:ﻪﺒﺗﺎﮑﻣ سردآ*
نﺎﺘﺳﺮﻟ ، .ﯽﮑﺷﺰﭘ هﺪﮑﺸﻧاد ،ﯽﮑﺷﺰﭘ مﻮﻠﻋ هﺎﮕﺸﻧاد ،دﺎﺑآ مﺮﺧ
ﺖﺴﭘ :ﮏﯿﻧوﺮﺘﮑﻟا [email protected]
يﻮﮕﻟا ﯽﺳرﺮﺑ ﯽﻧﺎﻣﻮﺑ ﺮﺘﮐﺎﺑﻮﺘﻨﯿﺳا ﯽﻨﯿﻟﺎﺑ يﺎﻫ ﻪﻟوﺰﯾا ﯽﮑﯿﺗﻮﯿﺑ ﯽﺘﻧآ ﺖﻣوﺎﻘﻣ
دﺎﺑآ مﺮﺧ ﺮﻬﺷ يﺎﻫ نﺎﺘﺳرﺎﻤﯿﺑ رد
يدﻻﻮﭘ نﺎﻤﯾا ﯽﻧﺎﻔﻟد ﻪﯿﻤﺳ ، 1
وﺮﺳ هرﺎﺘﺳ ، 2
ش ﯽﻧﺎﻄﻠﺳ ﺎﺿرﺪﻤﺤﻣ ، 2
، 3
ﯽﯾﺎﺿر ﮏﻧاﺮﻓ
2
*
1 - ﻮﺠﺸﻧاد ي ﯽﯾﻮﺠﺸﻧاد تﺎﻘﯿﻘﺤﺗ ﻪﺘﯿﻤﮐ ،
ﯽﮑﺷﺰﭘ هﺪﮑﺸﻧاد
، نﺎﺘﺳﺮﻟ ﯽﮑﺷﺰﭘ مﻮﻠﻋ هﺎﮕﺸﻧاد
، دﺎﺑآ مﺮﺧ
، ناﺮﯾا
2 - ،رﺎﯾدﺎﺘﺳا ﯽﺳﺎﻨﺷ بوﺮﮑﯿﻣ هوﺮﮔ ،
ﯽﮑﺷﺰﭘ هﺪﮑﺸﻧاد
، نﺎﺘﺳﺮﻟ ﯽﮑﺷﺰﭘ مﻮﻠﻋ هﺎﮕﺸﻧاد
، دﺎﺑآ مﺮﺧ
، ﯾا ناﺮ
3 - ﻮﺠﺸﻧاد ،ﯽﮑﺷﺰﭘ ي ﯽﮑﺷﺰﭘ هﺪﮑﺸﻧاد
، نﺎﺘﺳﺮﻟ ﯽﮑﺷﺰﭘ مﻮﻠﻋ هﺎﮕﺸﻧاد
، دﺎﺑآ مﺮﺧ
، ناﺮﯾا
هرود / ﻪﺘﻓﺎﯾ 23
هرﺎﻤﺷ / 3
/ نﺎﺘﺴﺑﺎﺗ 1400
/ ﻞﺴﻠﺴﻣ 88
:ﻪﻟﺎﻘﻣ ﺖﻓﺎﯾرد 22
/1 / 1400 ﻟﺎﻘﻣ شﺮﯾﺬﭘ :ﻪ
1/
3 / 1400
ﻪﻣﺪﻘﻣ :
ﺎﻣﻮﺑ ﺮﺘﮐﺎﺑﻮﺘﻨﯿﺳا وراد ﻪﺑ موﺎﻘﻣ يﺎﻫ ﻪﯾﻮﺳ هزوﺮﻣا ﯽﻣ حﺮﻄﻣ نﺎﻬﺟ رد ﺐﻠﻃ ﺖﺻﺮﻓ يﺎﻫ نژﻮﺗﺎﭘ زا ﯽﮑﯾ ناﻮﻨﻋ ﻪﺑ ﯽﻧ
ﺑ ﺪﻨـﺷﺎ .
فﺪﻫ زا ﻪﻌﻟﺎﻄﻣ ﻦﯾا ﯽﺳرﺮﺑ
يﻮﮕﻟا ﺖﻣوﺎﻘﻣ ﯽﺘﻧآ ﯽﻧﺎﻣﻮﺑﺮﺘﮐﺎﺑﻮﺘﻨﯿﺳا ﯽﻨﯿﻟﺎﺑ يﺎﻫ ﻪﻟوﺰﯾا ﯽﮑﯿﺗﻮﯿﺑ مﺮـﺧ ﺮﻬﺷ يﺎﻫ نﺎﺘﺳرﺎﻤﯿﺑ رد
دﺎـﺑآ
(ﯽﻤﯿﺣر ﺪﯿﻬﺷ و ﺮﯾﺎﺸﻋ ياﺪﻬﺷ) ﯽﻣ
ﺪﺷﺎﺑ .
شور و داﻮﻣ :ﺎﻫ
ﯽﻔﯿﺻﻮﺗ ﻪﻌﻟﺎﻄﻣ ﻦﯾا -
ﺑ ﯽﻌﻄﻘﻣ ﻪﻧﻮﻤﻧ يور ﺮ ﯽﻨﯿﻟﺎﺑ يﺎﻫ
ﻊﻤﺟ ارﺎﻤﯿﺑ زا هﺪﺷ يروآ ن
ﺨﺑ رد يﺮﺘﺴﺑ يﺎﻫ ﺶ
ﻒﻠﺘﺨﻣ
ﺎﺘﺳرﺎﻤﯿﺑ ن يﺎﻫ يﺎﻬﻟﺎﺳ رد دﺎﺑآ مﺮﺧ ﺮﻬﺷ 95
- 1394 و 97 - 1396 ﺪﺷ مﺎﺠﻧا . ﻂﺳﻮﺗ نارﺎﻤﯿﺑ زا هﺪﺷ اﺪﺟ ﯽﻨﯿﻟﺎﺑ يﺎﻫ ﻪﻧﻮﻤﻧ ﺖﺸﮐ
و ﯽﺑوﺮﮑﯿﻣ ﯽﯾﺎﯿﻤﯿﺷﻮﯿﺑ يﺎﻫ نﻮﻣزآ
ناﻮﻨﻋ ﻪﺑ ﯽﻧﺎﻣﻮﺑ ﺮﺘﮐﺎﺑ ﻮﺘﻨﯿﺳا ﺪﻧﺪﺷ ﯽﯾﺎﺳﺎﻨﺷ
و ﺖﯾﻮﻫ ﺪﯿﯾﺎﺗ ياﺮﺑ ﯽﻧﺎﻣﻮﺑ ﺮﺘﮐﺎﺑﻮﺘﻨﯿﺳا
زا شور
ﺪﯾدﺮﮔ هدﺎﻔﺘﺳاPCR ﺖﯿﺳﺎﺴﺣ ﻦﯿﯿﻌﺗ ﺶﯾﺎﻣزآ .
يﺮﺘﮐﺎﺑ يﺎﻫ ﻪﻟوﺰﯾا ﺎﻫ ﮏﯿﺗﻮﯿﺑ ﯽﺘﻧآ ﻪﺑ ﺖﺒﺴﻧ
مﺎﺠﻧا و ﺖﻓﺮﮔ ﺎﻫ هداد راﺰﻓا مﺮﻧ ﻂﺳﻮﺗ
SPSS ﻪﺨﺴﻧ 22 و ﺮﺋﻮﮑﺳا يﺎﮐ نﻮﻣزآ ﺪﻧﺪﺷ ﺰﯿﻟﺎﻧآ
.
ﻪﺘﻓﺎﯾ :ﺎﻫ
ﻦﯿﺑ زا ﻪﺘﻓﺮﮔ ترﻮﺻ ماﺮﮔﻮﯿﺑ ﯽﺘﻧآ سﺎﺳاﺮﺑ 94
رد يﺮﺘﺴﺑ نارﺎﻤﯿﺑ زا هﺪﺷ اﺪﺟ ﯽﻧﺎﻣﻮﺑ ﺮﺘﮐﺎﺑﻮﺘﻨﯿﺳا ﻪﻟوﺰﯾا يﺎﻫ نﺎﺘﺳرﺎﻤﯿﺑ
دﺎﺑآ مﺮﺧ ﺮﻬﺷ ،
50
% ، 49 / 41
% و 51 / 8
% ﺪﻨﭼ ﻪﺑ ﺖﻣوﺎﻘﻣ ياراد ﺐﯿﺗﺮﺗ ﻪﺑ ﺎﻫ ﻪﻟوﺰﯾا د
ورا (،MDR) ﺖﻣوﺎﻘﻣ رﺎﯿﺴﺑ هدﺮﺘﺴﮔ ﻪﺑ ﺪﻨﭼ
وراد (XDR) و
وراد ﺪﻨﭼ ﻪﺑ موﺎﻘﻣ ﺮﯿﻏ ﺪﻧدﻮﺑ
.
ﻪﺠﯿﺘﻧ و ﺚﺤﺑ :يﺮﯿﮔ
ﺣ ﻪﺑ ﻪﺟﻮﺗ ﺎﺑ ﯽﻧﺎﻣﻮﺑ ﺮﺘﮐﺎﺑﻮﺘﻨﯿﺳا ندﻮﺑ سﺎﺴ
ﻪﺑ ﯽﺘﻧآ ﮏﯿﺗﻮﯿﺑ ﯽﺑ ﻦﯿﺴﮑﯿﻣ ﯽﻠﭘ يﺎﻫ ﯾﺎﺳﻮﻨﯾﺎﻣ و
ﯽﻣ ﻦﯿﻠﮑ
ناﻮﺗ زا ﻦﯾا ﯽﺘﻧآ ﮏﯿﺗﻮﯿﺑ
،ﺎﻫ ﻪﺑ ﻪﺑ صﻮﺼﺧ ترﻮﺻ
نﺎﻣرد ﯽﺒﯿﮐﺮﺗ رد نﺎﻣرد ﺖﻧﻮﻔﻋ يﺎﻫ ﯽﺷﺎﻧ زا ﻦﯾا يﺮﺘﮐﺎﺑ ﺮﮐ هدﺎﻔﺘﺳا .د
ﻞﯿﻟﺪﺑ
دﺎﺑآ مﺮﺧ ﺮﻬﺷ يﺎﻫ نﺎﺘﺳرﺎﻤﯿﺑ رد وراد ﺪﻨﭼ ﻪﺑ ﺖﻣوﺎﻘﻣ ناﺰﯿﻣ ﻪﮑﻨﯾا 49
/ 91 رﺎﯿﻌﻣ ﻪﺑ ﻪﺟﻮﺗ ﻦﯾاﺮﺑﺎﻨﺑ ،هﺪﺷ شراﺰﮔﺪﺻرد لﺮﺘﻨﮐ يﺎﻫ
ﺖﺳا يروﺮﺿ ﯽﻧﺎﺘﺳرﺎﻤﯿﺑ يﺎﻫ ﺖﻧﻮﻔﻋ .
