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In the past years, Gram-positive bacteria, especially S. aureus and Enterococcus spp., developed a worryingly high rate of resistant strains.
As northeast of Iran is in neighborhood of Afghanistan and Turkmenistan which are countries with a very high burden of disease and also high rate of resistant tuberculosis, prompt preventive policies and complete DOTS strategy should be implemented in order to prevent more incidences of resistance.
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In addition, isolated Acinetobacter baumanii strains showed high rates of resistant to all tested antibiotics except colistin.
Yet high rates of resistant tuberculosis have been notified for the Western Cape, Eastern Cape as well as KwaZulu-Natal (KZN) provinces.
India has one of the highest rates of infectious diseases and has alarmingly high rates of resistant bacteria, making utilization of diagnostics that help indicate when unnecessary antibiotics can be avoided a prime goal [ 87, 88].
These situations include patients with hemodynamic instability, suspected catheter-related infection, skin or soft tissue infection, pneumonia, previous infection or colonization with MRSA or VRE, or a hospital setting with high rates of resistant Gram-positive pathogens [ 5].
Furthermore, bacteria from patients with urinary catheters have a higher rate of resistant organisms [ 31– 31].
Our finding is somewhat surprising, since one can assume a higher rate of resistant and integron-containing bacteria in older people due to the selective pressure of antibiotics consumed during a lifespan.
Our results also showed a correlation between the presence of resistant genes and high rate of resistance to cefixime, colistin, and cefepime.
To investigate the mechanisms of the observed high rate of resistance to colistin, all colistin-resistant isolates were screened for the presence of mutations in the lpxACD and pmrCAB genes.
When about metronidazole, we think that physicians might well refrain from using this antibiotic in order to prevent the emergence of more resistant strains especially because of the high rate of metronidazole resistant strains in Tunisia.
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