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Grupel D, Borer A, Yosipovich R, Nativ R, Sagi O, Saidel-Odes L. A multi-layered infection control intervention on carbapenem-resistant Acinetobacter baumannii acquisition: an interrupted time series. Am J Infect Control 2024:S0196-6553(24)00685-0. [PMID: 39182848 DOI: 10.1016/j.ajic.2024.08.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2024] [Revised: 08/19/2024] [Accepted: 08/19/2024] [Indexed: 08/27/2024]
Abstract
BACKGROUND Carbapenem-resistant Acinetobacter baumannii (CRAB) causes life-threating hospital-acquired infections in critically-ill patients. Due to a limited number of Intensive-Care-Unit (ICU) beds, these patients are often treated in high-dependency (HD) non-ICUs within internal-medicine wards (IMW) in Israel. We aimed to assess the effectiveness of a multi-layered infection-control intervention on CRAB infection-rate in IMWs, especially in its HD non-ICUs with ongoing CRAB transmission. METHODS A quasi-experimental, before-and-after, interrupted time-series study with control outcomes conducted from January 2019 through June 2022. We conducted a multi-layered intervention over 3.5 years which included 4 phases: 1) Pre-intervention; 2) Intervention-introduction: introduced enhanced environment cleaning; 3) Intervention phase 1: introduced active surveillance; 4) Intervention phase 2: introduced CRAB-positive patient cohorting, in addition to previous ongoing measures taken. RESULTS CRAB was isolated from 204 patients aged 69.8y/o ± 15.86y, 59.8% male. CRAB-positive clinical samples were found in 34.3% of these patients. Mean hospital length-of-stay was 30.5 days, with a 30-day post-discharge mortality-rate of 55.9%. Mean CRAB clinical cases decreased from 0.89 in pre-intervention to 0.11 at the end of Phase 2, with a change in slope and level after the intervention of p= 0.02 (CI: -0.204- to -0.040) and p=0.004 (CI: -0.013 to -0.003), respectively. CONCLUSIONS This multi-layered intervention, including enhanced environment cleaning, active surveillance, and patient cohorting, successfully reduced CRAB acquisition in IMWs and their HD non-ICUs.
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Affiliation(s)
- Daniel Grupel
- Department of Clinical Microbiology and Infectious Diseases, Hadassah Medical Center, Hebrew University, Jerusalem, Israel
| | - Abraham Borer
- Infection Control and Hospital Epidemiology Unit, Soroka University Medical Center and the Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Riki Yosipovich
- Infection Control and Hospital Epidemiology Unit, Soroka University Medical Center, Beer-Sheva, Israel
| | - Ronit Nativ
- Infection Control and Hospital Epidemiology Unit, Soroka University Medical Center, Beer-Sheva, Israel
| | - Orli Sagi
- Clinical Microbiology Labratory, Soroka University Medical Center and the Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Lisa Saidel-Odes
- Infection Control and Hospital Epidemiology Unit, Soroka University Medical Center and the Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel.
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Yang J, Li L, Zhu X, He C, Li T, Qin J, Wang Y. Microbial Community Characterization and Molecular Resistance Monitoring in Geriatric Intensive Care Units in China Using mNGS. Infect Drug Resist 2023; 16:5121-5134. [PMID: 37576519 PMCID: PMC10422961 DOI: 10.2147/idr.s421702] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2023] [Accepted: 07/29/2023] [Indexed: 08/15/2023] Open
Abstract
Background Surface pathogens in the ICU pose a global public health threat, especially to elderly patients who are immunocompromised. To detect these pathogens, unbiased methods such as metagenomic next-generation sequencing (mNGS) are increasingly utilized for environmental microbiological surveillance. Methods In a six-month study from January to July 2022, we investigated microbial communities in Chinese geriatric ICUs by regularly monitoring multiple surfaces at three-month intervals. Using mNGS sequencing, we analyzed microorganisms present at eight specific locations within the ICU. Additionally, we compared pathogen profiles and drug resistance genes between patient cultures and environmental samples collected during the same period. Results The microbial composition remained relatively stable over time, but significant differences in alpha diversities were observed among various surfaces such as floors, hands, pumps, trolleys, and ventilator inlets/outlets. Surfaces with high contact frequency for healthcare workers, including workstations, ventilator panels, trolleys, pumps, and beds, harbored pathogenic microorganisms such as Acinetobacter baumannii, Cutibacterium acnes, Staphylococcus haemolyticus, Pseudomonas aeruginosa, and Enterococcus faecium. Acinetobacter baumannii, particularly the carbapenem-resistant strain (CRAB), was the most frequently identified pathogen in geriatric ICU patients regardless of testing method used. The mNGS approach enabled detection of viruses, fungi, and parasites that are challenging to culture. Additionally, an abundance of drug resistance genes was found in almost all environmental samples. Conclusion The microbial composition and abundance in the ICU remained relatively constant over time. The floor exhibited the highest microbial diversity and abundance in the ICU environment. Drug-resistant genes in the ICU environment may migrate between patients. Overall, mNGS is an emerging and powerful tool for microbiological monitoring of the hospital environment.
