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Wiener-Well Y, Tordgman D, Bnaya A, Wolfovitz-Barchad O, Assous MV, Yinnon AM, Ben-Chetrit E. Rate and Risk Factors for Carbapenem Resistant Acinetobacter baumannii Clinical Infections in Colonized Patients. THE ISRAEL MEDICAL ASSOCIATION JOURNAL : IMAJ 2022; 24:235-240. [PMID: 35415982] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
BACKGROUND Carbapenem-resistant Acinetobacter baumannii (CRAB) is an important cause of nosocomial infections. Active surveillance for CRAB carriage to identify and isolate colonized patients is used to reduce transmission. OBJECTIVES To assess the rate and risks of clinical infection among CRAB-carrier and non-carrier patients. METHODS Hospitalized patients from whom CRAB screening-cultures were obtained between January and June 2018 were identified retrospectively. All CRAB-carriers were compared to a convenient sample of non-carriers and were followed to detect development of CRAB clinical infection during admission. RESULTS We compared 115 CRAB carriers to 166 non-carriers. The median age in the study group was 76 years (IQR 71-87) vs. 65 years (55-79) in the non-carriers group (P < 0.001). Residence in a nursing facility, debilitated state, and admission to medical wards vs. intensive care units were more frequent among CRAB-carriers (P < 0.001). Mechanically ventilated patients included 51 CRAB carriers (44%) and 102 non-carriers (61%). Clinical infection developed in 49 patients (17%), primarily CRAB pneumonia. Of the CRAB-carriers and non-carriers, 26/115 (23%) and 23/166 (14%), respectively, developed a clinical infection (P = 0.05). One-third of the ventilated patients were infected. Debilitated state and antibiotic treatment during hospitalization were linked to higher infection rates (P = 0.01). Adjusted analysis showed that mechanical ventilation and CRAB colonization were strongly associated with clinical infection (P < 0.05). CONCLUSIONS The rate of CRAB infection among carriers was high. Mechanical ventilation and CRAB colonization were associated with CRAB clinical infection, primarily pneumonia.
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Hahm C, Chung HS, Lee M. Whole-genome sequencing for the characterization of resistance mechanisms and epidemiology of colistin-resistant Acinetobacter baumannii. PLoS One 2022; 17:e0264335. [PMID: 35245298 PMCID: PMC8896714 DOI: 10.1371/journal.pone.0264335] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2021] [Accepted: 02/08/2022] [Indexed: 11/18/2022] Open
Abstract
Background Multidrug-resistant Acinetobacter baumannii is an important causal pathogen of healthcare-associated infections, and colistin-resistant strains have recently emerged owing to the increased use of colistin. Using next-generation sequencing (NGS), a single whole-genome sequencing (WGS) protocol can identify and type pathogens, analyze genetic relationships among different pathogens, predict pathogenic transmissions, and detect antibiotic resistance genes. However, only a few studies have applied NGS in studying the resistance mechanism and epidemiology of colistin-resistant A. baumannii. This study aimed to elucidate the resistance mechanism of colistin-resistant A. baumannii and analyze its molecular epidemiology through WGS. Materials and methods The subjects in this study were patients who visited a university hospital between 2014 and 2018. Thirty colistin-resistant strains with high minimum inhibitory concentrations were selected from various patient samples, and WGS was performed. Comparative genomic analysis was performed for the 27 colistin-resistant A. baumannii strains using a colistin-susceptible strain as the reference genome. Results The WGS analysis found no mutation for lpxA, lpxC, lpx D, pmrA, pmrB, and mcr1, the genes known to be associated with colistin resistance. Fifty-seven coding sequences (CDS) showed differences; they included 13 CDS with known names and functions that contained 21 genes. From the whole-genome multi-locus sequence typing (wgMLST) and single nucleotide polymorphism (SNP) analyses, two major clusters were found for the colistin-resistant A. baumannii strains. However, no differences were observed by the time of detection for each cluster, the samples, the pattern of antibiotic resistance, or the patient characteristics. In the conventional MLST following the Oxford scheme, the typing result showed ST1809, ST451, ST191, ST1837, and ST369 in the global clone 2 (GC2), without any relation with the results of wgMLST and SNP analyses. Conclusion Based on the findings of the resistance gene analysis through WGS and comparative genomic analysis, the potential genes associated with colistin-resistance or CDS were examined. Furthermore, the analysis of molecular epidemiology through WGS regarding colistin-resistant A. baumannii may prove helpful in preventing infection by multidrug-resistant bacteria and controlling healthcare-associated infections.
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Ababneh Q, Abulaila S, Jaradat Z. Isolation of extensively drug resistant Acinetobacter baumannii from environmental surfaces inside intensive care units. Am J Infect Control 2022; 50:159-165. [PMID: 34520789 DOI: 10.1016/j.ajic.2021.09.001] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2021] [Revised: 09/01/2021] [Accepted: 09/02/2021] [Indexed: 12/15/2022]
Abstract
BACKGROUND Acinetobacter baumannii is a nosocomial pathogen that has emerged as a major threat in the health-care settings, particularly intensive care units (ICUs). The aim of this study was to investigate the prevalence of A. baumannii in the environment of intensive care and emergency units in 4 hospitals in Jordan. METHODS A total of 311 surface and 26 air samples were collected from 6 different ICUs and 2 emergency units. Examined high-touch surfaces included bed rails, sinks, food tables, trolley handles, ventilator inlets, blankets, sheets, door handles, light switches, bedside tables and drawers, curtains, normal saline stands and neonatal incubators. A. baumannii isolates were identified by CHROMagar and confirmed using 2 different PCR assays. All obtained isolates were characterized for their antibiotic resistance phenotypes, biofilm formation capacities and were typed by multi-locus sequence typing. RESULTS Of the 337 samples, 24 A. baumannii isolates were recovered, mostly from surfaces in the internal medicine ICUs. Among the 24 isolates, 10 isolates were classified as extensively-resistant (XDR), harbored the blaOXA-23 like gene and able to form biofilms with varying capacities. ST2 was the most frequent sequence type, with all ST2 isolates classified as XDRs. CONCLUSIONS Our results showed that high-touch surfaces of adult and pediatric ICUs were contaminated with XDR A. baumannii isolates. Therefore, the cleaning practices of the surfaces and equipment surrounding ICU patients should be optimized, and health-care workers should continuously wash their hands and change their gloves constantly to control the spread of this pathogen.
