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La Acinetobacter baumannii se considera como un agente microbiano de gran importancia clínica debido a la resistencia que ha adquirido a los antimicrobianos, esto trae como consecuencias complicaciones al referir una terapia antibiótica, prolongando la estancia en la hospitalización de los pacientes infectados con esta bacteria, causando un alto grado de mortalidad por su elevada capacidad de proliferación en las diferentes áreas hospitalarias. OBJETIVO. Describir la epidemiología de los brotes causados por Acinetobacter baumannii en Latinoamérica, así como también los mecanismos de Resistencia de este patógeno causando inconvenientes al momento de emplear los diferentes tratamientos terapéuticos. MATERIAL Y METODOS. Es una revisión sistemática bajo la declaración PRISMA de las investigaciones relacionadas al tema. Para la búsqueda de información se emplearon fuentes de datos provenientes de: Scielo, Redalyc, Google académico, se encontraron 43 artículos de los cuales solo 25 fueron válidos para la investigación. RESULTADOS. La resistencia que presenta la Acinetobacter baumannii a los antibióticos se incrementó con el pasar de los años. Este incremento de la resistencia se debe a diversos factores entre los cuales se destacan el desarrollo de ß-lactamasas dirigidas contra los betalactámicos, ya sea de amplio espectro o carbapenemasas; variaciones en las proteínas que forman parte de la membrana externa bacteriana, en las bombas de expulsión, perdida de porinas, modificaciones del lugar (blanco o diana) de acción de los antibióticos y variaciones en la expresión de proteínas fijadoras de penicilina. Esta variabilidad depende en parte de la capacidad de la bacteria para adquirir genes de resistencia, a menudo a través de una transferencia horizontal de genes CONCLUSIONES. La Acinetobacter baumannii se caracteriza por tener múltiples mecanismos de resistencia a antibióticos, lo que ha aumentado las consecuencias nocivas de este potencial patógeno y representa un desafío importante para los pacientes y el personal de salud.
Acinetobacter baumannii is considered as a bacterium of great clinical importance due to the resistance it has acquired to antimicrobials, which has triggered complications when referring an antibiotic therapy, prolonging the stay in the hospital of patients infected with this bacterium, causing a high degree of mortality due to its high proliferation capacity between different hospital areas. OBJETIVE. To describe the most relevant aspects about the epidemiology of the outbreaks caused by Acinetobacter baumannii in Latin America, as well as the different resistance mechanisms that this pathogen has acquired thus causing inconveniences when using the different therapeutic treatments. MATERIALS AND METHODS. A systematic review was carried out, under the PRISMA declaration, for the search of the information were used databases such as: Scielo, Redalyc, Google academic, 43 articles were found of which only 25 were valid for research. RESULTS. The resistance of Acitetobacter baumannii to different antibiotic groups has increased over the years. This increase in resistance is due to several factors among which stand out: ß-lactamases directed against beta-lactams, either broad spectrum or carbapenemases; variations in proteins of the outer membrane, ejection pumps, loss of porins, modifications of the place (target) of action of the antibiotics and alterations in the expression of penicillin-fixing proteins. This ability depends in part on the ability of this bacterium to acquire resistance genes, often through horizontal gene transfer. CONCLUSIONS. A. baumannii has developed multiple antibiotic resistance mechanisms, which increase the harmful consequences of this potential pathogen and represents a major challenge for patients and health personnel.
Acinetobacter baumannii é considerada como uma bactéria de grande importância clínica devido à resistência que adquiriu aos antimicrobianos, o que desencadeou complicações no momento de referir uma terapia antibiótica, prolongando a estadia na hospitalização dos pacientes infectados com esta bactéria, causando um elevado grau de mortalidade devido à sua elevada capacidade de proliferação entre diferentes áreas hospitalares. OBJECTIVO. Descrever os aspectos mais relevantes sobre a epidemiologia dos surtos causados por Acinetobacter baumannii a nível da América Latina, bem como os diferentes mecanismos de resistência que adquiriu este patógeno causando com isto inconvenientes o momento de empregar os diferentes tratamentos terapéuticos. MATERIAL E METODOS. Realizou-se uma revisão sistemática, sob a declaração PRISMA, para a busca da informação empregaram-se bases de dados como: Scielo, Redalyc, Google acadêmico, foram encontrados 43 artigos dos quais apenas 25 foram válidos para a pesquisa. RESULTADOS. A resistência que apresenta Acitetobacter baumannii aos diferentes grupos de antibioticos aumentou com o passar dos anos. Este aumento da resistência deve-se a diversos factores, entre os quais se destacam: ß-lactamases dirigidos contra os beta-lactâmicos, quer de largo espectro quer carbapenemases; variações nas proteínas da membrana externa, as bombas de expulsão, perda de porinas, modificações do local (branco) de acção dos antibioticos e alterações na expressão das proteínas fixadoras de penicilina. Esta capacidade depende em parte da capacidade desta bactéria para adquirir genes de resistência, muitas vezes através da transferência horizontal de genes. CONCLUSOES. Acinetobacter baumannii desenvolveu múltiplos mecanismos de resistência aos antibióticos, o que aumentou as consequências nocivas deste potencial patogênico e representa um desafio importante para os pacientes e o pessoal de saúde.
