Drug Resistance Mechanism of Extensively Drug-resistant Acinetobacter baumannii (XDRAB) and Risk Factors of Healthcare-associated XDRAB Infections
Date Issued
2010
Date
2010
Author(s)
Chan, Ming-Chin
Abstract
The emergence of drug-resistant Acinetobacter baumannii (A. baumannii) is now a serious problem in healthcare-associated infections (HAIs) control. Data from Taiwan TINS showed that, while the percentage of carbapenem-resistant A. baumannii (CRAB) in ICU of medical centers/regional hospitals was less than 20% in 2003, it rose to 70% in Q3 2010. The objective of this study is to investage the distribution of integron drug-resistant gene and OXA typing of carbapenemase in extensively drug-resisitant A. baumannii (XDRAB) isolates from XDRAB-HAIs cases (2008~2010, 25 months). We also used pulsed-field gel electrophoresis (PFGE) to investigate the linkage between XDRAB strains. The risk factors of XDRAB-HAIs were investigated using case-control study (case: control=1:4). The result shows that 23 of 25 XDRAB isolates habored class I integron with a 2300-kb gene cassette. None carries class II integron. Most isolates had carry OXA 23 (n=21, 84%) and OXA51 (n=25, 100%). PFGE showed a genetic diversity among the 25 XDRAB isolates. Univariate analysis showed that long-term bed rest, hemodialysis, tracheostomy, use of glycopeptide, use of imipenem or meropenem, use of anti-pseudomonal penicillins, and use of the fourth generation cephalosporins, are statistically significant risk factors. Multiple conditional logistic regression analysis showed that, after adjusting for the effect of other variables, long-term bed rest (adjusted odds ratio 5.2, 95%CI: 1.1–24.4) and use of imipenem, meropenem, anti-pseudomonal penicillins, or the fourth-generation cephalosporins (adjusted odds ratio 4.3, 95%CI: 1.4–12.7) remain independent risk factors. We concluded that, for XDRAB HAIs control, it is essential to emphasize the prudent use of board-spectrum antibiotics active against gram-negative bacteria.
Subjects
extensively drug-resisitant A. baumannii
Pulsed-Field Gel Electrophoresis Analysis
case-control study
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