National Institute of Infectious Diseases and Vaccinology, National Health Research Institutes, No. 35 Keyan Road, Zhunan, Taiwan 35053.
BMC Infect Dis. 2012 Aug 28;12:200. doi: 10.1186/1471-2334-12-200.
Acinetobacter baumannii complex (ABC) has emerged as an important pathogen causing a variety of infections. Longitudinal multicenter surveillance data on ABC from different sources in Taiwan have not been published. Using data from the Taiwan Surveillance of Antimicrobial Resistance (TSAR) conducted biennially, we investigated the secular change in resistance of 1640 ABC from 2002 to 2010 (TSAR period III to VII) to different antimicrobial agents and identified factors associated with imipenem-resistant and extensively drug-resistant ABC (IRABC and XDRABC).
Isolates were collected by TSAR from the same 26 hospitals located in all 4 regions of Taiwan. Minimum inhibitory concentrations (MIC) were determined by reference broth microdilution method. Isolates nonsusceptible to all tested aminoglycosides, fluoroquinolones, β-lactam, β-lactam/β-lactam inhibitors, and carbapenems were defined as extensively drug-resistant (XDR). Multivariate logistic regression analysis was performed to assess the relationship between predictor variables among patients with resistant ABC and patients with non-resistant ABC.
The prevalence of IRABC increased from 3.4% in 2002 to 58.7% in 2010 (P < 0.001; odds ratio [OR], 2.138; 95% confidence interval [CI], 1.947 to 2.347) and that of XDRABC increased from 1.3% in 2002 to 41.0% in 2010 (P < 0.001; OR, 1.970; 95% CI, 1.773-2.189). The rates of non-susceptibility to other antimicrobial agents remained high (>55%) over the years with some fluctuations before and after TSAR V (2006) on some agents. Multivariate analysis revealed that recovery from elderly patients, origins other than blood, from ICU settings, or geographic regions are independent factors associated with IRABC and XDRABC. Although the prevalence of XDRABC increased in all four regions of Taiwan over the years, central Taiwan had higher prevalence of XDRABC starting in 2008. Susceptibility to polymyxin remained high (99.8%).
This longitudinal multicenter surveillance program revealed significant increase and nationwide emergence of IRABC and XDRABC in Taiwan over the years. This study also identified factors associated with IRABC and XDRABC to help guide empirical therapy and at-risk groups requiring more intense interventional infection control measures with focused surveillance efforts.
鲍曼不动杆菌复合群（ABC）已成为引起多种感染的重要病原体。来自台湾不同来源的 ABC 纵向多中心监测数据尚未公布。本研究利用台湾抗菌药物耐药性监测（TSAR）每两年进行一次的资料，调查了 2002 年至 2010 年（TSAR 期 III 至 VII）1640 株 ABC 对不同抗菌药物的耐药性的长期变化，并确定了与亚胺培南耐药和广泛耐药 ABC（IRABC 和 XDRABC）相关的因素。
TSAR 从台湾四个地区的 26 家医院采集分离株。采用参考肉汤微量稀释法测定最小抑菌浓度（MIC）。对所有测试的氨基糖苷类、氟喹诺酮类、β-内酰胺类、β-内酰胺/β-内酰胺抑制剂和碳青霉烯类药物均不敏感的分离株定义为广泛耐药（XDR）。采用多变量逻辑回归分析评估耐药 ABC 患者和非耐药 ABC 患者之间预测变量之间的关系。
2002 年至 2010 年，IRABC 的流行率从 3.4%上升至 58.7%（P<0.001；比值比[OR]，2.138；95%置信区间[CI]，1.947 至 2.347），XDRABC 的流行率从 1.3%上升至 41.0%（P<0.001；OR，1.970；95%CI，1.773 至 2.189）。多年来，其他抗菌药物的不敏感性率仍保持较高水平（>55%），在 TSAR V（2006 年）前后，一些药物的不敏感性率出现波动。多变量分析显示，老年患者、非血液来源、重症监护病房（ICU）环境或地理区域的恢复是与 IRABC 和 XDRABC 相关的独立因素。尽管台湾四个地区的 XDRABC 流行率多年来都有所增加，但从 2008 年开始，台湾中部地区的 XDRABC 流行率更高。对黏菌素的敏感性仍然很高（99.8%）。
本纵向多中心监测计划显示，台湾的 IRABC 和 XDRABC 近年来显著增加并在全国范围内出现。本研究还确定了与 IRABC 和 XDRABC 相关的因素，以帮助指导经验性治疗和需要更强化的干预性感染控制措施的高危人群，并进行有针对性的监测。
