Antimicrobial resistance and clonality in Acinetobacter baumannii Nemec, A.

Antimicrobial resistance and clonality in Acinetobacter baumannii

Nemec, A.

Citation

Nemec, A. (2009, September 23). Antimicrobial resistance and clonality in Acinetobacter baumannii. Retrieved from https://hdl.handle.net/1887/14012

Version: Corrected Publisher’s Version

License: Licence agreement concerning inclusion of doctoral thesis in the Institutional Repository of the University of Leiden Downloaded from: https://hdl.handle.net/1887/14012

Note: To cite this publication please use the final published version (if applicable).

CHAPTER 8

6DPHQYDWWLQJ



SAMENVATTING

Acinetobacter baumanniiLVHHQEHODQJULMNH]LHNHQKXLVEDFWHULHGLHYRRUDOELMSDWLsQWHQRS

LQWHQVLYHFDUHDIGHOLQJHQ DDQOHLGLQJ NDQ JHYHQ WRW NRORQLVDWLH HQ LQIHFWLHV 'H EHWURNNHQ

VWDPPHQ ]LMQ GLNZLMOV UHVLVWHQW YRRU PHHUGHUH DQWLELRWLFD ZDDUGRRU EHKDQGHOLQJ YDQ

LQIHFWLHV PRHLOLMN RI ]HOIV RQPRJHOLMN LV +RHZHO RRN JRHG JHYRHOLJHA. baumannii VWDPPHQYRRUNRPHQ]LMQKHWYRRUDOGHPXOWLUHVLVWHQWHVWDPPHQGLH]LFKHSLGHPLVFKRQGHU

SDWLsQWHQNXQQHQYHUVSUHLGHQ,QHHQSXEOLFDWLHGLHYHUVFKHHQLQZHUGYDVWJHVWHOGGDW

WZHHJURHSHQGH]RJHQDDPGH(XURSHVH(8NORQHQ,HQ,,YDQJHQRW\SLVFKYHUZDQWHA.

baumanniiVWDPPHQRYHUKHHUVWHQRQGHULVRODWHQXLWHSLGHPLHsQLQ]LHNHQKXL]HQYHUVSUHLG

RYHU 1RRUGZHVW(XURSD (U ZDV JHHQ EHNHQGH HSLGHPLRORJLVFKH UHODWLH WXVVHQ GH]H

]LHNHQKXL]HQ 'H]H ZDDUQHPLQJ ZHUG RQGHUVWHXQG GRRU HHQ SXEOLFDWLH XLW  ZDDULQ

ZHUGEHVFKUHYHQGDWVWDPPHQGLHYHUZDQWZDUHQDDQGH(8NORQHQ,HQ,,RRNRYHUKHHUVWHQ

onder klinische isolaten van A. baumanniiXLW]LHNHQKXL]HQYHUVSUHLGRYHU7VMHFKLs,QEHLGH

VWXGLHVEOHNHQGHVWDPPHQGLHEHKRRUGHQWRWGH(8NORQHQ,HQ,,YHHOUHVLVWHQWHUWH]LMQYRRU

DQWLELRWLFDGDQDQGHUHVWDPPHQ'LWZDVDDQOHLGLQJWHYHURQGHUVWHOOHQGDWGHNRSSHOLQJYDQ

PXOWLUHVLVWHQWLHHQNORQDOLWHLWHHQUROKHHIWJHVSHHOGELMGHLPPHUYRRUWVFKULMGHQGHWRHQDPH

van resistentie bij Acinetobacter'H]HEHYLQGLQJHQZDUHQDDQOHLGLQJWRWGLWSURHIVFKULIWGDW

]LFKULFKWRSGHUHODWLHWXVVHQGHHSLGHPLRORJLHHQGHPROHFXODLUHEDVLVYDQPHHUYRXGLJH

resistentie voor antibiotica in A. baumannii RSSRSXODWLHQLYHDX+LHUELMLVHHQEHVFKULMYHQGH

en vergelijkende benadering gevolgd waarbij een groot aantal eigenschappen van goed JHGH¿QLHHUGHVWDPPHQFROOHFWLHVZHUGRQGHU]RFKWRPGHUHODWLHWXVVHQPXOWLUHVLVWHQWLHHQ