هژاو ﺪﯿﻠﮐ يﺎﻫ :ي
،ﯽﻧﺎﻣﻮﺑ ﺮﺘﮐﺎﺑﻮﺘﻨﯿﺳا ﺪﻨﭼ ﻪﺑ ﺖﻣوﺎﻘﻣ
ﺖﻣوﺎﻘﻣ ،ﯽﮑﯿﺗﻮﯿﺑ ﯽﺘﻧآ رﺎﯿﺴﺑ
هدﺮﺘﺴﮔ ﻪﺑ ﯽﮑﯿﺗﻮﯿﺑ ﯽﺘﻧآ ﺪﻨﭼ .
هﺪﯿﮑﭼ
/
159هرود ،ﻪﺘﻓﺎﯾ 23
، نﺎﺘﺴﺑﺎﺗ 1400
ﻪﻣﺪﻘﻣ
ﻪﯿﺳﻼﺴﮐارﻮﻣ هداﻮﻧﺎﺧ ﻪﺑ ﻖﻠﻌﺘﻣ ﯽﻧﺎﻣﻮﺑ ﺮﺘﮐﺎﺑ ﻮﺘﻨﯿﺳا رد
سﻼﮐ ﯾﺮﺘﮐﺎﺑﻮﺌﺗوﺮﭘ ﯽـﻔﻨﻣ مﺮـﮔ ﻞﯿﺳﺎﺑﻮﮐﻮﮐ ﻪﮐ ﺪﺷﺎﺑ ﯽﻣ ﺎ
،
رﻮﭙـﺳا نوﺪﺑ و كﺮﺤﺘﻣ ﺮﯿﻏ ،يرﺎﺒﺟا يزاﻮﻫ ﺖـﺳا
رﻮـﻄﺑ و
دﻮـﺷ ﯽـﻣ ﺖﻓﺎﯾ نﺎﺴﻧا ﺖﺳﻮﭘ و بآ ،كﺎﺧ رد ﯽﻌﯿﺳو )
1 ( .
زا ﯽﺑﺎــﺴﺘﮐا ﻢــﻬﻣ نژﻮﺗﺎــﭘ ﮏــﯾ ناﻮــﻨﻋ ﻪــﺑ يﺮﺘﮐﺎــﺑ ﻦــﯾا ﺖـﺳا شﺮﺘﺴﮔ لﺎﺣ رد نﺎﻬﺟ ﺮﺳاﺮﺳ رد نﺎﺘﺳرﺎﻤﯿﺑ )
2،3 (
ﯽﯾﺎﻧاﻮﺗ ﺮﺘﮐﺎﺑﻮﺘﻨﯿﺳا يﺎـﻫ ﺺﺧﺎـﺷ يروآ ﻊـﻤﺟ رد ﯽﻧﺎـﻣﻮﺑ
ر ﺮﺑ نﺪﻧﺎﻣ هﺪﻧز رد نآ ﯽﯾﺎﻧاﻮﺗ ﺎﺑ هاﺮﻤﻫ ﺖﻣوﺎﻘﻣ ﻒﻠﺘﺨﻣ يو
تﺪﻣ ﻪﺑ) هﺪﻧز ﺮﯿﻏ و هﺪﻧز حﻮﻄﺳ 3
ﺎﺗ زور 5 ﮑﺸﺗ ﺎﺑ (هﺎﻣ ﻞﯿ
ﻢﻠﯿﻓﻮﯿﺑ نﺎﺘـﺳرﺎﻤﯿﺑ ﻂﯿـﺤﻣ رد يﺮﺘﮐﺎـﺑ ﻦﯾا يراﺪﯾﺎﭘ ﻞﻣﺎﻋ
ﺪﺷﺎﺑ ﯽﻣ ) 4،5 .(
ﯽﻧﺎﻣﻮﺑ ﺮﺘﮐﺎﺑ ﻮﺘﻨﯿﺳا زا ﯽﮑﯾ ناﻮﻨﻋ ﻪﺑ
هﺪـﻨﻨﮐ هدﻮـﻟآ
ﺪﻨﻧﺎﻣ ﯽﻧﺎﺘﺳرﺎﻤﯿﺑ يﺎﻫ ﻂﯿﺤﻣ ﻊﯾﺎﺷ يﺎﻫ يﺎـﻫرﻮﺗﻼﯿﺘﻧو
و ﺎـﻫ هﺎﮕﺘـﺳد ،نﻮﯿـﺳاﺮﺘﻠﯿﻓﻮﻤﻫ يﺎﻫ ﻦﯿﺷﺎﻣ ،ﯽﮑﯿﻧﺎﮑﻣ ﺖـﺨﺗ ،رد يﺎـﻫ هﺮﯿﮕﺘـﺳد ،ﻂﯿـﺤﻣ هﺪﻨﻨﮐ كﺎﭘ تﺎﻌﯾﺎﻣ ﻔﺻ و نارﺎﻤﯿﺑ ﺖﺳا هﺪﺷ ﻪﺘﺧﺎﻨﺷ ﺮﺗﻮﯿﭙﻣﺎﮐ ﺪﯿﻠﮐ ﻪﺤ
) 6 (
.
ﺖﻧﻮﻔﻋ رد ﻢﻬﻣ ﻞﻣاﻮﻋ زا ﯽﮑﯾ يﺎـﻫ ﺖـﻧﻮﻔﻋ ﻪـﻠﻤﺟ زا ﺎﻫ
ﺖﻓﺎﺑ و ﺖﺳﻮﭘ ﺖﻧﻮﻔﻋ ،ﯽﻧﻮﻣﻮﻨﭘ ،ﺖﯾﮋﻨﻨﻣ ،ﯽﻤﯾﺮﺘﮐﺎﺑ ،مﺮﻧ
و ﺖﯾدرﺎﮐوﺪـﻧا ،ﯽﻤـﺳ ﯽﺘﭙﺳ ،ﺖﯿﻧﻮﺘﯾﺮﭘ ،يراردا يرﺎﺠﻣ دور ﯽﻣ رﺎﻤﺷ ﻪﺑ ﺖﯿﺗاﺮﮐ )
7 ( .
ﻮﺘﻨﯿـﺳا ﺎـﺑ ﺖـﻧﻮﻔﻋ ﺎﯾ نﻮﯿﺳاﺰﯿﻧﻮﻠﮐ يﺎﻫرﻮﺘﮐﺎﻓ ﮏﺴﯾر تﺪـﻣ ﻪـﺑ نﺎﺘﺳرﺎﻤﯿﺑ رد نﺪﺷ يﺮﺘﺴﺑ ﻞﻣﺎﺷ ﯽﻧﺎﻣﻮﺑ ﺮﺘﮐﺎﺑ
ـﯿﺗﻮﯿﺑ ﯽﺘﻧآ ﺖﻓﺎﯾرد لﺎﺣ رد ﻪﮐ ﯽﯾﺎﻬﻧآ هﮋﯾو ﻪﺑ و ﯽﻧﻻﻮﻃ ﮏ
،ﺪﻨﺘـﺴﻫ نﺎﻃﺮـﺳ ﺪـﺿ ﺎـﯾ ﻒـﯿﻄﻟا ﻊﯿﺳو يﺎﻫ زا هدﺎﻔﺘـﺳا
،ﯽـﻗوﺮﻋ ﻞـﺧاد ﻞﯾﺎـﺳو ،ﯽﮑﯿﻧﺎﮑﻣ نﻮﯿﺳﻼﯿﺘﻧو يﺎـﻫ شور
و ﯽﺣاﺮﺟ ﺎﯾ ﯽﺟﺎﻬﺗ ﺪـﺷﺎﺑ ﯽـﻣ ﺎﻫ ﯽﮕﺘﺧﻮﺳ
) 8،9 .(
نﺎـﻣرد
ﻞﻣﺎـﺷ لﻮـﻤﻌﻣ رﻮـﻃ ﻪـﺑ يﺮﺘﮐﺎﺑ ﻦﯾا زا ﯽﺷﺎﻧ يﺎﻫ ﺖﻧﻮﻔﻋ ﺎﻫ نﻮﻟﻮﻨﯿﮐورﻮﻠﻓ و ﺎﻫ مﺎﺘﮐﻻﺎﺘﺑ زا هدﺎﻔﺘﺳا ﯽﻣ
ﺪﺷﺎﺑ ﻪـﮐ رد
ﻟﺎﺳ هدﺎﻔﺘﺳا ﻪﺘﺷﺬﮔ يﺎﻬ ﻪﯾور ﯽﺑ
ﺎـﻫ ﮏـﯿﺗﻮﯿﺑ ﯽـﺘﻧآ ﻦﯾا زا
ﺖﺳا هﺪﺷ موﺎﻘﻣ يﺎﻫ ﻪﯾﻮﺳ رﻮﻬﻇ ﻪﺑ ﺮﺠﻨﻣ )
10 (.
