Division of Infectious Diseases and Tropical Medicine, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Centre, Taipei, Taiwan; Penghu Branch, Tri-Service General Hospital, National Defense Medical Centre, Penghu, Taiwan; Institute of Clinical Medicine, School of Medicine, National Yang-Ming University, Taipei, Taiwan.
Institute of Clinical Medicine, School of Medicine, National Yang-Ming University, Taipei, Taiwan; Emergency Department, Taipei Veterans General Hospital, Taipei, Taiwan.
Clin Microbiol Infect. 2015 Aug;21(8):758-64. doi: 10.1016/j.cmi.2015.05.005. Epub 2015 May 14.
The clinical characteristics of patients with colistin-resistant Acinetobacter baumannii bacteraemia have been documented, but those of patients with bacteraemia caused by other Acinetobacter species remain unknown. Previous exposure to colistin has been shown to be associated with the emergence of colistin resistance, but may be not the only predisposing factor. In the current study, we highlight the risk and outcome of patients without previous exposure to colistin who acquired colistin-resistant Acinetobacter nosocomialis (ColRAN) bacteraemia. This 11-year single-centre retrospective study analysed 58 patients with ColRAN bacteraemia and 213 patients with colistin-susceptible A. nosocomialis (ColSAN) bacteraemia. Antimicrobial susceptibilities were determined with an agar dilution method. The clonal relationship of ColRAN isolates was determined with pulsed-field gel electrophoresis. A conjugation mating-out assay was conducted to delineate the potential transfer of colistin resistance genes. Multivariable analysis was performed to evaluate the risk factors for ColRAN bacteraemia. Chronic obstructive pulmonary disease (COPD) was independently associated with ColRAN bacteraemia (OR 3.04; 95% CI 1.45-6.37; p 0.003). Patients with ColRAN bacteraemia had higher APACHE II scores, but the two groups showed no significant differences in 14-day mortality (10.3% vs. 10.3%) or 28-day mortality (15.5% vs. 15.0%). ColRAN isolates had greater resistance than ColSAN isolates to all antimicrobial agents except for ciprofloxacin (0% vs. 6.6%). There were 16 different ColRAN pulsotypes, and two major clones were found. Colistin resistance did not transfer to colistin-susceptible A. baumannii or A. nosocomialis. These results show that COPD is an independent risk factor for acquisition of ColRAN bacteraemia. The mortality rates were similar between patients with ColRAN and ColSAN bacteraemia.
已经记录了对粘菌素耐药鲍曼不动杆菌菌血症患者的临床特征，但对其他不动杆菌种引起的菌血症患者的特征尚不清楚。先前接触粘菌素已被证明与粘菌素耐药的出现有关，但可能不是唯一的诱发因素。在本研究中，我们强调了先前未接触过粘菌素但获得耐粘菌素的鲍曼不动杆菌（ColRAN）菌血症的患者的风险和结局。这项为期 11 年的单中心回顾性研究分析了 58 例 ColRAN 菌血症患者和 213 例粘菌素敏感的鲍曼不动杆菌（ColSAN）菌血症患者。采用琼脂稀释法测定抗菌药物敏感性。脉冲场凝胶电泳法测定 ColRAN 分离株的克隆关系。通过接合交配试验来描绘潜在的粘菌素耐药基因转移。进行多变量分析以评估 ColRAN 菌血症的危险因素。慢性阻塞性肺疾病（COPD）与 ColRAN 菌血症独立相关（OR 3.04；95%CI 1.45-6.37；p 0.003）。ColRAN 菌血症患者的 APACHE II 评分较高，但两组在 14 天死亡率（10.3%比 10.3%）或 28 天死亡率（15.5%比 15.0%）方面无显著差异。ColRAN 分离株对除环丙沙星（0%比 6.6%）以外的所有抗菌药物的耐药性均高于 ColSAN 分离株。发现有 16 种不同的 ColRAN 脉冲型，并且发现了两个主要克隆。粘菌素耐药性不会转移到粘菌素敏感的鲍曼不动杆菌或鲍曼不动杆菌。这些结果表明，COPD 是获得 ColRAN 菌血症的独立危险因素。ColRAN 和 ColSAN 菌血症患者的死亡率相似。
