تعیین فراوانی سویه‌های MDR اسینتوباکتر بومانی ایزوله شده از بخش مراقبت‌های ویژه (ICU) بیمارستان‌های شهر اصفهان با روش مولکولی و بررسی الگوی مقاومت دارویی آن‌ها

نوع مقاله : مقاله های پژوهشی

نویسندگان

1 دانشجوی کارشناسی ارشد، گروه میکروب‌شناسی، دانشکده‌ی پزشکی و کمیته‌ی تحقیقات دانشجویی، دانشگاه علوم پزشکی اصفهان، اصفهان، ایران

2 دانشیار، گروه میکروب‌شناسی، دانشکده‌ی پزشکی، دانشگاه علوم پزشکی اصفهان، اصفهان، ایران

چکیده

مقدمه: اسینتوباکتر بومانی از مهم‌ترین پاتوژن‌ها در عفونت‌های کسب شده‌ی بیمارستانی به خصوص در بخش مراقبت‌های ویژه است. این پاتوژن فرصت طلب به راحتی از خاک، آب و تجهیزات بیمارستانی جدا می‌شود و به اکثر آنتی‌بیوتیک‌های وسیع‌الطیف مقاومت نشان می‌دهد. هدف از این مطالعه، تعیین فراوانی اسینتوباکتر بومانی ایزوله شده از بخش مراقبت‌های ویژه (ICU یا Intensive care unit) و تعیین الگوی مقاومت آنتی‌بیوتیکی آن‌ها بود.روش‌ها: در طول دوره‌ی یک ساله‌ی 92-1391، تعداد 350 نمونه از بیماران بستری در واحد مراقبت‌های ویژه‌ی بیمارستان‌های شهر اصفهان به دست آمد. تعیین خصوصیات نمونه‌ها به عنوان اسینتوباکتر، با استفاده ازآزمایش‌های فنوتیپی و بیوشیمیایی صورت گرفت و ایزوله‌ها با اثبات وجود ژن like 51-OXA توسط تکنیک PCR (Polymerase chain reaction) تأیید شدند. آزمایش حساسیت آنتی‌بیوتیکی به روش دیسک دیفیوژن طبق دستورالعمل CLSI (Clinical and Laboratory Standards Institute) انجام گرفت.یافته‌ها: از 350 نمونه‌ی جدا شده از بیماران، 43 نمونه‌ی اسینتوباکتر بومانی شناخته شد. میزان فراوانی الگوهای ضد میکروبی جدایه‌ها نشان داد که 5/53 درصد ایزوله‌ها به آمیکاسین، 7/83 درصد به تتراسایکلین، 0/86 درصد به سفتازیدیم، 7/90 درصد به تری‌متوپریم سولفامتوکسازول و 0/93 درصد به ایمی‌پنم، مروپنم، سفیپیم و آمپی‌ سیلین سولباکتام مقاوم بودند و همچنین تمام جدایه‌ها به سیپروفلوکسازین مقاوم بودند. تمامی اسینتوباکترهای جدا شده از ICU بیمارستان‌های شهر اصفهان، مقاوم به چند دارو (MDR یا Multi-drug resistance) بودند.نتیجه‌گیری: این مطالعه مقاومت بالای اسینتوباکتر بومانی به طیف وسیع آنتی‌بیوتیک‌ها را نشان داد. از این رو، استراژی مناسب جهت کنترل انتشار باکتری در بخش مراقبت‌های ویژه و سایر بخش‌ها ضروری به نظر می‌رسد. 

کلیدواژه‌ها

عنوان مقاله [English]

Frequency of Multi-Drug Resistance Acinetobacter Baumannii Isolates in Intensive Care Units (ICU) of Isfahan Hospitals, Iran, via Molecular Method and Their Antimicrobial Resistance Patterns

نویسندگان [English]

  • Hasan Ghajavand 1
  • Asghar Havaei 2
  • Bahram Nasr-Esfahani 2
  • Hossein Fazeli 2
  • Sharareh Moghim 2
1 MSc Student, Department of Microbiology, School of Medicine AND Student Research Committee, Isfahan University of Medical Sciences, Isfahan, Iran
2 Associate Professor, Department of Microbiology, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
چکیده [English]

