Characterization of the Multidrug-Resistant Acinetobacter species Causing a Nosocomial Outbreak at Intensive Care Units in a Korean Teaching Hospital: Suggesting the Correlations with the Clinical and Environmental Samples, Including Respiratory Tract-related Instruments
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Background: Acinetobacter spp. is an important no- socomial pathogen for which increasing resistance to multiple antimicrobial agents has been observed. Prevalence of multidrug-resistant (MDR) Acinetobacter spp. in the intensive care unit (ICU) at a teaching hospital in Korea started to increase in 2008. The aim of this study was to determine the source of pathogen spread and to characterize the emerging strains at an early stage of outbreak. Methods: Samples from respiratory instruments and fomites in the ICUs, as well as from the healthcare workers, were cultured to identify the sources of MDR Acinetobacter spp. Antimicrobial susceptibility was determined by the CLSI disk diffusion method. Pulsed field gel electrophoresis (PFGE) was per- formed for clinical and environmental isolates in or- der to determine clonality. Carbapenemase genes were detected by multiplex PCR. Infection control measures including peer-monitoring of hand washing, environmental cleaning and standard precautions were enforced. Results: Among the samples from the ICU tools (105)and healthcare worker’s hands (44), 31 (30%) and 2 (5%) respective samples yielded MDR Acinetobacter spp. Among the environmental samples, 90% were from respiratory-related equipment. The majority of clinical and environmental MDR Acinetobacter spp. (44/55) belonged to the pulsotype A. baumannii and carried both blaOXA-51-like and blaOXA-23-like genes. Even though infection-control measures were enforced, prevalence of MDR Acinetobacter spp. continues to increase. Conclusion: An outbreak of MDR Acinetobacter spp. in a Korean hospital was caused by A. baumannii carrying the blaOXA-23-gene and was correlated with contaminated respiratory-related instruments in the ICUs. More intensive measures for nosocomial in- fection control are needed for successful prevention of Acinetobacter spread in hospitals. (Ann Clin Microbiol 2014;17:29-34)
Abstract
Background: Acinetobacter spp. is an important no- socomial pathogen for which increasing resistance to multiple antimicrobial agents has been observed. Prevalence of multidrug-resistant (MDR) Acinetobacter spp. in the intensive care unit (ICU) at a teaching hospital in Korea started to increase in 2008. The aim of this study was to determine the source of pathogen spread and to characterize the emerging strains at an early stage of outbreak. Methods: Samples from respiratory instruments and fomites in the ICUs, as well as from the healthcare workers, were cultured to identify the sources of MDR Acinetobacter spp. Antimicrobial susceptibility was determined by the CLSI disk diffusion method. Pulsed field gel electrophoresis (PFGE) was per- formed for clinical and environmental isolates in or- der to determine clonality. Carbapenemase genes were detected by multiplex PCR. Infection control measures including peer-monitoring of hand washing, environmental cleaning and standard precautions were enforced. Results: Among the samples from the ICU tools (105)and healthcare worker’s hands (44), 31 (30%) and 2 (5%) respective samples yielded MDR Acinetobacter spp. Among the environmental samples, 90% were from respiratory-related equipment. The majority of clinical and environmental MDR Acinetobacter spp. (44/55) belonged to the pulsotype A. baumannii and carried both blaOXA-51-like and blaOXA-23-like genes. Even though infection-control measures were enforced, prevalence of MDR Acinetobacter spp. continues to increase. Conclusion: An outbreak of MDR Acinetobacter spp. in a Korean hospital was caused by A. baumannii carrying the blaOXA-23-gene and was correlated with contaminated respiratory-related instruments in the ICUs. More intensive measures for nosocomial in- fection control are needed for successful prevention of Acinetobacter spread in hospitals. (Ann Clin Microbiol 2014;17:29-34)
참고문헌 (13)
- 이경원, "Multidrug-Resistant Acinetobacter spp.: Increasingly Problematic Nosocomial Pathogens", Yonsei Medical Journal, 52(6), pp.879~891 (2011), 연세대학교의과대학
- Peleg AY, "Acinetobacter baumannii: emergence of a successful pathogen", Clin Microbiol Rev, 21, pp.538~582 (2008)
- Fournier PE, "Comparative genomics of multidrug resistance in Acinetobacter baumannii", PLoS Genet, 2, pp.e7~ (2006)
- 이경원, "Increase of Ceftazidime- and Fluoroquinolone-Resistant Klebsiella pneumoniae and Imipenem-Resistant Acinetobacter spp. in Korea: Analysis of KONSAR Study Data from 2005 and 2007", Yonsei Medical Journal, 51(6), pp.901~911 (2010), 연세대학교의과대학
- Mera RM, "Acinetobacter baumannii 2002-2008: increase of carbapenem-associated multiclass resistance in the United States", Microb Drug Resist, 16, pp.209~215 (2010)
- Clinical and Laboratory Standards Institute, "Performance Standards for Antimicrobial Susceptibility Testing; Eighteenth Informational Supplement" (2008), Clinical and Laboratory Standards Institute
- Lee K, "Modified Hodge and EDTA-disk synergy tests to screen metallo-betalactamase-producing strains of Pseudomonas and Acinetobacter species", Clin Microbiol Infect, 7, pp.88~91 (2001)
- Lee K, "Evaluation of the Hodge test and the imipenem-EDTA double-disk synergy test for differentiating metallo-beta-lactamase-producing isolates of Pseudomonas spp. and Acinetobacter spp", J Clin Microbiol, 41, pp.4623~4629 (2003)
- Tenover FC, "Interpreting chromosomal DNA restriction patterns produced by pulsed-field gel electrophoresis: criteria for bacterial strain typing", J Clin Microbiol, 33, pp.2233~2239 (1995)
- Lee K, "KONSAR Group. Wide dissemination of OXA-type carbapenemases in clinical Acinetobacter spp. isolates from South Korea", Int J Antimicrob Agents, 33, pp.520~524 (2009)
- Woodford N, "Multiplex PCR for genes encoding prevalent OXA carbapenemases in Acinetobacter spp", Int J Antimicrob Agents, 27, pp.351~353 (2006)
- Kim CK, "Prevalence and diversity of carbapenemases among imipenemnonsusceptible Acinetobacter isolates in Korea: emergence of a novel OXA-182", Diagn Microbiol Infect Dis, 68, pp.432~438 (2010)
- Lee Y, "Carbapenemnon-susceptible Acinetobacter baumannii of sequence type 92 or its single-locus variants with a G428T substitution in zone 2 of the rpoB gene", J Antimicrob Chemother, 66, pp.66~72 (2011)