Subject(s)
Acinetobacter baumannii , Bacteria , PorinsABSTRACT
RESUMEN Las infecciones del sistema nervioso central asociadas a dispositivos como el drenaje ventricular externo son frecuentes. Sin embargo, la ventriculitis por bacterias Gram negativas y resistentes a antibióticos genera un reto para el tratamiento médico y quirúrgico. Se presenta el caso de un paciente con diagnóstico de malformación arteriovenosa rota con hemorragia intraventricular que requirió la colocación de un dren ventricular externo. En la evolución posterior, desarrolló ventriculitis por Acinetobacter baumanii multidrogo resistente (MDR) confirmada por cultivos de líquido cefalorraquídeo y se procedió a tratamiento antibiótico dirigido por antibiograma, usando colistina endovenosa e intraventricular asociando meropenem, logrando la normalización de los valores de LCR. Además describimos la evolución clínica, tratamiento médico-quirúrgico y complicaciones asociadas durante su estancia en la unidad de cuidados intensivos.
SUMMARY Central nervous system infections associated with devices such as external ventricular drains are frequent. Ventriculitis due to multi drug resistant (MDR) Gram-negative bacteria represent a surgical and medical challenge. We present the case of a patient who presented with intraventricular hemorrhage due to a rupture of an arteriovenous malformation that needed the insertion of an external ventricular drainage. The patient subsequently developed ventriculitis due to a MDR Acinetobacter baumanii confirmed by isolation from the cerebral spinal fluid (CSF) hat was treated based on the drug susceptibility test with intravenous and intraventricular colistin plus meropenem achieving normalization of the CSF parameters. We report the clinical evolution, complications and medical-surgical treatment in the intensive care unit.
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Objective: To determine the antibiotic resistance patterns of the Acinetobacter (A.) baumannii complex isolates that cause the confirmed infection. Methods: The present descriptive study was performed from March 2016 to March 2018 in three referral hospitals in Isfahan, Iran. All A. baumannii complex strains isolated from different clinical samples were identified by conventional phenotypic methods and antibiotic susceptibility pattern was detected. After the clinical investigation, contaminated samples were excluded and the source (hospital/community) and site of the infection were determined. Data on antibiotic susceptibility testing were extracted from WHONET software and analysis was done with SPSS. Results: From 254 patients who had confirmed A. baumannii complex infection, 158 (62.20%) cases were male, 27 (10.63%) were less than 20 years old, 172 (67.72%) had healthcare-Associated infections and 96 (37.79%) were admitted in intensive care units. The most frequent infection was bloodstream infections (111, 43.70%). Our results showed that most of the isolates were resistant to most of the antibiotics (more than 75.00%) and a lower rate of non-susceptibility was observed against minocycline (20, 44.44%) and colistin (0%). The rate of multidrug-resistant isolates was 88.97%. There was no significant difference between resistance of A. baumannii complex isolates according to age. However, the resistance to amikacin and minocycline and the rate of multidrug resistance (MDR) were significantly different between males and females. In patients with healthcare associated infection (HAI), MDR isolates were significantly different regarding admission in ICU ward. Resistance to levofloxacin and ciprofloxacin were lower in isolates from patients with bloodstream infections in comparison to other diagnoses. Conclusions: In our study, a high level of antibiotic resistance was detected in both community-Acquired and healthcare-Associated A. baumannii complex infections. Appropriate antibiotic prescription in a clinical setting is an essential need for the control and prevention of A. baumannii resistant infections.
