Evolution of Drug-resistant Acinetobacter baumannii After DCD Renal Transplantation.
Evolution of Drug-resistant Acinetobacter baumannii After DCD Renal Transplantation.
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DCD 肾移植后耐药鲍曼不动杆菌的演变。
DOI：
10.1038/s41598-017-01683-7
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发表时间：
2017-05-16
影响因子：
4.6
通讯作者：
Chen J
中科院分区：
文献类型：
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作者：
Jiang H;Cao L;Qu L;Qu T;Liu G;Wang R;Li B;Wang Y;Ying C;Chen M;Lu Y;Feng S;Xiao Y;Wang J;Wu J;Chen J
肾移植术后感染是导致患者发病和死亡的主要原因，尤其是广泛耐药菌A。鲍曼不动杆菌。总共有14个A。2013年3月至2014年11月在浙江大学医学院附属第一医院肾脏病中心从DCD（心脏性死亡后捐献）肾移植供者的保存液和受者的引流液中分离出4株鲍曼不动杆菌。A.追踪DCD肾移植后出现的鲍曼不动杆菌，了解病原体的传播。PFGE显示来自同一医院的分离株之间的DNA模式相似。使用K-B扩散法和eTest对13种抗菌药物进行了药敏试验。采用全基因组测序方法分析了分离株的亲缘关系。结合临床资料和研究结果，我们认为A。鲍曼不动杆菌分离株3R 1和3R 2可能是从在ICU期间获得细菌的供体传播的，而分离株4 R1是通过医疗操作从3R 1和3R 2传播的。本研究证明了临床特征与分子方法在暴发调查中的整合价值及其在控制感染和预防DCD移植后严重并发症中的重要性。
Infection after renal transplantation remains a major cause of morbidity and death, especially infection from the extensively drug-resistant bacteria, A. baumannii. A total of fourteen A. baumannii isolates were isolated from the donors’ preserved fluid from DCD (donation after cardiac death) renal transplantation and four isolates in the recipients’ draining liquid at the Kidney Disease Center, The First Affiliated Hospital, College of Medicine, Zhejiang University, from March 2013 to November 2014. An outbreak of A. baumannii emerging after DCD renal transplantation was tracked to understand the transmission of the pathogen. PFGE displayed similar DNA patterns between isolates from the same hospital. Antimicrobial susceptibility tests against thirteen antimicrobial agents were determined using the K-B diffusion method and eTest. Whole-genome sequencing was applied to investigate the genetic relationship of the isolates. With the clinical data and research results, we concluded that the A. baumannii isolates 3R1 and 3R2 was probably transmitted from the donor who acquired the bacteria during his stay in the ICU, while isolate 4R1 was transmitted from 3R1 and 3R2 via medical manipulation. This study demonstrated the value of integration of clinical profiles with molecular methods in outbreak investigation and their importance in controlling infection and preventing serious complications after DCD transplantation.