ﻪﻄـﺳاو ﻪـﺑ ﯽﻧﺎﻣﻮﺑﺮﺘﮐﺎﺑﻮﺘﻨﯿـﺳا ﯽﮑﯿﺗﻮﯿﺑ ﯽﺘﻧآ ﺖﻣوﺎﻘﻣ و ﯽﺑﺎـﺴﺘﮐا يﺎـﻫ ﻢﺴﯿﻧﺎﮑﻣ ﺮـﯿﯿﻐﺗ ﻞﻣﺎـﺷ ﻪـﮐ ﺖـﺳا ﯽـﺗاذ
ﯽﻤﯾﺰﻧآ يﺮﯾﺬـﭘ ذﻮـﻔﻧ ﺮـﯿﯿﻐﺗ ،فﺪﻫ يﺎﻫ نژ رد نﻮﯿﺳﺎﺗﻮﻣ ،
ﺪـﺷﺎﺑ ﯽـﻣ ﺎـﻫ ﭗﻤﭘ ﺲﮐﻼﻓا نﺎﯿﺑ ﺶﯾاﺰﻓا و ﯽﺟرﺎﺧ يﺎﺸﻏ ) 11 (.
وراد ﺪـﻨﭼ ﻪـﺑ موﺎـﻘﻣ يﺎـﻫ ﻪﯾﻮﺳ ﺎﺑ ﺖﻧﻮﻔﻋ
(MDR)
Multi Drug Resistant
ﺮﺘﮐﺎﺑﻮﺘﻨﯿـﺳا زا ﯽﯾﺎـﻫ ﻪﯾﻮﺳ ﯽﻨﻌﯾ
ﺪﻨـﺷﺎﺑ موﺎﻘﻣ ﺞﯾار ﯽﮑﯿﺗﻮﯿﺑ ﯽﺘﻧآ سﻼﮐ ﻪﺳ ﻪﺑ ﻪﮐ ﯽﻧﺎﻣﻮﺑ و
ﻪـﮐ ﯽﻧﺎـﻣﻮﺑ ﺮﺘﮐﺎﺑﻮﺘﻨﯿﺳا زا ﯽﯾﺎﻫ ﻪﯾﻮﺳ ﻦﯿﻨﭽﻤﻫ مﺎـﻤﺗ ﻪـﺑ
هوﺮـﮔ ود ﺰـﺠﺑ ﺪﻨﺘـﺴﻫ موﺎـﻘﻣ ﯽﮑﯿﺗﻮـﯿﺑ ﯽﺘﻧآ يﺎﻫ سﻼﮐ ،
) (XDR Extensive Drug Resistant
ﻪـﮐ ،دﻮـﺷ ﯽﻣ ﻪﺘﻔﮔ
ﺖﺳا هدﻮﻤﻧ دﺎﺠﯾا يرﺎﯿﺴﺑ ﯽﻧﺎﻣرد تﻼﮑﺸﻣ .
ﻪﻟوﺰﯾا ﻦﯾا دﻮﺟو ﺎـﻫ
,يﺮﺘـﺴﺑ تﺪـﻣ نﺪـﺷ ﯽﻧﻻﻮـﻃ ﺎـﺑ
ﻪﻨﯾﺰﻫ ﺶﯾاﺰﻓا ﻪـﻄﺑار نارﺎـﻤﯿﺑ ﺮـﯿﻣ و گﺮـﻣ ﺖﯾﺎﻬﻧ رد و ﺎﻫ
دراد يراد ﯽـــﻨﻌﻣ )
12 (.
ﻒـــﻠﺘﺨﻣ يﺎـــﻫﻮﮕﻟا و حﻮﻄـــﺳ
ﯽﮑﯿﺗﻮــﯿﺑ ﯽــﺘﻧآ ﺖﯿــﺳﺎﺴﺣ ﻒــﻠﺘﺨﻣ يﺎــﻫ ﻪــﻧﻮﮔ ﻦﯿــﺑ
نﺎﺸﻧ ﯽﻧﺎﻣﻮﺑﺮﺘﮐﺎﺑﻮﺘﻨﯿﺳا هﺪﻨﻫد
ـﺘﻧآ ﺖﻣوﺎﻘﻣ ﺮﺗﻻﺎﺑ عﻮﯿﺷ ﯽ
رد ﯽﻧﺎﻣﻮﺑﺮﺘﮐﺎﺑﻮﺘﻨﯿـﺳا يﺎﻫ ﻪﻧﻮﮔ ﻦﯿﺑ ﯽﮑﯿﺗﻮﯿﺑ ﻪـﺴﯾﺎﻘﻣ
ﺎـﺑ
ﺮﯾﺎﺳ ﺮﺘﮐﺎﺑﻮﺘﻨﯿﺳا يﺎﻫ ﻪﻧﻮﮔ ﺪﺷﺎﺑ ﯽﻣ
) 13 ( .
ﻪﻘﻄﻨﻣ ﺮﻫ رد ﯽﮑﯿﺗﻮﯿﺑ ﯽﺘﻧآ ﺖﯿﺳﺎﺴﺣ يﻮﮕﻟا ﯽﯾﺎﺳﺎﻨﺷ ﯽﮑﯿﺗﻮﯿﺑ ﯽﺘﻧآ ﺖﻣوﺎﻘﻣ شﺮﺘﺴﮔ زا يﺮﯿﮔﻮﻠﺟ ﺖﻬﺟ يروﺮﺿ
ﯽﺘﻧآ ﺖﯿﺳﺎﺴﺣ يﻮﮕﻟا ﻦﯿﯿﻌﺗ فﺪﻫ ﺎﺑ ﻪﻌﻟﺎﻄﻣ ﻦﯾا اﺬﻟ ،ﺖﺳا اﺪـﺟ ﯽﻧﺎـﻣﻮﺑ ﺮﺘﮐﺎﺑﻮﺘﻨﯿـﺳا ﯽﻨﯿﻟﺎـﺑ يﺎﻫ ﻪﻟوﺰﯾا رد ﯽﮑﯿﺗﻮﯿﺑ زا هﺪﺷ رد يﺮﺘﺴﺑ نارﺎﻤﯿﺑ نﺎﺘﺳرﺎﻤﯿﺑ
يﺎﻫ دﺎـﺑآ مﺮـﺧ ﺮﻬﺷ
ﺸﻋ ياﺪﻬﺷ) (ﯽﻤﯿﺣر ﺪﯿﻬﺷ و ﺮﯾﺎ
مﺎﺠﻧا .ﺖﻓﺮﮔ
شور و داﻮﻣ ﺎﻫ
ﯽﻔﯿﺻﻮﺗ ﻪﻌﻟﺎﻄﻣ ﻦﯾا -
ﻪﻧﻮﻤﻧ يور ﺮﺑ ﯽﻌﻄﻘﻣ ﯽﻨﯿﻟﺎـﺑ يﺎـﻫ
ﻊﻤﺟ ارﺎﻤﯿﺑ زا هﺪﺷ يروآ ن
ـﺨﺑ رد يﺮﺘـﺴﺑ يﺎـﻫ ﺶ
ﻒـﻠﺘﺨﻣ
ﺎﺘﺳرﺎﻤﯿﺑ ن يﺎـﻫ و ﺮﯾﺎـﺸﻋ ياﺪﻬـﺷ) دﺎـﺑآ مﺮـﺧ ﺮﻬـﺷ ﺪﯿﻬـﺷ
يﺎﻬﻟﺎــﺳ رد (ﯽــﻤﯿﺣر 95
- 1394 و 97 - 1396 ﺪــﺷ مﺎــﺠﻧا .
زا
ﺎـﺳرا ﯽﻨﯿﻟﺎﺑ يﺎﻫ ﻪﻧﻮﻤﻧ ،راردا ،نﻮـﺧ ﻞﻣﺎـﺷ هﺎﮕـﺸﯾﺎﻣزآ ﻪـﺑ ﯽﻟ
ﯽﺴﻔﻨﺗ
،ﺖﻓﺎﺑ ، ﻢﺧز وCSF
(ﯽﮕﺘﺧﻮـﺳ ﻢـﺧز ،ﯽـﺣاﺮﺟ ﻢﺧز)
94 ﻪــﻟوﺰﯾا ﺮﺘﮐﺎﺑﻮﺘﻨﯿــﺳا ﯽﻧﺎــﻣﻮﺑ
اﺪــﺟ
،ﺪــﯾدﺮﮔ يﺎــﻫ ﻪــﻟوﺰﯾا
ﯽﻧﺎﻣﻮﺑ ﺮﺘﮐﺎﺑﻮﺘﻨﯿﺳا ﺎﺑ
هدﺎﻔﺘﺳا زا نﻮﻣزآ يﺎﻫ ﯽﯾﺎﯿﻤﯿﺷﻮﯿﺑ ﻞـﺜﻣ
ﺪﺷر يور ﻂﯿﺤﻣ ﯽﮑﻧﺎﮐ ﮏﻣ
،رﺎﮔآ مﺪﻋ ﺮﯿﻤﺨﺗ
،زﻮـﺘﮐﻻ ﺖـﺴﺗ
زاﺪﯿــﺴﮐا
،ﯽــﻔﻨﻣ ﺪــﻋ م ﺗ ﻂﯿــﺤﻣ يور كﺮــﺤ يﻮــﮕﻟا ،SIM
ALK/ALK
يور ﻣ ،TSI
ﻣ رد ﺎﻫﺪـﻨﻗ ﻮﯿﺗاﺪﯿـﺴﮐا فﺮﺼ ﻂﯿـﺤ
ﺖﺸﮐ
Oxidation/Fermentation (OF)
، ﺪـﯿﻟﻮﺗ مﺪﻋ نﺎـﻤﮕﯿﭘ
ﯽﯾﺎﺳﺎﻨﺷ مﺮﮔ يﺰﯿﻣآ ﮓﻧر و و
ﺪﯿﯾﺎﺗ و ﺪﻧﺪﺷ ﺖـﻬﺟ نآ زا ﺲﭘ
ﺪــﯿﯾﺎﺗ ﻪــﻧﻮﮔ ا نژ ﺮــﯿﺜﮑﺗ زا ﯽﻧﺎــﻣﻮﺑ ﺮﺘﮐﺎﺑﻮﺘﻨﯿــﺳ
bla-OXA51
ﻂﺳﻮﺗ هدﺎﻔﺘـﺳا PCR
ﺪـﺷ ) 14 (.
