Department of Preventive Medical Sciences, University of Napoli Federico II, Naples, Italy.
Int J Antimicrob Agents. 2013 Jan;41(1):11-9. doi: 10.1016/j.ijantimicag.2012.09.008. Epub 2012 Nov 3.
The rapid expansion of Acinetobacter baumannii clinical isolates exhibiting resistance to carbapenems and most or all available antibiotics during the last decade is a worrying evolution. The apparent predominance of a few successful multidrug-resistant lineages worldwide underlines the importance of elucidating the mode of spread and the epidemiology of A. baumannii isolates in single hospitals, at a country-wide level and on a global scale. The evolutionary advantage of the dominant clonal lineages relies on the capability of the A. baumannii pangenome to incorporate resistance determinants. In particular, the simultaneous presence of divergent strains of the international clone II and their increasing prevalence in international hospitals further support the ongoing adaptation of this lineage to the hospital environment. Indeed, genomic and genetic studies have elucidated the role of mobile genetic elements in the transfer of antibiotic resistance genes and substantiate the rate of genetic alterations associated with acquisition in A. baumannii of various resistance genes, including OXA- and metallo-β-lactamase-type carbapenemase genes. The significance of single nucleotide polymorphisms and transposon mutagenesis in the evolution of A. baumannii has been also documented. Establishment of a network of reference laboratories in different countries would generate a more complete picture and a fuller understanding of the importance of high-risk A. baumannii clones in the international dissemination of antibiotic resistance.
过去十年中，鲍曼不动杆菌临床分离株对碳青霉烯类和大多数或所有现有抗生素的耐药性迅速扩大，这是一个令人担忧的演变。在全球范围内，少数几种成功的多药耐药谱系明显占主导地位，这突显了阐明单家医院、全国范围内和全球范围内鲍曼不动杆菌分离株传播方式和流行病学的重要性。优势克隆谱系的进化优势依赖于鲍曼不动杆菌泛基因组整合耐药决定因子的能力。特别是，国际克隆 II 的不同菌株同时存在及其在国际医院的患病率不断增加，进一步支持了该谱系对医院环境的持续适应。事实上，基因组和遗传研究阐明了可移动遗传元件在抗生素耐药基因转移中的作用，并证实了与各种耐药基因（包括 OXA 和金属β-内酰胺酶型碳青霉烯酶基因）在鲍曼不动杆菌中获得相关的遗传改变率。单核苷酸多态性和转座子诱变在鲍曼不动杆菌进化中的作用也已得到证实。在不同国家建立参考实验室网络将更全面地了解高风险鲍曼不动杆菌克隆在抗生素耐药性国际传播中的重要性。