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Fundamento: en los últimos años, las bacterias del género Acinetobacter han adquirido importancia epidemiológica de forma gradual y ascendente, debido a su emergencia como patógeno oportunista. Objetivo: caracterizar los aislamientos microbiológicos de Acinetobacter en pacientes ingresados en Unidades de Cuidados Intensivos en el Hospital Provincial de Cienfuegos. Métodos: estudio descriptivo que incluyó los 231 aislamientos de Acinetobacter de las muestras provenientes de pacientes de las Salas de Cuidados Intensivos en el período del 1 de septiembre del 2015 hasta el 30 de septiembre del 2016 en el Hospital Provincial de Cienfuegos. Se analizaron las variables: salas de dónde provenía el aislamiento, tipo de muestra, susceptibilidad antimicrobiana in vitro, especie. Resultados: el mayor número de aislamientos de Acinetobacter se obtuvo en la Unidad de Cuidados Intensivos Polivalentes (62,3 %). Acinetobacter baumannii fue la especie más aislada en todos los servicios para un 92,2 %; las secreciones respiratorias fueron las muestras con más aislamientos(56,3 %). Más de un 80 % de los aislamientos fueron resistentes a la mayoría de los antibióticos β-lactámicos y se encontró un porciento elevado de cepas multirresistencia y panrresistencia(41,6 % y 48,1 % respectivamente).Conclusiones: el género Acinetobacter se encuentra vinculado a las infecciones asociadas a los Servicios Sanitarios, fundamentalmente el Acinetobacter baumannii y en los cuidados intensivos polivalentes.
Foundation: in the last years bacterias of the Acinetobacter gender have adquired great epidemiological relevance in gardual ascending way, due to its emergence as an opportunistic pathogen. Objective: to characterize microbiological isolations of Acinetobacter in patients admitted to the Intensive Care Units at the Provincial Hospital Dr Gustavo Aldereguia Lima. Methods: descriptive study which included the 231 Acinetobacter isolations of samples from Intensive Care Units in the period September 1st 2015 to September 30th 2016 in the Cienfuegos Provincial Hospital. The following variables were analyzed: Wards from which the isolation was coming from, type of sample, antimicrobial susceptibility in vitro and specie. Results: the highest number of Acinetobacter isolations was obtained at the Polyvalent Intensive Care Unit (62,3%). Acinetobacter baumannii was the most isolated specie with a 92,2%. Respiratory exudate were the samples with more isolations (53,3%). More than 80% of the isolations were resistant to most β-lactam antibiotics and it was found a high percentage of multi-drug and pan-drug resistant strains (41,6% and 48,1% respectively).Conclusion: the Acinetobacter gender is linked to infections connected to Sanitary Services mainly the Acinetobacter baumannii and in the Intensive Care Units.
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Abstract Introduction: The extensive use of antibiotics has led to the emergence of multi-resistant strains in some species of the genus Acinetobacter. Objective: To investigate the molecular characteristics of multidrug-resistant of Acinetobacter ssp. strains isolated from 52 patients collected between March 2009 and July 2010 in medical intensive care units in Cali - Colombia. Methods: The susceptibility to various classes of antibiotics was determined by disc diffusion method, and the determination of the genomic species was carried out using amplified ribosomal DNA restriction analysis (ARDRA) and by sequencing of the 16s rDNA gene. Also, the genes of beta-lactamases as well as, integrases IntI1 and IntI2 were analyzed by PCR method. Results: The phenotypic identification showed that the isolates belong mainly to A. calcoaceticus- A. baumannii complex. All of them were multi-resistant to almost the whole antibiotics except to tigecycline and sulperazon, and they were grouped into five (I to V) different antibiotypes, being the antibiotype I the most common (50.0%). The percent of beta-lactamases detected was: blaTEM (17.3%), blaCTX-M (9.6%), blaVIM (21.2%), blaIMP (7.7%), blaOXA-58 (21.2%), and blaOXA-51 (21.2%). The phylogenetic tree analysis showed that the isolates were clustering to A. baumannii (74.1%), A. nosocomialis (11.1%) and A. calcoaceticus (7.4 %). Besides, the integron class 1 and class 2 were detected in 23.1% and 17.3% respectively. Conclusion: The isolates were identified to species A. baumanii mainly, and they were multiresistant. The resistance to beta-lactams may be by for presence of beta-lactamases in the majority of the isolates.