ﻂـﺳﻮﺗ ﻪـﮐ ﺐـﯿﺗﺮﺗ ﻦﯾﺪـﺑ
لوﺪﺟ) ﯽﺻﺎﺼﺘﺧا يﺎﻫﺮﻤﯾاﺮﭘ 1
يﺎﻣد رد نژ ﻦﯾا ،(
ﯽﮕﺘﺷﺮﺳاو
)
Denaturation
( 94 ﻪﺟرد داﺮـﮔ ﯽﺘﻧﺎﺳ تﺪـﻣ ﻪـﺑ
5
،ﻪـﻘﯿﻗد
94 ﻪﺟرد داﺮـﮔ ﯽﺘﻧﺎـﺳ 40
يﺎـﻣد و ،ﻪـﯿﻧﺎﺛ ﺎـﻫﺮﻤﯾاﺮﭘ لﺎـﺼﺗا
Annealing)
( 59 ﻪﺟرد داﺮﮔ ﯽﺘﻧﺎﺳ 1
يﺎﻣد ،ﻪﻘﯿﻗد شﺮﺘـﺴﮔ
لﻮــﺼﺤﻣ ﺮــﯿﺜﮑﺗ و
Extension)
( 72 ــﺟرد ﻪ داﺮــﮔ ﯽﺘﻧﺎــﺳ 1
ﻪﻘﯿﻗد و يﺎـﻣد ﺮـﯿﺜﮑﺗ ﯽﯾﺎـﻬﻧ )
Final Extension
( 72 ﻪـﺟرد
داﺮﮔ ﯽﺘﻧﺎﺳ 5
ﻪﻘﯿﻗد ) 35 ﻞﮑﯿﺳ ( ﺮﯿﺜﮑﺗ .ﺪﺷ ﯽـﺘﻧآ ﺖﯿـﺳﺎﺴﺣ
ﯽﺑﺮﮐ شور زا هدﺎﻔﺘﺳا ﺎﺑ ﯽﮑﯿﺗﻮﯿﺑ -
ﺮﺋﺎﺑ ﺮـﺑ (نژﻮـﯿﻔﯾد ﮏﺴﯾد)
لﺎـﺳ ﻞﻤﻌﻟارﻮﺘـﺳد ﻪـﺑ ﻪﺟﻮﺗ ﺎﺑ رﺎﮔآ نﻮﺘﻨﯿﻫ ﺮﻟﻮﻣ ﻂﯿﺤﻣ يور 2017 ﺪﺷ مﺎﺠﻧاCLSI
) 15 (.
ﯽﺘﻧآ ﮏﯿﺗﻮﯿﺑ يﺎﻫ درﻮﻣ ﻪﻌﻟﺎﻄﻣ ) مﺎـﻧوﺮﺗزآ ﻞﻣﺎـﺷ
،( ATM
ﻢﯾﺮﭘﻮــﺘﻣ يﺮــﺗ -
) لوزﺎــﺴﮐﻮﺘﻣﺎﻔﻟﻮﺳ ) ﻦﯿﻠﮑﯾﺎــﺳاﺮﺘﺗ ،(SXT
،( T
) ﻢﯿﭙﻔــﺳ
،( CPM
) ﻢﯿــﺴﮐﺎﺗﻮﻔﺳ
،( CTX
ﯽــﻤﯾا ) ﻢﻨــﭘ
،( IMI
) ﻢﻨﭘوﺮﻣ ) ﻦﯿﺘﺴﯿﻠﮐ ،(MEM
،( CO
ﻦﯿـﺴﮑﯿﻣ ﯽـﻠﭘ ﯽـﺑ
) ،(PB
ﻦﯿــﺴﯾﺎﻣﺮﺘﯾرﻼﮐ )
( ،CLA
) ﻦﯿﻠﯿــﺳاﺮﭙﯿﭘ ﻦﯿــﺴﯾﺎﻣﺎﺘﻨﺟ ،(PRL
) ،(GM
ﻣﺎ ﻦﯿﻠﮑﯾﺎﺳﻮﻨﯾ )
(MN
ﯿﺗ ، ﺠ ﻦﯿﻠﮑﯾﺎﺴ ) (، TGC
ﻦﯿﻠﯿـﺴﻔﻧ
) ( NET
و ) ﻦﯿﭙﻣﺎﻔﯾر ( RP
ﺖﮐﺮﺷ لﻮﺼﺤﻣ نﺎﺘـﺴﻠﮕﻧاMAST
ﯽﻠﮐﺎﯿﺷﺮﺷا دراﺪﻧﺎﺘﺳا ﻪﯾﻮﺳ زا .ﺪﻧدﻮﺑ
ATCC 25922
ناﻮﻨﻋ ﻪﺑ
ﯽﻧﺎﻣﻮﺑﺮﺘﮐﺎﺑﻮﺘﻨﯿـﺳا دراﺪﻧﺎﺘـﺳا ﻪﯾﻮﺳ زا و ﯽﻔﻨﻣ لﺮﺘﻨﮐ
ATCC
19606
لﺮﺘﻨﮐ ناﻮﻨﻋ ﻪﺑ ﺖﺒﺜﻣ
ﺖﻬﺟ ﻦﯿﻤـﻀﺗ ﺖـﯿﻔﯿﮐ ﯽـﺘﻧآ
ماﺮﮔﻮﯿﺑ هدﺎﻔﺘﺳا ﺪﺷ . ترﻮﺻ ﻪﺑ ﺞﯾﺎﺘﻧ سﺎﺴﺣ
و موﺎﻘﻣ شراﺰـﮔ
ﺪــﺷ و ﻪﯾﻮــﺳ يﺎــﻫ ،MDR Non MDR
و ﺺﺨــﺸﻣXDR
.ﺪﻧﺪﺷ هداد ﻒﯿﺻﻮﺗ ياﺮﺑ
ﺎﻫ ﺧﺎـﺷ و ﯽـﻧاواﺮﻓ ﻊـﯾزﻮﺗ لوﺪﺟ زا ﺺ
-
،ﻦﯿﮕﻧﺎﯿﻣ يﺎﻫ ﻣ رادﻮﻤﻧ و تاﺮﯿﯿﻐﺗ ﻪﻨﻣاد و رﺎﯿﻌﻣ فاﺮﺤﻧا
ﻪـﻠﯿ ا ي
ﯽﺠﻨﺳ طﺎﺒﺗرا ياﺮﺑ .ﺪﺷ هدﺎﻔﺘﺳا ﯿﻓ ﻖﯿﻗد نﻮﻣزآ زا ﺰﯿﻧ ﺎﻫ
و ﺮـﺸ
يراد ﺎــﻨﻌﻣ ﺢﻄــﺳ ﺖــﺤﺗ يﺎـﮐ روﺬــﺠﻣ لﻼﻘﺘــﺳا نﻮـﻣزآ 5
%
ﺪﺷ هدﺎﻔﺘﺳا و
هدﺎﻔﺘﺳا درﻮﻣ يرﺎﻣآ راﺰﻓا مﺮﻧ ﻪﺨـﺴﻧSPSS
22
دﻮﺑ .
لوﺪﺟ 1.
اﺮﺑ هﺪﺷ هدﺎﻔﺘﺳا يﺎﻫﺮﻤﯾاﺮﭘ نژ ﺮﯿﺜﮑﺗ ي
bla-OXA51
نژ ﺮﻤﯾاﺮﭘ ﯽﻟاﻮﺗ
ﻊﺒﻨﻣ
OXA- 51-F TAATGCTTTGATCGGCCTTG
) 16 (
OXA- 51-R TGGATTGCACTTCATCTTGG
ﻪﺘﻓﺎﯾ ﺎﻫ
ﻦﯿــﺑ رد ﻪــﻌﻟﺎﻄﻣ ﻦــﯾا رد 94
ﻪــﻧﻮﻤﻧ نارﺎــﻤﯿﺑ 2/
53 رد %
ﻦﯿﻨﺳ 50 ﺪﻨﺘﺷاد راﺮﻗ ﺮﺗﻻﺎﺑ ﺎﯾ
، 1/
69 % ﻪﻧﻮﻤﻧ ﺎﻫ ﺑ ﺮﮐﺬﻣ ﺪـﻧدﻮ .
ﺶﺨﺑ ﻪﺑ طﻮﺑﺮﻣ ﯽﻨﯿﻟﺎﺑ يﺎﻫ ﻪﻧﻮﻤﻧ ﻦﯾﺮﺘﺸﯿﺑ ﺎـﺑ يژﻮﻟورﻮﻧICU
27 ) ﻪﻧﻮﻤﻧ 7/
28 (%
، ـﺑ طﻮـﺑﺮﻣ ﯽﻨﯿﻟﺎـﺑ ﻪـﻧﻮﻤﻧ عﻮﻧ ﻦﯾﺮﺘﺸﯿﺑ ﻪ
ﻂﻠﺧ ﻪﻧﻮﻤﻧ 49
) ﻪﻧﻮﻤﻧ 1/
52 % ( ﻢﺧز و 20 ﻪـﻧﻮﻤﻧ ) 3/
21 % و (
ﻦﯾﺮﺘﻤﮐ ﻪﻧﻮﻤﻧ ﯽﻨﯿﻟﺎﺑ طﻮﺑﺮﻣ ﻪﺑ ﻪﻧﻮﻤﻧ ﻪـﯾر تﺎﺤـﺷﺮﺗ 3
ﻪـﻧﻮﻤﻧ
) 2/
3 لوﺪﺟ) ﺖﺳا هدﻮﺑ (%
2 ( .
