RESUMO
This study analysed the occurrence of carbapenem resistance among Acinetobacter baumannii isolates from a tertiary-care hospital in Poland, together with the molecular epidemiology of these isolates and the risk-factors for their acquisition and possible nosocomial spread. The medical charts of 21 patients with Acinetobacter infection or colonisation revealed that A. baumannii isolates were obtained most frequently from intensive care unit and surgical patients (particularly those receiving transplantation surgery). First isolation occurred, on average, on day 21 following admission (range 5-45 days). Infection with Acinetobacter contributed directly to the death of seven patients. Several patients were infected with more than one strain, and molecular typing revealed the co-circulation of three predominant clones, of which two belonged to the Acinetobacter lineages designated as European clones I and II. All three clones encoded an OXA-51-type carbapenemase, but were negative for carbapenemases belonging to the OXA-23, OXA-24 and OXA-58 families. The OXA-51 gene was found in both resistant and susceptible isolates, and was not associated directly with carbapenem resistance. Etests with imipenem and imipenem plus EDTA indicated production of a metallo-beta-lactamase (MBL) in carbapenem-resistant isolates. PCRs for IMP-type MBLs were negative, but PCR using consensus primers for VIM-type MBLs were positive for carbapenem-resistant isolates belonging to the European clone II lineage. The occurrence of a VIM-type MBL in association with one of the epidemic lineages of A. baumannii is a cause for concern. Further studies are needed to evaluate possible inter-hospital spread of resistant A. baumannii strains in Poland.
Assuntos
Infecções por Acinetobacter/epidemiologia , Acinetobacter baumannii , Carbapenêmicos/farmacologia , Infecção Hospitalar/microbiologia , Farmacorresistência Bacteriana Múltipla , beta-Lactamases/genética , Infecções por Acinetobacter/tratamento farmacológico , Infecções por Acinetobacter/genética , Acinetobacter baumannii/efeitos dos fármacos , Acinetobacter baumannii/genética , Acinetobacter baumannii/patogenicidade , Adulto , Idoso , Infecções Comunitárias Adquiridas/tratamento farmacológico , Infecções Comunitárias Adquiridas/genética , Infecções Comunitárias Adquiridas/microbiologia , Infecção Hospitalar/tratamento farmacológico , Infecção Hospitalar/epidemiologia , Feminino , Hospitais Universitários , Humanos , Masculino , Testes de Sensibilidade Microbiana , Pessoa de Meia-Idade , Polônia/epidemiologia , Estudos Retrospectivos , beta-Lactamases/classificaçãoRESUMO
The bacteria most frequently isolated from blood cultures of haematology patients in Warsaw were staphylococci (58.0%), Enterobacteriaceae (18.6%), non-fermenting rods (6.9%), enterococci (4.3%) and anaerobes (4.3%). Coagulase-negative staphylococci were the most common species isolated (92.7%) with 83.2% of these strains resistant to methicillin. Among enteric bacteria, 17.3% strains produced extended-spectrum-beta-lactamases. All eight isolates of enterococci showed high level resistance to aminoglycosides.
Assuntos
Antibacterianos/farmacologia , Bactérias/efeitos dos fármacos , Farmacorresistência Bacteriana Múltipla , Doenças Hematológicas/microbiologia , Doenças Hematológicas/sangue , Humanos , Resistência a Meticilina , Testes de Sensibilidade Microbiana , Polônia , beta-Lactamases/metabolismoRESUMO
The study comprised strains of Candida albicans isolated from patients hospitalised in a tertiary care hospital during a 2-year period. In total 851 strains were cultured, including 379 (44.5%) strains from internal medicine patients, 243 (28.6%) from surgical patients and 229 (26.9%) from patients in the surgical intensive care unit. The strains were tested for susceptibility to the triazoles: fluconazole and itraconazole. There were 523 (61.5%) strains susceptible, 11 strains (1.3%) showed intermediate susceptibility and 317 (37.2%) were resistant to fluconazole, while 403 (47.3%) strains were susceptible, 43 (5.1%) intermediately susceptible and 405 (47.6%) resistant to itraconazole. Regular surveillance of fungal resistance patterns should be carried out and there should be prudent use of hospital triazole usage.
Assuntos
Antifúngicos/farmacologia , Candida albicans/efeitos dos fármacos , Candidíase/microbiologia , Farmacorresistência Fúngica , Fluconazol/farmacologia , Itraconazol/farmacologia , Candidíase/epidemiologia , Infecção Hospitalar/epidemiologia , Infecção Hospitalar/microbiologia , Humanos , Estudos RetrospectivosRESUMO
An outbreak of nosocomial meningitis caused by Acinetobacter baumannii, which developed postoperatively in seven neurosurgical patients is described. The clinical isolates of A. baumannii were typed by biochemical profiles and antibiogram patterns, and by random amplified polymorphic DNA polymerase chain reaction (RAPD-PCR) and amplified fragment length polymorphism (AFLP) fingerprinting. The implicated strain was multi-drug resistant, however, susceptibility to imipenem and netilmicin was detected. An extensive search for the environmental source of the epidemic strain was carried out. Two of several isolates from hospital environment, corresponded to the A. baumannii outbreak strain, one being cultured from the suctioning equipment used in the care of these patients. The introduction of multiresistant epidemic A. baumannii into a neurosurgical unit is a severe risk factor for patients undergoing neurosurgical procedures. Genotypic typing methods are important for definitive identification of these strains in patients and their environment.