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Fedrigo NH, Xavier DE, Cerdeira L, Fuga B, Marini PVB, Shinohara DR, Carrara-Marroni FE, Lincopan N, Tognim MCB. Genomic insights of Acinetobacter baumannii ST374 reveal wide and increasing resistome and virulome. INFECTION, GENETICS AND EVOLUTION : JOURNAL OF MOLECULAR EPIDEMIOLOGY AND EVOLUTIONARY GENETICS IN INFECTIOUS DISEASES 2022; 97:105148. [PMID: 34801753 DOI: 10.1016/j.meegid.2021.105148] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/17/2021] [Revised: 09/23/2021] [Accepted: 11/15/2021] [Indexed: 06/13/2023]
Abstract
WGS-based surveillance has significantly improved the ability to track global spread and emergence of multidrug-resistant clones of clinically relevant pathogens. In this study, we performed the genomic characterization and comparative analysis of an Acinetobacter baumannii (strain Ac56) belonging to the sequence type ST374, which was isolated for the first time in Brazil, in 1996. Genomic analysis of Ac56 predicted a total of 5373 genes, with 3012 being identical across nine genomes of A. baumannii isolates of ST374 from European, Asian, North and South American countries. GoeBURST analysis grouped ST374 lineages into clonal complex CC3 (international clone IC-III). Resistome analysis of ST374 clone predicted genes associated with resistance to heavy metals and clinically relevant beta-lactams and aminoglycosides antibiotics. In this regard, in two closely related A. baumannii strains, the intrinsic blaADC gene was linked to the insertion sequence ISAba1; including the Ac56 strain, where it has been possibly associated with intermediate susceptibility to meropenem. Other four carbapenem-resistant A. baumannii strains carried the ISAba1/blaOXA-23 gene array, which was associated with the transposon Tn2008 or with Tn2006 in an AbaR4-type resistance island. While most virulence genes were shared for A. baumannii strains of ST374, three isolates from Thailand harbored KL49 capsular loci, previously identified in the hypervirulent A. baumannii LAC-4 strain. Analysis of thirty-four predicted plasmids showed eight major groups, of which GR-6 (LN-1) and GR-2 (LN-2) were prevalent. All strains, including the earliest isolate Ac56 harbored at least one complete prophage, whereas none CRISPR-associated (cas) gene was detected. In summary, genomic data of A. baumannii ST374 reveal a potential of this lineage to become a successful clone.
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Jabeen F, Khan Z, Sohail M, Tahir A, Tipu I, Murtaza Saleem HG. Antibiotic Resistance Pattern Of Acinetobacter Baumannii Isolated From Bacteremia Patients In Pakistan. J Ayub Med Coll Abbottabad 2022; 34:95-100. [PMID: 35466635 DOI: 10.55519/jamc-01-9105] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
BACKGROUND Acinetobacter baumannii causes a number of life-threatening infections in Hospitalized patients attributed to its ability to develop resistance against multiple antibiotics. The current scrutinisation is aimed to observe the prevalence and antibiotic resistance profile of A. baumannii strains isolated from blood of tertiary care Hospitalized patients in Lahore, Pakistan. METHODS This research is a retrospective study conducted over a period of one year where 1864 blood samples were collected from both male and female patients with septicaemia. Total 156 A. baumannii species were identified by conventional method and their antimicrobial resistance pattern against 22 antimicrobials (representing all known classes of antibiotics) was evaluated by Kirby Bauer disc diffusion method. MICs of colistin, polymyxin B and vancomycin against A. baumannii were calculated by E test and broth dilution method. RESULTS More males (n=97, 62%) were found infected than females (n=59, 38%). The spreading rate of A. baumannii was highest (n=101, 65%) in patients of age ≤20 years, and lowest (n=12, 7%) in the patients with the age of 41-60 years. Most of the strains of A. baumannii (n=118, 75.6%) were found to be MDR (multi drug resistant), 37 (23.7%) strains were XDR (Extensively drug-resistant) and only 1 (0.05%) strain was PDR (pandrug resistant). All the strains were sensitive to minocycline and tigecycline whereas highest non-susceptibility (n=144, 92%) was seen against Ampicillin-Sulbactam. Most of the strains demonstrated resistance against carbapenem and cephalosporin beckoning that A. baumannii can no longer be considered for salvage therapy by carbapenem. MICs of colistin, polymyxin B and vancomycin against A. baumannii divulged polymixin B as the most effective drug. CONCLUSIONS Use of wide range of drugs has made A. baumannii multidrug resistant. Colistin, polymyxin B and vancomycin are the preferable drugs for the treatment of A. baumannii infections.
