Donor‐derived transmission through lung transplantation of carbapenem‐resistant Acinetobacter baumannii producing the OXA‐23 carbapenemase during an ongoing healthcare facility outbreak

We describe a rare instance of donor‐derived OXA‐23‐producing carbapenem‐resistant Acinetobacter baumannii transmission during lung transplantation and the subsequent public health response. This investigation highlights how transplantation can introduce rare multidrug‐resistant organisms into different healthcare facilities and regions.     

Increasing Carbapenem-Resistant Gram-Negative Bacilli and Decreasing Metallo-β-Lactamase Producers over Eight Years from Korea

The trends and types of carbapenemase-producing Gram-negative bacilli were analyzed from clinical specimens collected between 2005 and 2012 at a Korean teaching hospital. The proportions of carbapenem-resistant Acinetobacter spp. increased markedly to 66%. Metallo-β-lactamase producers significantly decreased and the majority shifted from the bla_VIM-2 type to the bla_IMP-1 type.     

某院耐碳青霉烯类肠杆菌科细菌的临床分布特点及药物敏感性分析

目的分析该院耐碳青霉烯类肠杆菌科细菌(CRE)的临床分布特点及药物敏感性,为临床合理有效治疗CRE菌株提供理论依据。方法收集医院2019年全年临床标本中分离的肠杆菌科细菌(共计2435株),采用VITEK 2 Compact全自动微生物分析系统进行细菌鉴定、药敏试验,对筛选出的CRE菌株采用K-B药敏纸片扩散法对亚胺培南进行复核,并采用改良碳青霉烯灭活(mCIM)试验和EDTA改良碳青霉烯灭活(eCIM)试验进行碳青霉烯酶表型分析。所有实验数据采用WHONET5.6和SPSS17.0软件进行统计分析处理。结果共分离出213株CRE菌株,以肺炎克雷伯菌为主(161株);标本来源以呼吸道痰液标本为主(41.3%);54.5%的标本分离自重症监护室(ICU),CRE菌株在ICU的分离率明显高于普通病房(χ^2=81.00,P<0.01)。药敏结果显示,CRE菌株除对替加环素比较敏感(耐药率为2.8%),对阿米卡星(51.6%)和四环素(52.0%)的耐药率低一些外,对其余大多数抗菌药物的耐药率均在80%以上。与碳青霉烯类敏感肠杆菌科细菌(CSE)的耐药率相比,CRE菌株对除四环素以外的其他抗菌药物的耐药率均明显高于CSE菌株(P<0.01)。mCIM和eCIM试验结果显示,213株CRE菌株中,170株为丝氨酸酶阳性,43株为金属酶阳性,且43株产金属酶的CRE菌株中,22株都来源于ICU,占比超过50%。不同细菌种类的CRE菌株中,耐碳青霉烯类阴沟肠杆菌和耐碳青霉烯类大肠埃希菌产金属酶的比例均≥50%。结论CRE菌株对多种抗菌药物高度耐药,其临床分离率逐年增高,给临床治疗带来困难。因此应加强抗菌药物的管理,合理选择和使用抗菌药物,注重医院感染的预防和监测,防止医院内感染的传播和流行。     

Severe infection in a lung transplant recipient caused by donor-transmitted carbapenem-resistant Acinetobacter baumannii

We describe a case of proven donor transmission of carbapenem-resistant Acinetobacter baumannii, which resulted in severe infectious complications after lung transplantation. A single bla(OXA-23) positive strain, belonging to a new multilocus sequence type (ST231), was isolated from donor and recipient, who died 65 days after transplantation. This report highlights the current challenges associated with the potential transmission of multidrug-resistant infections through organ transplantation.     

Does the urinary tract infection caused by carbapenem‐resistant Gram‐negative bacilli impact the outcome of kidney transplant recipients?

