻣﻄﺎﻟﻌﻪ ﺑﻮﺩﻩ‪ ،‬ﮔﺰﺍﺭﺷـﻲ ﺍﺳـﺖ ﮐـﻪ‬ ‫ﺑﺎ ‪ %۲۸‬ﻣﺸﺎﻫﺪﻩ ﮔﺮﺩﻳﺪ‪ .‬ﻟﻨﺰﻭﻻﻳﺪ ﻭ ﺳﻴﻨﺮﺳﻴﺪ ﺑﺎ ﻣﻘﺎﻭﻣـﺖ ﺻـﻔﺮ‬ ‫ﺗﻮﺳﻂ ﻓﻴﺾ ﺁﺑﺎﺩﻱ ﻭ ﻫﻤﮑـﺎﺭﺍﻥ ﺩﺭ ﺳـﺎﻝ ‪ ۲۰۰۸‬ﺍﺯ ﺑﻴﻤﺎﺭﺳـﺘﺎﻥ‬ ‫ﺩﺭ ﺻﺪ ﻣﻮﺛﺮﺗﺮﻳﻦ ﻭ ﺁﻣﭙﻲﺳﻴﻠﻴﻦ‪ ،‬ﺟﻨﺘﺎﻣﻴﺴﻴﻦ‪ ،‬ﺳﻴﭙﺮﻭﻓﻠﻮﮐﺴﺎﺳﻴﻦ‬ ‫ﮔﺰﺍﺭﺵ ﮔﺮﺩﻳﺪﻩ ﺍﺳﺖ‪ .‬ﺩﺭ ﺣـﺎﻟﻲﮐـﻪ ﺗﻌـﺪﺍﺩ ﻧﻤﻮﻧـﻪﻫـﺎﻱ ﻣـﻮﺭﺩ‬ ‫ﻧﺎﻣﻨﺎﺳﺐﺗﺮﻳﻦ ﺁﻧﺘﻲﺑﻴﻮﺗﻴﮏ ﺷﻨﺎﺧﺘﻪ ﺷﺪﻧﺪ‪ .‬ﻳﮑﻲ ﺍﺯ ﺩﻻﻳـﻞ ﻋـﺪﻡ‬ ‫ﺑﺮﺭﺳﻲ ﺩﺭ ﻣﻄﺎﻟﻌﻪﻱ ﻣﺎ ﺑﻴﺶ ﺍﺯ ﺍﻳﻦ ﺗﺤﻘﻴـﻖ ﻣـﺬﮐﻮﺭ ﻣـﻲﺑﺎﺷـﺪ‬ ‫ﻣﻘﺎﻭﻣﺖ ﺑـﻪ ﻟﻴﻨﺰﻭﻻﻳـﺪ ﻭ ﺳﻴﻨﺮﺳـﻴﺪ ﻋـﺪﻡ ﺗﺠـﻮﻳﺰ ﻓـﺮﻭﺍﻥ ﺍﻳـﻦ‬ ‫)‪ .(۳۰‬ﺍﺧﻴﺮﺍ ﺩﺭ ﻳﮏ ﻣﻄﺎﻟﻌﻪ ﮐﻪ ﺗﻮﺳﻂ ﺻﺪﺍﻗﺖ ﻭ ﻫﻤﮑـﺎﺭﺍﻥ ﺩﺭ‬ ‫ﺁﻧﺘﻲﺑﻴﻮﺗﻴﮏ ﺩﺭ ﺑﻴﻤﺎﺭﺳﺘﺎﻥﻫﺎﻱ ﺍﻳﺮﺍﻥ ﻭ ﻫﻤﭽﻨـﻴﻦ ﻋﺮﺿـﻪ ﺁﻥ ﺩﺭ‬ ‫‪ ۲۰۱۲‬ﻣﻨﺘﺸﺮ ﺷﺪﻩ‪ ،‬ﺑـﻪ ﺑﺮﺭﺳـﻲ ﻣﻘﺎﻭﻣـﺖ ﺑـﻪ ﻭﻧﮑﻮﻣﺎﻳـﺴﻴﻦ ﺩﺭ‬ ‫ﺳﺎﻝﻫﺎﻱ ﺍﺧﻴـﺮ ﻭ ﺑـﻪ ﻣﻘـﺪﺍﺭ ﭘـﺎﻳﻴﻦ ﺩﺭ ﺩﺍﺭﻭﺧﺎﻧـﻪﻫـﺎﻱ ﮐـﺸﻮﺭ‬ ‫ﻟﺒﺎﻓﻲﻧﮋﺍﺩ ﺍﺭﺍﻳﻪ ﮐﺮﺩﻩﺍﻧﺪ ﮐﻪ ﺩﺭ ﺁﻥ ﻣﻴﺰﺍﻥ ‪ VRE‬ﻫـﺎ ‪ ۷۰‬ﺩﺭﺻـﺪ‬ ‫ﺳﻮﻳﻪﻫﺎﻱ ﺍﻧﺘﺮﻭﮐﻮﮐﻮﺱ ﻓﺴﻴﻮﻡ ﺟﺪﺍ ﺷﺪﻩ ﺍﺯ ﻧﻤﻮﻧﻪﻫـﺎﻱ ﺑـﺎﻟﻴﻨﻲ‬ ‫ﻭ ﺍﺭﻳﺘﺮﻭﻣﺎﻳﺴﻴﻦ ﺑﺎ ﻣﻘﺎﻭﻣﺖ ‪ ۱۰۰‬ﺩﺭﺻﺪ ﺩﺭ ﺳـﻮﻳﻪﻫـﺎﻱ ‪VRE‬‬ ‫ﻣﻲﺑﺎﺷﺪ )‪.(۳۳‬‬ ‫ﻣﺠﻠﻪﻱ ﻋﻠﻤﻲ‪ ،‬ﭘﮋﻭﻫﺸﻲ ﺩﺍﻧﺸﮕﺎﻩ ﻋﻠﻮﻡ ﭘﺰﺷﮑﻲ ﻭ ﺧﺪﻣﺎﺕ ﺑﻬﺪﺍﺷﺘﻲ‪ ،‬ﺩﺭﻣﺎﻧﻲ ﺯﻧﺠـﺎﻥ‪ ،‬ﺩﻭﺭﻩﻱ ‪ ,٢٢‬ﺷﻤﺎﺭﻩﻱ ‪ ,٩١‬ﺧﺮﺩﺍﺩ ﻭ ﺗﻴﺮ ‪١٣٩٣‬‬ ‫ﻟﻴﻠﻲ ﺷﻜﻮﻫﻲ ﺯﺍﺩﻩ ﻭ ﻫﻤﻜﺎﺭﺍﻥ‬ 127 ‫ﻣﻘﺎﻭﻣﺖ ﺑﺎﮐﺘﺮﻱﻫﺎﻱ ﺑﻴﻤﺎﺭﺳﺘﺎﻧﻲ ﺍﺯ ﺟﻤﻠﻪ ﺳﻮﻳﻪﻫﺎﻱ ﻣﻘـﺎﻭﻡ ﺑـﻪ‬ ‫ﻃﺒــﻖ ﺍﻳــﻦ ﺗﺤﻘﻴــﻖ ﻭ ﺩﻳﮕــﺮ ﻣﻄﺎﻟﻌــﺎﺕ ﺑﻴﻤــﺎﺭﺍﻥ ﺑــﺴﺘﺮﻱ ﺩﺭ‬ .