لوﺪﺟ 2 . ﺖﯿﻌﻤﺟ يﺎﻫﺮﯿﻐﺘﻣ ﺐﺴﺣﺮﺑ نارﺎﻤﯿﺑ ﯽﻧاواﺮﻓ ﻊﯾزﻮﺗ
يا ﻪﻨﯿﻣز و ﯽﺘﺧﺎﻨﺷ ﺎﻫﺮﯿﻐﺘﻣ (%) داﺪﻌﺗ
ﯽﻨﺳ هوﺮﮔ
< 50 8/
46 ( )44
>= 50 (532/)50
ﺲﻨﺟ ن ز
(309/)29
دﺮﻣ (691/)65
يﺮﺘﺴﺑ ﺶﺨﺑ (234/)22 ICU
لاﺮﻨﺟ ICU (16)15
ﻧﻮ ر يژﻮﻟور ICU (287/)27
ﯽﻧﻮﻔﻋ (96/)9
ﺎﻫ ﺶﺨﺑ ﺮﯾﺎﺳ (223/)21
ﻪﻧﻮﻤﻧ عﻮﻧ ﯽﻋﺎﺨﻧ ﻊﯾﺎﻣ
(64/)6
يراردا (53/)5
ﺖﻓﺎﺑ (53/)5
ﻪﯾر تﺎﺤﺷﺮﺗ (32/)3
ﻂﻠﺧ (521/)49
نﻮﺧ (64/)6
ﻢﺧز (213/)20
ﻪﻧﻮﻤﻧ يروآ ﻊﻤﺟ لﺎﺳ 95
- 94 (457/)43
97 - 96 (543/)51
/
161هرود ،ﻪﺘﻓﺎﯾ 23
، نﺎﺘﺴﺑﺎﺗ 1400
ﻪﺑ ﺖﺒﺴﻧ ﺖﻣوﺎﻘﻣ ناﺰﯿﻣ ﻦﯾﺮﺘﻤﮐ ﯽﺑ ﻦﯿﺴﮑﯿﻣ ﯽﻠﭘ
) 4/
39
% ( و ﻦﯿﻠﮑﯿﺳﻮﻨﯾﺎﻣ )
6/
43%
( و ناﺰﯿﻣ ﻦﯾﺮﺘﺸﯿﺑ
ﺖﺒﺴﻧ ﺖﻣوﺎﻘﻣ ﻪﺑ
ﻦﯿﺴﯾﺎﻣوﺮﺘﯾرﻼﮐ )
1/
96%
( ، ﻦﯿﭙﻣﺎﻔﯾر و
ﻦﯿﺴﯾﺎﻣ ﻞﯿﺘﻧ )
1/
94%
( دﻮﺑ لوﺪﺟ) 3 رادﻮﻤﻧ و 1 ( .
لوﺪﺟ 3 . ﺖﻣوﺎﻘﻣ يﻮﮕﻟا ﺳا يﺎﻫ ﻪﻟوﺰﯾا ﯽﮑﯿﺗﻮﯿﺑ ﯽﺘﻧآ
ﺮﺘﮐﺎﺑﻮﺘﻨﯿ
ﯽﻧﺎﻣﻮﺑ
=داﺪﻌﺗ) 94 (
ﮏﯿﺗﻮﯿﺑ ﯽﺘﻧآ ﺖﯿﺳﺎﺴﺣ
ﺖﻣوﺎﻘﻣ
(%) ﯽﻧاواﺮﻓ (%) ﯽﻧاواﺮﻓ
ﺮﺗ ي ﺮﭘﻮﺘﻣ ﻢﯾ / لوزﺎﺴﮐﻮﺘﻣﺎﻔﻟﻮﺳ (138/)13
(862/) 81
ﭙﻔﺳ ﻢﯿ (64/) 6
(936/)88
ﻦﯿﻠﮑﯾﺎﺳاﺮﺘﺗ (117/)11
(883/)83
مﺎﻧوﺮﺗزآ (106/)10
(894/)84
ﯽﺑ ﻦﯿﺴﮑﯿﻣ ﯽﻠﭘ (606/)57
(394/)37
ﺮﻣ ﻢﻨﭘو (96/)9
(904/)85
ﻢﻨﭘ ﯽﻤﯾا (117/)11
(883/)83
ﻢﯿﺴﮐﺎﺗﻮﻔﺳ (53/)5
(947/)89
ﻦﯿﺘﺴﯿﻟﻮﮐ (468/)44
(532/)50
ﻦﯿﻠﯿﺳاﺮﭙﯿﭘ (53/)5
(947/)89
ﻦﯿﺴﯾﺎﻣﺎﺘﻨﺟ (245/)23
(755/)71
ﻦﯿﻠﮑﯾﺎﺴﺠﯿﺗ (351/)33
(649/)61
ﻦﯿﭙﻣﺎﻔﯾر (59/)3
(941/)48
ﻦﯿﺴﯾﺎﻣوﺮﺘﯾرﻼﮐ (39/)2
(961/)49
ﻦﯿﺴﯾﺎﻣ ﻞﯿﺘﻧ (59/)3
(941/)48
ﻦﯿﻠﮑﯾﺎﺳﻮﻨﯾﺎﻣ (564/)53
(436/)41
ﻞﮑﺷ 1 . عﻮﻧ ﮏﯿﮑﻔﺗ ﻪﺑ ﯽﮑﯿﺗﻮﯿﺑ ﯽﺘﻧآ ﺖﻣوﺎﻘﻣ ﯽﻘﻓاﻮﺗ رادﻮﻤﻧ
ﮏﯿﺗﻮﯿﺑ ﯽﺘﻧآ
ﺶﺨﺑ ﻦﯾﺮﺘﺸﯿﺑ ﺪﺟ نآ زا ﺮﺘﮐﺎﺑﻮﺘﻨﯿﺳا يﺎﻫ ﻪﻟوﺰﯾا ﻪﮐ
ا
ﺪﺷ
، ﺶﺨﺑ ) يژﻮﻟورﻮﻧICU
7/
28 % دﻮﺑ ( لوﺪﺟ) 4 .(
ﺮﺑ سﺎﺳا ﯽﺘﻧآ ﺮﮔﻮﯿﺑ ما ترﻮﺻ ﻪﺘﻓﺮﮔ زا 94 ﻪﻟوﺰﯾا
ﺮﺘﮐﺎﺑﻮﺘﻨﯿﺳا ﯽﻧﺎﻣﻮﺑ
اﺪﺟ هﺪﺷ زا ﻒﻠﺘﺨﻣ يﺎﻫ ﺶﺨﺑ
نﺎﺘﺳرﺎﻤﯿﺑ ،
50
% ﺎﻫ ﻪﻟوﺰﯾا و MDR
49 / 41
% ﻪﻟوﺰﯾا ﺎﻫ ﻂﻘﻓ و ﺪﻧدﻮﺑ XDR
51 /8
% ﻪﻟوﺰﯾا ﺎﻫ
Non-MDR
ﺪﻧدﻮﺑ .
ﻦﯾﺮﺘﺸﯿﺑ ﻪﻟوﺰﯾا
يﺎﻫ وMDR XDR
ﻪﻧﻮﻤﻧ ﻪﺑ طﻮﺑﺮﻣ
ﻂﻠﺧ دﻮﺑ ) لوﺪﺟ 5 (.
لوﺪﺟ 4.
ﻪﻟوﺰﯾا ﯽﻧاواﺮﻓ ﻊﯾزﻮﺗ ﺮﺑ ﯽﻧﺎﻣﻮﺑ ﺮﺘﮐﺎﺑﻮﺘﻨﯿﺳا يﺎﻫ
يﺮﺘﺴﺑ ﺶﺨﺑ ﺐﺴﺣ
يﺮﺘﺴﺑ ﺶﺨﺑ (ﺪﺻرد)داﺪﻌﺗ
22 ICU ) 4/
23 (
لاﺮﻨﺟ ICU 15
) 0/
16 (
يژﻮﻟورﻮﻧ ICU 27
) 7/
28 (
ﯽﻧﻮﻔﻋ 9
)6 /9
( 3/ )21 ﺎﻫ ﺶﺨﺑ ﺮﯾﺎﺳ
22 (
لوﺪﺟ 5 . يﺎﻫ ﻪﻟوﺰﯾا ﺖﻣوﺎﻘﻣ ﭗﯿﺗﻮﻨﻓ ﯽﻧاواﺮﻓ ﻊﯾزﻮﺗ
ﯽﻨﯿﻟﺎﺑ يﺎﻫ ﻪﻧﻮﻤﻧ ﺐﺴﺣ ﺮﺑ ﯽﻧﺎﻣﻮﺑ ﺮﺘﮐﺎﺑﻮﺘﻨﯿﺳا ﻮﻧ ع ﻪﻧﻮﻤﻧ (%)MDR
(%)XDR NON-
(%)MDR (%)ﻞﮐداﺪﻌﺗ
ﻢﺧز 12
) 60 ( 7 ) 35 ( 1 ) 5 ( 20 ) 100 (
ﺖﻓﺎﺑ 2
) 40 ( 3 ) 60 ( 0 ) 0 ( 5 ) 100 (
ﻂﻠﺧ 22 ) 9/
44 ( 21 ) 9/
42 ( 6 ) 2/
12 ( 49 ) 100 (
راردا 3
) 60 ( 2 ) 40 ( 0 ) 0 ( 5 ) 100 (
ﻊﯾﺎﻣ ﯽﻋﺎﺨﻧ 2
) 3/
33 ( 4 ) 7/
66 ( 0 ) 0 ( 6 ) 100 (
تﺎﺤﺷﺮﺗ ﻪﯾر 2 ) 7/
66 ( 1 ) 3/
33 ( 0 ) 0 ( 3 ) 100 (
نﻮﺧ 4
) 7/
66 ( 1 ) 7/
16 ( 1 )6 / 16 ( 6 ) 100 (