The incidence of urinary tract infection (UTI) after kidney transplantation (KT) caused by multidrug‐resistant (MDR) bacteria is growing. The aim of this study was to analyze the impact of UTI caused by carbapenem‐resistant Gram‐negative bacteria (CR‐GNB) in the survival of graft and recipients following KT. This was a retrospective cohort study involving patients who underwent KT between 2013 and 2016. Patients were followed since the day of the KT until loss of graft, death or end of the follow‐up period (31th December 2016). The outcomes measured were UTI by MDR following KT and graft and patient survival. Analyses were performed using Cox regression; for the graft and patient survival analysis, we used a propensity score for UTI by CR‐GNB to matching a control group. UTI was diagnosed in 178 (23.9%) of 781 patients, who developed 352 UTI episodes. 44.6% of the UTI cases were caused by MDR bacteria. Identified risk factors for UTI by MDR bacteria were DM, urologic disease as the cause of end‐stage renal failure, insertion of ureteral stent, carbapenem use, and delayed graft function (DGF). Risk factors for death during the follow‐up period were female gender, patients over 60 years old at the time of KT, DM, body mass index over 31.8, UTI caused by CR‐GNB. In conclusion, UTIs caused by CR‐GNB have great impact on patients’ survival after KT.     

Prevalence and drug resistance characteristics of carbapenem-resistant Enterobacteriaceae in Hangzhou,China

With the abuse of antimicrobial agents in developing countries, increasing number of carbapenem-resistant Enterobacteriaceae (CRE) attracted considerable public concern. A retrospective study was conducted based on 242 CRE strains from a tertiary hospital in Hangzhou, China to investigate prevalence and drug resistance characteristics of CRE in southeast China. Bacterial species were identified. Antimicrobial susceptibility was examined by broth microdilution method or epsilometer test. Resistant β-lactamase genes were identified by polymerase chain reaction and sequencing. Genotypes were investigated by phylogenetic analysis. Klebsiella pneumoniae and Escherichia coli were the most prevalent types of species, with occurrence in 71.9% and 21.9% of the strains, respectively. All strains exhibited high resistance (>70%) against β-lactam antibiotics, ciprofloxacin, trimethoprim–sulfamethoxazole, and nitrofurantoin but exhibited low resistance against tigecycline (0.8%) and minocycline (8.3%). A total of 123 strains harbored more than two kinds of β-lactamase genes. bla_KPC-2, bla_SHV-11, bla_TEM-1, and bla_CTX-M-14 were the predominant genotypes, with detection rates of 60.3%, 61.6%, 43.4%, and 16.5%, respectively, and were highly identical with reference sequences in different countries, indicating potential horizontal dissemination. IMP-4 was the most frequent class B metallo-lactamases in this study. In conclusion, continuous surveillance and effective prevention should be emphasized to reduce spread of CRE.     

心脏外科瓣膜术后耐碳青霉烯类革兰阴性杆菌感染临床特征与影响因素

目的 了解心脏瓣膜术后医院感染及耐碳青霉烯类革兰阴性菌(CR-GNB)感染的临床特征、耐药性及影响因素。 方法 回顾性收集2018年1月—2021年10月某院心脏瓣膜术后患者的临床资料, 按术后是否发生CR-GNB感染分为CR-GNB组和非耐碳青霉烯类革兰阴性菌(non-CR-GNB)组, 选取同时期非感染患者, 按年龄、性别与不同感染组(CR-GNB组和non-CR-GNB组)分别进行2:1配对, 分析感染发生的影响因素, 比较各组患者临床特征的差异。 结果 11 120例瓣膜手术患者, 术后296例(2.7%)发生医院感染, 其中170例为革兰阴性菌感染, 126例为革兰阳性菌感染。革兰阴性菌感染患者中, 62(36.5%)例归为CR-GNB组, 108例(63.5%)为non-CR-GNB组。CR-GNB组患者检出112株CR-GNB, 以鲍曼不动杆菌最多(48株, 42.9%), 对多种常用抗菌药物耐药率较高, 仅对阿米卡星和多黏菌素耐药率较低(分别为12.5%、5.3%)。各组比较, CR-GNB组较non-CR-GNB组患者、CR-GNB组较非感染组患者、non-CR-GNB较非感染组患者手术时间、ICU停留时间和体外循环时间更长, 感染前使用抗菌药物的比例更高(均P < 0.05)。多因素分析结果显示, 手术时间、ICU停留时间和体外循环时间是心脏外科瓣膜术后患者CR-GNB感染的独立危险因素(均P < 0.05)。CR-GNB组和non-CR-GNB组患者全因病死率(31.8%, 54/170)高于非感染组患者(5.0%, 17/340;P < 0.05)。 结论 加强心脏外科手术治疗期间围手术期管理至关重要, 优化手术操作及合理使用抗菌药物可减少耐药菌的发生, 改善患者预后。