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Affiliation(s)
- Jilin Yang
- Department of Critical Care Medicine, The First Affiliated Hospital of Kunming Medical University, Kunming, People’s Republic of China
| | - Lingyi Li
- Department of Medical, Hangzhou Matridx Biotechnology Company, Hangzhou, People’s Republic of China
| | - Xiaolin Zhu
- Department of Critical Care Medicine, The First Affiliated Hospital of Kunming Medical University, Kunming, People’s Republic of China
| | - Chen He
- Department of Critical Care Medicine, The First Affiliated Hospital of Kunming Medical University, Kunming, People’s Republic of China
| | - Ting Li
- Department of Critical Care Medicine, The First Affiliated Hospital of Kunming Medical University, Kunming, People’s Republic of China
| | - Jiahong Qin
- Department of Critical Care Medicine, The First Affiliated Hospital of Kunming Medical University, Kunming, People’s Republic of China
| | - Yijie Wang
- Department of Critical Care Medicine, The First Affiliated Hospital of Kunming Medical University, Kunming, People’s Republic of China
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Anggraini D, Santosaningsih D, Saharman YR, Endraswari PD, Cahyarini C, Saptawati L, Hayati Z, Farida H, Siregar C, Pasaribu M, Homenta H, Tjoa E, Jasmin N, Sarassari R, Setyarini W, Hadi U, Kuntaman K. Distribution of Carbapenemase Genes among Carbapenem-Non-Susceptible Acinetobacter baumanii Blood Isolates in Indonesia: A Multicenter Study. Antibiotics (Basel) 2022; 11:antibiotics11030366. [PMID: 35326829 PMCID: PMC8944540 DOI: 10.3390/antibiotics11030366] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2022] [Revised: 03/03/2022] [Accepted: 03/07/2022] [Indexed: 12/05/2022] Open
Abstract
Carbapenem non-susceptible Acinetobacter baumannii (CNSAB) is an important pathogen that causes nosocomial bacteremia among critically ill patients worldwide. The magnitude of antibiotic resistance of A. baumanii in Indonesia is expected to be significant; however, the data available are limited. The aim of this study was to analyze the genetic profiles of CNSAB isolates from patients with bacteremia in Indonesia. CNSAB isolates from blood cultures of bacteremia patients in 12 hospitals in Indonesia were included. The blood cultures were conducted using the BacT/Alert or BACTEC automated system. The CNSAB were identified with either Vitek 2 system or Phoenix platform followed by a confirmation test using a multiplex polymerase chain reaction (PCR) assay, targeting the specific gyrB gene. The carbapenemase genes were detected by multiplex PCR. In total, 110 CNSAB isolates were collected and were mostly resistant to nearly all antibiotic classes. The majority of CNSAB isolates were susceptible to tigecycline and trimethoprim-sulfamethoxazole (TMP-SMX), 45.5% and 38.2%, respectively. The blaOXA-51-like gene was identified in all CNSAB isolates. Out of the total, 83.6% of CNSAB isolates had blaOXA-23-like gene, 37.3% blaOXA-24-like gene, 4.5% blaNDM-1 gene, 0.9% blaIMP-1 gene, and 0.9% blaVIM gene. No blaOXA-48-like gene was identified. The blaOXA-23-like gene was the predominant gene in all except two hospitals. The presence of the blaOXA-24-like gene was associated with resistance to tigecycline, amikacin, TMP-SMX and cefoperazone-sulbactam, while blaOXA-23-like gene was associated with resistance to TMP-SMX and cefoperazone-sulbactam. In conclusion, the blaOXA-23-like gene was the predominant gene among CNSAB isolates throughout Indonesia. A continuous national surveillance system needs to be established to further monitor the genetic profiles of CNSAB in Indonesia.
