ABSTRACT
Acinetobacter baumannii has emerged as a main nosocomial pathogen exhibiting high rates of resistance to clinically relevant antibiotics. Six pandrug-resistant A. baumannii (PDR-A. baumannii) were recovered from three patients in a Tunisian Intensive Care Unit (ICU) between 10th and 16th of May 2018 resulting in one fatal case and raising the possibility of an outbreak. On 18th of May environmental screening of ICU surfaces was carried out. On 22nd of May a fourth patient was infected with PDR-A. baumannii and died. A second investigation was carried out for environmental screening and PDR-A. baumannii was isolated from the respirator. Antimicrobial susceptibility testing was performed according to EUCAST (2019) guidelines. MIC of colistin was determined by broth microdilution method. PCR was used to detect 14 beta-lactamases/carbapenemases and mcr (mcr-1 to mcr-5) genes. The genetic relatedness of PDR-A. baumannii isolates was determined by PFGE and MLST. Seven PDR-A. baumannii isolates were recovered from four patients, one MDR strain from wash basin, a PDR strain from hand sanitizer bottle and another PDR strain from respirator. All PDR-A. baumannii (n = 9) harbored blaOXA-69 gene and none carried mcr. Moreover, seven carried blaGES and blaOXA-23 genes. PFGE identified four pulsotypes (A, B, C, and D) with the pulsotype A gathering seven PDR-A. baumannii isolates: six from three patients and one from hygiene sample. MLST revealed that all PDR-A. baumannii isolates of pulsotype A belonged to the pandemic clone ST2. Systematic screening of MDR and PDR-A. baumannii is highly recommended to limit dissemination of such strains in ICUs.
Subject(s)
Acinetobacter baumannii , Cross Infection , Humans , Interleukin-1 Receptor-Like 1 Protein/genetics , Multilocus Sequence Typing , Drug Resistance, Multiple, Bacterial/genetics , Cross Infection/epidemiology , Anti-Bacterial Agents/pharmacology , beta-Lactamases/genetics , Bacterial Proteins/genetics , Intensive Care Units , Disease Outbreaks , Microbial Sensitivity TestsABSTRACT
Objective To explore the efficacy of tigecycline combined with cefoperazone/sulbactam in the treatment of infections due to multiple drug resistant strains and pandrug-resistant acinetobacter baumannii, so as to guide the reasonable clinical medication.Methods A total of 16 cases of ventilator associated pneumonia caused by multiple drug resistant strains and pandrug-resistant acinetobacter baumannii treated in the First Hospital of Shijiazhuang from November 2012 to November 2014 were retrospectively analyzed, and the severity of the infection, clinical efficacy and mortality were observed.Results The multiple drug resistant strains and pandrugresistant acinetobacter baumannii were frequently detected in the 16 patients.Fifteen cases had been used other antibiotics before tigecycline, such as imipenem, cefoperazone/Shubatan, minocycline etc.The severity of underlying disease was assessed with the acute physiology and chronic health score(APACHE Ⅱ sore) within 24 h of admission, on the first day of tigecycline (TGC) therapy and after 7 days of TGC therapy.It showed that the average APACHE Ⅱ score were (25±6.0), (24.2±6.4) and (17.8±6.6) within 24 hours of admission(P＜0.01), on the first day of TGC therapy and after 7 days of TGC therapy.Thirty days after application of the TGC, the bacterial eradication rate was 56.25％ (9/16).The effective rate was 87.5％ (14/16).The failure rate was 12.5％ (2/16).Conclusion The effect of the tigecycline combined with cefoperazone/sulbactam on the clearance of the multiple drug resistant strains and pandrug-resistant acinetobacter baumanniiis is satisfied.
ABSTRACT
OBJECTIVE To study the homology of the pandrug-resistant Acinetobactor baumannii(PRABA) by randomly amplificed polymorphic DNA(CRPD) to guide the control of the nosocomial infection and epidemology investigation.METHODS Eighteen strains of PRABA were collected from Jul 2008 to Mar 2009 in our hospital.The bacteria were examined by DADE BEHRING Microscan WalkAway 96SI;DNA extracted from all isolates was amplified by polymerase chain reaction using random primers.In addition epidemology investigation and antimicrobial susceptibility testing were also under taken.RESULTS Fifteen strains were divided into 6 RAPD profiles.There were two clonal strains derived,respectively,from two intensive care units.One strain was isolated from a patient in surgical ward who was transferred from ICU1,showing same homology with that in the ICU1.The homology was different from sensitive strains and drug-resistant strains obviously.CONCLUSIONS An outbreak of PRABA happens in intensive care unit.
ABSTRACT
Objective To analyze the clinical features of pandrug-resistant Acinetobacter baumannii (PDR-Ab) in a hospital and compare the efficacy of different antibiotic treatments on patients with pneumonia caused by PDR-Ab.Methods Data were ret- rospectively collected from all isolated PDR-Ab strains in our hospital from February 2004 to March 2005.The clinical features and outcomes were reviewed.Results A total of 77 strains of PDR-Ab were collected, 45 of which were pathogens causing clini- cal infections (35 strains from lower respiratory tract, 6 from bloodstream, 3 from drainage fluid, and 1 from wounds).Lower respiratory tract was the most common source of PDR-Ab.More than 90% of the isolated PDR-Ab strains produced OXA-23 type?-lactamase.Cefoperazone-sulbactam plus minocyeline showed good efficacy for patients with PDR-Ab pneumonia.The total clinical cure rate was 68.4%.Bacterial eradication rate was 42.1%.The factors influencing bacterial clearance were pro- longed mechanical ventilation prior to positive culture (17.5 d vs 5.5 d).mixed infection (100% vs 12.5%) and lower GCS score (9.1?0.7 vs 13.2?2.1).Concomitant septic shock (OR=13.8) and APACHEⅡscore (OR=2.1) were independent factors of clinical outcome.Conclusions Nosocomial infections caused by PDR-Ab are not untreatable.Our analysis suggests that cefoperazone-sulbactam plus minocycline may be an effective treatment for lower respiratory tract infections caused by PDR-Ab in our hospital.
