Department of Nursing, Jen-Teh Junior College of Medicine, Nursing and Management, Miaoli, Taiwan; School of Medicine, College of Medicine, Fu Jen Catholic University, New Taipei, Taiwan; Molecular Infectious Disease Research Center, Chang Gung Memorial Hospital, Taoyuan, Taiwan; Department of Pediatrics, Wei-Gong Memorial Hospital, Miaoli, Taiwan.
Department of Pediatrics, Chang Gung Memorial Hospital at Keelung, Chang Gung University College of Medicine, Taoyuan, Taiwan.
J Microbiol Immunol Infect. 2018 Jun;51(3):367-376. doi: 10.1016/j.jmii.2017.07.013. Epub 2017 Aug 8.
Acinetobacter baumannii infections in neonates are not uncommon but rarely studied.
Clinical and molecular epidemiology of 40 patients with A. baumannii bacteremia in the neonatal intensive care units (NICUs) of a medical center from 2004 to 2014 was analyzed.
Multi-drug resistance was found in only 3 isolates (7.5%). Sequence types (STs) of A. baumannii defined by multilocus sequencing typing were diverse, and 72.4% identified isolates belonged to novel STs. Majority of the isolates were susceptible to antibiotics tested. Among the 3 imipenem-resistant A. baumannii (IRAB) isolates, 2 (66.7%) belonged to ST684, a novel ST. All of the 3 isolates were susceptible to tigecycline and colistin. The predominant mechanism of imipenem resistance in these neonatal isolates is ISAba1-bla, which has never been reported in Asia before. Most infected newborns were premature (95%), with very low birth weight (70% < 1500 g), prolonged intubation, usage of percutaneous central venous catheter (65%) and long-term usage of total parenteral nutrition or intravenous lipid (95%). IRAB infection, inappropriate initial therapy, 1-minute Apgar score and early onset infection within the first 10 days of life were found to correlate with mortality by log-rank test. Prior use of imipenem for at least 5 days and use of high frequency oscillation ventilation (HFOV) were statistically significant risk factors for acquiring IRAB infections.
To reduce mortality of IRAB infection, it is crucial to consider giving effective agents, such as colistin, in 2 days for high risk neonates who has been given imipenem or used HFOV.
新生儿鲍曼不动杆菌感染并不罕见，但研究甚少。
对 2004 年至 2014 年期间某医学中心新生儿重症监护病房（NICU）40 例鲍曼不动杆菌菌血症患者的临床和分子流行病学进行了分析。
仅 3 株（7.5%）分离株表现出多药耐药。多位点序列分型（MLST）确定的鲍曼不动杆菌序列型多种多样，72.4%的分离株属于新型 ST 型。大多数分离株对抗生素测试敏感。3 株耐亚胺培南鲍曼不动杆菌（IRAB）中，2 株（66.7%）属于新型 ST684。3 株均对替加环素和黏菌素敏感。这些新生儿分离株中，亚胺培南耐药的主要机制为 ISAba1-bla，此前在亚洲尚未报道过。大多数感染新生儿为早产儿（95%），极低出生体重（70%<1500g），长时间插管，使用经皮中心静脉导管（65%），长期全胃肠外营养或静脉用脂肪乳（95%）。经对数秩检验发现，IRAB 感染、初始治疗不当、1 分钟 Apgar 评分和出生后 10 天内早期发病与死亡率相关。亚胺培南使用至少 5 天和高频振荡通气（HFOV）的使用是获得 IRAB 感染的统计学显著危险因素。
为降低 IRAB 感染的死亡率，对于使用过亚胺培南或接受高频振荡通气的高危新生儿，应考虑在 2 天内给予有效药物，如黏菌素。