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Jung J, Choe PG, Choi S, Kim E, Lee HY, Kang CK, Lee J, Park WB, Lee S, Kim NJ, Choi EH, Oh M. Reduction in the acquisition rate of carbapenem-resistant Acinetobacter baumannii (CRAB) after room privatization in an intensive care unit. J Hosp Infect 2021; 121:14-21. [PMID: 34929231 DOI: 10.1016/j.jhin.2021.12.012] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2021] [Revised: 12/08/2021] [Accepted: 12/12/2021] [Indexed: 11/17/2022]
Abstract
BACKGROUND Acinetobacter baumannii is one of the major pathogens responsible for healthcare-associated infections, especially in intensive care units (ICUs). AIM To evaluate the effect of room privatization in an ICU on the acquisition of carbapenem-resistant A. baumannii (CRAB). METHODS Between March and August 2017, a medical ICU was renovated from a multibed bay room to single rooms. Acquisition of CRAB was compared between patients admitted to the ICU over 18 months pre-renovation (September 2015 to February 2017) and post-renovation (September 2017 to February 2019). A Cox proportional hazard model was used with adjustment for demographics and comorbidities. FINDINGS Of the 901 patients, who contributed 8,276 patient-days, 95 (10.5%) acquired CRAB during their ICU stay. The CRAB acquisition rate was significantly higher during the pre-renovation period (1.87 per 100 patient-days) than during the post-renovation period (0.39 per 100 patient-days) (P < 0.001). In the multivariable Cox regression model, CRAB acquisition was significantly associated with the presence of a feeding tube (adjusted hazard ratio [aHR], 6.08; 95% confidence interval [CI], 2.46-15.06; P < 0.001), continuous renal replacement therapy (aHR, 1.66; 95% CI, 1.09-2.53; P = 0.019) and admission after renovation of the ICU to single rooms (aHR, 0.23; 95% CI, 0.12-0.41; P < 0.001). CONCLUSIONS Renovation of ICUs to single rooms is an efficient strategy to prevent transmission of multidrug-resistant organisms and hospital-acquired infections.
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Ababneh Q, Aldaken N, Jaradat Z, Al Sbei S, Alawneh D, Al-Zoubi E, Alhomsi T, Saadoun I. Molecular epidemiology of carbapenem-resistant Acinetobacter baumannii isolated from three major hospitals in Jordan. Int J Clin Pract 2021; 75:e14998. [PMID: 34714567 DOI: 10.1111/ijcp.14998] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2021] [Accepted: 10/27/2021] [Indexed: 12/01/2022] Open
Abstract
BACKGROUND In the last decade, incidences of carbapenem-resistant Acinetobacter baumannii have been increasingly reported worldwide. Consequently, A. baumannii was included in the World Health Organization's new list of critical pathogens, for which new drugs are desperately needed. The objective of this research was to study the molecular epidemiology and antimicrobial susceptibility of clinical carbapenem-resistant A. baumannii isolated from Jordanian hospitals. METHODS A total of 78 A. baumannii and 8 Acinetobacter spp. isolates were collected from three major hospitals in Jordan during 2018. Disc diffusion and microdilution methods were used to test their susceptibility against 19 antimicrobial agents. Multilocus sequence typing (MLST) was performed using the Pasteur scheme, followed by eBURST analysis for all isolates. PCR was used to detect β-lactam resistance genes, blaOXA-23-like , blaOXA-51-like , and blaNDM-1 . RESULTS Of the 86 tested isolates, 78 (90.6%) exhibited resistance to carbapenems, whereas no resistance was recorded to tigecycline or polymyxins. Based on the resistance profiles, 10.4% and 84.8% of isolates were classified into multidrug resistant (MDR) or extensively drug resistant (XDR), respectively. The most prevalent carbapenems resistance genes amongst isolates were blaOXA-51-Like (89.5%), followed by blaOXA-23-Like (88.3%) and blaNDM-1 (10.4%). MLST revealed the presence of 19 sequence types (STs), belonging to eight different international complexes. The most commonly detected clonal complex (CC) was CC2, representing 64% of all typed isolates. CONCLUSIONS This is the first study to report the clonal diversity of A. baumannii isolates in Jordan. A high incidence of carbapenem resistance was detected in the isolates investigated. In addition, our findings provided evidence for the widespread of blaOXA-23-like harbouring carbapenem-resistant A. baumannii and belonging to CC2. The number of XDR isolates identified in this study is alarming. Thus, periodic surveillance and molecular epidemiological studies of resistance factors are important to improve treatment outcomes and prevent the spread of A. baumannii infections.
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Huertas Vaquero M, Asencio Egea MA, Carranza González R, Padilla Serrano A, Conde García MC, Tenias Burillo JM, Redondo González O. Association between antibiotic pressure and the risk of colonization/infection by multidrug-resistant Acinetobacter baumannii complex: a time series analysis. REVISTA ESPAÑOLA DE QUIMIOTERAPIA 2021; 34:623-630. [PMID: 34610732 PMCID: PMC8638773 DOI: 10.37201/req/061.2021] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
Introduction. To analyze the association between antibiotic pressure and the risk of colonization/infection by Acinetobacter baumannii complex (AB), evaluating both the individual and general prescriptions of antibiotics. Methods. This is an analytical, observational, case-control study on patients admitted to an Intensive Care Unit (ICU) during an AB outbreak (14 months). A five-year time series was constructed with the monthly incidence of cases of infection/colonization with strains of AB resistant to each antibiotic administered and with the monthly consumption of these antibiotics in the ICU. Results. We identified 40 patients either infected (23) or colonized (17) by AB and 73 controls. We found an epidemic multidrug-resistant clone of AB in 75% of cases. Risk factors associated with the development of AB infection/colonization were: greater use of medical instruments, the presence of a tracheostomy, cutaneous ulcers, surgical lesions and prior antibiotic therapies. The regression analysis of individual use of antibiotics showed that prior treatment with ceftazidime, ceftriaxone, amoxicillin/clavulanate, imipenem, levofloxacin, linezolid, and vancomycin was a risk factor for acquiring AB. ARIMA models showed that the relationship were greatest and statistically significant when the treatment occurred between 6 months (ceftazidime) and 9 months (imipenem and levofloxacin) prior. Conclusions. The dynamic and aggregate relationship between the incidence of infection/colonization by multidrug-resistant strains of AB and prior antibiotic treatment was statistically significant for intervals of 6 to 9 months.
