Oteo Jesús, García-Estébanez Carmen, Migueláñez Silvia, Campos José, Martí Sara, Vila Jordi, Domínguez Maria Angeles, Docobo Fernando, Larrosa Nieves, Pascual Alvaro, Pintado Vicente, Coll Pere
Laboratorio de Antibióticos, Centro Nacional de Microbiología, Instituto de Salud Carlos III, Majadahonda, Madrid, Spain.
J Infect. 2007 Sep;55(3):260-6. doi: 10.1016/j.jinf.2007.04.009. Epub 2007 Jun 14.
To investigate relevant clinical and microbiological features of Acinetobacter baumannii in Spanish hospitals and to establish the genotypic diversity of imipenem resistant isolates.
Seven Spanish hospitals collected 354 consecutive isolates that were subjected to antimicrobial susceptibility testing by standard methods. Further genetic analysis was determined by PFGE in a subset of 135 isolates from three hospitals selected because each of them presented high-, medium-, and low imipenem resistance rates.
Most isolates were from males (61.9%), age >65 years (52.3%), admitted to ICU (35.6%), and isolated from the respiratory tract (31.1%). Rates of carbapenem- and sulbactam resistance were 44.9% and 39.9%, respectively. Colistin was active against multiresistant isolates. Rates of imipenem resistance varied according to individual hospital (average: 43.8%; range: 13.5%-85.0%), medical department (more prevalent in ICU), and clinical sample (higher in isolates from the respiratory tract). Of the 135 isolates studied by PFGE (64 of them imipenem-resistant), 115 (85.1%) were distributed among 14 clusters and 20 were unrelated. Of the imipenem-resistant isolates, 45 (70.3%) belonged to six clusters that also had imipenem- susceptible isolates; 14 constituted four exclusive clusters, and five were unrelated.
Acquisition of imipenem resistance in A. baumannii is likely due to both clonal and non-clonal dissemination; resistance rates strongly vary between different hospitals and even between different hospital departments.
调查西班牙医院中鲍曼不动杆菌的相关临床和微生物学特征，并确定耐亚胺培南菌株的基因型多样性。
七家西班牙医院收集了354株连续分离株，采用标准方法进行药敏试验。对从三家医院选取的135株分离株进行PFGE进一步基因分析，这三家医院分别呈现高、中、低亚胺培南耐药率。
大多数分离株来自男性（61.9%），年龄>65岁（52.3%），入住重症监护病房（35.6%），且分离自呼吸道（31.1%）。碳青霉烯类和舒巴坦耐药率分别为44.9%和39.9%。黏菌素对多重耐药菌株有活性。亚胺培南耐药率因医院个体（平均：43.8%；范围：13.5%-85.0%）、科室（在重症监护病房更普遍）和临床样本（呼吸道分离株中更高）而异。在通过PFGE研究的135株分离株中（其中64株耐亚胺培南），115株（85.1%）分布在14个簇中，20株不相关。耐亚胺培南的分离株中，45株（70.3%）属于六个也有亚胺培南敏感分离株的簇；14株构成四个独立的簇，5株不相关。
鲍曼不动杆菌对亚胺培南耐药的获得可能是由于克隆和非克隆传播；不同医院甚至不同医院科室之间的耐药率差异很大。