SRSXODWLHVWUXFWXXUYDQA. baumannii YDVWWHVWHOOHQ'HEHVWXGHHUGHRUJDQLVPHQEHVWRQGHQLQ

KRRIG]DDNXLWNOLQLVFKHLVRODWHQGLHVLQGVZDUHQYHUNUHJHQXLW]LHNHQKXL]HQLQ7VMHFKLs

HQXLWLVRODWHQXLWYHUVFKHLGHQHDQGHUH(XURSHVHODQGHQGLHLQGHDIJHORSHQGHFHQQLDLQGH

GHFXOWXXUFROOHFWLHYDQKHW/HLGV8QLYHUVLWDLU0HGLVFK&HQWUXPZDUHQRSJHQRPHQ

,QGHHHUVWHVWXGLHRQGHU]RFKWHQZLMPHWEHKXOSYDQ$)/3¿QJHUSULQWLQJHQULERW\SHULQJGH

JHQRW\SLVFKHUHODWLHWXVVHQHQHU]LMGV7VMHFKLVFKHA. baumanniiVWDPPHQGLHHHUGHUZDUHQ

LQJHGHHOGLQGH]RJHQDDPGHJURHSHQ$DQG%HQDQGHU]LMGVVWDPPHQYDQGH1RRUGZHVW

(XURSHVHNORQHQ'HVWXGLHFROOHFWLHRPYDWWHPXOWLUHVLVWHQWHHQJHYRHOLJHVWDPPHQ

XLW7VMHFKLsRYHUGHSHULRGHHQUHIHUHQWLHVWDPPHQYDQGH(8NORQHQ,DQG,,'H

UHVXOWDWHQEHYHVWLJGHQGDWGHWZHHRYHUKHHUVHQGHJURHSHQ$HQ%XLW7VMHFKLsJHQRPLVFK

FRQJUXHQWZDUHQPHWGHNORQHQ,HQ,,,QGHYROJHQGHVWXGLHRQGHU]RFKWHQZLMGHGLYHUVLWHLW

YDQGHJHQHQGLHFRGHUHQYRRUDPLQRJO\FRVLGHPRGL¿FHUHQGHHQ]\PHQDOVPHGHGHDVVRFLDWLH

YDQ GH]H HQ]\PHQ PHW NODVVH , LQWHJURQHQ LQ GH EHNHQGH (8NORQHQ LQFOXVLHI GH QLHXZ

EHVFKUHYHQ NORRQ ,,, :LM YRQGHQ GDW NORRQ ,,, ]RZHO LQ UHVLVWHQWLHJHQHQ HQ LQWHJURQHQ

UHODWLHIKRPRJHHQZDVWHUZLMONORRQ,HQ,,HHQRSYDOOHQGHLQWUDNORQDOHGLYHUVLWHLWKDGGHQ

PDDU]RQGHUVFKHUSRQGHUVFKHLGWXVVHQGHNORQHQ(FKWHUELQQHQGH7VMHFKLVFKHNORQHQ,

HQ,,ZDVGHGLYHUVLWHLWYDQUHVLVWHQWLHJHQHQHQLQWHJURQVWUXFWXUHQEHSHUNWLQYHUJHOLMNLQJWRW



6DPHQYDWWLQJ

HOGHUV'LW]RXNXQQHQZRUGHQYHUNODDUGGRRUDDQWHQHPHQGDWHUORFDOHUHVHUYRLUV]LMQYDQ

UHVLVWHQWLHJHQHQHQGDWHUPRJHOLMNKRUL]RQWDOHRYHUGUDFKWLVYDQUHVLVWHQWLHGHWHUPLQDQWHQ

WXVVHQGHWZHHNORQHQ,QWKHGHUGHVWXGLHVWRQGGHYUDDJQDDUGHNOLQLVFKHSLGHPLRORJLVFKH

EHWHNHQLV YDQ GH UHFHQW RQWGHNWH QLHWVSHFL¿HNH HIÀX[SRPS $GH$%& LQA. baumannii FHQWUDDO(HQFROOHFWLHYDQVWDPPHQDINRPVWLJXLW(XURSHVHODQGHQHQLQJH]DPHOG

over een periode van 23 jaar, werd onderzocht op de aanwezigheid van genen die waren JHDVVRFLHHUG PHW KHW HIÀX[V\VWHHP %RYHQGLHQ ZHUG GH GLYHUVLWHLW YDQ GH VWDPPHQ

