Outbreak of imipenem-resistant Acinetobacter calcoaceticus-Acinetobacter baumannii complex harboring different carbapenemase gene-associated genetic structures in an intensive care unit
Outbreak of imipenem-resistant Acinetobacter calcoaceticus-Acinetobacter baumannii complex harboring different carbapenemase gene-associated genetic structures in an intensive care unit
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DOI：
10.1016/j.jmii.2011.09.020
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发表时间：
2012-02-01
影响因子：
7.4
通讯作者：
Cho, Wen-Long
中科院分区：
文献类型：
--
作者：
Lee, Yi-Tzu;Fung, Chang-Phone;Cho, Wen-Long
背景与目的：探讨一起重症监护病房（ICU）爆发的耐亚胺培南钙醋不动杆菌-鲍曼不动杆菌（IRAcb）复群的临床和分子流行病学。方法：对2003年12月~ 2004年3月在台北荣民总医院ICU分离到的临床分离株46株和环境分离株11株进行分析。利用脉冲场凝胶电泳（PFGE）对这些分离物进行基因分型。PCR分析碳青霉烯酶基因及其相关遗传结构。从患者获得的临床资料也进行了回顾和分析。结果：在基因组种水平上鉴定为鲍曼不动杆菌基因组种13TU（临床分离株42株，环境分离株5株）和不动杆菌基因组种13TU（临床分离株4株，环境分离株6株）。两个物种组成的两个pulsotypes,但这些的a . baumannii相似(83%)密切相关。分别在22株和21株鲍曼不动杆菌临床分离株中鉴定出IS1008-Delta ISAba1-bla（oxa -58样）和ISAba1-bla（oxa -51样）（1株同时含有这两种成分）。在不动杆菌基因组种13TU的所有分离株中均检测到isaba3 - brackett bla（oxa -58样）基因。患者在ICU不同科室之间的转移是导致鲍曼不动杆菌两种脉型传播的重要因素。然而，在已鉴定的鲍曼不动杆菌分离株中，环境中仅发现携带IS1008-Delta ISAba3-bla（oxa -58样）的分离株，表明存在另外的传播途径。先前使用碳青霉烯类或头孢吡肟与随后感染携带ISAba1-bla（oxa -51样）基因的鲍曼不动杆菌有关，而先前使用哌拉西林/他唑巴坦与随后感染携带IS1008-Delta ISAba3-bla（oxa -58样）基因的鲍曼不动杆菌有关。结论：鲍曼不动杆菌分离株携带不同的碳青霉烯酶基因及其相关遗传结构，可能以不同的方式传播或选择。台湾省微生物学会版权所有爱思唯尔台湾有限责任公司出版，版权所有。
Background and Purpose: To investigate the clinical and molecular epidemiology of the imipenem-resistant Acinetobacter calcoaceticus-Acinetobacter baumannii (IRAcb) complex during an outbreak in an intensive care unit (ICU).Methods: Forty-six clinical and 11 environmental isolates of the IRAcb complex were collected from the ICU of Taipei Veterans General Hospital, Taiwan between December 2003 and March 2004. These isolates were genotyped using pulsed-field gel electrophoresis (PFGE). Carbapenemase genes and their associated genetic structures were analyzed using PCR. Clinical data obtained from the patients were also reviewed and analyzed.Results: The isolates were identified at the genomic species level as A. baumannii (42 clinical and five environmental isolates) and Acinetobacter genomic species 13TU (four clinical and six environmental isolates). Both species were comprised of two pulsotypes, but those of A. baumannii were closely related (83% similar). IS1008-Delta ISAba3-bla(OXA-58-like) and ISAba1-bla(OXA-51-like) were identified in 22 and 21 clinical isolates of A. baumannii, respectively (one isolate contained both). The ISAba3-bracketed bla(OXA-58-like) gene was detected in all isolates of Acinetobacter genomic species 13TU. Patient transfers between different sections of the ICU were important factors that contributed to the spread of the two pulsotypes of A. baumannii. However, among the A. baumannii isolates identified, only those carrying IS1008-Delta ISAba3-bla(OXA-58-like) could be found in the environment, indicating an additional route of transmission. The prior use of carbapenem or cefepime was associated with the subsequent infection with A. baumannii carrying the ISAba1-bla(OXA-51-like) gene, while prior piperacillin/tazobactam use was associated with the subsequent infection with A. baumannii carrying the IS1008-Delta ISAba3-bla(OXA-58-like) gene.Conclusion: A. baumannii isolates carrying different carbapenemase genes and their associated genetic structures might be transmitted or selected in different ways. Copyright (C) 2011, Taiwan Society of Microbiology. Published by Elsevier Taiwan LLC. All rights reserved.