印度尼西亚一家三级医院临床分离鲍曼不动杆菌 blaOXA-23 基因的药敏模式和分布。

The susceptibility pattern and distribution of blaOXA-23 genes of clinical isolate Acinetobacter baumannii in a tertiary hospital, Indonesia.

机构信息

Doctoral Program of Medical Science, Faculty of Medicine, Universitas Airlangga, Surabaya, Indonesia .

Department of Medical Biology, Faculty of Medicine, Universitas Riau, Pekanbaru, Indonesia.

出版信息

J Infect Dev Ctries. 2022 May 30;16(5):821-826. doi: 10.3855/jidc.15902.

DOI:10.3855/jidc.15902

PMID:35656953

Abstract

INTRODUCTION

Acinetobacter baumannii, a pathogen of concern in hospitals worldwide, has diverse antimicrobial resistance mechanisms leading to limiting the antibiotic options and carbapenemase enzyme production is one of the common mechanisms in carbapenem resistance. The epidemiology and resistance pattern of clinical isolates are critical in developing a prevention and treatment strategy. The aim of this was to determine the prevalence and resistance pattern of carbapenem non-susceptible strains (CNS) A. baumannii at Arifin Achmad General Hospital, Pekanbaru, Indonesia.

METHODOLOGY

Data were retrieved from the culture and susceptibility test results from various clinical specimens from January 2015 to December 2019. A susceptibility test was conducted using Vitek 2 Compact following the manufacturer's protocol. To explore the genetic profile of CNS A. baumannii, we amplified the blaOXA-23 and blaOXA-51 genes, carbapenemase producing genes, using a duplex polymerase chain reaction (PCR) among 24 isolates Chi-squared was used to assess the factors associated with the presence of CNS A. baumannii.

RESULTS

Between 2015-2019, 1.263 A. baumannii isolates were tested and the prevalence of CNS A. baumannii was 50%. The trend decreased from 53% in 2016 to 45% in 2019. The proportion of CNS A. baumannii was higher among samples from patients treated in the Intensive Care Unit (ICU) compared to non-ICU (p < 0.001). The CNS A. baumannii was also more frequently detected from sputum than from non-sputum samples (p = 0.009). CNS A. baumannii were highly resistant to almost all antibiotics and the highest susceptibility was to amikacin, tigecycline, and trimethoprim/sulfamethoxazole with 64%, 53%, and 43%, respectively. The blaOXA-23 gene was detected in 92% of tested CNS A. baumannii isolates.

CONCLUSIONS

The prevalence of CNS A. baumannii is high at Arifin Achmad Hospital Riau, Indonesia. This is also supported by the high prevalence of the blaOXA-23 gene among tested isolates. Based on the antibiotic susceptibility pattern there are limited antibiotic choices for CNS A. baummannii urging the strengthening of antimicrobial stewardship programs in the country.

摘要

介绍

鲍曼不动杆菌是一种在全球医院中引起关注的病原体，它具有多种抗菌药物耐药机制，导致抗生素选择受限，而碳青霉烯酶的产生是碳青霉烯类耐药的常见机制之一。临床分离株的流行病学和耐药模式对于制定预防和治疗策略至关重要。本研究旨在确定印度尼西亚巨港阿利芬·阿赫马德综合医院耐碳青霉烯非敏感株（CNS）鲍曼不动杆菌的流行率和耐药模式。

方法

从 2015 年 1 月至 2019 年 12 月的各种临床标本的培养和药敏试验结果中检索数据。采用 Vitek 2 Compact 按照制造商的方案进行药敏试验。为了探索 CNS 鲍曼不动杆菌的遗传特征，我们使用双重聚合酶链反应（PCR）扩增 blaOXA-23 和 blaOXA-51 基因，这两个基因是产碳青霉烯酶的基因，在 24 株菌中进行。卡方检验用于评估与 CNS 鲍曼不动杆菌存在相关的因素。

结果

2015-2019 年间，共检测到 1263 株鲍曼不动杆菌，其中 CNS 鲍曼不动杆菌的流行率为 50%。2016 年的流行率为 53%，2019 年的流行率为 45%，呈下降趋势。与非 ICU 患者相比，CNS 鲍曼不动杆菌在 ICU 患者的标本中更为常见（p < 0.001）。与非痰标本相比，CNS 鲍曼不动杆菌也更常从痰标本中检出（p = 0.009）。CNS 鲍曼不动杆菌对几乎所有抗生素均高度耐药，对阿米卡星、替加环素和复方磺胺甲噁唑的敏感性最高，分别为 64%、53%和 43%。blaOXA-23 基因在检测到的 92%的 CNS 鲍曼不动杆菌分离株中均有检出。