title: Extensively drug-resistant Acinetobacter baumannii: risk factors for acquisition and prevalent OXA-type carbapenemases--a multicentre study.
abstract: In this study, we investigated the risk factors for and carbapenem resistance mechanisms of extensively drug-resistant Acinetobacter baumannii (XDR-AB). Isolates of XDR-AB were collected from seven tertiary care hospitals in South Korea. A case-control study for risk factor analysis was performed and the presence of the metallo-β-lactamase (MBL) and OXA genes was examined. The control group consisted of adult inpatients receiving care from the same hospital. XDR-AB were isolated from 26 patients who were studied for risk factor analysis. Third-generation cephalosporin use [odds ratio (OR)=9.6, 95% confidence interval (CI) 1.3-171.3; P=0.02] and Acute Physiology and Chronic Health Evaluation (APACHE) II score (OR=1.2, 95% CI 1.1-1.5; P=0.004) were identified as risk factors for acquisition of XDR-AB. Pulsed-field gel electrophoresis (PFGE) showed clonal epidemic isolates in hospitals. MBLs were not detected, and all 30 XDR-AB isolates had upregulated OXA-type carbapenemase genes. These results suggest that third-generation cephalosporin use and disease severity are associated with XDR-AB acquisition amongst typical adult inpatients. This study also points to intrahospital spread of XDR-AB. Upregulated OXA-type carbapenemases are prevalent in XDR-AB founded in South Korean hospitals.
authors.affiliation: Department of Internal Medicine, Gachon University Gil Hospital, Namdong-gu, Incheon, South Korea.
authors.forename: Yoon Soo
authors.initials: YS
authors.lastname: Park
authors.forename: Hyukmin
authors.initials: H
authors.lastname: Lee
authors.forename: Kkot Sil
authors.initials: KS
authors.lastname: Lee
authors.forename: Seung Sik
authors.initials: SS
authors.lastname: Hwang
authors.forename: Yong Kyun
authors.initials: YK
authors.lastname: Cho
authors.forename: Hyo Youl
authors.initials: HY
authors.lastname: Kim
authors.forename: Young
authors.initials: Y
authors.lastname: Uh
authors.forename: Bum Sik
authors.initials: BS
authors.lastname: Chin
authors.forename: Sang Hoon
authors.initials: SH
authors.lastname: Han
authors.forename: Seok Hoon
authors.initials: SH
authors.lastname: Jeong
authors.forename: Kyungwon
authors.initials: K
authors.lastname: Lee
authors.forename: June Myung
authors.initials: JM
authors.lastname: Kim
mesh_terms: D000151:Acinetobacter Infections / Q000453:epidemiology* / Q000382:microbiology* / Q000473:pathology; D040981:Acinetobacter baumannii / Q000145:classification / Q000187:drug effects* / Q000201:enzymology* / Q000235:genetics; D000328:Adult; D000368:Aged; D000900:Anti-Bacterial Agents / Q000494:pharmacology*; D001426:Bacterial Proteins / Q000096:biosynthesis*; D015373:Bacterial Typing Techniques; D016022:Case-Control Studies; D003428:Cross Infection / Q000453:epidemiology / Q000382:microbiology / Q000473:pathology; D016172:DNA Fingerprinting; D016521:Electrophoresis, Gel, Pulsed-Field; D005260:Female; D005838:Genotype; D006761:Hospitals; D006801:Humans; D008297:Male; D008875:Middle Aged; D056910:Republic of Korea / Q000453:epidemiology; D012307:Risk Factors; D012720:Severity of Illness Index; D018440:beta-Lactam Resistance; D001618:beta-Lactamases / Q000096:biosynthesis*
chemical_list: D000900:Anti-Bacterial Agents; D001426:Bacterial Proteins; D001618:beta-Lactamases; C063912:carbapenemase