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- Title
Pneumonia caused by extensive drug-resistant Acinetobacter baumannii among hospitalized patients: genetic relationships, risk factors and mortality.
- Authors
Yu jun Li; Chu zhi Pan; Chang quan Fang; Zhu xiang Zhao; Hui ling Chen; Peng hao Guo; Zi wen Zhao; Li, Yu Jun; Pan, Chu Zhi; Fang, Chang Quan; Zhao, Zhu Xiang; Chen, Hui Ling; Guo, Peng Hao; Zhao, Zi Wen
- Abstract
<bold>Background: </bold>The 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.<bold>Methods: </bold>Fifty-two A. baumannii isolates were collected. Multilocus sequence typing (MLST) was used to assess the genetic relationships among the isolates. The bla OXA-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.<bold>Results: </bold>Most 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 bla OXA-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).<bold>Conclusions: </bold>ST195 may be the most common ST in Guangzhou, China, and may serve as a severe epidemic marker. SBT of bla OXA-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.
- Subjects
CHINA; PNEUMONIA; DRUG resistance in bacteria; ACINETOBACTER baumannii; LUNG diseases; DEATH rate; HOSPITAL mortality; PUBLIC health; GENETICS; DISEASE risk factors; ANTIBIOTICS; PNEUMONIA-related mortality; ACADEMIC medical centers; ACINETOBACTER infections; APACHE (Disease classification system); DRUG resistance in microorganisms; HYDROLASES; INTENSIVE care units; OBSTRUCTIVE lung diseases; MICROBIAL sensitivity tests; MOLECULAR epidemiology; RETROSPECTIVE studies; CASE-control method; GRAM-negative aerobic bacteria; SEQUENCE analysis
- Publication
BMC Infectious Diseases, 2017, Vol 17, p1
- ISSN
1471-2334
- Publication type
journal article
- DOI
10.1186/s12879-017-2471-0