Jasemi S, Douraghi M, Adibhesami H, Zeraati H, Rahbar M, Boroumand M A, Aliramezani A, Ghourchian S, Mohammadzadeh M
Division of Microbiology, Department of Pathobiology, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran.
Food Microbiology Research Center, Tehran University of Medical Sciences, Tehran, Iran.
Lett Appl Microbiol. 2016 Dec;63(6):466-472. doi: 10.1111/lam.12669. Epub 2016 Nov 2.
Comprehensive data on drug-resistant patterns of Acinetobacter baumannii isolates in developing countries is limited. We conducted a multihospital study to assess the rate and trend of drug-resistant phenotypes in Ac. baumannii using standardized definitions and to determine the remaining therapeutic options against resistant phenotypes. The 401 nonduplicate isolates were collected from six hospitals which are geographically distributed across Tehran, Iran over a 3-year period. Following PCR of bla gene, susceptibility testing was performed against nine antimicrobial agent categories. Three hundred and ninety (97%) isolates were resistant to least two carbapenems; carbapenem-resistant Ac. baumannii. The majority of isolates (366, 91·3%) were extensively drug resistant (XDR) and the rest of the isolates were classified as multidrug resistant (26, 6·8%) and susceptible (9, 2·2%). The rate of XDR-AB slightly decreased from 93·8% in 2011 to 89·8% in 2013. A considerable decrease in resistance to doxycycline, minocycline and tigecycline was demonstrated. The XDR-AB isolates showed susceptibility to gentamicin (10·4%), tobramycin (23%), ampicilin-sulbactam (30·1%), minocycline (32·8%), tigecycline (10·7%), doxycycline (21·6%), colistin (100%) and polymixin B (100%). We demonstrated the rising trend of resistance to all antibiotic categories except tetracyclines and folate pathway inhibitors. We found that the treatment options against XDR-AB are extremely limited and each treatment alternative including even old, but safe, antibiotics might be considered.
The high frequency of drug-resistant phenotypes including carbapenem-resistant Acinetobacter baumannii, multidrug-resistant, and extensively resistant has been demonstrated in Ac. baumannii isolates tested here. As the antibiotic resistance pattern of isolates varies in different geographical regions, this study can provide comprehensive information about the antibiotic resistance profile of Ac. baumannii isolates in Tehran. In addition, the resistance profiles could be effectively considered by clinicians to manage antibiotic therapy. This work also emphasizes on the prudent use of antibiotics and the monitoring of antibiotic susceptibility trend and rate.
发展中国家鲍曼不动杆菌分离株耐药模式的全面数据有限。我们开展了一项多医院研究，以使用标准化定义评估鲍曼不动杆菌耐药表型的发生率和趋势，并确定针对耐药表型的剩余治疗选择。在3年期间，从伊朗德黑兰不同地理位置的6家医院收集了401株非重复分离株。对bla基因进行PCR扩增后，对9类抗菌药物进行了药敏试验。390株（97%）分离株对至少两种碳青霉烯类耐药，即耐碳青霉烯鲍曼不动杆菌。大多数分离株（366株，91.3%）为广泛耐药（XDR），其余分离株分为多重耐药（26株，6.8%）和敏感（9株，2.2%）。XDR-AB的发生率从2011年的93.8%略有下降至2013年的89.8%。强力霉素、米诺环素和替加环素的耐药率有显著下降。XDR-AB分离株对庆大霉素（10.4%）、妥布霉素（23%）、氨苄西林-舒巴坦（30.1%）、米诺环素（32.8%）、替加环素（10.7%）、强力霉素（21.6%）、黏菌素（100%）和多黏菌素B（100%）敏感。我们证明了除四环素类和叶酸途径抑制剂外，所有抗生素类别的耐药性呈上升趋势。我们发现针对XDR-AB的治疗选择极其有限，甚至包括老的但安全的抗生素在内的每种治疗选择都可能被考虑。
在此测试的鲍曼不动杆菌分离株中，已证明包括耐碳青霉烯鲍曼不动杆菌、多重耐药和广泛耐药在内的耐药表型频率很高。由于不同地理区域分离株的抗生素耐药模式不同，本研究可以提供有关德黑兰鲍曼不动杆菌分离株抗生素耐药谱的全面信息。此外，临床医生可以有效地参考耐药谱来管理抗生素治疗。这项工作还强调了谨慎使用抗生素以及监测抗生素敏感性趋势和发生率。
