Mózes Julianna, Ebrahimi Fatemeh, Gorácz Orsolya, Miszti Cecília, Kardos Gábor
Department of Medical Microbiology, Faculty of Medicine, University of Debrecen, H-4032 Debrecen Nagyerdei krt. 98, Hungary.
Clinical Pharmacy, Faculty of Medicine, University of Debrecen, H-4032 Debrecen Nagyerdei krt. 98, Hungary.
J Med Microbiol. 2014 Dec;63(Pt 12):1654-1662. doi: 10.1099/jmm.0.082818-0. Epub 2014 Sep 26.
This study investigated the molecular epidemiology of Acinetobacter baumannii in the University of Debrecen in relation to antibiotic consumption. Overall and ward-specific antibiotic consumption was measured by the number of defined daily doses (DDD) per 100 bed-days between 2002 and 2012. Consumption was analysed against the number of A. baumannii positive patients per 100 bed-days, number of isolates per positive sample, and proportion of carbapenem resistant A. baumannii, using time-series analysis. Altogether 160 A. baumannii isolates from different wards were collected and analysed. Carbapenemase genes bla(OXA-23-like), bla(OXA-24-like), bla(OXA-48-like), bla(OXA-51-like), bla(OXA-58-like) and integrons were sought by PCR. Relatedness of isolates was assessed by PFGE. Prevalence and carbapenem resistance of A. baumannii were statistically associated with carbapenem consumption. Prevalence data followed carbapenem usage with three quarterly lags (r = 0.51-0.53, P<0.001), and meropenem and ertapenem, but not imipenem usage, affected prevalence. Colistin usage, in turn, lagged behind prevalence with one lag (r = 0.68-0.70, P<0.001). Six clusters were identified; the neurology ward with the lowest carbapenem consumption was associated with the carbapenem-susceptible cluster, as well as with the carbapenem-susceptible isolates in the cluster with variable susceptibility. Wards with high carbapenem usage almost exclusively harboured isolates from carbapenem-resistant clusters. All clusters were dominated by isolates of one or two wards, but most wards were represented in multiple clusters. Increases in prevalence and carbapenem resistance of A. baumannii were associated with usage of meropenem and ertapenem but not of imipenem, which led to the spread of multiple clones in the University.
本研究调查了德布勒森大学鲍曼不动杆菌的分子流行病学及其与抗生素使用的关系。通过计算2002年至2012年期间每100床日的限定日剂量（DDD）数量来衡量总体及各病房特定的抗生素使用情况。利用时间序列分析，将抗生素使用情况与每100床日鲍曼不动杆菌阳性患者数量、每个阳性样本的分离株数量以及耐碳青霉烯鲍曼不动杆菌的比例进行分析。共收集并分析了来自不同病房的160株鲍曼不动杆菌分离株。通过聚合酶链反应（PCR）寻找碳青霉烯酶基因bla(OXA - 23样)、bla(OXA - 24样)、bla(OXA - 48样)、bla(OXA - 51样)、bla(OXA - 58样)和整合子。通过脉冲场凝胶电泳（PFGE）评估分离株的相关性。鲍曼不动杆菌的患病率和耐碳青霉烯性与碳青霉烯类抗生素的使用在统计学上相关。患病率数据在碳青霉烯类抗生素使用后有三个季度的滞后（r = 0.51 - 0.53，P<0.001），美罗培南和厄他培南的使用，但亚胺培南的使用未影响患病率。相反，黏菌素的使用滞后于患病率一个滞后时间（r = 0.68 - 0.70，P<0.001）。鉴定出六个聚类；碳青霉烯类抗生素使用量最低的神经科病房与碳青霉烯敏感聚类相关，以及与敏感性可变聚类中的碳青霉烯敏感分离株相关。碳青霉烯类抗生素使用量高的病房几乎只含有来自耐碳青霉烯聚类的分离株。所有聚类均由一两个病房的分离株主导，但大多数病房在多个聚类中都有代表。鲍曼不动杆菌患病率和耐碳青霉烯性的增加与美罗培南和厄他培南的使用相关，而与亚胺培南的使用无关，这导致了该大学中多个克隆的传播。
