Citywide clonal outbreak of multiresistant Acinetobacter baumannii and Pseudomonas aeruginosa in Brooklyn, NY -: The preantibiotic era has returned
Citywide clonal outbreak of multiresistant Acinetobacter baumannii and Pseudomonas aeruginosa in Brooklyn, NY -: The preantibiotic era has returned
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DOI：
10.1001/archinte.162.13.1515
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发表时间：
2002-07-08
影响因子：
--
通讯作者：
Brooks, S
中科院分区：
文献类型：
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作者：
Landman, D;Quale, JM;Brooks, S
背景：碳青霉烯类抗生素是治疗医院革兰氏阴性菌感染的重要药物。在某些地区，耐碳青霉烯类抗生素的问题日益严重。本研究确定了纽约布鲁克林耐碳青霉烯类抗生素鲍曼不动杆菌和铜绿假单胞菌在全市的流行情况和分子流行病学特征。方法：所有独特的鲍曼不动杆菌和铜绿假单胞菌分离自1999年7月1日至1999年9月30日在布鲁克林的15家医院。结果：共收集鲍曼不动杆菌419株，铜绿假单胞菌823株。为了一杯鲍曼尼。53%对美罗培南和/或亚胺培南耐药，12%对所有标准抗生素耐药。核糖体分型显示，单个克隆占样本的62%，并从所有13家医院的患者中分离到。碳青霉烯耐药率与各医院头孢菌素的使用有关(P=0.004)。铜绿假单胞菌对亚胺培南的耐药率为24%，对阿米卡星的耐药率为5%，对其他抗肿瘤药物的耐药率为15%~29%。核糖体分型显示3个克隆占分离株的近一半，并被大多数医院共享。结论：1999年3个月期间约有400例患者感染或定植耐碳青霉烯类鲍曼不动杆菌和铜绿假单胞菌。一些菌株已经在该地区的医院广泛传播。耐药鲍曼不动杆菌的流行似乎与头孢菌素的使用有关。医院获得的多重耐药细菌应该被视为一个严重的公共卫生问题，而不是个别医院的问题。要有效地解决这一问题，需要作出密集的协调努力。
Background: Carbapenems are important agents for treating nosocomial gram-negative infections. Carbapenem-resistant bacteria have become increasingly problematic in certain regions. This study determined the city-wide prevalence and molecular epidemiological features of carbapenem-resistant Acinetobacter baumannii and Pseudomonas aeruginosa in Brooklyn, NY.Methods: All unique patient isolates of A baumannii and P aeruginosa were collected from 15 Brooklyn hospitals from July 1, 1999, through September 30, 1999. Antibiotic susceptibilities, the genetic relatedness of resistant isolates, and the relationship between antibiotic use and resistance rates were determined.Results: A total of 419 isolates of A baumannii and 823 isolates of P aeruginosa were collected. For A baumannii. 53% were resistant to meropenem and/or imipenem, and 12% were resistant to all standard antibiotics. Ribotyping revealed that a single clone accounted for 62% of the samples and was isolated from patients at all 13 hospitals. The rate of carbapenem resistance was associated with cephalosporin use at each hospital (P=.004). For P aeruginosa, 24% were resistant to imipenem, 5% to amikacin, and 15% to 29% to other antipseudomonal agents. Ribotyping revealed that 3 clones accounted for nearly half of the isolates and were shared by most hospitals.Conclusions: Approximately 400 patients were infected or colonized with carbapenem-resistant A baumannii and P aeruginosa during a 3-month period in 1999. A few strains have spread widely throughout hospitals in this region. The prevalence of resistant A baumannii seems to be correlated with cephalosporin use. Multiresistant hospital-acquired bacteria should be viewed as a serious public health issue rather than an individual hospital's problem. An intensive coordinated effort will be needed to effectively address this problem.