لﺎﺳ طﺎﺒﺗرا ﯽﺳرﺮﺑ ﺎـﺑ ﻪـﻧﻮﻤﻧ يروآ ﻊـﻤﺟ يﺎـﻫ
ﯽﯾوراد ﺖﻣوﺎﻘﻣ ﺮﺸﯿﻓ ﻖﯿﻗد نﻮﻣزآ ﻪﮐ داد نﺎﺸﻧ
ﻦﯿﺑ لﺎﺳ ﻊﻤﺟ يﺎﻫ
ﯽﮑﯿﺗﻮﯿﺑ ﯽﺘﻧآ ﺖﻣوﺎﻘﻣ ﺎﺑ ﻪﻧﻮﻤﻧ يروآ ﺮﺗﻮﮐ
ﯾ لوزﺎﺴﮐﻮﻤ
دﻮﺟو يرادﺎﻨﻌﻣ يرﺎﻣآ طﺎﺒﺗرا دراﺪﻧ
) 766 /0 .(P =
ﺖﻣوﺎﻘﻣ
ﯽﯾوراد ﺮﺗﻮﮐ ﯾ لوزﺎﺴﮐﻮﻤ رد
لﺎﺳ يﺎﻫ 95 - 94 ، 4/
88
% هدﻮﺑ
رد و لﺎﺳ يﺎﻫ 98 - 97 ، 3/
96
% .ﺖﺳا هدﻮﺑ ﻦﯿﻨﭽﻤﻫ
،
ﯽﯾوراد ﺖﻣوﺎﻘﻣ رد ﻦﯿﺴﯾﺎﻣﺎﺘﻨﺟ ﮏﯿﺗﻮﯿﺑ ﯽﺘﻧآ
لﺎﺳ يﺎﻫ
95 - 94 ، 4/
67
% رد و هدﻮﺑ لﺎﺳ
يﺎﻫ 97 - 96 ، 4/
82
% هدﻮﺑ
ﺖﺳا . ﻌﻣ يرﺎﻣآ طﺎﺒﺗرا ﺎﻬﻨﺗ رادﺎﻨ
) 001 /0 ( p =
رد درﻮﻣ
ﻦﯿﺴﮑﯿﻣ ﯽﻠﭘ ﮏﯿﺗﻮﯿﺑ ﯽﺘﻧآ ﯽﺑ
دﻮﺑ ﺖﻣوﺎﻘﻣ ﻪﮐ نآ ﯽﯾوراد
رد لﺎﺳ يﺎﻫ 95 - 94 ، 1/
72 رد و % لﺎﺳ
يﺎﻫ 97 - 96 ،
4/
39
% .ﺖﺳا هدﻮﺑ
ﺑ ﻪﺠﯿﺘﻧ و ﺚﺤ يﺮﯿﮔ
ﻣ ﻪﺘﺷﺬﮔ ﻪﻫد رد ناﺰﯿ
ﻻﺎﺑ ي ا ﻪﻟوﺰﯾ ﺎﻫ ي ﺳا ﻮﺘﻨﯿ ﺘﮐﺎﺑ ﺮ
نﺎﻬﺟ ﺮﺳاﺮﺳ رد نﺎﻣرد ﻪﺑ موﺎﻘﻣ 95
- 21
% هﺪﺷ شراﺰﮔ
ﺖﺳا ) 17 ( . ﺶﯾاﺰﻓا ﺖﻣوﺎﻘﻣ ﯽﺘﻧآ ﯽﮑﯿﺗﻮﯿﺑ رد ﺘﮐﺎﺑﻮﺘﻨﯿﺳا ﺮ
ﻊﻧﺎﻣ ﺖﯾﺮﯾﺪﻣ ﺐﺳﺎﻨﻣ رد نﺎﻣرد ﯽﺘﻧآ ﯽﮑﯿﺗﻮﯿﺑ هﺪﺷ .ﺖﺳا
ﺪﻨﭼﺮﻫ ﻪﮐ توﺎﻔﺗ ﻞﺑﺎﻗ ﯽﺘﯿﻤﻫا يﻮﮕﻟارد ﺖﻣوﺎﻘﻣ
ﯽﺘﻧآ
ﺮﺘﮐﺎﺑﻮﺘﻨﯿﺳا ﯽﮑﯿﺗﻮﯿﺑ ﺮﺑ
ﺐﺴﺣ
،ﻪﻧﻮﮔ رﻮﺸﮐ و يا ﻪﯿﺣﺎﻧ ﮐ
ﻪ
يﺮﺘﮐﺎﺑ زا نآ اﺪﺟ هﺪﺷ دﻮﺟو دراد ) 18،19 (.
رد ا ﻪﻌﻟﺎﻄﻣ ي ﺪﻤﺣا ﻂﺳﻮﺗ ﻪﮐ ي
ا رد نارﺎﮑﻤﻫ و ناﺮﯾ
لﺎﺳ رد 1392 ﺖﻓﺮﮔ مﺎﺠﻧا
، 7/
76
% ﻮﺳ زا ﻪﯾ ﺎﻫ ي اﺪﺟ
نارﺎﻤﯿﺑ زا هﺪﺷ ا ﻪﺑ ﺖﺒﺴﻧ
ﯽﻤﯾ ﺪﻧدﻮﺑ موﺎﻘﻣ ﻢﻨﭘ .
هﺪﻫﺎﺸﻣ
ا ﻪﺑ ﺖﺒﺴﻧ ﻻﺎﺑ ﺖﻣوﺎﻘﻣ ﯽﻤﯾ
وراد ناﻮﻨﻋ ﻪﺑ ﻢﻨﭘ ي
ﺮﺧآ ﻂﺧ
ﻧﺎﻣرد ﯽ ﺎﻫ ﺖﻧﻮﻔﻋ نﺎﻣرد رد ي
ﺷﺎﻧ ﯽ ﺮﺘﮐﺎﺑ زا ي ﺎﻫ ي مﺮﮔ
ﻔﻨﻣ ﯽ ﺴﺑ رﺎﯿ و دﻮﺑ هﺪﻨﻨﮐ ناﺮﮕﻧ ﭘ
دﺎﻬﻨﺸﯿ ﮐ ﻪﮐ ﺪﻧدﺮ ﻪﺑ
ﮔﻮﻠﺟ رﻮﻈﻨﻣ يﺮﯿ
ا ﺎﺠﺑﺎﻧ فﺮﺼﻣ زا ﻦﯾ
ﺑ رد وراد نﺎﺘﺳرﺎﻤﯿ ﺎﻫ
ﺎﻫ ﻪﻣﺎﻧﺮﺑ ي ﺗرﺎﻈﻧ ﯽ ﺪﻧﺮﯿﮔ ترﻮﺻ )
20 ( . ﻪﻌﻟﺎﻄﻣ رد و Xie
ﻢﻨﭘ ﯽﻤﯾا ﻪﺑ ﺖﻣوﺎﻘﻣ ﯽﻧاواﺮﻓ نارﺎﮑﻤﻫ 8/
77 - 9/
73
%
ﺖﺳا هﺪﺷ شراﺰﮔ )
21 ( ﺎﻣا ناﺰﯿﻣ ﺮﺿﺎﺣ ﻪﻌﻟﺎﻄﻣ رد
ﺖﻣوﺎﻘﻣ ﯽﻧاواﺮﻓ ﺎﺑ 3 / 88 % هﺪﺷ ﺮﮐذ يﺎﻫ ﻪﻌﻟﺎﻄﻣ زا ﺮﺗﻻﺎﺑ
ﺪﺷﺎﺑ ﯽﻣ . ﻪﮐ ﺖﺳا ﻦﯾا ﺮﺿﺎﺣ ﻪﻌﻟﺎﻄﻣ ﺖﯿﻤﻫا ﺰﺋﺎﺣ ﻪﺘﮑﻧ ﺮﮔا
ﻪﭼ ياﺮﺑ نﺎﻣرد ﻪﺑ ﯽﻧﺎﻣﻮﺑﺮﺘﮐﺎﺑ ﻮﺘﻨﯿﺳا زا ﯽﺷﺎﻧ يﺎﻫ ﺖﻧﻮﻔﻋ
لﻮﻤﻌﻣ رﻮﻃ زا
ﯽﻤﯾا ﻢﻨﭘ هدﺎﻔﺘﺳا ﯽﻣ
،دﻮﺷ ﺮﺿﺎﺣ لﺎﺣ رد
ﯽﻤﯾا ﻢﻨﭘ ﯽﻤﻧ ﺪﻧاﻮﺗ د يورا ﯽﺑﻮﺧ ياﺮﺑ نﺎﻣرد ﺖﻧﻮﻔﻋ يﺎﻫ
ﯽﺷﺎﻧ زا ﻦﯾا يﺮﺘﮐﺎﺑ .ﺪﺷﺎﺑ رد ﻦﯾا ﺖﻣوﺎﻘﻣ ﻦﯾﺮﺘﻤﮐ ﻪﻌﻟﺎﻄﻣ
ﻪﺑ طﻮﺑﺮﻣ ﺐﯿﺗﺮﺗ ﻪﺑ
،ﯽﺑ ﻦﯿﺴﮑﯿﻣ ﯽﻠﭘ ،ﻦﯿﻠﮑﯾﺎﺳﻮﻨﯿﻣ
دﻮﺑ ﻦﯿﻠﮑﯿﺳﺎﮕﯿﺗ و ﻦﯿﺘﺴﯿﻠﮐ ﻪﻌﻟﺎﻄﻣ ﺞﯾﺎﺘﻧ ﺎﺑ ﻪﮐ
ﻢﯿﺣر هداز
و نارﺎﮑﻤﻫ ) 22 ( ﻪﻌﻟﺎﻄﻣ و يود
و نارﺎﮑﻤﻫ ) 23 ( ﺖﻘﺑﺎﻄﻣ
دراد . ﻦﯾا ﺞﯾﺎﺘﻧ ﯽﺘﻧآ ﻦﯾا ﻪﮐ ﺖﺳا ﻦﯾا هﺪﻨﻫد نﺎﺸﻧ
ﻪﯾﻮﺳ زا ﯽﺷﺎﻧ يﺎﻫ ﺖﻧﻮﻔﻋ نﺎﻣرد ياﺮﺑ زﻮﻨﻫ ﺎﻫ ﮏﯿﺗﻮﯿﺑ .ﺪﻨﺷﺎﺑ ﯽﻣ ﺐﺳﺎﻨﻣ ﻢﻨﭘ ﯽﻤﯾا ﻪﺑ موﺎﻘﻣ يﺎﻫ
ﺎﻫ ﮏﯿﺗﻮﯿﺑ ﯽﺘﻧآ زا ﺮﮕﯾد ﯽﮑﯾ ﺎﺑ
ﻟﺎﺑ دﺮﺑرﺎﮐ ﯿﻨ ﯽ ياﺮﺑ
ﺮﺘﮐﺎﺑ ﻮﺘﯿﻨﺳا زا ﯽﺷﺎﻧ يﺎﻫ ﺖﻧﻮﻔﻋ نﺎﻣرد ،
ﺎﻫ ﻦﯾرﻮﭙﺳﻮﻟﺎﻔﺳ ﺷﺎﺑ ﯽﻣ
ﻨ ﻪﮐ ﺪ 6/
93
% و 7/
94
% ﺿﺎﺣ ﻪﻌﻟﺎﻄﻣ يﺎﻫ ﻪﻟوﺰﯾا زا ﺮ
موﺎﻘﻣ ﻢﯿﺴﮐﺎﺗﻮﻔﺳ و ﻢﯿﭙﻔﺳ ﻪﺑ ﺪﻧدﻮﺑ
و ﻦﯾا ﺎﺑ ﻪﺑﺎﺸﻣ ﺞﯾﺎﺘﻧ
نارﺎﮑﻤﻫ و يﺪﺳا ﻪﻌﻟﺎﻄﻣ رد
ﺪﺷﺎﺑ ﯽﻣ نارﺪﻧزﺎﻣ )
24 (.