Resumen Introducción: El uso extensivo de antibióticos ha llevado a la emergencia de cepas multirresistentes en algunas especies del género Acinetobacter. Objetivo: Investigar las características moleculares de resistencia a múltiples fármacos de cepas aisladas de Acinetobacter spp. colectadas entre marzo de 2009 y julio de 2010 en 52 pacientes de unidades de cuidados intensivos en Cali - Colombia. Métodos: La susceptibilidad a diversas clases de antibióticos se determinó mediante el método de difusión de disco, y la determinación de la especie genómica se llevó a cabo usando un análisis de restricción de ADN ribosómico amplificado (ARDRA) y mediante la secuenciación del gen 16s de ADNr. Además, se analizaron por el método de PCR los genes de las beta-lactamasas, como también, las integrasas IntI1 e IntI2. Resultados: La identificación fenotípica mostró que los aislamientos pertenecen principalmente al complejo A. calcoaceticus - A. baumannii. Todos ellos eran multirresistentes a casi todos los antibióticos excepto tigeciclina y sulperazón, y se agruparon en cinco (I a V) antibitipos diferentes, siendo el antibiotipo I el más común (50%). El porcentaje de betalactamasas detectadas fue: blaTEM (17,3%), blaCTX-M (9,6%), blaVIM (21,2%), blaIMP (7,7%), blaOXA-58 (21,2%), blaOXA- 51 (21.2%). El análisis del árbol filogenético mostró que los aislados se agrupaban en A. baumannii (74.1%), A. nosocomialis (11.1%) y A. calcoaceticus (7.4%). Además, el integrón clase 1 y clase 2 se detectaron en 23.1% y 17.3% respectivamente. Conclusión: los aislamientos se identificaron principalmente como la especie A. baumanii, y fueron multirresistentes. La resistencia a los betalactámicos puede deberse a la presencia de betalactamasas en la mayoría de los aislamientos.
Subject(s)
Humans , Acinetobacter/drug effects , beta-Lactamases/genetics , Acinetobacter Infections/drug therapy , Anti-Bacterial Agents/pharmacology , Acinetobacter/classification , Acinetobacter/genetics , Acinetobacter Infections/microbiology , Acinetobacter Infections/epidemiology , DNA, Bacterial/genetics , DNA, Ribosomal/genetics , Polymerase Chain Reaction/methods , Colombia , Drug Resistance, Multiple, Bacterial , Disk Diffusion Antimicrobial Tests , Intensive Care UnitsABSTRACT
Objective To investigate the resistance and infection case for the Multidrug-Resistant Acinetobacter baumanii (MDRAb) strains.Methods Retrospective study.Thirty-eight MDRAb strains were collected in Beijing Friendship Hospital from February to August 2008.VITEK2-compact system was used to detect the MDRAb.PCR was carried out to detect their resistance related genes and look up the medical records those who were infected by MDRAb.Results The resistance rate of the MDRAb is the highest in ICU.PCR confirmed that OXA-23 and OXA-51 were 100％ related with the MDRAb.Combination drug therapy such as sulbactam combined with β-lactam antibiotics was more effective than β-lactam antibiotics only to treat the infection with MDRAb.Cases analysis showed that a number of patients infected by MDRAb were the aged with basic diseases,low immunity,received a variety of antibiotic therapy even traumatic operation,and they had a poor prognosis finally.Conclusions The resistance rate of the MDRAb is the highest in ICU,OXA-23 is closely related to multidrug-resistance.Combination drug therapy is necessary and sulbactam can play a great role in curing the inpatients infected with MDRAb.
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Objective To construct the mice pneumonia model with imipenem-resistant Acinetobacter baumannii and provide experimental model in anti-pan-resistant Acinetobacter baumannii therapy study. Methods A total number of 120 4-week-old BALB/C male mice were randomly selected and divided into three groups including micro-intratracheal injection, ultrasonic atomizing and nasal dripping. The mice were treated with methotrexate to induce hypo-immunity in every group. These BALB/C mice of normal immunity and hypo-immunity were infected through Imipenem-resistant Acinetobacter baumannii by microintratracheal injection, ultrasonic atomizing and nasal dripping, respectively. The morbidity, mortality,bacterial clearance rate and histopathology in lung were determined. Results The morbidities of BALB/C mice with hypo-immunity infected by micro-intratracheal injection and ultrasonic atomizing achieved 100%(30/30), while the mortalities were 100% (10/10) and 33.3% (3/10), respectively. Mice in two groups above displayed the influx of neutrophils, lymphocytes and macrophages in the peri-bronchial and alveolar interstitial space 12-24 h after pulmonary infection. In addtion, the mice in micro-intratracheal injection group displayed coUapse of partial alveolar walls, formation of abscesses and bacterial colonies in alveoli. While the lung pathology in mice of ultrasonic atomizing group was characterized by cell degeneration in some regions in the lungs, slight relaxation, congestion in alveolar wall vessels and normal of bronchial and alveolar tissue 24 h after inoculation. Degeneration in peri-tracheal and peri-bronchial areas was observed 24-48 h after inoculation, along with highly expanded pulmonary blood vessels and edems. The inflammation was reduced at 48 hours. There was no obvious pulmonary infection in BALB/C mice with hypo-immunity by nasal dripping with mortality of 0% (0/10) and no significant histopathologic change in lungs. Conclusions BALB/C mice with hypo-immunity pneumonia model with Imipenem-resistant Acinetobacter baumannii can be conducted by micro-intratracheal injection or ultrasonic atomizing, but the latter has the advantages of high-productivity, easy-operation, low-cost, time-saving and usefulness. Mice with normal immunity are not susceptible to imipenem-resistant Acinetobacter baumannii.
