Pedro Kourí Tropical Medicine Institute (IPK), Havana, Cuba.
Bizkaia International Vaccination Center, Bilbao, Spain.
MEDICC Rev. 2022 Jan 31;24(1):59-69. doi: 10.37757/MR2022.V24.N1.8.
Carbapenem-resistant Acinetobacter baumannii is a complex health problem, causing difficulties in clinical-therapeutic management worldwide. It is of particular concern in Latin America, the Caribbean and China, where it is an emerging health problem. Carbapenemases produced by these organisms inactivate carbapenem antibiotics. Monitoring circulating genotypes' geographic dispersion contributes to more effective control measures. However, exhaustive studies on carbapenem-resistant A. baumannii are scarce.
Study the production of carbapenemases in clinical isolates of A. baumannii resistant to carbapenem antibiotics and the geographic distribution of the sequences circulating in China, Latin America and the Caribbean.
We followed PRISMA indications. We carried out a systematic search in Pubmed, BVS and CKNI on papers on A. baumannii and carbapenemases published during 2015-2020 in English, Spanish and Chinese, and selected 29 cross-sectional studies that met the search criteria. Studies were evaluated using JBI Critical Appraisal tools, and quantitative data were collated for meta-analysis using the Metaprop library in Stata15.
OXA-type carbapenemases were detected in all studies; among A. baumannii resistant to carbapenem antibiotics, predominant types were OXA-23, OXA-24, OXA-54 and OXA-72; metallobetalactamases were identified less frequently than OXA carbapenemases. Only one clinical isolate producer of Class A carbapenemases (KPC) was identified in Colombia. In total, 41 sequence types were identified; in Latin America and the Caribbean the most common types were: ST79, ST25, ST1 and ST15; in China, the sequences ST195, ST208, ST191, ST368 and ST369 were the most prevalent. ST2 was found in both regions.
The most prevalent carbapenemases and sequence types vary by region, indicating different ancestral strains. Microbiological surveillance, antibiotic use optimization, adequate infection treatment and timely control strategies are essential for carbapenem-resistant A. baumannii prevention and control in geographies such as Latin America, the Caribbean and China where such resistance is an emerging health problem.
耐碳青霉烯鲍曼不动杆菌是一个复杂的健康问题，在全球范围内给临床治疗管理带来了困难。在拉丁美洲、加勒比地区和中国，它是一个新出现的健康问题，尤其令人关注。这些生物体产生的碳青霉烯酶使碳青霉烯类抗生素失活。监测循环基因型的地理分布有助于采取更有效的控制措施。然而，关于耐碳青霉烯鲍曼不动杆菌的详尽研究却很少。
研究对碳青霉烯类抗生素耐药的鲍曼不动杆菌临床分离株中产碳青霉烯酶的情况，以及在中国、拉丁美洲和加勒比地区循环的序列的地理分布。
我们遵循 PRISMA 指示。我们在 Pubmed、BVS 和 CKNI 上系统地搜索了 2015-2020 年期间发表的关于鲍曼不动杆菌和碳青霉烯酶的英文、西班牙文和中文论文，并选择了符合搜索标准的 29 项横断面研究。使用 JBI 批判性评价工具对研究进行评估，并使用 Stata15 中的 Metaprop 库对定量数据进行荟萃分析。
所有研究均检测到 OXA 型碳青霉烯酶；在耐碳青霉烯类抗生素的鲍曼不动杆菌中，主要类型为 OXA-23、OXA-24、OXA-54 和 OXA-72；金属β-内酰胺酶的检出率低于 OXA 碳青霉烯酶。在哥伦比亚只发现了一株产 A 类碳青霉烯酶（KPC）的临床分离株。共鉴定出 41 种序列类型；在拉丁美洲和加勒比地区，最常见的类型是：ST79、ST25、ST1 和 ST15；在中国，最常见的序列是 ST195、ST208、ST191、ST368 和 ST369。在两个地区都发现了 ST2。
不同地区流行的碳青霉烯酶和序列类型不同，表明存在不同的祖菌株。在拉丁美洲、加勒比地区和中国等出现此类耐药性的新兴健康问题地区，微生物学监测、抗生素使用优化、适当的感染治疗和及时的控制策略对于耐碳青霉烯鲍曼不动杆菌的预防和控制至关重要。
