Institute for Medical Microbiology and Hospital Epidemiology, Hannover Medical School, Carl-Neuberg-Straße 1, 30625, Hannover, Germany.
Department of Plastic, Aesthetic, Hand and Reconstructive Surgery, Burn Center, Hannover Medical School, Carl-Neuberg-Straße 1, 30625, Hannover, Germany.
Antimicrob Resist Infect Control. 2024 Sep 6;13(1):99. doi: 10.1186/s13756-024-01459-5.
Carbapenem-resistant Acinetobacter baumannii (CRAB) frequently causes both healthcare-associated infections and nosocomial outbreaks in burn medicine/plastic surgery and beyond. Owing to the high antibiotic resistance, infections are difficult to treat, and patient outcomes are often compromised. The environmental persistence capability of CRAB favors its transmission in hospitals. A comprehensive analysis and understanding of CRAB epidemiology and microbiology are essential for guiding management.
A three-year retrospective cohort study (2020-2022) was conducted in a German tertiary burn and plastic surgery center. In addition to epidemiological analyses, microbiological and molecular techniques, including whole-genome sequencing, were applied for the comprehensive examination of isolates from CRAB-positive patients.
During the study period, eight CRAB cases were found, corresponding to an overall incidence of 0.2 CRAB cases per 100 cases and an incidence density of 0.35 CRAB cases per 1000 patient-days. Six cases (75%) were treated in the burn intensive care unit, and four cases (50%) acquired CRAB in the hospital. Molecular analyses comprising 74 isolates supported the epidemiologic assumption that hospital acquisitions occurred within two separate clusters. In one of these clusters, environmental CRAB contamination of anesthesia equipment may have enabled transmission. Furthermore, molecular diversity of CRAB isolates within patients was observed.
CRAB can pose a challenge in terms of infection prevention and control, especially if cases are clustered in time and space on a ward. Our study demonstrates that high-resolution phylogenetic analysis of several bacterial isolates from single patients can greatly aid in understanding transmission chains and helps to take precision control measures.
耐碳青霉烯鲍曼不动杆菌（CRAB）经常在烧伤医学/整形外科学和其他领域引起医院获得性感染和医院内暴发。由于抗生素耐药性高，感染难以治疗，患者预后往往受到影响。CRAB 的环境持久性有利于其在医院内传播。对 CRAB 的流行病学和微生物学进行全面分析和了解对于指导管理至关重要。
对德国一家三级烧伤和整形外科学中心进行了一项为期三年的回顾性队列研究（2020-2022 年）。除了进行流行病学分析外，还应用了微生物学和分子技术，包括全基因组测序，对 CRAB 阳性患者的分离物进行了全面检查。
在研究期间，发现了 8 例 CRAB 病例，总发病率为每 100 例 0.2 例 CRAB 病例，发病率密度为每 1000 例患者 0.35 例 CRAB 病例。6 例（75%）在烧伤重症监护病房接受治疗，4 例（50%）在医院获得 CRAB。包含 74 个分离株的分子分析支持了医院获得的假设，即医院内获得的感染发生在两个独立的集群中。在其中一个集群中，麻醉设备的环境 CRAB 污染可能导致了传播。此外，还观察到患者体内 CRAB 分离株的分子多样性。
CRAB 可能在感染预防和控制方面构成挑战，尤其是如果病例在病房中按时间和空间聚类。我们的研究表明，对单个患者的多个细菌分离株进行高分辨率系统发育分析可以极大地帮助理解传播链，并有助于采取精准控制措施。
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