Molecular and epidemiologic study of polyclonal outbreaks of multidrug-resistant Acinetobacter baumannii infection in an Israeli hospital
Molecular and epidemiologic study of polyclonal outbreaks of multidrug-resistant Acinetobacter baumannii infection in an Israeli hospital
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DOI：
10.1086/518970
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发表时间：
2007-08-01
影响因子：
4.5
通讯作者：
Carmeli, Yehuda
中科院分区：
文献类型：
--
作者：
Marchaim, Dror;Navon-Venezia, Shiri;Carmeli, Yehuda
目标.对一个机构中观察到多克隆爆发的多药耐药（MDR）鲍曼不动杆菌进行分子和流行病学调查，并确定这些多克隆爆发是否具有内源性来源或由院内患者间传播引起。前瞻性收集数据的回顾性分析。设置. MDR A发病病例的流行病学和基因型调查。鲍曼不动杆菌感染在以色列大学三级保健中心。MDR A住院患者。从2003年4月15日至2003年7月15日的13周期间从临床样本中分离的鲍曼不动杆菌。所有新发MDR A的患者。招募鲍曼不动杆菌感染者，并使用脉冲场凝胶电泳对分离株进行分型。从计算机化数据库中提取了关于医院内移动和咨询的数据。传播机会（TOP）的量化，定义为MDR A的现有载体和未来载体之间的相遇。鲍曼不动杆菌，并进行病房聚类分析。对96株MDR A.鲍曼不动杆菌分离株，属于18个不同的脉冲场凝胶电泳克隆。在65%的病例中，表现出涉及具有相同克隆的患者的TOP，这显著大于涉及具有不同克隆的患者的TOP的数量（P = 0.01）。虽然MDR A.鲍曼不动杆菌感染可能是多克隆的，我们相信病人与病人之间的传播解释了大多数传播病例。多克隆局部爆发反映了同时发生的多个克隆爆发。A.鲍曼不动杆菌感染按病房和时间聚集仍有待解释。
OBJECTIVES. To perform a molecular and epidemiologic investigation of multidrug-resistant (MDR) Acinetobacter baumannii in an institution were polyclonal outbreaks have been observed and determine whether these polyclonal outbreaks had an endogenous origin or were caused by in-hospital patient-to-patient transmission.DESIGN. Retrospective analysis of prospectively collected data. Setting. An epidemiologic and genotypic investigation of incident cases of MDR A. baumannii infection in an Israeli university tertiary care center.PATIENTS. Hospitalized patients with MDR A. baumannii isolated from clinical samples during a 13-week period, from April 15, 2003, through July 15, 2003.INTERVENTION. All patients with new MDR A. baumannii infections were recruited, and isolates were typed using pulsed-field gel electrophoresis. Data on in-hospital movements and consultations were extracted from computerized databases. Quantification of transmission opportunities (TOPs), defined as encounters between an established carrier and a future carrier of MDR A. baumannii, and analysis of ward clusters were performed.RESULTS. We studied 96 MDR A. baumannii isolates, which belonged to 18 different pulsed-field gel electrophoresis clones. In 65% of cases, TOPs involving patients with the same clone were demonstrated, which is significantly greater than the number of TOPs involving patients with different clones (P = .01).CONCLUSION. Although outbreaks of MDR A. baumannii infection may be polyclonal, we believe that patient-to-patient transmission explains most cases of transmission. Polyclonal local outbreaks reflect several clonal outbreaks occurring simultaneously. The cause of polyclonal outbreaks of A. baumannii infections clustered by ward and time remains to be explained.