High incidence of pandrug-resistant Acinetobacter baumannii isolates collected from patients with ventilator-associated pneumonia in Greece, Italy and Spain as part of the MagicBullet clinical trial.
High incidence of pandrug-resistant Acinetobacter baumannii isolates collected from patients with ventilator-associated pneumonia in Greece, Italy and Spain as part of the MagicBullet clinical trial.
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DOI：
10.1093/jac/dkx322
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发表时间：
2017-12-01
期刊：
影响因子：
--
通讯作者：
MagicBullet Working Group WP4
中科院分区：
文献类型：
--
作者：
Nowak J;Zander E;Stefanik D;Higgins PG;Roca I;Vila J;McConnell MJ;Cisneros JM;Seifert H;MagicBullet Working Group WP4
目的研究MagicBullet临床试验中诊断为呼吸机相关性肺炎（VAP）患者呼吸道样本中鲍曼不动杆菌分离株的分子流行病学、抗菌药物敏感性和碳青霉烯类耐药性决定因素。从希腊、意大利和西班牙的15家医院的65名患者的呼吸道样本中前瞻性地培养鲍曼杆菌分离株。采用微量肉汤稀释法进行药敏试验。通过PCR和测序鉴定碳青霉烯类耐药决定因素。利用DiversiLab的rep-PCR进行分子流行病学调查，利用内部数据库鉴定国际克隆（IC）。65株菌株除2株（97%）外均对亚胺培南耐药，且均与获得性碳青霉烯酶OXA-23（80%）、OXA-40（4.6%）、OXA-58（1.5%）或OXA-23/58（1.5%）相关。粘菌素耐药率为47.7%。22株为XDR菌株，20株为大耐药菌株。大多数分离株与IC2聚集在一起（n = 54），其中一个主要亚型包括来自三个国家12家医院的分离株，其中包括19株XDR和16株PDR分离株。从VAP患者中恢复的鲍曼不动杆菌碳青霉烯耐药率很高。几乎一半的分离株具有粘菌素耐药，42株（64.6%）为XDR或PDR。Rep-PCR证实IC2是欧洲主要的克隆谱系，并提示存在已在希腊、意大利和西班牙传播的流行XDR/PDR鲍曼尼原虫克隆。这些数据突出了在碳青霉烯耐药鲍曼不动杆菌高流行中心对鲍曼不动杆菌VAP患者进行经验性治疗的困难。
To investigate the molecular epidemiology, antimicrobial susceptibility and carbapenem resistance determinants of Acinetobacter baumannii isolates from respiratory tract samples of patients diagnosed with ventilator-associated pneumonia (VAP) who were enrolled in the MagicBullet clinical trial. A. baumannii isolates were prospectively cultured from respiratory tract samples from 65 patients from 15 hospitals in Greece, Italy and Spain. Susceptibility testing was performed by broth microdilution. Carbapenem resistance determinants were identified by PCR and sequencing. Molecular epidemiology was investigated using rep-PCR (DiversiLab) and international clones (IC) were identified using our in-house database. Of 65 isolates, all but two isolates (97%) were resistant to imipenem and these were always associated with an acquired carbapenemase, OXA-23 (80%), OXA-40 (4.6%), OXA-58 (1.5%) or OXA-23/58 (1.5%). Resistance to colistin was 47.7%. Twenty-two isolates were XDR, and 20 isolates were pandrug-resistant (PDR). The majority of isolates clustered with IC2 (n = 54) with one major subtype comprising isolates from 12 hospitals in the three countries, which included 19 XDR and 16 PDR isolates. Carbapenem resistance rates were very high in A. baumannii recovered from patients with VAP. Almost half of the isolates were colistin resistant, and 42 (64.6%) isolates were XDR or PDR. Rep-PCR confirmed IC2 is the predominant clonal lineage in Europe and suggests the presence of an epidemic XDR/PDR A. baumannii clone that has spread in Greece, Italy and Spain. These data highlight the difficulty in empirical treatment of patients with A. baumannii VAP in centres with a high prevalence of carbapenem-resistant A. baumannii.
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