Department of Internal Medicine, Far Eastern Memorial Hospital, New Taipei City, Taiwan.
Eur J Clin Microbiol Infect Dis. 2012 Oct;31(10):2737-43. doi: 10.1007/s10096-012-1622-x. Epub 2012 May 6.
We investigated the clinical characteristics and outcomes of 43 patients with Acinetobacter junii bacteremia at a 2,500-bed tertiary care center in northern Taiwan. These organisms were confirmed to the species level by an array assay and 16S rRNA gene sequence analysis. The antimicrobial susceptibilities of the 43 A. junii isolates to 13 agents were determined using the agar dilution method. Susceptibility testing for tigecycline was determined using the broth microdilution method. Most of the patients were hospital-acquired (n = 36, 83.7 %) or healthcare facility-related infections (n = 6, 13.9 %), and 55.8 % had impaired immunity. Central venous access devices were present in 35 (81.4 %) patients; among the total of 43 patients with A. junii bacteremia, 8 patients were diagnosed as catheter-related bloodstream infection and 19 patients were diagnosed as catheter-associated bloodstream infection. Shock requiring inotropic agents occurred in 2 patients (4.6 %). Most patients developed bacteremia in general wards (n = 36, 83.7 %). The overall in-hospital mortality rate was low (7 %), despite the low rate of removal of central venous devices, low rate of holding usage of original central venous devices, and high rate of inappropriate antimicrobial regimens. Carbapenems, fluoroquinolones, and amikacin had potent activity (>95 % susceptible rate) against A. junii isolates. Interestingly, 35 % of the A. junii isolates were resistant to colistin. Tigecycline exhibited low minimum inhibitory concentration (MIC) values (range, 0.06-2 μg/ml, MIC(90), 1 μg/ml) against the A. junii isolates.
我们调查了在台湾北部一家 2500 张床位的三级保健中心的 43 例不动杆菌属 junii 菌血症患者的临床特征和结局。这些生物体通过阵列分析和 16S rRNA 基因序列分析被确认为特定物种。使用琼脂稀释法测定了 43 株 A. junii 分离株对 13 种药物的抗菌药敏性。使用肉汤微量稀释法测定替加环素的药敏性。大多数患者为医院获得性(n=36,83.7%)或医疗保健相关感染(n=6,13.9%),55.8%的患者免疫受损。35 名患者(81.4%)存在中心静脉通路装置;在 43 名 A. junii 菌血症患者中,有 8 名患者被诊断为导管相关血流感染,19 名患者被诊断为导管相关血流感染。2 名患者(4.6%)发生需要正性肌力药物的休克。大多数患者在普通病房发生菌血症(n=36,83.7%)。尽管中心静脉导管的移除率低、原始中心静脉导管的保留使用率低、抗菌方案不合理的比例高,但总的院内死亡率仍较低(7%)。碳青霉烯类、氟喹诺酮类和阿米卡星对 A. junii 分离株具有较强的活性(>95%敏感率)。有趣的是,35%的 A. junii 分离株对多粘菌素耐药。替加环素对 A. junii 分离株表现出较低的最小抑菌浓度(MIC)值(范围,0.06-2μg/ml,MIC90,1μg/ml)。