Annals of Laboratory Medicine

  • 제38권6호
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  • Pages.545-554
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  • 2018
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  • 2234-3806(pISSN)
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  • 2234-3814(eISSN)
대한진단검사의학회 (Korean Society for Laboratory Medicine)
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Differences in Colistin-resistant Acinetobacter baumannii Clinical Isolates Between Patients With and Without Prior Colistin Treatment

  • Park, Yu Jin (Department of Laboratory Medicine, Yonsei University College of Medicine) ;
  • Hong, Duck Jin (Department of Laboratory Medicine, Sheikh Khalifa Specialty Hospital) ;
  • Yoon, Eun-Jeong (Department of Laboratory Medicine and Research Institute of Bacterial Resistance, Yonsei University) ;
  • Kim, Dokyun (Department of Laboratory Medicine and Research Institute of Bacterial Resistance, Yonsei University) ;
  • Choi, Min Hyuk (Department of Laboratory Medicine, Yonsei University College of Medicine) ;
  • Hong, Jun Sung (Department of Laboratory Medicine and Research Institute of Bacterial Resistance, Yonsei University) ;
  • Lee, Hyukmin (Department of Laboratory Medicine and Research Institute of Bacterial Resistance, Yonsei University) ;
  • Yong, Dongeun (Department of Laboratory Medicine and Research Institute of Bacterial Resistance, Yonsei University) ;
  • Jeong, Seok Hoon (Department of Laboratory Medicine and Research Institute of Bacterial Resistance, Yonsei University)
  • 투고 : 2017.11.09
  • 심사 : 2018.06.08
  • 발행 : 2018.11.01
⟨ 이전 논문 다음 논문 ⟩

초록

Background: The increasing morbidity and mortality rates associated with Acinetobacter baumannii are due to the emergence of drug resistance and the limited treatment options. We compared characteristics of colistin-resistant Acinetobacter baumannii (CR-AB) clinical isolates recovered from patients with and without prior colistin treatment. We assessed whether prior colistin treatment affects the resistance mechanism of CR-AB isolates, mortality rates, and clinical characteristics. Additionally, a proper method for identifying CR-AB was determined. Methods: We collected 36 non-duplicate CR-AB clinical isolates resistant to colistin. Antimicrobial susceptibility testing, Sanger sequencing analysis, molecular typing, lipid A structure analysis, and in vitro synergy testing were performed. Eleven colistin-susceptible AB isolates were used as controls. Results: Despite no differences in clinical characteristics between patients with and without prior colistin treatment, resistance-causing genetic mutations were more frequent in isolates from colistin-treated patients. Distinct mutations were overlooked via the Sanger sequencing method, perhaps because of a masking effect by the colistin-susceptible AB subpopulation of CR-AB isolates lacking genetic mutations. However, modified lipid A analysis revealed colistin resistance peaks, despite the population heterogeneity, and peak levels were significantly different between the groups. Conclusions: Although prior colistin use did not induce clinical or susceptibility differences, we demonstrated that identification of CR-AB by sequencing is insufficient. We propose that population heterogeneity has a masking effect, especially in colistin non-treated patients; therefore, accurate testing methods reflecting physiological alterations of the bacteria, such as phosphoethanolamine-modified lipid A identification by matrix-assisted laser desorption ionization-time of flight, should be employed.

키워드

과제정보

연구 과제 주관 기관 : Korean Centers for Disease Control and Prevention

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