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Sana F, Hussain A, Hussain W, Zaman G, Abbas MW, Imtiaz A, Satti L. Frequency And Clinical Spectrum Of Multidrug Resistant Acinetobacter Baumannii As A Significant Nosocomial Pathogen In Intensive Care Unit Patients. J Ayub Med Coll Abbottabad 2021; 33(Suppl 1):S752-S756. [PMID: 35077621] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
BACKGROUND Acinetobacter baumannii has emerged as one of the leading causes of multidrug resistant nosocomial infections worldwide. It is able to survive in hospital environment and build up diverse resistance mechanisms making it difficult to treat with current antibiotics. Objective: It was to determine the frequency and patterns of Acinetobacter baumannii in intensive care units (ICU) settings. METHODS A cross sectional study was carried out in the Department of Microbiology, Armed Forces Institute of Pathology, Rawalpindi, from 1st July 2017 to 30th June 2019. A total of 603 non-duplicate clinical specimens were received from intensive care units. Specimens yielding growth of multidrug resistant Acinetobacter baumannii, were evaluated as per standard protocol. The antimicrobial sensitivity testing was performed as per Clinical and Laboratory Standard Institute guidelines (2017-2018). RESULTS Among Acinetobacter baumannii (310 isolates), 5% were multidrug resistant, 93% extensively drug resistant and 1% pan drug resistant. Percentage of carbapenem resistant strains was 92%. In drugs like tigecycline and polymyxin, resistance was noted as 73% and 1% respectively. High yield of this superbug was mainly obtained from respiratory specimens (43.5%), whereas 24% were detected from wound infections and 29% from other samples. . CONCLUSION This study showed a rapidly increasing resistance in Acinetobacter baumannii. Therefore, polymyxin remains the only option in our intensive care units, but its usage as empirical therapy in our setting has led to the emergence of resistance to this drug. Implementing infection control practices, antimicrobial stewardship and restricted use of polymyxin can play a significant role in reducing health care burden.
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Chilam J, Argimón S, Limas MT, Masim ML, Gayeta JM, Lagrada ML, Olorosa AM, Cohen V, Hernandez LT, Jeffrey B, Abudahab K, Hufano CM, Sia SB, Holden MT, Stelling J, Aanensen DM, Carlos CC. Genomic surveillance of Acinetobacter baumannii in the Philippines, 2013-2014. Western Pac Surveill Response J 2021; 12:1-15. [PMID: 35251744 PMCID: PMC8873916 DOI: 10.5365/wpsar.2021.12.4.863] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
OBJECTIVE Acinetobacter baumannii is an opportunistic nosocomial pathogen that has increasingly become resistant to carbapenems worldwide. In the Philippines, rates of carbapenem resistance and multidrug resistance are above 50%. We undertook a genomic study of carbapenem-resistant A. baumannii in the Philippines to characterize the population diversity and antimicrobial resistance mechanisms. METHODS We sequenced the whole genomes of 117 A. baumannii isolates recovered by 16 hospitals in the Philippines between 2013 and 2014. From the genome sequences, we determined the multilocus sequence type, presence of acquired determinants of antimicrobial resistance and relatedness between isolates. We also compared the phenotypic and genotypic resistance results. RESULTS Carbapenem resistance was mainly explained by acquisition of the class-D β-lactamase gene blaOXA-23. The concordance between phenotypic and genotypic resistance to imipenem was 98.15%, and it was 94.97% overall for the seven antibiotics analysed. Twenty-two different sequence types were identified, including 7 novel types. The population was dominated by the high-risk international clone 2 (i.e. clonal complex 92), in particular by ST195 and ST208 and their single locus variants. Using whole-genome sequencing, we identified local clusters representing potentially undetected nosocomial outbreaks, as well as multihospital clusters that indicated interhospital dissemination. Comparison with global genomes suggested that the establishment of carbapenem-resistant international clone 2 in the Philippines is likely the result of clonal expansion and geographical dissemination, and at least partly explained by inadequate hospital infection control and prevention. DISCUSSION This is the first extensive genomic study of carbapenem-resistant A. baumannii in the Philippines, and it underscores the importance of hospital infection control and prevention measures to contain high-risk clones.
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Abdollahi A, Aliramezani A, Salehi M, Norouzi Shadehi M, Ghourchian S, Douraghi M. Co-infection of ST2 IP carbapenem-resistant Acinetobacter baumannii with SARS-CoV-2 in the patients admitted to a Tehran tertiary referral hospital. BMC Infect Dis 2021; 21:927. [PMID: 34496774 PMCID: PMC8423834 DOI: 10.1186/s12879-021-06642-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2021] [Accepted: 08/28/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Carbapenem-resistant Acinetobacter baumannii (CRAB) is among the most concerning cause of healthcare-associated infections (HAI) due to its high level of antibiotic resistance and high mortality. In the era of the COVID-19 pandemic, the key priority of infection control committees is to contain the dissemination of antibiotic resistant Gram-negative bacteria. Here, we aimed to timely recognize the emergence of CRAB in COVID-19 cases admitted to the wards of a tertiary referral hospital and to identify the genetic relatedness of the isolates. METHODS From 30 March to 30 May 2020, a total of 242 clinical samples from COVID-19 cases were screened for CRAB isolates using standard microbiologic and antibiotic susceptibility tests. The PCRs targeting oxa23, oxa24, oxa58, blaTEM and blaNDM-1 genes were performed. Two multiplex PCRs for identifying the global clones (GC) of A. baumannii were also performed. The sequence type of CRABs was determined using Institut Pasteur (IP) multilocus sequence typing (MLST) scheme. RESULTS Eighteen CRAB isolates were recovered from COVID-19 patients with the mean age of 63.94 ± 13.8 years. All but 4 COVID-19 patients co-infected with CRAB were suffering from an underlying disease. Death was recorded as the outcome in ICUs for 9 (50%) COVID-19 patients co-infected with CRAB. The CRAB isolates belong to GC2 and ST2IP and carried the oxa23 carbapenem resistance gene. CONCLUSION This study demonstrated the co-infection of CRAB isolates and SARS-CoV-2 in the patients admitted to different ICUs at a referral hospital in Tehran. The CRAB isolates were found to belong to ST2IP, share the oxa23 gene and to have caused several outbreaks in the wards admitting COVID-19 patients.