NORQDDO YHUZDQW RI QLHW RQGHU]RFKW PHW YHUVFKLOOHQGH PHWKRGHQ 'H UHVXOWDWHQ WRRQGHQ

DDQGDWGH$GH$%&JHQHQDDQZH]LJZDUHQLQGHPHHVWHA. baumanniiVWDPPHQLQFOXVLHI

VSRUDGLVFKH VWDPPHQ HQ GDW RYHUH[SUHVVLH YDQ GLW V\VWHHP HHQ DOJHPHQH HLJHQVFKDS LV

YDQPXOWLUHVLVWHQWHVWDPPHQ+HWGRHOYDQGHODDWVWHVWXGLHZDVRPLQ]LFKWWHNULMJHQLQ

GHRSNRPVWYDQFDUEDSHQHPUHVLVWHQWLHYDQDIKHWEHJLQYDQGHMDUHQLQ7VMHFKLs9RRU

dit doel werden klinische isolaten van AcinetobacterLQGHSHULRGHSURVSHFWLHI

LQJH]DPHOGYDQHHQJURRWDDQWDOLQWHQVLYHFDUHDIGHOLQJHQYHUVSUHLGRYHUKHWODQG9DQGH]H

VWDPPHQZHUGKHWJHQRW\SHHQGHDDQZH]LJKHLGYDQUHVLVWHQWLHGHWHUPLQDQWHQEHSDDOG'H

UHVXOWDWHQ WRRQGHQ DDQ GDW GH RSNRPVW YDQ FDUEDSHQHPUHVLVWHQWLH YHUEDQG KLHOG PHW GH

verspreiding van A. baumanniiVWDPPHQGLHEHKRRUGHQWRWHHQVXENORRQYDQ(8NORRQ,,

(UZHUGHHQLQGUXNZHNNHQGHGLYHUVLWHLWLQUHVLVWHQWLHGHWHUPLQDQWHQZDDUJHQRPHQLQGH]H

JURHSYDQQDXZYHUZDQWHVWDPPHQ7RWVORWZRUGHQLQKRRIGVWXN]HVGHYHUVFKLOOHQGHVWXGLHV

LQVDPHQKDQJPHWHONDDUHQLQKHWOLFKWYDQGHPHHVWUHFHQWHRQWZLNNHOLQJHQEHVSURNHQ

'H UHVXOWDWHQ YDQ GLW SURHIVFKULIW GUDJHQ ELM WRW KHW EHHOG GDW GH WRHQHPHQGH UHVLVWHQWLH

voor antibiotica van A. baumanniiLQEHODQJULMNHPDWHVDPHQKDQJWPHWGHDDQZH]LJKHLG

YDQ HHQ EHSHUNW DDQWDO ZLMGYHUVSUHLGH JURHSHQ YDQ QDXZ YHUZDQWH VWDPPHQ NORQHQ

+HW ZDUHQ YRRUDO GH (8NORQHQ , HQ ,, GLH LQ YHUVFKHLGHQH (XURSHVH ODQGHQ YDQDI GH

WDFKWLJHUMDUHQYDQGHYRULJHHHXZGRPLQHHUGHQRQGHUHSLGHPLVFKHVWDPPHQ7HUZLMONORRQ

,DDQYDQNHOLMNYDNHUZHUGJHYRQGHQGDQNORRQ,,WRQHQUHFHQWHVWXGLHVHHQWRHQHPHQGH

DDQZH]LJKHLG YDQ NORRQ ,, DDQ 2Q]H EHYLQGLQJHQ HQ RRN GLH YDQ DQGHUH VWXGLHV ODWHQ

]LHQ GDW UHVLVWHQWLH YRRU FDUEDSHQHPV GH EHODQJULMNVWH DQWLELRWLFD YRRU EHKDQGHOLQJ YDQ

PXOWLUHVLVWHQWHDFLQHWREDFWHUVJHNRSSHOGNDQ]LMQDDQEHSDDOGHJHRJUD¿VFKHVXEJURHSHQ

YDQNORRQ,,'LWVXJJHUHHUWGDWMXLVWGH]HNORRQHHQEHODQJULMNHUROVSHHOWLQGHRQWZLNNHOLQJ

HQYHUVSUHLGLQJYDQFDUEDSHQHPUHVLVWHQWLH2QGHU]RHNXLWGHDIJHORSHQWLMGKHHIWHHQDDQWDO

UHVLVWHQWLHPHFKDQLVPHQLQA. baumanniiJHćGHQWL¿FHHUGHQRRNDDQJHWRRQGGDWYHUVFKLOOHQGH

PHFKDQLVPHQ WHJHOLMNHUWLMG LQ HHQ VWDP DDQZH]LJ NXQQHQ ]LMQ ,QPLGGHOV LV EHNHQG GDW

]RZHO DFWLYDWLH YDQ LQWULQVLHNH UHVLVWHQWLHPHFKDQLVPHQ DOV KRUL]RQWDOH RYHUGUDFKW YDQ

UHVLVWHQWLHJHQHQHHQURONXQQHQVSHOHQELMGHHYROXWLHYDQUHVLVWHQWLHYRRUDQWLELRWLFDYDQGLW

RUJDQLVPH'DDUQDDVWKHEEHQ]HHUUHFHQWHVWXGLHVHHQDDQWDOXQLHNHJHQHWLVFKHVWUXFWXUHQ

JHćGHQWL¿FHHUGGH]RJHQDDPGHUHVLVWHQWLHHLODQGHQGLHHHQJURRWDDQWDOUHVLVWHQWLHJHQHQ

NXQQHQRPYDWWHQHQYHUDQWZRRUGHOLMN]LMQYRRUHHQHQRUPHYDULDWLHDDQUHVLVWHQWLHJHQRW\SHQ

HQ IHQRW\SHQ ELQQHQ NORQDDO HQ HSLGHPLRORJLVFK YHUZDQWH VWDPPHQ $OOHV ELM HONDDU



&KDSWHU

JHYHQGHUHVXOWDWHQYDQGLWSURHIVFKULIWHQGLHXLWGHOLWHUDWXXUDDQOHLGLQJWRWQLHXZHPHHU

IXQGDPHQWHOHYUDJHQ'H]HYUDJHQYRUPHQGHEDVLVYRRUYHUGHURQGHU]RHNPHWDOVGRHOHHQ

EHWHUEHJULSWHNULMJHQYDQGHIDFWRUHQGLHELMGUDJHQWRWKHWYHUPRJHQYDQA. baumanniiRP

UHVLVWHQWLHWHRQWZLNNHOHQWHJHQDOOHPRJHOLMNHNOLQLVFKUHOHYDQWHWKHUDSHXWLFD