ﻦﯿﻨﭽﻤﻫ
،
،ﻢﻨﭘوﺮﻣ ،مﺎﻧوﺮﺗزآ ،ﻦﯿﻠﮑﯾﺎﺳاﺮﺘﺗ يﺎﻫ ﮏﯿﺗﻮﯿﺑ ﯽﺘﻧآ
ﺰﯿﻧ ﻦﯿﺴﯾﺎﻣ ﻞﯿﺘﻧ و ﻦﯿﺴﯾﺎﻣوﺮﺘﯾرﻼﮐ ،ﻦﯿﭙﻣﺎﻔﯾر ،ﻦﯿﻠﯿﺳاﺮﭙﯿﭘ زا ﯽﺷﺎﻧ يﺎﻫ ﺖﻧﻮﻔﻋ نﺎﻣرد ياﺮﺑ ﯽﺒﺳﺎﻨﻣ يﺎﻫوراد .ﺪﻨﺘﺴﯿﻧ دﺎﺑآ مﺮﺧ ﺮﻬﺷ رد ﺮﺘﮐﺎﺑﻮﺘﻨﯿﺳا
رد زا ﺮﺿﺎﺣ ﻪﻌﻟﺎﻄﻣ نﺎﯿﻣ
16 ﻟﺎﻄﻣ درﻮﻣ ﮏﯿﺗﻮﯿﺑ ﯽﺘﻧآ ،ﻪﻌ
11 ﻮﯿﺑ ﯽﺘﻧآ عﻮﻧ يﻻﺎﺑ ﺖﻣوﺎﻘﻣ ياراد ﮏﯿﺗ
80 و ﺪﺻرد 7 ﻧ عﻮ
يﻻﺎﺑ ﺖﻣوﺎﻘﻣ ياراد 90
% ﻪﮐ ﺪﻧدﻮﺑ ﺖﯾدوﺪﺤﻣ هﺪﻨﻫد نﺎﺸﻧ
رﺎﯿﺴﺑ يﻻﺎﺑ ﺎﻣ بﺎﺨﺘﻧا رد يوراد
ﻣ ﻪﻘﻄﻨﻣ ﻦﯾا رد ﺐﺳﺎﻨﻣ ﯽ
.ﺪﺷﺎﺑ ﻪﺑ ﻪﺟﻮﺗ ﺎﺑ تﺎﻌﻟﺎﻄﻣ ﺮﯾﺎﺳ و ﺮﺿﺎﺣ ﻪﻌﻟﺎﻄﻣ ﺞﯾﺎﺘﻧ
، ) 25 -
28 ( وﺎﻘﻣ ﯽﻧاواﺮﻓ ﺘﮐﻻﺎﺘﺑ يﺎﻫ ﮏﯿﺗﻮﯿﺑ ﯽﺘﻧآ ﻪﺑ ﺖﺒﺴﻧ ﺖﻣ
مﺎ و
ﯿﺑ رد ﺮﺘﮐﺎﺑﻮﺘﻨﯿﺳا ﯽﻨﯿﻟﺎﺑ يﺎﻫ ﻪﻟوﺰﯾا رد ﺎﻫ ﻢﻨﭘﺎﺑرﺎﮐ رﺎﻤ
نﺎﺘﺳ
يﻻﺎﺑ ناﺮﯾا ﻒﻠﺘﺨﻣ ﻖﻃﺎﻨﻣ يﺎﻫ 60
% واﺮﻓ ﻦﯾا ﻪﮐ ﺪﺷﺎﺑ ﯽﻣ ﯽﻧا
راﺪﺸﻫ ﺪﻧاﻮﺗ ﯽﻣ ﯽﻧﺎﺘﺳرﺎﻤﯿﺑ ﺖﻧﻮﻔﻋ لﺮﺘﻨﮐ ﻪﺘﯿﻤﮐ ياﺮﺑ .ﺪﺷﺎﺑ هﺪﻨﻫد
رد لﺎﺣ ﺮﺘﮐﺎﺑﻮﺘﻨﯿﺳا ﺮﺿﺎﺣ ﯽﻧﺎﻣﻮﺑ
ءﺰﺟ ﻢﻬﻣ ﻦﯾﺮﺗ
ﻞﻣاﻮﻋ دﺎﺠﯾا هﺪﻨﻨﮐ ﺖﻧﻮﻔﻋ يﺎﻫ ﯽﻧﻮﻣﻮﻨﭘ ﻂﺒﺗﺮﻣ ﺎﺑ هﺎﮕﺘﺳد
يﺎﻫ ﺲﻔﻨﺗ ﯽﻣ هﺪﻨﻫد ﺪﺷﺎﺑ
ﻪﺑ و رﻮﻃ ﻊﯾﺎﺷ ﻪﻧﻮﻤﻧ زا يﺎﻫ
ﻂﻠﺧ ﻦﯾا نارﺎﻤﯿﺑ اﺪﺟ ﯽﻣ دﻮﺷ ﻪﻌﻟﺎﻄﻣ رد .
يا ﻂﺳﻮﺗ ﻪﮐ
Gerald
لﺎﺳ رد ﺶﻧارﺎﮑﻤﻫ و 2010
رد درﻮﻣ ﺖﻧﻮﻔﻋ يﺎﻫ
ﯽﻧﺎﺘﺳرﺎﻤﯿﺑ ﯽﺷﺎﻧ
زا ﺘﻓﺮﮔ مﺎﺠﻧا ﺮﺘﮐﺎﺑﻮﺘﻨﯿﺳا ،ﺖﺳا ﻪ
ﯿﻣ ناﺰ
ﯽﯾﻻﺎﺑ يزﺎﺳاﺪﺟ دراﻮﻣ زا يﺮﺘﮐﺎﺑ
زا ﺶﺨﺑ ﺖﺒﻗاﺮﻣ يﺎﻫ
هﮋﯾو ﺖﺳا هﺪﺷ شراﺰﮔ .
ﺖﺳا ﻦﮑﻤﻣ ﻻﺎﺑ
ندﻮﺑ ناﺰﯿﻣ
يزﺎﺳاﺪﺟ ﻦﯾا
يﺮﺘﮐﺎﺑ ﺶﺨﺑ زا ﺖﺒﻗاﺮﻣ يﺎﻫ هﮋﯾو ﯽﮔدﻮﻟآ ﺎﺑ
ﻞﻨﺳﺮﭘ و ﻞﯾﺎﺳو ﯽﮑﺷﺰﭘ ﺪﻨﻧﺎﻣ رﻮﺗﻼﯿﺘﻧو ﺎﺑ ﺮﺘﮐﺎﺑﻮﺘﻨﯿﺳا و
ﺎﯾ
ﺶﻫﺎﮐ ﻢﺘﺴﯿﺳ ﯽﻨﻤﯾا داﺮﻓا ﻪﺑ ﻞﯿﻟد ﺖﻣﺎﻗا ﯽﻧﻻﻮﻃ تﺪﻣ رد
ﻤﯿﺑ نﺎﺘﺳرﺎ
، ﻂﺒﺗﺮﻣ ﻄﻣ ﻦﯾا ﺞﯾﺎﺘﻧ ﺎﺑ ﺎﻣ ﺞﯾﺎﺘﻧ ﻪﮐ ﺪﺷﺎﺑ ﻪﻌﻟﺎ
دراد ﯽﻧاﻮﺧ ﻢﻫ )
29 (.
ﺶﻫوﮋﭘ رد ﺮﺿﺎﺣ
زا 94 درﻮﻣ ﻪﻧﻮﻤﻧ ﯽﺳرﺮﺑ
، 50
%
MDR
و 49 / 41
% دراﻮﻣ ﯽﻠﮐ ترﻮﺼﺑ و ،XDR
49 / 91
% موﺎﻘﻣ ﻪﺑ
/
163هرود ،ﻪﺘﻓﺎﯾ 23
، نﺎﺘﺴﺑﺎﺗ 1400
ﮏﯿﺗﻮﯿﺑ ﯽﺘﻧآ ﯽﯾﺎﺳﺎﻨﺷ
هﺪﺷ ﺖﺳا ا.