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McKinsey DS, Gasser C, McKinsey JP, Ditto G, Agard A, Zellmer B, Poteete C, Vagnone PS, Dale JL, Bos J, Hahn R, Turabelidze G, Poiry M, Franklin P, Vlachos N, McAllister GA, Halpin AL, Glowicz J, Ham DC, Epstein L. A comprehensive approach to ending an outbreak of rare bla OXA-72 gene-positive carbapenem-resistant Acinetobacter baumannii at a Community Hospital, Kansas City, MO, 2018. Am J Infect Control 2021; 49:1183-1185. [PMID: 33839188 DOI: 10.1016/j.ajic.2021.03.022] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2021] [Revised: 03/30/2021] [Accepted: 03/31/2021] [Indexed: 02/01/2023]
Abstract
We identified a cluster of extensively drug-resistant, carbapenemase gene-positive, carbapenem-resistant Acinetobacter baumannii (CP-CRAB) at a teaching hospital in Kansas City. Extensively drug-resistant CRAB was identified from eight patients and 3% of environmental cultures. We used patient cohorting and targeted environmental disinfection to stop transmission. After implementation of these measures, no additional cases were identified.
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Hassan RM, Salem ST, Hassan SIM, Hegab AS, Elkholy YS. Molecular characterization of carbapenem-resistant Acinetobacter baumannii clinical isolates from Egyptian patients. PLoS One 2021; 16:e0251508. [PMID: 34166384 PMCID: PMC8224909 DOI: 10.1371/journal.pone.0251508] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2021] [Accepted: 04/27/2021] [Indexed: 11/18/2022] Open
Abstract
Acinetobacter baumannii (A. baumannii) represents a global threat owing to its ability to resist most of the currently available antimicrobial agents. Moreover, emergence of carbapenem resistant A. baumannii (CR-AB) isolates limits the available treatment options. Enzymatic degradation by variety of ß-lactamases, have been identified as the most common mechanism of carbapenem resistance in A. baumannii. The alarming increase in the prevalence of CR-AB necessitates continuous screening and molecular characterization to appreciate the problem. The present study was performed to assess the prevalence and characterize carbapenemases among 206 CR-AB isolated from various clinical specimens collected from different intensive care units at Kasr Al-Aini Hospital. All isolates were confirmed to be A. baumannii by detection of the blaOXA-51-like gene. Molecular screening of 13 common Ambler class bla carbapenemases genes in addition to insertion sequence (IS-1) upstream OXA-23 were performed by using four sets of multiplex PCR, followed by identification using gene sequencing technology. Among the investigated genes, the prevalence of blaOXA-23, and blaOXA-58 were 77.7%, and 1.9%, respectively. The ISAba1 was detected in 10% of the blaOXA-23 positive isolates. The prevalence of metallo-β-lactamases (MBLs) studied; blaNDM-1, blaSPM, blaVIM, blaSIM-1 were 11.7%, 6.3%, 0.5%, and 0.5% respectively. One of class A; bla KPC was detected in 10.7% of the investigated isolates. blaOXA-24/40, blaIMP, blaGES, blaVEB and blaGIM were not detected in any of the studied isolates. Moreover, 18.4% of the isolates have shown to harbor two or more of the screened bla genes. We concluded that the most prevalent type of ß-lactamases genes among CR-AB isolates collected from Egyptian patients were blaOXA-23 followed by blaNDM-1 and blaKPC.
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Rabea RA, Zaki MES, Fahmy EM, Fathelbab A. Molecular Study of Nodulation Division Genes and Integron Genes in Acinetobacter baumannii. Clin Lab 2021; 66. [PMID: 32902213 DOI: 10.7754/clin.lab.2020.200124] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
BACKGROUND Acinetobacter is an opportunistic bacterial pathogen, primarily associated with hospital-acquired infections. Antibiotic resistance in Acinetobacter is mainly mediated by efflux systems. This study aimed to identify the prevalence of adeA, adeI, adeJ, and adeY genes in Acinetobacter baumannii (A. baumannii) by PCR, assess the presence of integron genes by polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP), and relate the presence of these genes to antimicrobial resistance of the clinically isolated A. baumannii. METHODS The study included identification of Acinetobacter spp. and antimicrobial antibiotic susceptibility. PCR was performed for adeA, adeI, adeJ, and adeY genes. Detection of Integron (Intl) system was performed by PCR followed by restriction fragment length polymorphism (PCR-RFLP). RESULTS The frequency of Ade genes among isolates were 66%, 62%, 60%, and 2% for AdeJ, AdeI, AdeA, and AdeY genes, respectively. The intI gene was detected in 10% of the isolates. There was a statistically significant difference in resistance to amikacin, gentamicin, and tetracycline between A. baumanii positive. The most frequent association was between AdeJ, AdeA, and AdeI (31%). CONCLUSIONS Our study highlighted the high prevalence of AdeJ, AdeI, and AdeA in A. baumannii. Integron gene was detected with considerable frequency. There was a statistically significant association of these genes with resistance to aminoglycosides and tetracycline.
