Analysis of antibiotic resistance genes in multidrug-resistant Acinetobacter sp isolates from military and civilian patients treated at the Walter Reed Army Medical Center
Analysis of antibiotic resistance genes in multidrug-resistant Acinetobacter sp isolates from military and civilian patients treated at the Walter Reed Army Medical Center
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DOI：
10.1128/aac.00778-06
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发表时间：
2006-12-01
影响因子：
4.9
通讯作者：
Bonomo, Robert A.
中科院分区：
文献类型：
--
作者：
Hujer, Kristine M.;Hujer, Andrea M.;Bonomo, Robert A.
治疗伊拉克和阿富汗受伤患者的军事医疗设施已经鉴定出大量多重耐药（MDR）鲍曼不动杆菌分离株。为了预测这些病原体对患者护理的影响，我们分析了从沃尔特里德陆军医学中心（WRAMC）患者中收集的不动杆菌属分离株中导致MDR表型的抗生素耐药基因。药敏试验，PCR扩增的抗性遗传决定因素，克隆性进行了测定。本研究包括75个独特的患者分离株：53%来自血流感染，89%对至少三类抗生素具有耐药性，15%对所有9种测试抗生素具有耐药性。37%的分离株是从WRAMC医院感染或定植的患者中回收的。检测到16个独特的抗性基因或基因家族和4个移动的遗传元件。此外，这是在美国MDR鲍曼不动杆菌分离株中首次报告bla（OXA-58）样和bla（PER）样基因，从75例患者中的49例中回收了至少8个确定的耐药决定簇。分子分型显示多个克隆，8个主要的克隆类型是医院获得的，超过60%的分离株与三个泛欧洲类型有关。这份报告给出了一个“快照”的复杂的遗传背景负责抗菌素耐药性不动杆菌属。来自WRAMC鉴定与MDR表型相关的基因并确定传播模式是设计策略以限制这些严重感染的临床影响的起点。
Military medical facilities treating patients injured in Iraq and Afghanistan have identified a large number of multidrug-resistant (MDR) Acinetobacter baumannii isolates. In order to anticipate the impact of these pathogens on patient care, we analyzed the antibiotic resistance genes responsible for the MDR phenotype in Acinetobacter sp. isolates collected from patients at the Walter Reed Army Medical Center (WRAMC). Susceptibility testing, PCR amplification of the genetic determinants of resistance, and clonality were determined. Seventy-five unique patient isolates were included in this study: 53% were from bloodstream infections, 89% were resistant to at least three classes of antibiotics, and 15% were resistant to all nine antibiotics tested. Thirty-seven percent of the isolates were recovered from patients nosocomially infected or colonized at the WRAMC. Sixteen unique resistance genes or gene families and four mobile genetic elements were detected. In addition, this is the first report of bla(OXA-58)-like and bla(PER)-like genes in the U.S. MDR A.baumannii isolates with at least eight identified resistance determinants were recovered from 49 of the 75 patients. Molecular typing revealed multiple clones, with eight major clonal types being nosocomially acquired and with more than 60% of the isolates being related to three pan-European types. This report gives a "snapshot" of the complex genetic background responsible for antimicrobial resistance in Acinetobacter spp. from the WRAMC. Identifying genes associated with the MDR phenotype and defining patterns of transmission serve as a starting point for devising strategies to limit the clinical impact of these serious infections.