Go E S, Urban C, Burns J, Kreiswirth B, Eisner W, Mariano N, Mosinka-Snipas K, Rahal J J
Department of Medicine, Cornell University Medical School, New York, NY.
Lancet. 1994 Nov 12;344(8933):1329-32. doi: 10.1016/s0140-6736(94)90694-7.
A nosocomial outbreak of infections due to imipenem-resistant Acinetobacter baumannii occurred in a New York hospital after increased use of imipenem for cephalosporin-resistant klebsiella infections. We identified all A baumannii isolates over 12 months, reviewed corresponding patient records, and compared strains with different antibiotic susceptibility patterns by restriction endonuclease analysis. Environmental surveillance cultures were done before and after institution of control measures. 59 patients harboured imipenem-resistant A baumannii, and 18 were infected. Isolates from patients were resistant to all routinely tested antibiotics, including imipenem. Further studies showed susceptibility to polymyxin B and sulbactam. These isolates were identical by restriction endonuclease analysis to A baumannii isolates susceptible to imipenem alone, or to imipenem and amikacin, but differed from broadly susceptible isolates. Surveillance cultures showed hand and environmental colonisation by imipenem-resistant strains. Infection and colonisation were eliminated by intensive infection control measures, and irrigation of wounds with polymyxin B. Increased use of imipenem against cephalosporin-resistant klebsiella may lead to imipenem resistance among other species, particularly acinetobacter. Such resistance appears to derive from a prior multi-resistant clone, in contrast to one which retains susceptibility to several antibiotics.
在一家纽约医院，由于针对耐头孢菌素克雷伯菌感染增加了亚胺培南的使用，发生了耐亚胺培南鲍曼不动杆菌引起的医院感染暴发。我们确定了12个月内所有的鲍曼不动杆菌分离株，查阅了相应的患者记录，并通过限制性内切酶分析比较了具有不同抗生素敏感性模式的菌株。在采取控制措施前后进行了环境监测培养。59例患者携带耐亚胺培南鲍曼不动杆菌，18例被感染。来自患者的分离株对所有常规检测的抗生素耐药，包括亚胺培南。进一步研究表明对多粘菌素B和舒巴坦敏感。通过限制性内切酶分析，这些分离株与仅对亚胺培南敏感或对亚胺培南和阿米卡星敏感的鲍曼不动杆菌分离株相同，但与广泛敏感的分离株不同。监测培养显示耐亚胺培南菌株在手部和环境中定植。通过强化感染控制措施以及用多粘菌素B冲洗伤口，感染和定植得以消除。针对耐头孢菌素克雷伯菌增加亚胺培南的使用可能导致其他菌种出现亚胺培南耐药，尤其是不动杆菌。这种耐药性似乎源自先前的多重耐药克隆，与仍对几种抗生素敏感的克隆形成对比。