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Bogue AL, Panmanee W, McDaniel CT, Mortensen JE, Kamau E, Actis LA, Johannigman JA, Schurr MJ, Satish L, Kotagiri N, Hassett DJ. AB569, a non-toxic combination of acidified nitrite and EDTA, is effective at killing the notorious Iraq/Afghanistan combat wound pathogens, multi-drug resistant Acinetobacter baumannii and Acinetobacter spp. PLoS One 2021; 16:e0247513. [PMID: 33657146 PMCID: PMC7928478 DOI: 10.1371/journal.pone.0247513] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2020] [Accepted: 02/08/2021] [Indexed: 11/19/2022] Open
Abstract
Multi-drug resistant (MDR) Acinetobacter baumannii (Ab) and Acinetobacter spp. present monumental global health challenges. These organisms represent model Gram-negative pathogens with known antibiotic resistance and biofilm-forming properties. Herein, a novel, nontoxic biocide, AB569, consisting of acidified nitrite (A-NO2-) and ethylenediaminetetraacetic acid (EDTA), demonstrated bactericidal activity against all Ab and Acinetobacter spp. strains, respectively. Average fractional inhibitory concentrations (FICs) of 0.25 mM EDTA plus 4 mM A-NO2- were observed across several clinical reference and multiple combat wound isolates from the Iraq/Afghanistan wars. Importantly, toxicity testing on human dermal fibroblasts (HDFa) revealed an upper toxicity limit of 3 mM EDTA plus 64 mM A-NO2-, and thus are in the therapeutic range for effective Ab and Acinetobacter spp. treatment. Following treatment of Ab strain ATCC 19606 with AB569, quantitative PCR analysis of selected genes products to be responsive to AB569 revealed up-regulation of iron regulated genes involved in siderophore production, siderophore biosynthesis non-ribosomal peptide synthetase module (SBNRPSM), and siderophore biosynthesis protein monooxygenase (SBPM) when compared to untreated organisms. Taken together, treating Ab infections with AB569 at inhibitory concentrations reveals the potential clinical application of preventing Ab from gaining an early growth advantage during infection followed by extensive bactericidal activity upon subsequent exposures.
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Grisold AJ, Luxner J, Bedenić B, Diab-Elschahawi M, Berktold M, Wechsler-Fördös A, Zarfel GE. Diversity of Oxacillinases and Sequence Types in Carbapenem-Resistant Acinetobacter baumannii from Austria. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18042171. [PMID: 33672170 PMCID: PMC7926329 DOI: 10.3390/ijerph18042171] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/11/2021] [Revised: 02/17/2021] [Accepted: 02/18/2021] [Indexed: 12/20/2022]
Abstract
Carbapenem-resistant Acinetobacter baumannii is a significant health problem worldwide. A multicenter study on A. baumannii was performed to investigate the molecular epidemiology and genetic background of carbapenem resistance of A. baumannii isolates collected from 2014–2017 in Austria. In total, 117 non-repetitive Acinetobacter spp. assigned to A. baumannii (n = 114) and A. pittii (n = 3) were collected from four centers in Austria. The isolates were uniformly resistant to piperacillin/tazobactam, ceftazidime, and carbapenems, and resistance to imipenem and meropenem was 97.4% and 98.2%, respectively. The most prominent OXA-types were OXA-58-like (46.5%) and OXA-23-like (41.2%), followed by OXA-24-like (10.5%), with notable regional differences. Carbapenem-hydrolyzing class D carbapenemases (CHDLs) were the only carbapenemases found in A.baumannii isolates in Austria since no metallo-β-lactamases (MBLs) nor KPC or GES carbapenemases were detected in any of the isolates. One-third of the isolates harbored multiple CHDLs. The population structure of A. baumannii isolates from Austria was found to be very diverse, while a total of twenty-three different sequence types (STs) were identified. The most frequent was ST195 found in 15.8%, followed by ST218 and ST231 equally found in 11.4% of isolates. Two new ST types, ST2025 and ST2026, were detected. In one A. pittii isolate, blaOXA-143-like was detected for the first time in Austria.
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Redondo González O, Lorenzo Prieto I, Cobos López J, Bravo Villaseñor CM, Martínez NM, Oteo Iglesias J. [Carbapenamase OXA-23 like-producing Acinetobacter baumanii epidemic outbreak in a hospitalization unit.]. Rev Esp Salud Publica 2021; 95:e202102027. [PMID: 33576346] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2019] [Accepted: 12/26/2020] [Indexed: 06/12/2023] Open
Abstract
OBJECTIVE Despite its great ubiquity and morbidity and mortality, the scientific evidence on the hospital control of multiresistant Acinetobacter baumanii (ABMR) outside the Intensive Care Units in Spain is scarce. The objective was to describe an epidemic outbreak by MRAB and analyze the effectiveness of the actions carried out. METHODS Prospective observational study of admitted-rotated patients in a multipathological control at the University Hospital of Guadalajara, Spain, during the outbreak (September 20-November 3, 2017); using Mambrino Electronic Health Record. A genetic study of the resistance mechanism and molecular characterization of the strains were carried out. Frequency measurements were estimated, with subsequent comparative analysis of cases vs controls. RESULTS The median age of the study population (N=138) was 83.2 years (Interquartile Range [IR]=69.7-90.1). There were 3 cases of ABMR infection among them. Thirteen percent required issolation, 17% because of MRAB. The MRAB incidence was 2.2 cases/100 admitted-rotated (mortality rate=33%). The excess stay for cases was 17±4.3 (95%CI=8.5-25.6), with an incidence density of 3 cases/103 days. The responsible strain was carbapenemase OXA-23. We found a single case in the colonization study of contacts. No MRAB was isolated from environmental samples. CONCLUSIONS Along with epidemiological research, coordination and compliance with precautions; prompt identification and management of an outbreak are crucial to minimize the colonization pressure and to stop dissemination.
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Szczypta A, Talaga-Ćwiertnia K, Kielar M, Krzyściak P, Gajewska A, Szura M, Bulanda M, Chmielarczyk A. Investigation of Acinetobacter baumannii Activity in Vascular Surgery Units through Epidemiological Management Based on the Analysis of Antimicrobial Resistance, Biofilm Formation and Genotyping. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18041563. [PMID: 33562194 PMCID: PMC7915860 DOI: 10.3390/ijerph18041563] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/22/2020] [Revised: 02/01/2021] [Accepted: 02/02/2021] [Indexed: 12/17/2022]
Abstract
Background/Objectives: The genus Acinetobacter demonstrates resistance to antibiotics and has been shown to spread in the hospital environment causing epidemic outbreaks among hospitalized patients. The objectives of the present study was to investigate the antibiotic resistance, biofilm formation, and clonality among Acinetobacter baumannii strains. Materials and Methods: The study involved 6 (I Outbreak) and 3 (II Outbreak) A. baumannii strains isolated from patients hospitalized in vascular surgery unit. Results: All tested A. baumannii strains were extensively drug resistant (XDR) and all the isolates were carbapenem-resistant and among them, all carried the blaOXA-51 gene, the blaOXA-24 gene, as well as the blaOXA-23 gene. All of the investigated strains had the ability to form a biofilm, but all of them produced less biofilm than the reference strain. Multi-locus sequence typing (MLST) showed that all strains belonged to the ST2 clone. Pulsed-field gel electrophoresis (PFGE) divided the tested outbreak strains into two clones (A and B). Conclusion: This study shows a nosocomial spread of XDR A. baumannii ST2 having the blaOXA-51 gene, the blaOXA-24 gene, as well as the blaOXA-23 gene, low biofilm formers, that was prevalent in the vascular surgery unit. To identify the current situation of vascular surgery departments targeted epidemiological investigation was needed. Effective implementation of infection control prevented the spread of the epidemic outbreaks.
