Pneumonia caused by extensive drug-resistant Acinetobacter baumannii among hospitalized patients: genetic relationships, risk factors and mortality

BMC Infectious Diseases

Research Article

Hui ling Chen¹  Peng hao Guo²  Chu zhi Pan³  Zhu xiang Zhao⁴  Zi wen Zhao⁴  Chang quan Fang⁵  Yu jun Li⁶ 

[1] Department of Clinic Laboratory, Guangzhou First People’s Hospital, Guangzhou Medical University, Panfu Road, Guangzhou, China;Department of Clinic Laboratory, the First Affiliated Hospital of Sun Yat-sen University, Zhong Shan Er Road, Guangzhou, China;Department of Hepatobiliary Surgery, the Third Affiliated Hospital of Sun Yat-sen University, Tian He Road, Guangzhou, China;Department of Respiratory Medicine, Guangzhou First People’s Hospital, Guangzhou Medical University, Panfu Road, Guangzhou, China;Department of Respiratory Medicine, Guangzhou Red Cross Hospital, Tong Fu Zhong Road, Guangzhou, China;The First Affiliated Hospital of Jinan University, the West of Huangpu Street, Guangzhou, China;Department of Respiratory Medicine, Guangzhou First People’s Hospital, Guangzhou Medical University, Panfu Road, Guangzhou, China;

关键词: Acinetobacter baumannii;    Extensive drug resistance;    Multilocus sequence typing;    bla;    Pneumonia;   

DOI  :  10.1186/s12879-017-2471-0

 received in 2016-08-26, accepted in 2017-05-16,  发布年份 2017

来源: Springer

【 摘 要 】

BackgroundThe clonal spread of multiple drug-resistant Acinetobacter baumannii is an emerging problem in China. We analysed the molecular epidemiology of Acinetobacter baumanni isolates at three teaching hospitals and investigated the risk factors, clinical features, and outcomes of hospital-acquired pneumonia caused by extensive drug-resistant Acinetobacter baumannii (XDRAB) infection in Guangzhou, China.MethodsFifty-two A. baumannii isolates were collected. Multilocus sequence typing (MLST) was used to assess the genetic relationships among the isolates. The blaOXA-51-like gene was amplified using polymerase chain reaction (PCR) and sequencing. The resistance phenotypes were determined using the disc diffusion method. A retrospective case-control study was performed to determine factors associated with XDRAB pneumonia.ResultsMost of the 52 A. baumannii isolates (N = 37, 71.2%) were collected from intensive care units (ICUs). The respiratory system was the most common bodily site from which A. baumannii was recovered (N = 45, 86.5%). Disc diffusion classified the isolates into 17 multidrug-resistant (MDR) and 35 extensively drug-resistant (XDR) strains. MLST grouped the A. baumannii isolates into 5 existing sequence types (STs) and 7 new STs. ST195 and ST208 accounted for 69.2% (36/52) of the isolates. The clonal relationship analysis showed that ST195 and ST208 belonged to clonal complex (CC) 92. According to the sequence-based typing (SBT) of the blaOXA-51-like gene, 51 A. baumannii isolates carried OXA-66 and the rest carried OXA-199. There were no significant differences with respect to the resistance phenotype between the CC92 and non-CC92 strains (P = 0.767). The multivariate analysis showed that the APACHE II score, chronic obstructive pulmonary disease (COPD) and cardiac disease were independent risk factors for XDRAB pneumonia (P < 0.05). The mortality rate of XDRAB pneumonia was high (up to 42.8%), but pneumonia caused by XDRAB was not associated with in-hospital mortality (P = 0.582).ConclusionsST195 may be the most common ST in Guangzhou, China, and may serve as a severe epidemic marker. SBT of blaOXA-51-like gene variants may not result in sufficient dissimilarities to type isolates in a small-scale, geographically restricted study of a single region. XDRAB pneumonia was strongly related to systemic illnesses and the APACHE II score but was not associated with in-hospital mortality.

【 授权许可】

CC BY   
© The Author(s). 2017