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Affiliation(s)
- Dewi Anggraini
- Doctoral Program, Faculty of Medicine, Universitas Airlangga, Surabaya 60115, Indonesia;
- Department of Microbiology, Faculty of Medicine, Universitas Riau, Pekanbaru 28133, Indonesia;
- Arifin Achmad General Hospital, Pekanbaru 28156, Indonesia
| | - Dewi Santosaningsih
- Department of Clinical Microbiology, Faculty of Medicine, Universitas Brawijaya, Malang 65145, Indonesia;
- Dr. Saiful Anwar Hospital, Malang 65112, Indonesia
| | - Yulia Rosa Saharman
- Department of Clinical Microbiology, Faculty of Medicine, Universitas Indonesia, Jakarta 10320, Indonesia;
- Pelni Hospital, Jakarta 11410, Indonesia
| | - Pepy Dwi Endraswari
- Department of Medical Microbiology, Faculty of Medicine, Universitas Airlangga, Surabaya 60115, Indonesia; (P.D.E.); (R.S.)
- Dr. Soetomo General Academic Hospital, Surabaya 60286, Indonesia;
| | - Cahyarini Cahyarini
- Department of Clinical Microbiology, Persahabatan General Hospital, Jakarta 13230, Indonesia;
| | - Leli Saptawati
- Department of Microbiology, Faculty of Medicine, Universitas Sebelas Maret, Surakarta 57126, Indonesia;
- Department of Microbiology, Dr. Moewardi Teaching Hospital, Surakarta 57126, Indonesia
| | - Zinatul Hayati
- Department of Microbiology, Faculty of Medicine, Universitas Syiah Kuala, Banda Aceh 23111, Indonesia;
- Department of Microbiology, Dr. Zainoel Abidin Hospital, Banda Aceh 24415, Indonesia
| | - Helmia Farida
- Department of Microbiology, Faculty of Medicine, Diponegoro University, Semarang 50275, Indonesia;
- Dr. Kariadi Hospital, Semarang 50244, Indonesia
| | | | | | - Heriyannis Homenta
- Department of Clinical Microbiology, Faculty of Medicine, University of Sam Ratulangi, Manado 95115, Indonesia;
| | - Enty Tjoa
- Department of Microbiology, School of Medicine and Health Sciences, Atma Jaya Catholic University of Indonesia, Jakarta 12930, Indonesia;
| | - Novira Jasmin
- Department of Microbiology, Faculty of Medicine, Universitas Riau, Pekanbaru 28133, Indonesia;
| | - Rosantia Sarassari
- Department of Medical Microbiology, Faculty of Medicine, Universitas Airlangga, Surabaya 60115, Indonesia; (P.D.E.); (R.S.)
| | - Wahyu Setyarini
- Institute of Tropical Disease, Universitas Airlangga, Surabaya 60115, Indonesia;
| | - Usman Hadi
- Department of Medical Microbiology, Faculty of Medicine, Universitas Airlangga, Surabaya 60115, Indonesia; (P.D.E.); (R.S.)
- Department of Internal Medicine, Faculty of Medicine, Universitas Airlangga, Surabaya 60115, Indonesia
| | - Kuntaman Kuntaman
- Department of Medical Microbiology, Faculty of Medicine, Universitas Airlangga, Surabaya 60115, Indonesia; (P.D.E.); (R.S.)
- Dr. Soetomo General Academic Hospital, Surabaya 60286, Indonesia;
- Correspondence: ; Tel.: +62-31-5020251
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Kasimova AA, Cahill SM, Shpirt AM, Dudnik AG, Shneider MM, Popova AV, Shelenkov AA, Mikhailova YV, Chizhov AO, Kenyon JJ, Knirel YA. The K139 capsular polysaccharide produced by Acinetobacter baumannii MAR17-1041 belongs to a group of related structures including K14, K37 and K116. Int J Biol Macromol 2021; 193:2297-2303. [PMID: 34793811 DOI: 10.1016/j.ijbiomac.2021.11.062] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2021] [Revised: 10/31/2021] [Accepted: 11/10/2021] [Indexed: 11/15/2022]
Abstract
Capsular polysaccharide (CPS) is a key target for bacteriophage and vaccine therapies currently being developed for treatment of infections caused by the extensively antibiotic resistant bacterial species, Acinetobacter baumannii. Identification of new CPS structures and the genetics that drive their synthesis underpins tailored treatment strategies. A novel CPS biosynthesis gene cluster, designated KL139, was identified in the whole genome sequence of a multiply antibiotic resistant clinical isolate, A. baumannii MAR-17-1041, recovered in Russia in 2017. CPS material extracted from A. baumannii MAR-17-1041 was studied by sugar analysis and Smith degradation along with one- and two-dimensional 1H and 13C NMR spectroscopy, and the structure was found to include a branched pentasaccharide repeating unit containing neutral carbohydrates. This structure closely resembles the topology of the A. baumannii K14 CPS but differs in the presence of d-Glcp in place of a d-Galp sugar in the repeat-unit main chain. The difference was attributed to a change in the sequence for two glycosyltransferases. These two proteins are also encoded by the A. baumannii KL37 gene cluster, and a multiple sequence alignment of KL139 with KL14 and KL37 revealed a hybrid relationship. The global distribution of KL139 was also assessed by probing 9065 A. baumannii genomes available in the NCBI non-redundant and WGS databases for the KL139 gene cluster. KL139 was found in 16 genomes from four different countries. Eleven of these isolates belong to the multidrug resistant global lineage, ST25.