ﻦﯾ داﺪﻌﺗ ﺮﺘﮐﺎﺑﻮﺘﻨﯿﺳا
ﯽﻧﺎﻣﻮﺑ رﺎﯿﺴﺑ ﺮﺗﻻﺎﺑ از خﺮﻧ ﯽﻧاواﺮﻓ شراﺰﮔ هﺪﺷ رد ﺶﻫوﮋﭘ
ﯽﻧﺎﻘﺷﻮﺟ و
ﺶﻧارﺎﮑﻤﻫ )
30 ( ﻪﮐ دوﺪﺣ 40
% دﻮﺑ و ﺰﯿﻧ
ﺶﻫوﮋﭘ رﻮﯾﺮﻓ نﺎﯿﺗدﺎﻌﺳ و
ﺶﻧارﺎﮑﻤﻫ )
31 ( ﻪﮐ دوﺪﺣ 21
%
،دﻮﺑ ﺪﺷﺎﺑ ﯽﻣ داﺪﻌﺗ ﻦﯾا ﯽﻓﺮﻃ زا . زا ﺮﺘﻤﮐ
ناﺰﯿﻣ يﺎﻫ ﻪﯾاﺪﺟ
ياراد 52 MDR
/ 72
% رد ﻪﻌﻟﺎﻄﻣ ي هﺪﺷ مﺎﺠﻧا ﻂﺳﻮﺗ
يﺪﻤﺣا نﺎﺘﺳرﺎﻤﯿﺑ رد نارﺎﮑﻤﻫ و ﺰﯾﺮﺒﺗ
لﺎﺳ رد 1398 ﯽﻣ
ﺪﺷﺎﺑ ) 25 ( . لﺎﻤﺘﺣا ﯽﻣ دور ﻪﮐ تﺎﻌﻟﺎﻄﻣ ﺞﯾﺎﺘﻧ توﺎﻔﺗ
ﻒﻠﺘﺨﻣ ﻪﺑ ﻠﻋ ﺖ عﻮﻨﺗ رد يﺎﻫ ﻪﻧﻮﻤﻧ
،ﯽﻨﯿﻟﺎﺑ لﺎﺳ مﺎﺠﻧا
ﻪﻌﻟﺎﻄﻣ ﯽﻧﺎﻣرد يﺎﻫ شور و رد
ﺮﻫ .ﺪﺷﺎﺑ ﯽﯾﺎﯿﻓاﺮﻐﺟ ﻪﻘﻄﻨﻣ
ﻦﯿﻨﭽﻤﻫ يﺎﻫ ﯽﺳرﺮﺑ
مﺎﺠﻧا هﺪﺷ ﺎﯿﺳآ رد و ﻪﻧﺎﯿﻣروﺎﺧ هرﺎﺷا
ﺶﯾاﺰﻓا ﻪﺑ ﺮﺘﮐﺎﺑﻮﺘﻨﯿﺳا ﯽﻧاواﺮﻓ
ﻪﻧﺎﮔﺪﻨﭼ ﺖﻣوﺎﻘﻣ ﺎﺑ ﯽﻧﺎﻣﻮﺑ
دراد ﻖﻃﺎﻨﻣ ﻦﯾا رد ﯽﯾوراد )
17،32 (.
ﻪﮐ ﺖﺳا ﺮﮐذ ﻪﺑ مزﻻ
ﯿﯿﻌﺗ ) ﯽﮔﺪﻨﻨﮐ رﺎﻬﻣ ﺖﻈﻠﻏ ﻞﻗاﺪﺣ ﻦ ﻪﺑ ﺪﻧاﻮﺗ ﯽﻣ ﺰﯿﻧ (MIC
ﺎﻘﻣ ﯽﺳرﺮﺑ ﺖﻬﺟ ﻖﯿﻗد شور ﮏﯾ ناﻮﻨﻋ و
ﯽﮑﯿﺗﻮﯿﺑ ﯽﺘﻧآ ﺖﻣ
.دﺮﯿﮔ راﺮﻗ هدﺎﻔﺘﺳا درﻮﻣ
ﺞﯾﺎﺘﻧ ﺖﻣوﺎﻘﻣ ناﺰﯿﻣ ﻪﮐ ﺪﻫد ﯽﻣ نﺎﺸﻧ ﻖﯿﻘﺤﺗ ﻦﯾا
ﯽﯾوراد ﺪﻨﭼ وMDR
ﻪﮐ ﺎﺠﻧآ زا و ﺖﺳا ﻪﺟﻮﺗ ﻞﺑﺎﻗ XDR
درﻮﻣ نﺎﺘﺳرﺎﻤﯿﺑ رد ﯽﯾوراد ﺪﻨﭼ ﺖﻣوﺎﻘﻣ ناﺰﯿﻣ ﻪﻌﻟﺎﻄﻣ
49 / 91
% ﻦﯿﯿﻌﺗ
،ﺪﯾدﺮﮔ موﺰﻟ ﻪﺟﻮﺗ ﻪﺑ يﺎﻫرﺎﯿﻌﻣ لﺮﺘﻨﮐ
ﺖﻧﻮﻔﻋ يﺎﻫ ﺘﺳرﺎﻤﯿﺑ .ددﺮﮔ ﯽﻣ سﺎﺴﺣا ﯽﻧﺎ رد
ﻪﻌﻟﺎﻄﻣ
ﺮﺿﺎﺣ ﺺﺨﺸﻣ ﺪﺷ ﺐﻠﻏا ﻪﯾﻮﺳ يﺎﻫ سﺎﺴﺣﺮﯿﻏ ﻪﺑ
ﯽﻤﯾا
ﻢﻨﭘ ﻪﺑ ﻦﯿﻠﮑﯾﺎﺳﻮﻨﯿﻣ و
ﻦﯿﺴﮑﯿﻣ ﯽﻠﭘ ﯽﺑ
سﺎﺴﺣ ﺪﻧدﻮﺑ .
ﻦﯾاﺮﺑﺎﻨﺑ ﭘﯿ دﺎﻬﻨﺸ ﯽﻣ دﻮﺷ ﻪﮐ ياﺮﺑ نﺎﻣرد ﺖﻧﻮﻔﻋ يﺎﻫ
ﯽﺷﺎﻧ زا ﻮﺳ ﻪﯾ يﺎﻫ موﺎﻘﻣ ﻪﺑ ﯽﻤﯾا ﻢﻨﭘ زا ﺐﯿﮐﺮﺗ ﺮﯾﺎﺳ
ﯽﺘﻧآ ﮏﯿﺗﻮﯿﺑ ﺎﻫ هدﺎﻔﺘﺳا دﻮﺷ
، ﻪﺘﺒﻟا ﻟﺎﻄﻣ ﻦﯾا ﺞﯾﺎﺘﻧ ﻌ
ﻪ
ﻪﺑ ﯽﺳرﺮﺑ ﺎﺑ ﺪﯿﺋﺎﺗ و داﺪﻌﺗ
ﻪﻟوﺰﯾا ﺮﺘﺸﯿﺑ زﺎﯿﻧ دراد .
ﺮﮑﺸﺗ و ﯽﻧادرﺪﻗ
ﻣزآ نﺎﺳﺎﻨﺷرﺎﮐ زا ﯽﺷزﻮﻣآ يﺎﻫ نﺎﺘﺳرﺎﻤﯿﺑ يﺎﻫ هﺎﮕﺸﯾﺎ
يروآ ﻊﻤﺟ رد ﻪﮐ ﯽﯾﺎﺑﺎﺑ ﻢﻧﺎﺧ و دﺎﺑآ مﺮﺧ ﺮﻬﺷ ﯽﻧﺎﻣرد ﻪﻟوﺰﯾا
دﺮﮐ ﮏﻤﮐ ﺎﻣ ﻪﺑ ﯽﻨﯿﻟﺎﺑ يﺎﻫ ﺪﻧ
.ﻢﯿﻨﮐ ﯽﻣ ﯽﻧاد رﺪﻗ و ﺮﮑﺸﺗ
ﻊﺑﺎﻨﻣ ﻦﯿﻣﺎﺗ ﺖﻬﺟ نﺎﺘﺳﺮﻟ ﯽﮑﺷﺰﭘ مﻮﻠﻋ هﺎﮕﺸﻧاد زا ﻦﯿﻨﭽﻤﻫ ﻖﯿﻘﺤﺗ ﻦﯾا مﺎﺠﻧا ﺖﻬﺟ زﺎﯿﻧ درﻮﻣ ﯽﻟﺎﻣ ﺎﺑ
ﺪﮐ قﻼﺧا
IR.LUMS.REC.1397.097
.ﻢﯾراد ار ﺮﮑﺸﺗ لﺎﻤﮐ
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Evaluation of antibiotic resistance pattern of Acinetobacter baumannii clinical isolates in Khorramabad hospitals
Poladi I 1, Delfani S 2,Soroush S P2P, Soltani MR P3P, URezaei FUP2*
1. Student of Student Research Committee, School of Medicine, Lorestan University of Medical Sciences, Khorramabad, Iran
2.Assistant Professor, Department of Medical Microbiology, School of Medicine, Lorestan University of Medical Sciences, Khorramabad, Iran, [email protected]
3.Medical Student, School of Medicine, Lorestan University of Medical Sciences, Khorramabad, Iran
Received: 11 April 2021 Accepted: 22 May 2021
Abstract
Background: Today, drug-resistant strains of Acinetobacter baumannii are one of the opportunistic pathogens in the world. This study aimed to determine the antibiotic resistance pattern of clinical isolates of A. baumannii in Khorramabad hospitals (i.e., Shohaday Ashayer-Shahid Rahimi), Khorramabad, Iran.
Materials and Methods: This cross-sectional study was conducted on the clinical samples collected from patients hospitalized in the different wards of Khorramabad hospitals in 2015-16 and 2017-18. The clinical samples were identified as A. baumannii by microbiological culture and biochemical tests then confirmed by polymerase chain reaction. The susceptibility test of bacterial isolates to antibiotics was performed and the obtained data were analyzed by SPSS software (version 22) using the Chi-square test.
Results: According to the results of the antibiogram, among the 94 isolates of A. baumannii
collected from the patients admitted to Khorramabad hospitals, 50%, 41.49%, and 8.51% of isolates were multiple-drug resistant, extensively drug-resistant, and non-multidrug resistance, respectively.
Conclusion: Due to the sensitivity of A. baumannii to polymyxin B and minocycline antibiotics, these antibiotics can be used, especially as a combination therapy, in the treatment of infections caused by this bacterium. Since the rate of multidrug resistance in Khorramabad hospitals was found to be 91.49%, it is necessary to pay attention to the criteria for controlling nosocomial infections.
Keywords: Acinetobacter baumannii, multiple-drug resistant, extensively drug-resistant.
*Citation: Poladi I, Delfani S, Soroush S, Soltani MR, Rezaei F. Evaluation of antibiotic resistance pattern of Acinetobacter baumannii clinical isolates in Khorramabad hospitals. Yafte. 2021; 23(3):158-167.
