https://scholars.lib.ntu.edu.tw/handle/123456789/556776
標題: | Risk factors for healthcare-associated extensively drug-resistant Acinetobacter baumannii infections: A case-control study | 作者: | Chan M.-C. Chiu S.-K. PO-REN HSUEH Wang N.-C. Wang C.-C. CHI-TAI FANG |
公開日期: | 2014 | 出版社: | Public Library of Science | 卷: | 9 | 期: | 1 | 來源出版物: | PLoS ONE | 摘要: | The emergence of extensively drug-resistant Acinetobacter baumannii (XDRAB) is a serious threat to hospitalized patients. From 2008 to 2010, surveillance detected 25 hospital-acquired infection (HAI) cases caused by XDRAB at a medical center in Taipei. The site of XDRAB infection was bloodstream (n = 8), urinary tract (n = 12), lower respiratory tract (n = 3), surgical site (n = 1), and cardiovascular (n = 1). The isolates were resistant to all currently available antibiotics except for colistin. The XDRAB isolates are genetically diverse, shown by pulsed-field gel electrophoresis, but 23 of 25 harbored class 1 integron with a 2.3-kb gene cassette. Most of these isolates carry OXA-23 (n = 21) and OXA-51-like carbapenemase genes (n = 25). To identify the risk factors, a case-control study was conducted. The 25 cases were compared with 100 controls randomly selected from hospitalized patients without XDRAB-HAIs, matched by the onset date, ward, and age, at a ratio of 1:4. Prior use of imipenem, meropenem, piperacillin/tazobactam or fourth-generation cephalosporins (adjusted OR: 3.2, 95% CI: 1.03-10.2, P = 0.04) and >30 days bed-ridden (adjusted OR: 6.0, 95% CI: 1.3-27.6, P = 0.02) were found to be the independent risk factors for XDRAB-HAIs. These findings highlight that, even in the absence of clonal dissemination, XDRAB can emerge under the selective pressure of broad-spectrum antibiotics and causes subsequent HAIs in compromised hosts. An appropriate response to the XDRAB threat therefore should include a component of prudent use of broad-spectrum antibiotics active against gram-negative bacteria. ? 2014 Chan et al. |
URI: | https://www.scopus.com/inward/record.uri?eid=2-s2.0-84908161170&doi=10.1371%2fjournal.pone.0085973&partnerID=40&md5=9c278db7afd8749be2d0252e32324c51 https://scholars.lib.ntu.edu.tw/handle/123456789/556776 |
ISSN: | 1932-6203 | DOI: | 10.1371/journal.pone.0085973 | SDG/關鍵字: | carbapenemase; cephalosporin derivative; imipenem; meropenem; piperacillin plus tazobactam; Acinetobacter baumannii; Acinetobacter infection; aged; antibiotic resistance; article; bacterial gene; bacterium identification; bacterium isolation; carbapenemase gene; case control study; clinical article; controlled study; disease association; female; gene function; gene identification; human; infection risk; integron; male; nonhuman; outcome assessment; risk assessment; risk factor; Acinetobacter baumannii; Acinetobacter Infections; Aged; Anti-Infective Agents; Bacterial Proteins; Bacterial Typing Techniques; beta-Lactamases; Case-Control Studies; Cross Infection; Delivery of Health Care; Drug Resistance, Multiple, Bacterial; Electrophoresis, Gel, Pulsed-Field; Female; Genes, Bacterial; Humans; Integrons; Male; Microbial Sensitivity Tests; Multivariate Analysis; Risk Factors; Taiwan |
顯示於: | 流行病學與預防醫學研究所 |
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