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Objective To explore the clinical features,risk factors and the sensitivity to antibiotics of lower respiratory tract acinetobacterial infection.Methods The clinical data,results of sputum bacterial culture and drug sensitivity of the 72 cases with lower respiratory tract acinetobacterial infection were netrospectively reviewed.Results 53 cases(73.6%)were elder than 60 years old,69 cases(95.8%)had basic diseases,and 59 cases(81.9%)were nosocomial infection.Risk factors included basic diseases,lower immune function,all kinds of invasive operations,aerosol inhalation,unreasonable usage of antibiotics.Drug sensitivity test showed that the drugs which sensitive to acinetobacter was upper than 50% included Imipenen,Levofloxacin,Cefooerazone/sulbactum and Amikacin.Conclusion The patients who sufferred from lower respiratory tract acinetobacterial infection usually are elder than 60 years old,and have basic diseases.Most of this kind of infection is nosocomial infection.Because of severe clinical symptom and high drug resistant rate,the prognosis is poor.Reasonable selection of sensitive antibiotics is important.
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Fundamento: La gravedad de las infecciones intrahospitalarias es cada vez más frecuente y difícil de tratar, constituye una importante causa de morbilidad y mortalidad. Objetivo: Caracterizar la infección intrahospitalaria en servicios clínicos. Método: Se realizó un estudio descriptivo transversal en los servicios clínicos de Nefrología, Unidad de Cuidados Intermedios, Unidad de Cuidados Intensivos, Cardiocentro y Medicina Interna del Hospital Provincial Docente Clínico Quirúrgico «Manuel Ascunce Domenech¼ de Camagüey durante un período de tres años (enero de 2004 a diciembre de 2006). La muestra estuvo constituida por 751 pacientes ingresados en estos servicios y en cuyas historias clínicas existían datos inequívocos de infección intrahospitalaria desde el punto de vista clínico y de laboratorio microbiológico. Resultados: No se encontraron diferencias significativas en cuanto al sexo. Los procederes invasivos terapéuticos con el 94 % fueron los principales factores de riesgo identificados, dentro de los cuales el empleo de sondaje vesical, catéter venoso central y ventilación mecánica artificial fueron los más importantes. El mayor número de pacientes le correspondió a Unidad de Cuidados Intermedios y al servicio de Medicina Interna en los que predominaron la infección por Enterobacterias y Estafilococo sp. Aunque no resultó significativo, se aisló en las salas de terapia el Acinetobacter sp. multirresistente. Los sitios más frecuentes de infección fueron el sistema respiratorio y urinario. Conclusiones: La mayoría de los pacientes egresaron vivos y un tercio tuvo una estadía de 23 días y más. El 12.2 % de los pacientes fallecieron a causa de la sepsis nosocomial.
Background: The gravity of intrahospital infections is more frequent and difficult to treat, constitutes an important cause of morbidity and mortality. Objective: To characterize the intrahospital infection at clinical services. Method: A cross-sectional descriptive study was carried out at Nephrology, Intermediate Care Unit, Intensive Care Unit, Cardiology Center and Internal Medicine clinical services of the Surgical Clinical Educational Provincial Hospital «Manuel Ascunce Domenech¼ of Camagüey during a period of three years (January 2004 to December 2006). The sample was constituted by 751 patients admitted in these services and in whose medical histories unmistakable data of intrahospital infection existed since the clinical point of view and microbiological laboratory. Results: It were not found significant differences about sex. The therapeutic invasive procedures with the 94% were the main risk factors identified, within the employment of vesical catheterization, central venous catheter and artificial mechanical ventilation were the most important. The major number of patients corresponded to Intermediate Care Unit and to Internal Medicine service in which the infection by Enterobacteria and Staphylococci sp dominated. Although did not turn out to be significant, the Acinetobacter sp. multirresistant was isolated in the therapy rooms. The most frequent sites of infection were the urinary and respiratory system. Conclusions: The majority of patients discharged alive and a one third had a stopover of 23 days and more. The 12.2% of patients died because of nosocomial sepsis.