摘要

本研究旨在评估新生儿筛查，入院时和新生儿重症监护室出院过程中鲍曼不动杆菌的获得率。 （NICU）。此外，我们调查了孤立抗性细菌的潜在定植和分子流行病学的风险因素。这项前瞻性研究于2013年2月至2015年7月在非斯哈桑二世大学医院的新生儿科进行。在此期间，所有连续入院的新生儿在入院时和出院过程中都接受了鲍曼不动杆菌肠道运输的筛查。根据国际标准评估细菌学和分子测试。本研究检查了455名新生儿的入院筛查，其中59％是男性。平均孕龄和出生体重分别为35.2周和2612.1克。入院时，共有277名患者参与了收购研究。多重耐药（MDR）鲍曼不动杆菌携带率为6.5％，而医院恢复期间的获得率为13.7％。在该研究中，收集了68株MDR A.鲍曼不动杆菌分离株。对不同抗生素类别（包括头孢他啶，庆大霉素和环丙沙星）的耐药率在92％至100％之间变化。此外，13％的MDR鲍曼不动杆菌分离株为碳青霉烯酶生产者，88％为鲍罗马基因-23基因。入院时，三个危险因素与鲍曼不动杆菌定植显着相关：年龄（OR，2.803; IC95％，1.191-6.596; P = 0.01），性别（OR，0.382; IC95％，0.158-0.921; P = 0.03）在大学医院（MUH）分娩时分娩（OR，0.196; IC95％，0.071-0.540; P = 0.002）。然而，在住院期间，与获得鲍氏不动杆菌相关的唯一风险因素是呼吸窘迫（OR，2.270; IC95％，1.055-4.881; P = 0.03）。在我们的新生儿重症监护室（NICU）中发现了鲍曼不动杆菌的高肠道携带率和多种抗生素耐药性。因此，应通过主动监测策略监测MDR A. baumannii的传播。

This study was conducted in order to assess the acquisition rate of Acinetobacter baumannii by newborn screening, on admission and during the discharge process of neonatal intensive care unit. (NICU). Furthermore, we investigated risk factors for potential colonization and molecular epidemiology of isolated resistant bacteria. This prospective study was conducted in the neonatal unit of Hassan II University Hospital of Fez from February 2013 to July 2015. During this period, all consecutive admitted neonates were screened for A. baumannii intestinal carriage, on admission and during the discharge process. Bacteriological and molecular tests were evaluated according to the international standards. This study examines the screening on admission of 455 newborns, 59% of whom were male. The average gestational age and birth weight were 35.2 weeks and 2612.1 g respectively. In total, 277 patients were included in the acquisition study on admission. The prevalence of multi-drug resistant (MDR) A. baumannii strain carriage was 6.5%, while the acquisition rate during the hospital recovery was 13.7%. In this study, 68 MDR A. baumannii isolates were collected. The resistance rates to different antibiotic classes including, Ceftazidime, Gentamycin and Ciprofloxacin varied between 92 and 100%. Moreover, 13% of MDR A. baumannii isolates were carbapenemase producers and 88% harbored blaOXA-23 gene. On admission, three risk factors were significantly associated with A. baumannii colonization: age (OR, 2.803; IC95%, 1.191-6.596; P = 0.01), gender (OR, 0.382; IC95%, 0.158-0.921; P = 0.03) and the delivery birth at the Maternity of University Hospital (MUH), (OR, 0.196; IC95%, 0.071-0.540; P = 0.002). However during hospitalization, the only risk factor associated with acquisition of A. baumannii was the respiratory distress (OR, 2.270; IC95%, 1.055-4.881; P = 0.03). A high intestinal carriage rate of A. baumannii and multiple antibiotic resistance were found in our NICU. Thus, the spread of MDR A. baumannii should be monitored by an active surveillance strategy.

https://www.ncbi.nlm.nih.gov/pubmed/30629614