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Konca C, Tekin M, Geyik M. Susceptibility Patterns of Multidrug-Resistant Acinetobacter baumannii. Indian J Pediatr 2021; 88:120-126. [PMID: 32500488 PMCID: PMC7271137 DOI: 10.1007/s12098-020-03346-4] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2019] [Accepted: 05/11/2020] [Indexed: 11/25/2022]
Abstract
OBJECTIVES To investigate the antimicrobial resistance patterns of multidrug-resistant Acinetobacter baumannii (MDRAB) in patients in pediatric intensive care units (PICU) in order to determine a guide for the empirical antibiotic treatment of MDRAB. METHODS The authors retrospectively evaluated the medical records of patients with MDRAB infections in the PICU during a follow-up period, between January 2015 and January 2017. The identification of A. baumannii was performed using a BD Phoenix 100 Automated Microbiology System. A BD Phoenix NMIC/ID-400 commercial kit was used to test antibiotic susceptibility. All data was entered into Microsoft Excel, and the data was analyzed using SPSS version 23.0. RESULTS The mean age of the patients was 8.1 ± 6.2 y. In all, 46 isolates were obtained from 33 patients. The most effective antimicrobial agents were colistin, trimethoprim/sulfamethoxazole, and tigecycline. Nevertheless, with the exception of colistin, no antibiotic was associated with a susceptibility rate of >45% for the isolates. Low sensitivities in 2015 to tigecycline, aminoglycosides, levofloxacin, and carbapenems had been lost in 2016. CONCLUSIONS Many drugs that were previously effective against MDRAB, have lost their effectiveness. Currently, there is no effective drug to fight MDRAB, apart from colistin. Thus, it is clear that new drugs and treatment protocols should be developed urgently.
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de Barcellos TAF, Bueno MS, Cunha MPV, Nagamori FO, de Carvalho E, Takagi EH, Moreno LZ, Moreno AM, Chimara E, Tiba-Casas MR, Camargo CH. Silent mutations in ribosomal protein genes are associated with high-risk clones of carbapenem-resistant Acinetobacter baumannii prevalent in Brazil. INFECTION GENETICS AND EVOLUTION 2020; 88:104686. [PMID: 33359045 DOI: 10.1016/j.meegid.2020.104686] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 10/22/2020] [Revised: 12/09/2020] [Accepted: 12/19/2020] [Indexed: 11/18/2022]
Abstract
OBJECTIVES To analyze the relationship of ribosomal protein mutations and clonality of high-risk clones Acinetobacter baumannii. METHODS Seventy-nine carbapenem-resistant A. baumannii were subjected to whole-genome sequencing (Illumina NextSeq), and codifying sequences of ribosomal proteins were extracted and screened for mutations. MALDI-TOF MS analysis (Bruker Biotyper) and Spectra data from MALDI-TOF was employed to generate a dendrogram based on principal component analysis (PCA) data. Clones were identified by Multilocus sequencing typing (MLST) based on WGS. RESULTS Ribosomal RNA protein sequences extracted from the genomes identified mutations that were associated with clonal complexes, but most of them were silent. PCA did not cluster the isolates according to their clonality identified by MLST. CONCLUSIONS By comparing the nucleotide and amino acid sequences of diversified A. baumannii, and Bruker Biotyper profiles, we showed that silent mutations in ribosomal RNA nucleotides are associated with clonal complexes, but since most of the mutations were silent, MALDI-TOF MS raw data was not a useful tool for typing the high-risk clones of this species.
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He S, Li Z, Yang Q, Quan M, Zhao L, Hong Z. Resistance Trends Among 1,294 Nosocomial Acinetobacter baumannii Strains from a Tertiary General Hospital in China, 2014 - 2017. Clin Lab 2020; 66. [PMID: 32162874 DOI: 10.7754/clin.lab.2019.190629] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
BACKGROUND To analyze the difference of the antibiotic resistance of Acinetobacter baumannii (A. baumannii) isolated from our hospital between 2014 and 2017. METHODS We retrospectively evaluated the patients with a confirmed diagnosis of A. baumannii infection at a tertiary general hospital in Guilin during the period between January 2014 and December 2017. The following clinical and demographic data were collected: age, gender, specimens, microbiology results, and antibiotic resistance patterns of isolates. Bacterial identification and susceptibility testing were performed using MALDI-TOF MS and VITEK 2 COMPACT systems. The results were analyzed according to the Clinical and Laboratory Standards Institute (CLSI) 2018 definitions. RESULTS From 2014 to 2017, 1,294 strains of A. baumannii were detected, 41.5% of which came from ICU. The sputum separation rate from ICU was significantly higher than those from non-ICU (p < 0.05). Except for amikacin, levofloxacin, and compound sulfamethoxazole, the resistant rates of the others increased year by year. Meanwhile, the resistance rate of carbapenem-resistant A. baumannii in our hospital showed a significant upward trend and exceeded the average of the national level in 2016 - 2017. CONCLUSIONS The drug resistance of A. baumannii has generally increased, and active measures have been taken to develop the combined application of antibiotics. Further studies should focus on the judicious use of available antibiotics and implementation of strict infection control measures to avoid the rapid spread or clonal dissemination of A. baumannii in healthcare facilities.
