Ying Li1, Qinglan Guo1, Peng Wang2, Demei Zhu1, Xinyu Ye1, Shi Wu1, Minggui Wang3. 1. Institute of Antibiotics, Huashan Hospital, Fudan University, Shanghai, China; Key Laboratory of Clinical Pharmacology of Antibiotics, National Health and Family Planning Commission, Shanghai, China. 2. Division of Infectious Diseases, Shanghai Jiaotong University Affiliated Sixth People's Hospital, Shanghai, China. 3. Institute of Antibiotics, Huashan Hospital, Fudan University, Shanghai, China; Key Laboratory of Clinical Pharmacology of Antibiotics, National Health and Family Planning Commission, Shanghai, China. Electronic address: mgwang@fudan.edu.cn.
Abstract
BACKGROUND/ PURPOSE: Extensively drug-resistant (XDR) Acinetobacter baumannii presents a serious therapeutic and infection control challenge. This study aimed to explore the causes for the rapid increase of XDR A. baumannii at a teaching hospital in Shanghai. METHODS: All consecutive clinical isolates of XDR A. baumannii were collected from January to December 2010 at Huashan Hospital in Shanghai. The prevalence of carbapenemase genes was investigated by polymerase chain reaction (PCR) amplification. Genetic relatedness of the isolates was determined by enterobacterial repetitive intergenic consensus-PCR and multilocus sequence typing. A retrospective case-control study was performed for the identification of risk factors of XDR A. baumannii infections. RESULTS: All 106 XDR A. baumannii isolates carried the blaOxA-23 gene and were resistant to all antimicrobial agents tested, except colistin, tigecycline and cefoperazone-sulbactam. One hundred and five of the strains belonged to clonal complex 92 by multilocus sequence typing, and 78 were classified as clone A1 by enterobacterial repetitive intergenic consensus-PCR. Intensive care unit residency at the time of isolation, recent general anesthesia, the number of previous antibiotic classes administered and previous hospitalization were identified as risk factors by case-control study. Efficacy rates were 62.5% (5/8), 47.4% (9/19), and 42.9% (3/7) when the XDR patients were treated with cefoperazone-sulbactam, carbapenems, or both cefoperazone-sulbactam and carbapenem, alone or in combination with other agents, respectively. CONCLUSION: XDR A. baumannii producing OXA-23 β-lactamase was clonally disseminated at a university hospital in Shanghai. Cefoperazone-sulbactam and carbapenems alone or combined with other antibiotics may benefit XDR A. baumannii infections in the absence of other effective antibiotics.
BACKGROUND/ PURPOSE: Extensively drug-resistant (XDR) Acinetobacter baumannii presents a serious therapeutic and infection control challenge. This study aimed to explore the causes for the rapid increase of XDR A. baumannii at a teaching hospital in Shanghai. METHODS: All consecutive clinical isolates of XDR A. baumannii were collected from January to December 2010 at Huashan Hospital in Shanghai. The prevalence of carbapenemase genes was investigated by polymerase chain reaction (PCR) amplification. Genetic relatedness of the isolates was determined by enterobacterial repetitive intergenic consensus-PCR and multilocus sequence typing. A retrospective case-control study was performed for the identification of risk factors of XDR A. baumannii infections. RESULTS: All 106 XDR A. baumannii isolates carried the blaOxA-23 gene and were resistant to all antimicrobial agents tested, except colistin, tigecycline and cefoperazone-sulbactam. One hundred and five of the strains belonged to clonal complex 92 by multilocus sequence typing, and 78 were classified as clone A1 by enterobacterial repetitive intergenic consensus-PCR. Intensive care unit residency at the time of isolation, recent general anesthesia, the number of previous antibiotic classes administered and previous hospitalization were identified as risk factors by case-control study. Efficacy rates were 62.5% (5/8), 47.4% (9/19), and 42.9% (3/7) when the XDR patients were treated with cefoperazone-sulbactam, carbapenems, or both cefoperazone-sulbactam and carbapenem, alone or in combination with other agents, respectively. CONCLUSION: XDR A. baumannii producing OXA-23 β-lactamase was clonally disseminated at a university hospital in Shanghai. Cefoperazone-sulbactam and carbapenems alone or combined with other antibiotics may benefit XDR A. baumannii infections in the absence of other effective antibiotics.
Authors: Mohsin Khurshid; Muhammad Hidayat Rasool; Usman Ali Ashfaq; Bilal Aslam; Muhammad Waseem; Muhammad Akhtar Ali; Ahmad Almatroudi; Farhan Rasheed; Muhammad Saeed; Qinglan Guo; Minggui Wang Journal: Infect Drug Resist Date: 2020-08-18 Impact factor: 4.003