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Affiliation(s)
- Anastasiya A Kasimova
- N. D. Zelinsky Institute of Organic Chemistry, Russian Academy of Sciences, Moscow, Russia
| | - Sarah M Cahill
- Centre for Immunology and Infection Control, School of Biomedical Sciences, Faculty of Health, Queensland University of Technology, Brisbane, Australia
| | - Anna M Shpirt
- N. D. Zelinsky Institute of Organic Chemistry, Russian Academy of Sciences, Moscow, Russia
| | | | - Mikhail M Shneider
- M. M. Shemyakin & Y. A. Ovchinnikov Institute of Bioorganic Chemistry, Russian Academy of Sciences, Moscow, Russia; Institute of Antimicrobial Chemotherapy, Smolensk State Medical University, Smolensk, Russia
| | - Anastasiya V Popova
- State Research Center for Applied Microbiology and Biotechnology, Obolensk, Moscow Region, Russia
| | | | | | - Alexander O Chizhov
- N. D. Zelinsky Institute of Organic Chemistry, Russian Academy of Sciences, Moscow, Russia
| | - Johanna J Kenyon
- Centre for Immunology and Infection Control, School of Biomedical Sciences, Faculty of Health, Queensland University of Technology, Brisbane, Australia.
| | - Yuriy A Knirel
- N. D. Zelinsky Institute of Organic Chemistry, Russian Academy of Sciences, Moscow, Russia
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Kenyon JJ, Kasimova AA, Sviridova AN, Shpirt AM, Shneider MM, Mikhaylova YV, Shelenkov AA, Popova AV, Perepelov AV, Shashkov AS, Dmitrenok AS, Chizov AO, Knirel YA. Correlation of Acinetobacter baumannii K144 and K86 capsular polysaccharide structures with genes at the K locus reveals the involvement of a novel multifunctional rhamnosyltransferase for structural synthesis. Int J Biol Macromol 2021; 193:1294-1300. [PMID: 34757131 DOI: 10.1016/j.ijbiomac.2021.10.178] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Revised: 10/18/2021] [Accepted: 10/24/2021] [Indexed: 10/19/2022]
Abstract
Whole genome sequence from Acinetobacter baumannii isolate Ab-46-1632 reveals a novel KL144 capsular polysaccharide (CPS) biosynthesis gene cluster, which carries genes for d-glucuronic acid (D-GlcA) and l-rhamnose (l-Rha) synthesis. The CPS was extracted from Ab-46-1632 and studied by 1H and 13C NMR spectroscopy, including a two-dimensional 1H,13C HMBC experiment and Smith degradation. The CPS was found to have a hexasaccharide repeat unit composed of four l-Rhap residues and one residue each of d-GlcpA and N-acetyl-d-glucosamine (D-GlcpNAc) consistent with sugar synthesis genes present in KL144. The K144 CPS structure was established and found to be related to those of A. baumannii K55, K74, K85, and K86. A comparison of the corresponding gene clusters to KL144 revealed a number of shared glycosyltransferase genes correlating to shared glycosidic linkages in the structures. One from the enzymes, encoded by only KL144 and KL86, is proposed to be a novel multifunctional rhamnosyltransfaerase likely responsible for synthesis of a shared α-l-Rhap-(1 → 2)-α-L-Rhap-(1 → 3)-L-Rhap trisaccharide fragment in the K144 and K86 structures.
