Department of Basic Medical Science, College of Medicine, University of Bisha, Bisha, Saudi Arabia.
Unit of Medical Microbiology, College of Medicine, University of Bisha, P. O. Box 731, Bisha, 61922, Saudi Arabia.
Ann Clin Microbiol Antimicrob. 2019 Jan 3;18(1):1. doi: 10.1186/s12941-018-0301-x.
Acinetobacter baumannii is an important opportunistic pathogen due to its capabilities for developing mechanisms of resistance to a wide range of antimicrobial agents including carbapenems. This review described the risk factors, antimicrobial susceptibility and mechanisms of carbapenem resistance of A. baumannii from different geographical regions of Saudi Arabia. Several factors including complexity of intensive care unit (ICU) environments, increased numbers of patients with serious diseases, wide spread gastrointestinal colonization and extensive use of antimicrobial drugs led to a wide prevalence of A. baumannii infections in hospitals in Saudi Arabia. A. baumannii has been noted to be less susceptible to antimicrobials agents, including carbapenems, over time, resulting in the evolution of multidrug-resistant (MDR) strains. Dissemination of MDR A. baumannii is attributed to the extreme use of wide-spectrum antimicrobial drugs in hospitals, cross infection between inpatients, invasive ICU procedures, and hospitalized patients with diabetic and cancer those are under frequent invasive diagnostic and therapeutic interventions. Although an increasing prevalence of colistin and tigecycline resistance has been reported in many hospitals, combinations of these agents with carbapenems or other antibiotics remain the best therapeutic choice and reasonably safe to treat patients with MDR A. baumannii infections. The wide distribution of carbapenem resistant A. baumannii (CRAB) due to several mechanisms with diverse genetic determinants has been documented. Although OXA-23 β-lactamase and OXA-51 β-lactamase are the most common genes responsible for CRAB, other novel genes such as blaVIM, PER-1-like and GES-5 have been discovered in carbapenem resistant strains. The high rates of MDR A. baumannii in Saudi hospitals indicate that extensive investigation into the molecular basis of MDR and developing new therapies of CRAB is needed. Moreover, the development of a local antibiogram database coupled with a nationwide antimicrobial stewardship and infection prevention program might help to improve our knowledge of the resistance patterns of A. baumannii, and in developing a treatment protocol for decreasing the infection burden in Saudi Arabia.
鲍曼不动杆菌是一种重要的机会致病菌，因为它能够产生对抗广泛抗菌药物（包括碳青霉烯类）的耐药机制。本综述描述了来自沙特阿拉伯不同地理区域的鲍曼不动杆菌的危险因素、抗菌药物敏感性和碳青霉烯类耐药机制。一些因素，包括重症监护病房（ICU）环境的复杂性、患有严重疾病的患者数量增加、广泛的胃肠道定植和广泛使用抗菌药物，导致沙特阿拉伯医院的鲍曼不动杆菌感染广泛流行。随着时间的推移，鲍曼不动杆菌对包括碳青霉烯类在内的抗菌药物的敏感性逐渐降低，导致多药耐药（MDR）菌株的出现。MDR 鲍曼不动杆菌的传播归因于医院中广泛使用广谱抗菌药物、住院患者之间的交叉感染、侵入性 ICU 操作以及患有糖尿病和癌症的住院患者经常进行侵入性诊断和治疗干预。尽管许多医院报告了多粘菌素和替加环素耐药性的增加，但这些药物与碳青霉烯类或其他抗生素联合使用仍然是治疗 MDR 鲍曼不动杆菌感染的最佳治疗选择，并且相对安全。由于具有不同遗传决定因素的多种机制，碳青霉烯类耐药鲍曼不动杆菌（CRAB）的广泛分布已得到证实。虽然 OXA-23 内酰胺酶和 OXA-51 内酰胺酶是导致 CRAB 的最常见基因，但在碳青霉烯类耐药菌株中发现了其他新基因，如 blaVIM、PER-1 样和 GES-5。沙特医院中 MDR 鲍曼不动杆菌的高发生率表明，需要对 MDR 的分子基础进行广泛研究，并开发新的 CRAB 治疗方法。此外，建立本地抗生素药敏数据库并结合全国性的抗菌药物管理和感染预防计划，可能有助于提高我们对鲍曼不动杆菌耐药模式的认识，并制定减少沙特阿拉伯感染负担的治疗方案。
