Lohr Benedikt, Pfeifer Yvonne, Heudorf Ursel, Rangger Christoph, Norris Douglas E, Hunfeld Klaus-Peter
1 Institute for Laboratory Medicine , Microbiology & Infection Control, Northwest Medical Centre, Frankfurt/Main, Germany .
2 Nosocomial Pathogens and Antibiotic Resistance, Robert Koch-Institute , Wernigerode, Germany .
Microb Drug Resist. 2018 Jun;24(5):578-584. doi: 10.1089/mdr.2017.0141. Epub 2017 Oct 17.
The ongoing Libyan conflict constantly causes victims among the military and civilian population. Cross-border transfer of patients represents a high risk of introducing multidrug-resistant organisms (MDROs), for example, methicillin-resistant Staphylococcus aureus (MRSA), vancomycin-resistant enterococci, and carbapenem-resistant gram-negative organisms (CROs), into the country of destination. This study assessed the MDRO status in Libyan war casualties (n = 67) admitted to Northwest Medical Centre in Frankfurt/Main, Germany, from August 2016 till January 2017. Identified multidrug-resistant nonfermenters and Enterobacteriaceae were subjected to molecular detection of β-lactamases and further mechanisms of resistance. All isolates were typed by enzymatic macrorestriction and subsequent pulsed-field gel electrophoresis. MDROs were found in 40 (60%) patients, including 25 (37%) positive for at least one CRO and 11 (16%) patients with MRSA. A total of 37 isolates of Klebsiella pneumoniae, Acinetobacter baumannii, Escherichia coli, Enterobacter cloacae, and Serratia marcescens produced carbapenemases: NDM (n = 17), OXA-48 (n = 15), and OXA-23 (n = 9) in addition to other β-lactamases (with bla being most frequent) and plasmid-mediated quinolone resistance genes (qnrB, aac(6')Ib-cr). Bacterial strain typing revealed the presence of various clones. This high MDRO rate in Libyan war casualties demands awareness, appropriate screening, and containment measures for medical institutions involved in medical care to avoid patient-to-patient transmission.
持续的利比亚冲突不断造成军事人员和平民伤亡。患者的跨境转移带来了将耐多药微生物（MDROs）引入目的地国的高风险，例如耐甲氧西林金黄色葡萄球菌（MRSA）、耐万古霉素肠球菌和耐碳青霉烯类革兰氏阴性菌（CROs）。本研究评估了2016年8月至2017年1月期间收治于德国美因河畔法兰克福西北医疗中心的67名利比亚战争伤员的MDROs状况。对鉴定出的耐多药非发酵菌和肠杆菌科细菌进行β-内酰胺酶分子检测及其他耐药机制检测。所有分离株通过酶切宏观限制性分析及随后的脉冲场凝胶电泳进行分型。在40名（60%）患者中发现了MDROs，包括25名（37%）至少对一种CRO呈阳性的患者和11名（16%）感染MRSA的患者。总共37株肺炎克雷伯菌、鲍曼不动杆菌、大肠埃希菌、阴沟肠杆菌和粘质沙雷氏菌产生了碳青霉烯酶：NDM（17株）、OXA-48（15株）和OXA-23（9株），此外还产生了其他β-内酰胺酶（bla最为常见）和质粒介导的喹诺酮耐药基因（qnrB、aac(6')Ib-cr）。细菌菌株分型显示存在各种克隆。利比亚战争伤员中如此高的MDROs发生率要求参与医疗护理的医疗机构提高认识、采取适当的筛查和控制措施，以避免患者之间的传播。