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Affiliation(s)
- Johanna J Kenyon
- Centre for Immunology and Infection Control, School of Biomedical Sciences, Faculty of Health, Queensland University of Technology. Brisbane, Australia
| | - Anastasiya A Kasimova
- N.D. Zelinsky Institute of Organic Chemistry, Russian Academy of Science, Moscow, Russia
| | | | - Anna M Shpirt
- N.D. Zelinsky Institute of Organic Chemistry, Russian Academy of Science, Moscow, Russia.
| | - Mikhail M Shneider
- M.M. Shemyakin and Y.A. Ovchinnikov Institute of Bioorganic Chemistry, Russian Academy of Science, Moscow, Russia
| | | | | | - Anastasiya V Popova
- State Research Center for Applied Microbiology and Biotechnology, Obolensk, Moscow, Region, Russia
| | - Andrei V Perepelov
- N.D. Zelinsky Institute of Organic Chemistry, Russian Academy of Science, Moscow, Russia
| | - Alexander S Shashkov
- N.D. Zelinsky Institute of Organic Chemistry, Russian Academy of Science, Moscow, Russia
| | - Andrei S Dmitrenok
- N.D. Zelinsky Institute of Organic Chemistry, Russian Academy of Science, Moscow, Russia
| | - Alexander O Chizov
- N.D. Zelinsky Institute of Organic Chemistry, Russian Academy of Science, Moscow, Russia
| | - Yuriy A Knirel
- N.D. Zelinsky Institute of Organic Chemistry, Russian Academy of Science, Moscow, Russia
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Cost-effectiveness analysis of whole-genome sequencing during an outbreak of carbapenem-resistant Acinetobacter baumannii. ANTIMICROBIAL STEWARDSHIP & HEALTHCARE EPIDEMIOLOGY 2021; 1:e62. [PMID: 36168472 PMCID: PMC9495627 DOI: 10.1017/ash.2021.233] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/16/2021] [Revised: 10/25/2021] [Accepted: 10/25/2021] [Indexed: 11/12/2022]
Abstract
Background: Whole-genome sequencing (WGS) shotgun metagenomics (metagenomics) attempts to sequence the entire genetic content straight from the sample. Diagnostic advantages lie in the ability to detect unsuspected, uncultivatable, or very slow-growing organisms. Objective: To evaluate the clinical and economic effects of using WGS and metagenomics for outbreak management in a large metropolitan hospital. Design: Cost-effectiveness study. Setting: Intensive care unit and burn unit of large metropolitan hospital. Patients: Simulated intensive care unit and burn unit patients. Methods: We built a complex simulation model to estimate pathogen transmission, associated hospital costs, and quality-adjusted life years (QALYs) during a 32-month outbreak of carbapenem-resistant Acinetobacter baumannii (CRAB). Model parameters were determined using microbiology surveillance data, genome sequencing results, hospital admission databases, and local clinical knowledge. The model was calibrated to the actual pathogen spread within the intensive care unit and burn unit (scenario 1) and compared with early use of WGS (scenario 2) and early use of WGS and metagenomics (scenario 3) to determine their respective cost-effectiveness. Sensitivity analyses were performed to address model uncertainty. Results: On average compared with scenario 1, scenario 2 resulted in 14 fewer patients with CRAB, 59 additional QALYs, and $75,099 cost savings. Scenario 3, compared with scenario 1, resulted in 18 fewer patients with CRAB, 74 additional QALYs, and $93,822 in hospital cost savings. The likelihoods that scenario 2 and scenario 3 were cost-effective were 57% and 60%, respectively. Conclusions: The use of WGS and metagenomics in infection control processes were predicted to produce favorable economic and clinical outcomes.
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Shu H, Li L, Wang Y, Guo Y, Wang C, Yang C, Gu L, Cao B. Prediction of the Risk of Hospital Deaths in Patients with Hospital-Acquired Pneumonia Caused by Multidrug-Resistant Acinetobacter baumannii Infection: A Multi-Center Study. Infect Drug Resist 2020; 13:4147-4154. [PMID: 33244244 PMCID: PMC7683351 DOI: 10.2147/idr.s265195] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2020] [Accepted: 10/15/2020] [Indexed: 11/23/2022] Open
Abstract
Purpose To predict the risk of hospital deaths in patients with hospital-acquired pneumonia (HAP) caused by multidrug-resistant Acinetobacter baumannii (MDR-AB) infection. Patients and Methods A total of 366 patients who were diagnosed with HAP caused by MDR-AB infection were enrolled between January 2013 and December 2016. The sociological characteristics and clinical data of these cases were collected. Univariate and multivariate logistic analyses were used to explore the risk factors of hospital deaths before medication and after drug withdrawal. The receiver operating characteristic (ROC) curve and the area under the curve (AUC) were utilized to assess the predictive effectiveness of the models with or without the adjustment. Results Hospital deaths occurred in 142 cases (38.80%). The results showed that acute physiology and chronic health evaluation II (APACHE II) and sequential organ failure assessment (SOFA) scores before medication and after drug withdrawal were associated with the risk of hospital deaths. Adjusting the covariants including the age, autoimmune disease, venous cannula, transfer of patients from other hospitals, and APACHE II score at admission, then no differences were discovered in predicting the hospital deaths between adjusted APACHE II and adjusted SOFA scores before medication (AUC: 0.808 vs 0.803, P =0.614) and after drug withdrawal (AUC: 0.876 vs 0.878, P =0.789). Conclusion Before medication or after drug withdrawal, the adjusted APACHE II and adjusted SOFA scores all performed well in determining the predictive effectiveness of the hospital deaths in patients with HAP caused by MDR-AB infection, indicating that the appropriate infection control may reduce the occurrence of nosocomial deaths and improve the prognosis.
