Assuntos
Serviço Hospitalar de Emergência/estatística & dados numéricos , Liderança , Tempo de Internação , Admissão do Paciente/estatística & dados numéricos , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Satisfação do Paciente , Taiwan , Adulto JovemRESUMO
BACKGROUND: The distribution and characterization of OXA-type carbapenemases in Acinetobacter sp in Taiwan has less been reported. The aim of the study was to investigate the molecular epidemiology and OXA-type carbapenemase genes in a regional hospital in Taiwan. METHODS: Imipenem-resistant Acinetobacter sp were collected between 2005 and 2007 in a regional hospital. Genotyping was performed by pulsed-field gel electrophoresis. OXA-type carbapenemase genes were determined by multiplex polymerase chain reaction (PCR) and gene sequencing. RESULTS: A total of 136 isolates were collected. Fifty-six pulsotypes were identified. None of the pulsotypes established predominance throughout the 3-year period. Multiplex PCR of blaOXA genes showed that 99% (135/136) of the Acinetobacter sp possessed blaOXA51-like genes. The coexistences of blaOXA51-like/blaOXA-23-like and blaOXA51-like/blaOXA-24-like were detected in 19% (26/136) and 1% (2/136) of the isolates, respectively. Among blaOXA-23-like gene-carrying isolates, two isolates (Pulsotypes 18 and 20) were found in 2006 and the remainder (n=24), including Pulsotypes 27 (n=18), 29 (n=1), 52 (n=3), and 53 (n=2), were found in 2007. Sequencing performed on the 26 representative isolates confirmed the presence of the blaOXA-23 carbapenemase gene. Analysis of the genetic content of blaOXA-23 showed that these genes were presumably chromosomal and associated with the upstream-located insertion sequence ISAba1. CONCLUSIONS: The emergence and imminent widespread of blaOXA-23-carrying imipenem-resistant Acinetobacter sp appeared in Taiwan during the period from 2006 to 2007.
Assuntos
Infecções por Acinetobacter/epidemiologia , Acinetobacter/efeitos dos fármacos , Antibacterianos/farmacologia , Infecção Hospitalar/epidemiologia , Imipenem/farmacologia , Resistência beta-Lactâmica , beta-Lactamases/genética , Acinetobacter/enzimologia , Acinetobacter/genética , Acinetobacter/isolamento & purificação , Infecções por Acinetobacter/microbiologia , Infecção Hospitalar/microbiologia , Eletroforese em Gel de Campo Pulsado , Genótipo , Hospitais de Distrito , Humanos , Tipagem Molecular , Reação em Cadeia da Polimerase Multiplex , Análise de Sequência de DNA , Taiwan/epidemiologiaRESUMO
We conducted a case-controlled study in a regional teaching hospital in Taiwan to investigate the clinical features and molecular epidemiology of multidrug-resistant Acinetobacter calcoaceticus-A baumannii (MDR Acb) complex. Case patients had higher mortality than controls did. MDR Acb complex acquisition risk factors include longer hospital stays, higher ratio of nasogastric tube and Foley catheter use, and more carbapenem use. All available isolates were divided into 36 subtypes by pulsed-field gel electrophoresis. The proportion of the same subtypes with their appearance within 1 and 2 months was 62.5% and 87.5%, respectively. We concluded that many different MDR Acb complex clones could be found in a hospital and that the same clones often spread on a small scale within a short period of time if no outbreaks noted.