(۲۵) ‫ﻭﻧﮑﻮﻣﺎﻳﺴﻴﻦ ﺍﻧﺘﺮﻭﮐﻮﮎ ﻣﻲﺷﻮﺩ‬ ‫ ﻧﻔﺮﻭﻟـﻮﮊﻱ ﺩﺭ ﻣﻌـﺰﺽ‬،ICU ،‫ﺑﺨﺶﻫﺎﻳﻲ ﭼﻮﻥ ﭘﻴﻮﻧـﺪ ﮐﻠﻴـﻪ‬ ‫ ﺍﻧﺘﺮﻭﮐﻮﮐـﻮﺱ ﻓـﺴﻴﻮﻡ ﺩﺭ‬VRE ‫ﺁﻟﻮﺩﮔﻲ ﺑﻴﺸﺘﺮﻱ ﺑﺎ ﺳﻮﻳﻪﻫﺎﻱ‬ ‫ﻧﺘﻴﺠﻪﮔﻴﺮﻱ‬ ‫ﺩﺭ ﻣﺠﻤـﻮﻉ ﺍﻓـﺰﺍﻳﺶ ﺳــﻮﻳﻪﻫـﺎﻱ ﻣﻘــﺎﻭﻡ ﺑـﻪ ﻭﻧﮑﻮﻣﺎﻳـﺴﻦ‬ ‫ﺍﻧﺘﺮﻭﮐﻮﮐــﻮﺱ ﻓــﺴﻴﻮﻡ ﺑــﺎ ﻣﻘﺎﻭﻣــﺖ ﭼﻨﺪﮔﺎﻧــﻪ ﺩﺭ ﺑﺮﺍﺑــﺮ ﺳــﺎﻳﺮ‬ ‫ﺁﻧﺘﻲﺑﻴﻮﺗﻴﮏﻫﺎﻱ ﻣﻮﺛﺮ ﺩﺭ ﺩﺭﻣﺎﻥ ﻋﻔﻮﻧﺖﻫﺎﻱ ﺍﺩﺭﺍﺭﻱ ﺟﺎﻱ ﺑﺴﻲ‬ ‫ ﮐﻪ ﺍﻳﻦ ﺍﻣﺮ ﻣﻲﺗﻮﺍﻧﺪ ﻧﺎﺷـﻲ ﺍﺯ ﺗﺠـﻮﻳﺰ‬.‫ﺗﺎﻣﻞ ﻭ ﻧﮕﺮﺍﻧﻲ ﻣﻲﺑﺎﺷﺪ‬ ‫ ﮐـﺴﺐ‬.‫ﺑﻲﺭﻭﻳﻪ ﺑﺮﺧﻲ ﺁﻧﺘـﻲﺑﻴﻮﺗﻴـﮏﻫـﺎ ﺩﺭ ﺑﻴﻤﺎﺭﺳـﺘﺎﻥ ﺑﺎﺷـﺪ‬ ‫ﻣﻘﺎﻭﻣﺖ ﺑﻪ ﻭﻧﮑﻮﻣﺎﻳﺴﻴﻦ ﺗﻮﺳﻂ ﺍﻧﺘﺮﻭﮐﻮﮎﻫﺎ ﺗﺎﺛﻴﺮﺍﺕ ﺟﺪﻱ ﺑـﺮ‬ .‫ﺭﻭﻧﺪ ﺩﺭﻣﺎﻥ ﻭ ﮐﻨﺘﺮﻝ ﻋﻔﻮﻧﺖﻫﺎﻱ ﻧﺎﺷﻲ ﺍﺯ ﺍﻧﺘﺮﻭﮐﻮﮎﻫﺎ ﺩﺍﺭﺩ‬ ‫ ﺑﺴﺘﺮﻱ ﺑﻮﺩﻥ ﻃﻮﻻﻧﻲ ﻣﺪﺕ ﺩﺭ‬،‫ﻗﺮﺍﺭ ﺩﺍﺭﻧﺪ ﮐﻪ ﻣﻲﺗﻮﺍﻧﺪ ﻧﺎﺷﻲ ﺍﺯ‬ ‫ ﺿﻌﻒ ﺳﻴـﺴﺘﻢ ﺍﻳﻤﻨـﻲ ﺩﺭ ﺍﺛـﺮ ﻋﻮﺍﻣـﻞ ﺯﻣﻴﻨـﻪﺍﻱ ﻭ‬،‫ﺑﻴﻤﺎﺭﺳﺘﺎﻥ‬ ‫ﻣﺼﺮﻑ ﺩﺍﺭﻭﻫﺎﻱ ﺳﺮﮐﻮﺏ ﮐﻨﻨﺪﻩ ﺳﻴﺴﺘﻢ ﺍﻳﻤﻨﻲ ﻭ ﮐﻬﻮﻟﺖ ﺳﻦ‬ ‫ﻓﺸﺎﺭ ﺁﻧﺘﻲﺑﻴﻮﺗﻴﮑﻲ ﺩﺭ ﻣﺤﻴﻂﻫﺎﻱ ﺑﻴﻤﺎﺭﺳﺘﺎﻧﻲ ﺑـﻪ ﺩﻟﻴـﻞ ﺗﺠـﻮﻳﺰ‬ ‫ﻓـﺮﺍﻭﺍﻥ ﻭ ﻏﻴـﺮ ﻣﻨﻄﻘـﻲ ﺑـﺴﻴﺎﺭﻱ ﺍﺯ ﺁﻧﺘـﻲﺑﻴﻮﺗﻴـﮏﻫـﺎ ﺑـﻪﻭﻳـﮋﻩ‬ ‫ ﺳﻔﺎﻟﻮﺳﭙﻮﺭﻳﻦﻫﺎ‬،‫ﻭﻧﮑﻮﻣﺎﻳﺴﻴﻦ ﻭ ﺁﻧﺘﻲﺑﻴﻮﺗﻴﮏﻫﺎﻱ ﻭﺳﻴﻊ ﺍﻟﻄﻴﻒ‬ ‫ﻭ ﻣﺘﺮﻭﻧﻴﺪﺍﺯﻭﻝ ﻣﻲﺑﺎﺷﺪ ﮐﻪ ﺑﺎﻋﺚ ﺑﻪ ﻫﻢ ﺧﻮﺭﺩﻥ ﻓﻠﻮﺭ ﻣﻴﮑﺮﻭﺑﻲ‬ ‫ﺩﺳﺘﮕﺎﻩ ﮔﻮﺍﺭﺵ ﻭ ﻣﺠﺎﻝ ﺭﺷﺪ ﭘﺎﺗﻮﮊﻥﻫـﺎﻱ ﺭﻭﺩﻩﺍﻱ ﻭ ﺍﻓـﺰﺍﻳﺶ‬ References vancomycin-sensitive 1- Fridken SK, Gynes RP. 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Infect Control Hosp Epidemiol. 2008; 29: 996-1011. ١٣٩٣ ‫ ﺧﺮﺩﺍﺩ ﻭ ﺗﻴﺮ‬,٩١ ‫ ﺷﻤﺎﺭﻩﻱ‬,٢٢ ‫ ﺩﻭﺭﻩﻱ‬،‫ ﺩﺭﻣﺎﻧﻲ ﺯﻧﺠـﺎﻥ‬،‫ ﭘﮋﻭﻫﺸﻲ ﺩﺍﻧﺸﮕﺎﻩ ﻋﻠﻮﻡ ﭘﺰﺷﮑﻲ ﻭ ﺧﺪﻣﺎﺕ ﺑﻬﺪﺍﺷﺘﻲ‬،‫ﻣﺠﻠﻪﻱ ﻋﻠﻤﻲ‬ ‫ﻓﺮﺍﻭﺍﻧﻲ ﻣﻘﺎﻭﻣﺖ ﺑﻪ ﻭﻧﮑﻮﻣﺎﻳﺴﻴﻦ ﺩﺭ ﻋﻔﻮﻧﺖﻫﺎﻱ ﺍﺩﺭﺍﺭﻱ‬ 130 Frequency of Vancomycin -Resistant Enterococcus