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Affiliation(s)
- Hongmei Shu
- Department of Pulmonary and Critical Care Medicine, Xuanwu Hospital Capital Medical University, Beijing, People's Republic of China.,Department of Pulmonary and Critical Care Medicine, China-Japan Friendship Hospital, Beijing, People's Republic of China.,Department of Respiration, Anqing Municipal Hospital, Anqing Hospital of Anhui Medical University, Anhui 246000, People's Republic of China
| | - Lijuan Li
- Department of Pulmonary and Critical Care Medicine, China-Japan Friendship Hospital, Beijing, People's Republic of China
| | - Yimin Wang
- Department of Pulmonary and Critical Care Medicine, China-Japan Friendship Hospital, Beijing, People's Republic of China
| | - Yiqun Guo
- Department of Infectious Diseases and Clinical Microbiology, Beijing Chao-Yang Hospital, Capital Medical University, Beijing 100020, People's Republic of China
| | - Chunlei Wang
- Laboratory of Clinical Microbiology and Infectious Diseases, China-Japan Friendship Hospital, Beijing, People's Republic of China
| | - Chunxia Yang
- Department of Infectious Diseases and Clinical Microbiology, Beijing Chao-Yang Hospital, Capital Medical University, Beijing 100020, People's Republic of China
| | - Li Gu
- Department of Infectious Diseases and Clinical Microbiology, Beijing Chao-Yang Hospital, Capital Medical University, Beijing 100020, People's Republic of China
| | - Bin Cao
- Department of Pulmonary and Critical Care Medicine, China-Japan Friendship Hospital, Beijing, People's Republic of China.,Laboratory of Clinical Microbiology and Infectious Diseases, China-Japan Friendship Hospital, Beijing, People's Republic of China.,Institute of Respiratory Medicine, Chinese Academy of Medical Sciences; National Clinical Research Center of Respiratory Disease, Clinical Center for Pulmonary Infection, Capital Medical University, Tsinghua University-Peking University Joint Center for Life Sciences, Beijing 100029, People's Republic of China
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8
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Rossi I, Royer S, Ferreira M, Braga IA, Campos P, Batistão D, Fuga B, Cerdeira L, Lincopan N, Gontijo-Filho PP, Ribas RM. Novel ST1465/CC216 Nosocomial Lineage of Carbapenem-Resistant Acinetobacter baumannii Harboring an Unusual Plasmid Carrying blaNDM-1 Gene. Microb Drug Resist 2020; 27:471-475. [PMID: 32915684 DOI: 10.1089/mdr.2020.0219] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
This study used whole-genome sequencing to analyze the first case of NDM-1-producing Acinetobacter baumannii belonging to the novel sequence type 1465/CC216 recovered in Brazil. The study identified an unusual plasmid carrying blaNDM-1 gene, in which some genes of the Tn125 transposon were lost. Besides, on the chromosome, the strain reported here presented blaOXA-106 gene, a variant of blaOXA-51 gene, and blaADC-25 with ISAba1 upstream. The isolation of new STs of A. baumannii carrying blaNDM-1 genes elicits our concerns about the possible spread of these genes among clinically relevant bacteria.
