Tsakris A, Ikonomidis A, Poulou A, Spanakis N, Vrizas D, Diomidous M, Pournaras S, Markou F
Department of Microbiology, Medical School, University of Athens, Athens, Greece.
Clin Microbiol Infect. 2008 Jun;14(6):588-94. doi: 10.1111/j.1469-0691.2008.01996.x. Epub 2008 Apr 5.
During a 2-year period (April 2005-March 2007), 31 intensive care unit (ICU) patients in a Greek hospital were infected or colonised with imipenem-resistant isolates of Acinetobacter baumannii. Twelve patients died, with imipenem-resistant A. baumannii infection contributing to the death of seven patients. The 31 representative A. baumannii isolates were multidrug-resistant and clustered in four distinct clones, each of which contained different carbapenemase genes: clone I was predominant and contained bla(VIM-1), bla(OXA-58) and the intrinsic bla(OXA-66) gene; clone II contained bla(VIM-4), bla(OXA-58) and the intrinsic bla(OXA-69) gene; clone III contained bla(OXA-58) and the intrinsic bla(OXA-69) gene; and clone IV contained only the intrinsic bla(OXA-66) gene. ISAba1 was not associated with the intrinsic bla(OXA-51-like) alleles, whereas ISAba3 was found upstream and downstream of bla(OXA-58) in isolates of clone I, and upstream of bla(OXA-58) in isolates of clone III, but was not detected in isolates of clone II. PCR, curing and hybridisation experiments indicated that the bla(VIM) alleles were chromosomally located, whereas the bla(OXA-58) alleles were plasmid-located. This study provides the first description of the clonal spread of multidrug-resistant A. baumannii isolates carrying bla(VIM-1) and bla(VIM-4) metallo-beta-lactamase genes, and revealed that distinct carbapenem-resistant A. baumannii clusters bearing different carbapenemase genes may emerge and cause severe infections, even in a well-defined regional hospital setting.
在2年期间（2005年4月至2007年3月），希腊一家医院的31名重症监护病房（ICU）患者感染或定植了耐亚胺培南的鲍曼不动杆菌分离株。12名患者死亡，耐亚胺培南鲍曼不动杆菌感染导致7名患者死亡。31株代表性鲍曼不动杆菌分离株具有多重耐药性，聚为四个不同的克隆群，每个克隆群含有不同的碳青霉烯酶基因：克隆群I占主导，含有bla(VIM-1)、bla(OXA-58)和固有bla(OXA-66)基因；克隆群II含有bla(VIM-4)、bla(OXA-58)和固有bla(OXA-69)基因；克隆群III含有bla(OXA-58)和固有bla(OXA-69)基因；克隆群IV仅含有固有bla(OXA-66)基因。ISAba1与固有bla(OXA-51样)等位基因无关, 而ISAba3在克隆群I分离株中位于bla(OXA-58)的上游和下游，在克隆群III分离株中位于bla(OXA-58)的上游，但在克隆群II分离株中未检测到。聚合酶链反应（PCR）、消除和杂交实验表明，bla(VIM)等位基因位于染色体上，而bla(OXA-58)等位基因位于质粒上。本研究首次描述了携带bla(VIM-1)和bla(VIM-4)金属β-内酰胺酶基因的多重耐药鲍曼不动杆菌分离株的克隆传播，并揭示即使在一个明确界定的地区医院环境中，携带不同碳青霉烯酶基因的不同耐碳青霉烯鲍曼不动杆菌簇也可能出现并导致严重感染。