Faecium Strains Isolated from Urinary Tract Infections (UTI) in 4 Hospitals of Tehran Shokoohizadeh L1, Mohabati Mobarez A1, Zali MR2, Ranjbar R3, Alebouyeh M2 1 2 Dept. of Bacteriology, Faculty of Medical Sciences, Tarbiat Modares University, Tehran, Iran Research Center of Gastroenterology and Liver Diseases, Shahid Beheshti University of Medical Sciences, Tehran, Iran 3 Molecular Biology Research Center, Baqiyatallah University of Medical Sciences, Tehran, Iran. Correspond Author: Dept. of Bacteriology, Faculty of Medical Sciences, Tarbiat Modares University, Tehran, Iran. E-mail: mmmobarez@modares.ac.ir Received: 30 Jun 2013 Accepted: 7 Oct 2013 Background and Objective: Vancomycin-resistant enterococci (VRE) are the major causative agents of urinary tract infections (UTIs) in hospitalized patients. The aim of this study was to determine the prevalence of urinary tract infections caused by enterococcus faecium and the level of resistance to vancomycine and other antibiotics which are effective in enterococcal infection therapy of hospitalized patients in four university teaching hospitals of Tehran. Materials and Methods: This study was carried out between September 2011 and May 2012. Urine samples were collected from hospitalized patients