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Affiliation(s)
- Iara Rossi
- Laboratory of Molecular Microbiology, Institute of Biomedical Sciences, Federal University of Uberlândia, Uberlândia, Brazil
| | - Sabrina Royer
- Laboratory of Molecular Microbiology, Institute of Biomedical Sciences, Federal University of Uberlândia, Uberlândia, Brazil
| | - Melina Ferreira
- Laboratory of Molecular Microbiology, Institute of Biomedical Sciences, Federal University of Uberlândia, Uberlândia, Brazil
| | - Iolanda A Braga
- Hospital das Clínicas and Federal University of Uberlândia, Uberlândia, Brazil
| | - Paola Campos
- Laboratory of Molecular Microbiology, Institute of Biomedical Sciences, Federal University of Uberlândia, Uberlândia, Brazil
| | - Deivid Batistão
- School of Medicine, Federal University of Uberlândia, Uberlândia, Brazil
| | - Bruna Fuga
- Department of Clinical Analysis, School of Pharmacy, University of São Paulo, São Paulo, Brazil
| | - Louise Cerdeira
- Department of Clinical Analysis, School of Pharmacy, University of São Paulo, São Paulo, Brazil.,Department of Infectious Diseases, Central Clinical School, Monash University, Melbourne, Australia
| | - Nilton Lincopan
- Department of Microbiology, Instituto de Ciências Biomédicas, Universidade de São Paulo, São Paulo, Brazil
| | - Paulo P Gontijo-Filho
- Laboratory of Molecular Microbiology, Institute of Biomedical Sciences, Federal University of Uberlândia, Uberlândia, Brazil
| | - Rosineide M Ribas
- Laboratory of Molecular Microbiology, Institute of Biomedical Sciences, Federal University of Uberlândia, Uberlândia, Brazil
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9
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Shi J, Sun T, Cui Y, Wang C, Wang F, Zhou Y, Miao H, Shan Y, Zhang Y. Multidrug resistant and extensively drug resistant Acinetobacter baumannii hospital infection associated with high mortality: a retrospective study in the pediatric intensive care unit. BMC Infect Dis 2020; 20:597. [PMID: 32787942 PMCID: PMC7422664 DOI: 10.1186/s12879-020-05321-y] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2019] [Accepted: 08/03/2020] [Indexed: 02/06/2023] Open
Abstract
Background Multidrug resistant (MDR) and extensively drug resistant (XDR) Acinetobacter baumannii presents challenges for clinical treatment and causes high mortality in children. We aimed to assess the risk factors and overall mortality for MDR/XDR Acinetobacter baumannii infected pediatric patients. Methods This retrospective study included 102 pediatric patients who developed MDR/XDR Acinetobacter baumannii infection in the pediatric intensive care unit (PICU) of Shanghai Children’s Hospital in China from December 2014 to May 2018. Acinetobacter baumannii clinical isolates were recovered from different specimens including blood, sputum, bronchoalveolar lavage fluid, cerebrospinal fluid, ascites, hydrothorax, and urine. Antibiotic susceptibility test was determined according to the Clinical and Laboratory Standards Institute interpretive criteria. Clinical and biological data were obtained from the patients’ medical records. Results 102 patients with Acinetobacter baumannii infection were enrolled. The median age was 36 (9.6, 98.8) months, and there were 63 male in the case group. The overall mortality rate was 29.4%, while the Acinetobacter baumannii-associated mortality rate was 16.7% (17/102, 12 bloodstream infections, 4 meningitis and 1 intra-abdominal infection). Bloodstream infections occurred in 28 patients (27.5%), and 10 patients (9.8%) among them had central line-associated bloodstream infections (6 central venous catheters, 2 PICCs, 1 venous infusion port and 1 arterial catheter). Cerebrospinal fluid (CSF) cultures were positive in 4(3.9%) patients. 14(13.7%) patients got positive cultures in ascites and hydrothorax. Lower respiratory isolates (56/102) accounted for 54.9% of all patients. Non-survival patients appeared to have a lower NK cell activity (6.2% ± 3.61% vs. 9.15% ± 6.21%, P = 0.029), higher CD4+ T cell ratio (39.67% ± 12.18% vs. 32.66% ± 11.44%, P = 0.039),and a higher serum level of interlukin-8 (IL-8, 15.25 (1.62, 47.22)pg/mL vs. 0.1 (0.1, 22.99)pg/mL, P = 0.01) when Acinetobacter baumannii infection developed. Multivariate logistic analysis indicated that high serum level of Cr (RR, 0.934, 95%CI, 0.890–0.981; P = 0.007) and high BUN/ALB level (RR, 107.893, 95%CI, 1.425–870.574; p = 0.005) were associated with high risk of mortality in MDR/XDR Acinetobacter baumannii infected patients. Conclusion MDR/XDR Acinetobacter baumannii infection is a serious concern in pediatric patients with high mortality. Bloodstream and central nervous system infection accounted for high risk of death. Acute kidney injury is associated with high risk of mortality.
