Abdollahi Alireza, Aliramezani Amir, Salehi Mohammadreza, Norouzi Shadehi Mahsa, Ghourchian Sedighe, Douraghi Masoumeh
Department of Pathology, School of Medicine, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran.
Department of Infectious Disease, School of Medicine, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran.
BMC Infect Dis. 2021 Sep 8;21(1):927. doi: 10.1186/s12879-021-06642-2.
Carbapenem-resistant Acinetobacter baumannii (CRAB) is among the most concerning cause of healthcare-associated infections (HAI) due to its high level of antibiotic resistance and high mortality. In the era of the COVID-19 pandemic, the key priority of infection control committees is to contain the dissemination of antibiotic resistant Gram-negative bacteria. Here, we aimed to timely recognize the emergence of CRAB in COVID-19 cases admitted to the wards of a tertiary referral hospital and to identify the genetic relatedness of the isolates.
From 30 March to 30 May 2020, a total of 242 clinical samples from COVID-19 cases were screened for CRAB isolates using standard microbiologic and antibiotic susceptibility tests. The PCRs targeting oxa23, oxa24, oxa58, bla and bla genes were performed. Two multiplex PCRs for identifying the global clones (GC) of A. baumannii were also performed. The sequence type of CRABs was determined using Institut Pasteur (IP) multilocus sequence typing (MLST) scheme.
Eighteen CRAB isolates were recovered from COVID-19 patients with the mean age of 63.94 ± 13.8 years. All but 4 COVID-19 patients co-infected with CRAB were suffering from an underlying disease. Death was recorded as the outcome in ICUs for 9 (50%) COVID-19 patients co-infected with CRAB. The CRAB isolates belong to GC2 and ST2 and carried the oxa23 carbapenem resistance gene.
This study demonstrated the co-infection of CRAB isolates and SARS-CoV-2 in the patients admitted to different ICUs at a referral hospital in Tehran. The CRAB isolates were found to belong to ST2, share the oxa23 gene and to have caused several outbreaks in the wards admitting COVID-19 patients.
耐碳青霉烯类鲍曼不动杆菌（CRAB）因其高度的抗生素耐药性和高死亡率，成为医疗保健相关感染（HAI）最令人担忧的病因之一。在新冠疫情时代，感染控制委员会的首要任务是遏制抗生素耐药革兰氏阴性菌的传播。在此，我们旨在及时识别三级转诊医院病房收治的新冠肺炎病例中CRAB的出现情况，并确定分离株的遗传相关性。
2020年3月30日至5月30日，共对242份新冠肺炎病例的临床样本进行筛查，采用标准微生物学和抗生素敏感性试验检测CRAB分离株。进行了针对oxa23、oxa24、oxa58、bla和bla基因的聚合酶链反应（PCR）。还进行了两个用于鉴定鲍曼不动杆菌全球克隆（GC）的多重PCR。使用巴斯德研究所（IP）多位点序列分型（MLST）方案确定CRAB的序列类型。
从新冠肺炎患者中分离出18株CRAB，患者平均年龄为63.94±13.8岁。除4例新冠肺炎合并CRAB感染患者外，其余患者均患有基础疾病。在重症监护病房（ICU）中，9例（50%）新冠肺炎合并CRAB感染患者的结局为死亡。CRAB分离株属于GC2和ST2，携带oxa23碳青霉烯耐药基因。
本研究证明了德黑兰一家转诊医院不同ICU收治的患者中存在CRAB分离株与严重急性呼吸综合征冠状病毒2（SARS-CoV-2）的合并感染。发现CRAB分离株属于ST2，共享oxa23基因，并在收治新冠肺炎患者的病房中引发了多次暴发。
