PDF(Pubmed)
Abstract：
Infections by Acinetobacter species are recognized as a serious global threat due to causing severe disease and their high levels of antibiotic resistance. Acinetobacter baumannii is the most prevalent pathogen in the genus, but infection by Acinetobacter nosocomialis has been reported widely. Diagnosis of patients with A. baumannii infection is often misdiagnosed with other Acinetobacter species, especially A. nosocomialis. This study investigated whether there were significant differences in clinical outcomes between patients infected with A. baumannii versus A. nosocomialis in Northeast Thailand, and to characterize serological responses to infection with these pathogens. The results show that A. baumannii had higher levels of multidrug resistance. Despite this, clinical outcomes for infection with A. baumannii or A. nosocomialis were similar with mortalities of 33% and 36%, respectively. Both pathogens caused community-acquired infections (A. baumannii 35% and A. nosocomialis 29% of cases). Plasma from uninfected healthy controls contained IgG antibody that recognized both organisms, and infected patients did not show a significantly enhanced antibody response from the first week versus 2 weeks later. Finally, the patterns of antigen recognition for plasma IgG were similar for patients infected with A. baumannii or A. nosocomialis infection, and distinct to the pattern for patients infected with non-Acinetobacter. In conclusion, our data revealed that infection with A. nosocomialis was associated with a similarly high level of mortality as infection with A. baumannii, the high rate of community-acquired infection and antibodies in uninfected individuals suggesting that there is significant community exposure to both pathogens. IMPORTANCE Bacterial infections by Acinetobacter species are global threats due to their severity and high levels of antibiotic resistance. A. baumannii is the most common pathogen in the genus; however, infection by A. nosocomialis has also been widely reported but is thought to be less severe. In this study, we have prospectively investigated 48 reported cases of A. baumannii infection in Northeast Thailand, and characterized the serological responses to infection. We found that 14 (29%) of these infections were actually caused by A. nosocomialis. Furthermore, the incidence of antibiotic resistance among A. nosocomialis strains, APACHE II scores, and mortality for patients infected with A. nosocomialis were much higher than published data. Both A. baumannii and A. nosocomialis had unexpectedly mortality rates of over 30%, and both pathogens caused a high rate of community-acquired infections. Importantly, background antibodies in uninfected individuals suggest significant community exposure to both pathogens in the environment.
摘要：
由于不动杆菌属物种的感染引起严重的疾病及其高水平的抗生素抗性,被认为是严重的全球威胁。鲍曼不动杆菌是该属中最常见的病原菌,但是医院内不动杆菌感染已被广泛报道。鲍曼不动杆菌感染患者的诊断经常被其他不动杆菌误诊，尤其是麻风病。这项研究调查了泰国东北部鲍曼不动杆菌感染患者与医院内感染患者之间的临床结局是否存在显着差异，并表征对这些病原体感染的血清学反应。结果表明鲍曼不动杆菌具有较高的多药耐药性。尽管如此,鲍曼不动杆菌或医院感染的临床结果相似，死亡率分别为33%和36%，分别。两种病原体均引起社区获得性感染（A.鲍曼不动杆菌占35%，医院感染占29%）。来自未感染健康对照的血浆含有识别两种生物的IgG抗体，与2周后相比，从第一周开始，感染患者的抗体反应没有显着增强。最后,对于感染鲍曼不动杆菌或医院内感染的患者，血浆IgG的抗原识别模式相似，与非不动杆菌感染患者的模式不同。总之,我们的数据显示，与鲍曼不动杆菌感染同样高的死亡率，未感染个体中社区获得性感染和抗体的发生率很高，这表明社区对这两种病原体的暴露量很大。重要性不动杆菌属的细菌感染由于其严重程度和高水平的抗生素耐药性而成为全球威胁。鲍曼不动杆菌是该属中最常见的病原体；然而，医院内A.感染也被广泛报道，但被认为不那么严重。在这项研究中,我们对泰国东北部48例鲍曼不动杆菌感染病例进行了前瞻性调查，并表征了对感染的血清学反应。我们发现，这些感染中有14例（29％）实际上是由医院内杆菌引起的。此外，医院内A.菌株中抗生素耐药性的发生率，APACHEII得分,感染医院内链球菌的患者的死亡率远高于已发表的数据。鲍曼不动杆菌和医院内杆菌的死亡率都意外超过30%，两种病原体都导致了很高的社区获得性感染。重要的是,未感染个体的背景抗体提示社区在环境中显著暴露于两种病原体.