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Affiliation(s)
- Jingyi Shi
- Department of Critical Care Medicine, Shanghai Children's Hospital, Shanghai Jiao Tong University, Shanghai, 20062, China
| | - Ting Sun
- Department of Critical Care Medicine, Shanghai Children's Hospital, Shanghai Jiao Tong University, Shanghai, 20062, China
| | - Yun Cui
- Department of Critical Care Medicine, Shanghai Children's Hospital, Shanghai Jiao Tong University, Shanghai, 20062, China
| | - Chunxia Wang
- Department of Critical Care Medicine, Shanghai Children's Hospital, Shanghai Jiao Tong University, Shanghai, 20062, China.,Institute of Pediatric Critical Care, Shanghai Jiao Tong University, Shanghai, 20062, China
| | - Fei Wang
- Department of Critical Care Medicine, Shanghai Children's Hospital, Shanghai Jiao Tong University, Shanghai, 20062, China
| | - Yiping Zhou
- Department of Critical Care Medicine, Shanghai Children's Hospital, Shanghai Jiao Tong University, Shanghai, 20062, China
| | - Huijie Miao
- Department of Critical Care Medicine, Shanghai Children's Hospital, Shanghai Jiao Tong University, Shanghai, 20062, China
| | - Yijun Shan
- Department of Critical Care Medicine, Shanghai Children's Hospital, Shanghai Jiao Tong University, Shanghai, 20062, China
| | - Yucai Zhang
- Department of Critical Care Medicine, Shanghai Children's Hospital, Shanghai Jiao Tong University, Shanghai, 20062, China. .,Institute of Pediatric Critical Care, Shanghai Jiao Tong University, Shanghai, 20062, China. .,Department of Critical Care Medicine, Shanghai, Children's Hospital, Shanghai Jiao Tong University, No.355 Luding Road, Putuo District, Shanghai, 200062, China.
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Overexpression of bla OXA-58 Gene Driven by IS Aba3 Is Associated with Imipenem Resistance in a Clinical Acinetobacter baumannii Isolate from Vietnam. BIOMED RESEARCH INTERNATIONAL 2020; 2020:7213429. [PMID: 32802871 PMCID: PMC7420922 DOI: 10.1155/2020/7213429] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/05/2020] [Revised: 06/02/2020] [Accepted: 06/29/2020] [Indexed: 02/06/2023]
Abstract
The aim of this study was to investigate genetic structures and expression of blaOXA-58 gene in five Acinetobacter baumannii clinical isolates recovered from two hospitals in southern Vietnam during 2012-2014. A. baumannii isolates were identified by automated microbiology systems and confirmed by PCR. All isolates were characterized as multidrug resistant by antimicrobial testing using the disk diffusion method. Four imipenem susceptible and one nonsusceptible isolates (MIC > 32 μg·ml−1) were identified by E-test. PCR amplification of blaOXA-58 gene upstream and downstream sequences revealed the presence of ISAba3 at both locations in one multidrug-resistant isolate. Semiquantitation of blaOXA-51 and blaOXA-58 gene expression was performed by the 2-ΔΔCt method. The blaOXA-51 gene expression of five isolates showed little difference, but the isolate bearing ISAba3-blaOXA-58-ISAba3 exhibited significantly higher blaOXA-58 mRNA level. Higher β-lactamases activity in periplasmic than cytoplasmic fraction was found in most isolates. The isolate overexpressing blaOXA-58 gene possessed very high periplasmic enzyme activity. In conclusion, the A. baumannii isolate bearing ISAba3-blaOXA-58 gene exhibited high resistance to imipenem, corresponding to an overexpression of blaOXA-58 gene and very high periplasmic β-lactamase activity.
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Wu F, Hu R. Risk factors for pneumonia caused by antimicrobial drug-resistant or drug-sensitive Acinetobacter baumannii infections: A retrospective study. Medicine (Baltimore) 2020; 99:e21051. [PMID: 32664118 PMCID: PMC7360211 DOI: 10.1097/md.0000000000021051] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
Acinetobacter baumannii (AB) is one of the major types of infection in hospitalized patients. The development of AB resistance is becoming a global clinical challenge. To assist in the clinical management of AB-induced pneumonia, we designed the present retrospective observational study to investigate the risk factors for antimicrobial drug-resistant/-sensitive AB infections.A total of 214 individuals were reviewed, in which 100 and 55 pneumonia patients were infected with drug-resistant and drug-sensitive AB, respectively. Fifty-nine pneumonia patients without AB infection served as a control group. Age, sex, duration of hospital stay, prior surgery history, the presence of coinfection and companion diseases, routine blood test results, and immunogenicity were recorded. