University of Medicine and Pharmacy, Ho Chi Minh City, Vietnam; University Medical Center, Ho Chi Minh City, Vietnam.
Oxford University Clinical Research Unit, Ho Chi Minh City, Vietnam.
J Glob Antimicrob Resist. 2023 Jun;33:267-275. doi: 10.1016/j.jgar.2023.04.007. Epub 2023 Apr 27.
To characterise the clinical features of Acinetobacter baumannii infections and investigate the phylogenetic structure and transmission dynamics of A. baumannii in Vietnam.
Between 2019 and 2020, a surveillance of A. baumannii (AB) infections was conducted at a tertiary hospital in Ho Chi Minh City, Vietnam. Risk factors for in-hospital mortality were analysed using logistic regressions. Whole-genome sequence data were used to characterise genomic species, sequence types (STs), antimicrobial resistance genes, surface antigens, and phylogenetic relatedness of AB isolates.
Eighty-four patients with AB infections were enrolled in the study, 96% of whom were hospital-acquired. Half of the AB isolates were identified from ICU-admitted patients, while the remaining isolates were from non-ICU patients. The overall in-hospital mortality was 56%, with associated risk factors including advanced age, ICU stay, exposure to mechanical ventilation/central venous catheterization, pneumonia as source of AB infection, prior use of linezolid/aminoglycosides, and AB treatment with colistin-based therapy. Nearly 91% of isolates were carbapenem-resistant; 92% were multidrug-resistant; and 6% were colistin-resistant. ST2, ST571, and ST16 were the three dominant carbapenem-resistant A. baumannii (CRAB) genotypes, exhibiting distinct AMR gene profiles. Phylogenetic analysis of CRAB ST2 isolates together with previously published ST2 collection provided evidence of intra- and inter-hospital transmission of this clone.
Our study highlights a high prevalence of carbapenem resistance and multidrug resistance in A. baumannii and elucidates the spread of CRAB within and between hospitals. Strengthening infection control measures and routine genomic surveillance are crucial to reducing the spread of CRAB and detecting novel pan-drug-resistant variants in a timely fashion.
描述鲍曼不动杆菌感染的临床特征，并研究越南鲍曼不动杆菌的系统发育结构和传播动态。
2019 年至 2020 年，在越南胡志明市的一家三级医院进行了一项鲍曼不动杆菌（AB）感染监测。使用逻辑回归分析医院内死亡率的危险因素。使用全基因组序列数据来描述 AB 分离株的基因组种、序列类型（ST）、抗生素耐药基因、表面抗原和系统发育相关性。
本研究纳入了 84 例 AB 感染患者，其中 96%为医院获得性感染。半数 AB 分离株来自 ICU 住院患者，其余分离株来自非 ICU 患者。总的院内死亡率为 56%，相关危险因素包括年龄较大、入住 ICU、暴露于机械通气/中心静脉置管、AB 感染源为肺炎、先前使用利奈唑胺/氨基糖苷类药物以及 AB 治疗采用粘菌素为基础的疗法。近 91%的分离株对碳青霉烯类耐药；92%为多药耐药；6%对粘菌素耐药。ST2、ST571 和 ST16 是三种主要的碳青霉烯类耐药鲍曼不动杆菌（CRAB）基因型，表现出不同的 AMR 基因谱。CRAB ST2 分离株的系统发育分析与先前发表的 ST2 集合作出了该克隆存在院内和院际传播的证据。
本研究表明，AB 中碳青霉烯类和多药耐药率较高，并阐明了 CRAB 在医院内和医院间的传播。加强感染控制措施和常规基因组监测对于减少 CRAB 的传播和及时发现新型泛耐药变异株至关重要。
