Institute of Antibiotics, Huashan Hospital, Fudan University, Shanghai, China; Key Laboratory of Clinical Pharmacology of Antibiotics, National Health and Family Planning Commission, Shanghai, China.
Division of Infectious Diseases, Shanghai Jiaotong University Affiliated Sixth People's Hospital, Shanghai, China.
J Microbiol Immunol Infect. 2015 Feb;48(1):101-8. doi: 10.1016/j.jmii.2014.04.005. Epub 2014 May 23.
BACKGROUND/PURPOSE: Extensively drug-resistant (XDR) Acinetobacter baumannii presents a serious therapeutic and infection control challenge. This study aimed to explore the causes for the rapid increase of XDR A. baumannii at a teaching hospital in Shanghai.
All consecutive clinical isolates of XDR A. baumannii were collected from January to December 2010 at Huashan Hospital in Shanghai. The prevalence of carbapenemase genes was investigated by polymerase chain reaction (PCR) amplification. Genetic relatedness of the isolates was determined by enterobacterial repetitive intergenic consensus-PCR and multilocus sequence typing. A retrospective case-control study was performed for the identification of risk factors of XDR A. baumannii infections.
All 106 XDR A. baumannii isolates carried the blaOxA-23 gene and were resistant to all antimicrobial agents tested, except colistin, tigecycline and cefoperazone-sulbactam. One hundred and five of the strains belonged to clonal complex 92 by multilocus sequence typing, and 78 were classified as clone A1 by enterobacterial repetitive intergenic consensus-PCR. Intensive care unit residency at the time of isolation, recent general anesthesia, the number of previous antibiotic classes administered and previous hospitalization were identified as risk factors by case-control study. Efficacy rates were 62.5% (5/8), 47.4% (9/19), and 42.9% (3/7) when the XDR patients were treated with cefoperazone-sulbactam, carbapenems, or both cefoperazone-sulbactam and carbapenem, alone or in combination with other agents, respectively.
XDR A. baumannii producing OXA-23 β-lactamase was clonally disseminated at a university hospital in Shanghai. Cefoperazone-sulbactam and carbapenems alone or combined with other antibiotics may benefit XDR A. baumannii infections in the absence of other effective antibiotics.
背景/目的：广泛耐药（XDR）鲍曼不动杆菌对治疗和感染控制构成严重挑战。本研究旨在探讨上海某教学医院 XDR 鲍曼不动杆菌快速增加的原因。
2010 年 1 月至 12 月，从上海华山医院连续收集 XDR 鲍曼不动杆菌临床分离株。通过聚合酶链反应（PCR）扩增检测碳青霉烯酶基因的流行情况。通过肠杆菌重复基因间一致性聚合酶链反应和多位点序列分型确定分离株的遗传相关性。进行回顾性病例对照研究，以确定 XDR 鲍曼不动杆菌感染的危险因素。
106 株 XDR 鲍曼不动杆菌均携带 blaOxA-23 基因，对所有检测的抗菌药物均耐药，除多黏菌素 E、替加环素和头孢哌酮/舒巴坦外。105 株菌经多位点序列分型属于克隆复合体 92，78 株菌经肠杆菌重复基因间一致性聚合酶链反应分类为 A1 克隆。病例对照研究发现，分离时在重症监护病房居住、近期全身麻醉、先前使用的抗生素类别数量和先前住院是 XDR 患者的危险因素。XDR 患者分别单独使用头孢哌酮/舒巴坦、碳青霉烯类药物或两者联合，联合其他药物治疗时，疗效分别为 62.5%（5/8）、47.4%（9/19）和 42.9%（3/7）。
产 OXA-23 碳青霉烯酶的 XDR 鲍曼不动杆菌在上海一所大学医院中克隆传播。头孢哌酮/舒巴坦和碳青霉烯类药物单独或联合其他抗生素治疗 XDR 鲍曼不动杆菌感染可能在没有其他有效抗生素的情况下获益。