Background: Acinetobacter baumannii is one of the most important pathogen in hospital acquired infections, especially in intensive care units (ICUs). This opportunistic pathogen can be easily isolated from water, soil, and hospital facilities. Acinetobacter baumannii, as a nosocomial opportunistic pathogen, is resistant to wide range of antibiotics. The aim of this study was to determine the frequency and resistance patterns of Acinetobacter baumannii isolated from intensive care units of Isfahan Hospitals, Iran.Methods: During one year period (2012-2013), 350 specimens were collected from intensive care units of Isfahan hospitals. The specimens were characterized as Acinetobacter baumannii via conventional phenotypic and biochemical tests. The isolates were confirmed using polymerase chain reaction (PCR) for OXA_51-like gene. Susceptibility of isolates was determined via standard disk diffusion method according to CLSI (Clinical and Laboratory Standards Institute).Findings: From 350 specimens, 43 isolates was Acinetobacter baumannii. 53.5% of isolates were resistant to amikacin, 83.7% to tetracyclin, 86.0% to ceftazidime, 90.7% to trimetoprim sulfametoxazol, 93.0% to imipenem, cefepime, meropenem, and ampicillin-sulbactam. All isolates were resistant to ciprofloxacin. Our findings showed that all of Acinetobacter baumannii, isolated from the intensive care units of Isfahan hospitals were multi-drug resistance (MDR).Conclusion: This study showed a high resistant of Acinetobacter baumannii to a wide range of antimicrobial agent. It is necessary to adopt appropriate strategies to control the spread of the bacteria in care unit centers and wards.

کلیدواژه‌ها [English]

  • Acinetobacter baumannii
  • Polymerase chain reaction (PCR)
  • Antibiotic Resistance
  • Intensive care units (ICU)

مراجع

  1. Perez F, Hujer AM, Hujer KM, Decker BK, Rather PN, Bonomo RA. Global challenge of multidrug-resistant Acinetobacter baumannii. Antimicrob Agents Chemother 2007; 51(10): 3471-84.
  2. Peleg AY, Seifert H, Paterson DL. Acinetobacter baumannii: emergence of a successful pathogen. Clin Microbiol Rev 2008; 21(3): 538-82.
  3. Murray PR, Baron EJ, Pfaller MA, Tenover FC, Yolken RH, editors. Manual of clinical microbiology. 7th ed. Washington, DC: ASM Press; 1999. p. 517-25.
  4. Barbolla RE, Centron D, Maimone S, Rospide F, Salgueira C, Altclas J, et al. Molecular epidemiology of Acinetobacter baumannii spread in an adult intensive care unit under an endemic setting. Am J Infect Control 2008; 36(6): 444-52.
  5. Mastoraki A, Douka E, Kriaras I, Stravopodis G, Saroglou G, Geroulanos S. Preventing strategy of multidrug-resistant Acinetobacter baumanii susceptible only to colistin in cardiac surgical intensive care units. Eur J Cardiothorac Surg 2008; 33(6): 1086-90.
  6. Bou G, Oliver A, Martinez-Beltran J. OXA-24, a novel class D beta-lactamase with carbapenemase activity in an Acinetobacter baumannii clinical strain. Antimicrob Agents Chemother 2000; 44(6): 1556-61.
  7. Sinha M, Srinivasa H, Macaden R. Antibiotic resistance profile & extended spectrum beta-lactamase (ESBL) production in Acinetobacter species. Indian J Med Res 2007; 126(1): 63-7.
  8. Dijkshoorn L, Van VW, Degener JE, Michel MF. Typing of Acinetobacter calcoaceticus strains isolated from hospital patients by cell envelope protein profiles. Epidemiol Infect 1987; 99(3): 659-67.
  9. Joly-Guillou ML. Clinical impact and pathogenicity of Acinetobacter. Clin Microbiol Infect 2005; 11(11): 868-73.
  10. Jawad A, Seifert H, Snelling AM, Heritage J, Hawkey PM. Survival of Acinetobacter baumannii on dry surfaces: comparison of outbreak and sporadic isolates. J Clin Microbiol 1998; 36(7): 1938-41.
  11. Martinez MA, Pinto ME, Giglio MS, Pommier J, Munoz LM. Identification and sensitivity of acinetobacter sp isolated from clinical specimens and hospital environment. Rev Med Chil 1992; 120(11): 1267-72. [In Spanish].
  12. Trilla A. Epidemiology of nosocomial infections in adult intensive care units. Intensive Care Med 1994; 20 Suppl 3: S1-S4.
  13. Diomedi A. Acinetobacter baumannii pandrug-resistant: update in epidemiological and antimicrobial managing issues. Rev Chilena Infectol 2005; 22(4): 298-320. [In Spanish].
  14. Dijkshoorn L, Nemec A, Seifert H. An increasing threat in hospitals: multidrug-resistant Acinetobacter baumannii. Nat Rev Microbiol 2007; 5(12): 939-51.
  15. Navon-Venezia S, Ben-Ami R, Carmeli Y. Update on Pseudomonas aeruginosa and Acinetobacter baumannii infections in the healthcare setting. Curr Opin Infect Dis 2005; 18(4): 306-13.
  16. Hsueh PR, Teng LJ, Chen CY, Chen WH, Yu CJ, Ho SW, et al. Pandrug-resistant Acinetobacter baumannii causing nosocomial infections in a university hospital, Taiwan. Emerg Infect Dis 2002; 8(8): 827-32.
  17. Coelho J, Woodford N, Turton J, Livermore DM. Multiresistant acinetobacter in the UK: how big a threat? J Hosp Infect 2004; 58(3): 167-9.
  18. Zarrilli R, Crispino M, Bagattini M, Barretta E, Di PA, Triassi M, et al. Molecular epidemiology of sequential outbreaks of Acinetobacter baumannii in an intensive care unit shows the emergence of carbapenem resistance. J Clin Microbiol 2004; 42(3): 946-53.
  19. Lee K, Lee WG, Uh Y, Ha GY, Cho J, Chong Y. VIM- and IMP-type metallo-beta-lactamase-producing Pseudomonas spp. and Acinetobacter spp. in Korean hospitals. Emerg Infect Dis 2003; 9(7): 868-71.
  20. Lee K, Yum JH, Yong D, Lee HM, Kim HD, Docquier JD, et al. Novel acquired metallo-beta-lactamase gene, bla(SIM-1), in a class 1 integron from Acinetobacter baumannii clinical isolates from Korea. Antimicrob Agents Chemother 2005; 49(11): 4485-91.
  21. Bou G, Cervero G, Dominguez MA, Quereda C, Martinez-Beltran J. Characterization of a nosocomial outbreak caused by a multiresistant Acinetobacter baumannii strain with a carbapenem-hydrolyzing enzyme: high-level carbapenem resistance in A. baumannii is not due solely to the presence of beta-lactamases. J Clin Microbiol 2000; 38(9): 3299-305.
  22. Brown S, Young HK, Amyes SG. Characterisation of OXA-51, a novel class D carbapenemase found in genetically unrelated clinical strains of Acinetobacter baumannii from Argentina. Clin Microbiol Infect 2005; 11(1): 15-23.
  23. Clinical Laboratory Standards Institute. Performance standards for antimicrobial susceptibility testing: twentieth informational supplement: M100-S20. Wayne PA: CLSI; 2012.
  24. Gaynes R, Edwards JR. Overview of nosocomial infections caused by gram-negative bacilli. Clin Infect Dis 2005; 41(6): 848-54.
  25. Rastegar Lari AR, Alaghehbandan R, Akhlaghi L. Burn wound infections and antimicrobial resistance in tehran, iran: an increasing problem. Ann Burns Fire Disasters 2005; 18(2): 68-73.
  26. Saadatian Farivar A, Nowroozi J, Emami M. The prevalence of acinetobacter in sergical ICU in Rasoul Akram Hospital in 2004-2005. J Rafsanjan Univ Med Sci 2005; 4(4): 342-7. [In Persian].
  27. Hosseini Jazani N, Babazadeh H, Khalkhali H. Evaluation of the sensitivity of Acinetobacter sp. burn isolates to ciprofloxacin and some of other used antibiotics for treatment. J Jahrom Univ Med Sci 2009; 7(2): 48-58. [In Persian].
  28. Koh TH, Sng LH, Wang GC, Hsu LY, Zhao Y. IMP-4 and OXA beta-lactamases in Acinetobacter baumannii from Singapore. J Antimicrob Chemother 2007; 59(4): 627-32.
  29. Paul M, Weinberger M, Siegman-Igra Y, Lazarovitch T, Ostfeld I, Boldur I, et al. Acinetobacter baumannii: emergence and spread in Israeli hospitals 1997-2002. J Hosp Infect 2005; 60(3): 256-60.
  30. Wisplinghoff H, Bischoff T, Tallent SM, Seifert H, Wenzel RP, Edmond MB. Nosocomial bloodstream infections in US hospitals: analysis of 24,179 cases from a prospective nationwide surveillance study. Clin Infect Dis 2004; 39(3): 309-17.
  31. Johnson EN, Burns TC, Hayda RA, Hospenthal DR, Murray CK. Infectious complications of open type III tibial fractures among combat casualties. Clin Infect Dis 2007; 45(4): 409-15.
  32. Saeed NK, Kambal AM, El-Khizzi NA. Antimicrobial-resistant bacteria in a general intensive care unit in Saudi Arabia. Saudi Med J 2010; 31(12): 1341-9.
  33. Costa SF, Newbaer M, Santos CR, Basso M, Soares I, Levin AS. Nosocomial pneumonia: importance of recognition of aetiological agents to define an appropriate initial empirical therapy. Int J Antimicrob Agents 2001; 17(2): 147-50.
  34. Rit K, Saha R. Multidrug-resistant acinetobacter infection and their susceptibility patterns in a tertiary care hospital. Niger Med J 2012; 53(3): 126-8.
  35. Bassetti M, Righi E, Esposito S, Petrosillo N, Nicolini L. Drug treatment for multidrug-resistant Acinetobacter baumannii infections. Future Microbiol 2008; 3(6): 649-60.
  36. Leung WS, Chu CM, Tsang KY, Lo FH, Lo KF, Ho PL. Fulminant community-acquired Acinetobacter baumannii pneumonia as a distinct clinical syndrome. Chest 2006; 129(1): 102-9.
  37. Michalopoulos A, Falagas ME. Treatment of Acinetobacter infections. Expert Opin Pharmacother 2010; 11(5): 779-88.
  38. Smolyakov R, Borer A, Riesenberg K, Schlaeffer F, Alkan M, Porath A, et al. Nosocomial multi-drug resistant Acinetobacter baumannii bloodstream infection: risk factors and outcome with ampicillin-sulbactam treatment. J Hosp Infect 2003; 54(1): 32-8.
  39. Wang SH, Sheng WH, Chang YY, Wang LH, Lin HC, Chen ML, et al. Healthcare-associated outbreak due to pan-drug resistant Acinetobacter baumannii in a surgical intensive care unit. J Hosp Infect 2003; 53(2): 97-102.
  40. Ayan M, Durmaz R, Aktas E, Durmaz B. Bacteriological, clinical and epidemiological characteristics of hospital-acquired Acinetobacter baumannii infection in a teaching hospital. J Hosp Infect 2003; 54(1): 39-45.
  41. Sadeghifard N, Ranjbar R, Zaeimi J, YousefAlikhani M, Ghafouryan S, Raftari M, et al. Antimicrobial susceptibility, plasmid profiles, and RAPD-PCR typing of Acinetobacter bacteria. Asian Biomedicine 2010; 4(6): 901-11.
  42. Prakasam G, Geethapriya S, Jayakeerthana KH, Ramesh S. Detection of certain virulence attributes and antimicrobial resistance pattern among clinical isolates of Acinetobacter baumannii. Int J Pharma Bio Sci 2011; 2(3): 501-7.
  43. Prashanth K, Badrinath S. In vitro susceptibility pattern of Acinetobacter species to commonly used cephalosporins, quinolones, and aminoglycosides. Indian J Med Microbiol 2004; 22(2): 97-103.
  44. Jamulitrat S, Thongpiyapoom S, Suwalak N. An outbreak of imipenem-resistant Acinetobacter baumannii at Songklanagarind Hospital: the risk factors and patient prognosis. J Med Assoc Thai 2007; 90(10): 2181-91.
  45. Amor A, Barguellil F, Othmani S, Bahri M. Acinetobacter baumannii infections. Contribution of bacteriologic studies. Semaine des Hôpitaux de Paris 1993; 69(2): 732-5. [In French].
  46. Lagamayo EN. Antimicrobial resistance in major pathogens of hospital-acquired pneumonia in Asian countries. Am J Infect Control 2008; 36(4 Suppl): S101-S108.
مجله دانشکده پزشکی اصفهان
دوره 32، شماره 295 - شماره پیاپی 295
مرداد و شهریور 1393
صفحه 1175-1185

فایل ها

سابقه مقاله

  • تاریخ دریافت: 04 اسفند 1392
  • تاریخ بازنگری: 07 اردیبهشت 1403
  • تاریخ پذیرش: 17 فروردین 1401

هم رسانی

ارجاع به این مقاله

آمار