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Perez S, Innes GK, Walters MS, Mehr J, Arias J, Greeley R, Chew D. Increase in Hospital-Acquired Carbapenem-Resistant Acinetobacter baumannii Infection and Colonization in an Acute Care Hospital During a Surge in COVID-19 Admissions - New Jersey, February-July 2020. MMWR-MORBIDITY AND MORTALITY WEEKLY REPORT 2020; 69:1827-1831. [PMID: 33270611 PMCID: PMC7714028 DOI: 10.15585/mmwr.mm6948e1] [Citation(s) in RCA: 127] [Impact Index Per Article: 31.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Ribeiro EA, Gales AC, de Oliveira APS, Coelho DD, de Oliveira RA, Pfrimer IAH, do Carmo JR. Molecular epidemiology and drug resistance of Acinetobacter baumannii isolated from a regional hospital in the Brazilian Amazon region. Rev Soc Bras Med Trop 2020; 54:e20200087. [PMID: 33206875 PMCID: PMC7670758 DOI: 10.1590/0037-8682-0087-2020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2020] [Accepted: 06/18/2020] [Indexed: 11/21/2022] Open
Abstract
INTRODUCTION In this study, we report a clonal dissemination of carbapenem resistant Acinetobacter baumannii isolates due to the acquisition of blaOXA-23 in a regional hospital located in Brazilian Amazon Region. METHODS The isolates were identified by MALDI-TOF and the carbapenemase-encoding genes were detected by multiplex-PCR. The genetic similarity was investigated by pulsed-field gel electrophoresis (PFGE). RESULTS Only 10 (55.6%) isolates harbored the gene bla OXA-23. PFGE analysis revealed that these isolates belong to a single clone. CONCLUSIONS This dissemination strategy indicates the need for surveillance, adoption of control procedures defined in guidelines, and the careful administration of antimicrobials should be reinforced.
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Kurihara MNL, de Sales RO, da Silva KE, Maciel WG, Simionatto S. Multidrug-resistant Acinetobacter baumannii outbreaks: a global problem in healthcare settings. Rev Soc Bras Med Trop 2020; 53:e20200248. [PMID: 33174956 PMCID: PMC7670754 DOI: 10.1590/0037-8682-0248-2020] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Accepted: 09/02/2020] [Indexed: 12/26/2022] Open
Abstract
INTRODUCTION The increase in the prevalence of multidrug-resistant Acinetobacter baumannii infections in hospital settings has rapidly emerged worldwide as a serious health problem. METHODS This review synthetizes the epidemiology of multidrug-resistant A. baumannii, highlighting resistance mechanisms. CONCLUSIONS Understanding the genetic mechanisms of resistance as well as the associated risk factors is critical to develop and implement adequate measures to control and prevent acquisition of nosocomial infections, especially in an intensive care unit setting.
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Duszynska W, Rosenthal VD, Szczesny A, Zajaczkowska K, Fulek M, Tomaszewski J. Device associated -health care associated infections monitoring, prevention and cost assessment at intensive care unit of University Hospital in Poland (2015-2017). BMC Infect Dis 2020; 20:761. [PMID: 33066740 PMCID: PMC7562760 DOI: 10.1186/s12879-020-05482-w] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2020] [Accepted: 10/06/2020] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND Device-associated health care-associated infections (DA-HAIs) in intensive care unit (ICU) patients constitute a major therapeutic issue complicating the regular hospitalisation process and having influence on patients' condition, length of hospitalisation, mortality and therapy cost. METHODS The study involved all patients treated > 48 h at ICU of the Medical University Teaching Hospital (Poland) from 1.01.2015 to 31.12.2017. The study showed the surveillance and prevention of DA-HAIs on International Nosocomial Infection Control Consortium (INICC) Surveillance Online System (ISOS) 3 online platform according to methodology of the INICC multidimensional approach (IMA). RESULTS During study period 252 HAIs were found in 1353 (549F/804M) patients and 14,700 patient-days of hospitalisation. The crude infections rate and incidence density of DA-HAIs was 18.69% and 17.49 ± 2.56 /1000 patient-days. Incidence density of ventilator-associated pneumonia (VAP), central line-associated bloodstream infection (CLA-BSI) and catheter-associated urinary tract infection (CA-UTI) per 1000 device-days were 12.63 ± 1.49, 1.83 ± 0.65 and 6.5 ± 1.2, respectively. VAP(137) constituted 54.4% of HAIs, whereas CA-UTI(91) 36%, CLA-BSI(24) 9.6%.The most common pathogens in VAP and CA-UTI was multidrug-resistant (MDR) Acinetobacter baumannii (57 and 31%), and methicillin-resistant Staphylococcus epidermidis (MRSE) in CLA-BSI (45%). MDR Gram negative bacteria (GNB) 159 were responsible for 63.09% of HAIs. The length of hospitalisation of patients with a single DA-HAI at ICU was 21(14-33) days, while without infections it was 6.0 (3-11) days; p = 0.0001. The mortality rates in the hospital-acquired infection group and no infection group were 26.1% vs 26.9%; p = 0.838; OR 0.9633;95% CI (0.6733-1.3782). Extra cost of therapy caused by one ICU acquired HAI was US$ 11,475/Euro 10,035. Hand hygiene standards compliance rate was 64.7%, while VAP, CLA-BSI bundles compliance ranges were 96.2-76.8 and 29-100, respectively. CONCLUSIONS DA-HAIs was diagnosed at nearly 1/5 of patients. They were more frequent than in European Centre Disease Control report (except for CLA-BSI), more frequent than the USA CDC report, yet less frequent than in limited-resource countries (except for CA-UTI). They prolonged the hospitalisation period at ICU and generated substantial additional costs of treatment with no influence on mortality. The Acinetobacter baumannii MDR infections were the most problematic therapeutic issue. DA-HAIs preventive methods compliance rate needs improvement.
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