一所大学医院成人重症监护病房中耐多药鲍曼不动杆菌和铜绿假单胞菌克隆在呼吸机相关性肺炎患者中的传播。
Spread of multidrug-resistant Acinetobacter baumannii and Pseudomonas aeruginosa clones in patients with ventilator-associated pneumonia in an adult intensive care unit at a university hospital.
作者信息
Royer Sabrina, Faria Ana Luiza Souza, Seki Liliane Miyuki, Chagas Thiago Pavoni Gomes, Campos Paola Amaral de, Batistão Deivid William da Fonseca, Asensi Marise Dutra, Gontijo Filho Paulo P, Ribas Rosineide Marques
机构信息
Laboratório de Microbiologia Molecular, Instituto de Ciências Biomédicas, Universidade Federal de Uberlândia, Uberlândia, MG, Brazil.
Laboratório de Microbiologia Molecular, Instituto de Ciências Biomédicas, Universidade Federal de Uberlândia, Uberlândia, MG, Brazil.
出版信息
Braz J Infect Dis. 2015 Jul-Aug;19(4):350-7. doi: 10.1016/j.bjid.2015.03.009. Epub 2015 May 19.
BACKGROUND
In Brazil, ventilator-associated pneumonia (VAP) caused by carbapenem resistant Acinetobacter baumannii and Pseudomonas aeruginosa isolates are associated with significant mortality, morbidity and costs. Studies on the clonal relatedness of these isolates could lay the foundation for effective infection prevention and control programs.
OBJECTIVES
We sought to study the epidemiological and molecular characteristics of A. baumannii vs. P. aeruginosa VAP in an adult intensive care unit (ICU).
METHODS
It was conducted a cohort study of patients with VAP caused by carbapenem resistant A. baumannii and P. aeruginosa during 14 months in an adult ICU. Genomic studies were used to investigate the clonal relatedness of carbapenem resistant OXA-23-producing A. baumannii and P. aeruginosa clinical isolates. The risk factors for acquisition of VAP were also evaluated. Clinical isolates were collected for analysis as were samples from the environment and were typed using pulsed field gel electrophoresis.
RESULTS
Multivariate logistic regression analysis identified trauma diagnosed at admission and inappropriate antimicrobial therapy as independent variables associated with the development of A. baumannii VAP and hemodialysis as independent variable associated with P. aeruginosa VAP. All carbapenem resistant clinical and environmental isolates of A. baumannii were OXA-23 producers. No MBL-producer P. aeruginosa was detected. Molecular typing revealed a polyclonal pattern; however, clone A (clinical) and H (surface) were the most frequent among isolates of A. baumannii tested, with a greater pattern of resistance than other isolates. In P. aeruginosa the most frequent clone I was multi-sensitive.
CONCLUSION
These findings suggest the requirement of constant monitoring of these microorganisms in order to control the spread of these clones in the hospital environment.
背景
在巴西，由耐碳青霉烯类鲍曼不动杆菌和铜绿假单胞菌分离株引起的呼吸机相关性肺炎（VAP）与显著的死亡率、发病率和成本相关。对这些分离株的克隆相关性进行研究可为有效的感染预防和控制计划奠定基础。
目的
我们试图研究成人重症监护病房（ICU）中鲍曼不动杆菌与铜绿假单胞菌VAP的流行病学和分子特征。
方法
在一家成人ICU中对耐碳青霉烯类鲍曼不动杆菌和铜绿假单胞菌引起的VAP患者进行了为期14个月的队列研究。采用基因组学研究来调查耐碳青霉烯类产OXA-23鲍曼不动杆菌和铜绿假单胞菌临床分离株的克隆相关性。还评估了发生VAP的危险因素。收集临床分离株以及环境样本进行分析，并使用脉冲场凝胶电泳进行分型。
结果
多因素逻辑回归分析确定入院时诊断的创伤和不适当的抗菌治疗是与鲍曼不动杆菌VAP发生相关的独立变量，而血液透析是与铜绿假单胞菌VAP相关的独立变量。所有耐碳青霉烯类鲍曼不动杆菌的临床和环境分离株均产OXA-23。未检测到产金属β-内酰胺酶的铜绿假单胞菌。分子分型显示为多克隆模式；然而，在测试的鲍曼不动杆菌分离株中，克隆A（临床）和H（表面）最为常见，其耐药模式比其他分离株更明显。在铜绿假单胞菌中，最常见的克隆I对多种药物敏感。
结论
这些发现表明需要持续监测这些微生物，以控制这些克隆在医院环境中的传播。
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