in Taleghani, Loghman, Mofid and Labaffi nejad Hospitals in Tehran. Enterococcus species were detected by biochemical and molecular tests. Antimicrobial susceptibility and minimum inhibitory concentration (MIC) of vancomycine were determined by disk diffusion and agar dilution methods. The presence of vanA and vanB genes were investigated in VRE strains by PCR. Results: 86 enterococci were isolated from urine samples of which 45(52%) were E.faecium. 42.2% of E. faecium isolates were resistant to vancomycin (VRE) and showed vanA genotype. All VRE isolates were resistant to ampicillin, gentamicin, ciprofloxacin and erythromycin, and 78% were resistant to nitrofurantoin. Furthermore, all VRE isolates were sensitive to linezolide and quiopristin-dalfopristin. MIC50 ≥ 128 and MIC90 ≥ 256 were detected in the VRE strains. Conclusion: The increase in the prevalence of vancomycin resistant E. faecium with high risk resistance profiles is a serious threat for some Iranian hospitals and limits the therapeutical options for patients infected with E. faecium. Keywords: Enterococcus faecium, Urinary tract infections, Vancomycin, resistance ١٣٩٣ ‫ ﺧﺮﺩﺍﺩ ﻭ ﺗﻴﺮ‬,٩١ ‫ ﺷﻤﺎﺭﻩﻱ‬,٢٢ ‫ ﺩﻭﺭﻩﻱ‬،‫ ﺩﺭﻣﺎﻧﻲ ﺯﻧﺠـﺎﻥ‬،‫ ﭘﮋﻭﻫﺸﻲ ﺩﺍﻧﺸﮕﺎﻩ ﻋﻠﻮﻡ ﭘﺰﺷﮑﻲ ﻭ ﺧﺪﻣﺎﺕ ﺑﻬﺪﺍﺷﺘﻲ‬،‫ﻣﺠﻠﻪﻱ ﻋﻠﻤﻲ‬