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[从血培养中分离出的单克隆鲍曼不动杆菌菌株的抗生素耐药谱特征及测定]

[Characterization and determination of antibiotic resistance profiles of a single clone Acinetobacter baumannii strains isolated from blood cultures].

作者信息

Karagöz Alper, Baran Irmak, Aksu Neriman, Acar Sümeyra, Durmaz Rıza

机构信息

Public Health Agency of Turkey, National Molecular Microbiology Reference Centers Laboratory, Ankara, Turkey.

出版信息

Mikrobiyol Bul. 2014 Oct;48(4):566-76. doi: 10.5578/mb.8276.

Abstract

Acinetobacter baumannii which is a significant cause of nosocomial infections, increases the rate of morbidity and mortality in health care settings especially in intensive care units (ICUs). The aim of this study was to determine the antibiotic resistance profiles of A.baumannii strains isolated from blood cultures of inpatients from different ICUs, wards and hospital environment and evaluate their clonal relationships and epidemiologic features. A total of 54 A.baumannii strains (47 from the blood cultures and 7 from the hospital environment), identified between 01 January 2012-28 December 2012 at the Clinical Microbiology Laboratory of Ankara Numune Training and Research Hospital, Turkey, were included in the study. Identification of A.baumannii isolates and their antimicrobial [sulbactam-ampicillin (SAM), piperacillin (PIP), piperacillin-tazobactam (TZP), ceftazidime (CFZ), cefoperazone-sulbactam (SCF), cefepime (CEF), imipenem (IMP), meropenem (MER), amikacin (AMK), gentamicin (GEN), netilmicin (NT), ciprofloxacin (CIP), levofloxacin (LVF), tetracycline (TET), tigecycline (TG), colistin (COL), trimethoprim-sulfamethoxazole (SXT)] susceptibility testing were performed by Vitek 2 (bioMérieux, France) system. The clonal relationship between the A.baumannii isolates was analysed by pulsed-field gel electrophoresis (PFGE). In our study colistin, tigecycline and netilmicin were found to be the most effective agents against A.baumannii isolates. All of the clinical isolates (n= 47) were found susceptible to COL, however all were resistant to SAM, PIP, TZP, CEF, IPM, CFZ, MER and CIP. While 1.85%, 14.8%, 14.8%, 16.6%, 59.2% and 22.2% of the isolates were susceptible to SCF, AMK, NT, GEN, TG and SXT, respectively; 1.85%, 1.85%, 9.2%, 16.6%, 38.8% and 27.7% of the isolates were intermediate to SCF, TET, AMK, NT, LVF and TG, respectively. Similarly, all of the environmental A.baumannii isolates (n= 7) were resistant to SAM, PIP, TZP, CFZ, CEF, IPM, MER and CIP, and all were susceptible to TG and COL. The resistance rates of the environmental isolates to SCF, AMK, GEN, NT, LVF, TET and SXT were determined as 57.1%, 85.7%, 85.7%, 28.8%, 28.6%, 85.7% and 57.1%, respectively. PFGE analysis done by the use of ApaI enzyme revealed the presence of one major clone. Dendogram analysis indicated that environmental and clinical isolates were in the same clone indicating that the outbreak was possibly originated from the same internal ICUs. Our data emphasized that multidrug resistant A.baumannii isolates were quite common in our hospital, and enviromental cross-contamination throughout the year was confirmed by molecular methods. Despite the precautions such as continous education on effective hand washing, use of gloves and hospital cleaning, established in our hospital, this single clonal spread was attributed to staff shortage and poor adherence to infection control rules. In conclusion, for the prevention of dissemination of multidrug resistant A.baumannii strains and control of nosocomial infections, infection control strategies should be established and strict compliance to these rules should be provided.

摘要

鲍曼不动杆菌是医院感染的重要原因,在医疗机构中,尤其是重症监护病房(ICU),会增加发病率和死亡率。本研究的目的是确定从不同ICU、病房和医院环境的住院患者血培养中分离出的鲍曼不动杆菌菌株的抗生素耐药谱,并评估它们的克隆关系和流行病学特征。本研究纳入了2012年1月1日至2012年12月28日期间在土耳其安卡拉努穆内培训和研究医院临床微生物实验室鉴定出的54株鲍曼不动杆菌菌株(47株来自血培养,7株来自医院环境)。采用Vitek 2(法国生物梅里埃公司)系统对鲍曼不动杆菌分离株进行鉴定及其抗菌药物[舒巴坦-氨苄西林(SAM)、哌拉西林(PIP)、哌拉西林-他唑巴坦(TZP)、头孢他啶(CFZ)、头孢哌酮-舒巴坦(SCF)、头孢吡肟(CEF)、亚胺培南(IMP)、美罗培南(MER)、阿米卡星(AMK)、庆大霉素(GEN)、奈替米星(NT)、环丙沙星(CIP)、左氧氟沙星(LVF)、四环素(TET)、替加环素(TG)、黏菌素(COL)、甲氧苄啶-磺胺甲恶唑(SXT)]敏感性测试。通过脉冲场凝胶电泳(PFGE)分析鲍曼不动杆菌分离株之间的克隆关系。在我们的研究中,发现黏菌素、替加环素和奈替米星是对抗鲍曼不动杆菌分离株最有效的药物。所有临床分离株(n = 47)对COL敏感,但对SAM、PIP、TZP、CEF、IPM、CFZ、MER和CIP均耐药。分离株对SCF、AMK、NT、GEN、TG和SXT的敏感率分别为1.85%、14.8%、14.8%、16.6%、59.2%和22.2%;分离株对SCF、TET、AMK、NT、LVF和TG的中介率分别为1.8%、1.85%、9.2%、16.6%、38.8%和27.7%。同样,所有环境鲍曼不动杆菌分离株(n = 7)对SAM、PIP、TZP、CFZ、CEF、IPM、MER和CIP均耐药,对TG和COL均敏感。环境分离株对SCF、AMK、GEN、NT、LVF、TET和SXT的耐药率分别为57.1%、85.7%、85.7%、28.8%、28.6%、85.7%和57.1%。使用ApaI酶进行的PFGE分析显示存在一个主要克隆。树形图分析表明环境分离株和临床分离株属于同一克隆,表明此次暴发可能起源于同一个内部ICU。我们的数据强调,多重耐药鲍曼不动杆菌分离株在我们医院相当常见,并且通过分子方法证实了全年存在环境交叉污染。尽管我们医院采取了诸如持续进行有效洗手教育、使用手套和医院清洁等预防措施,但这种单一克隆传播归因于人员短缺和对感染控制规则的遵守不力。总之,为预防多重耐药鲍曼不动杆菌菌株的传播和控制医院感染,应制定感染控制策略并严格遵守这些规则。

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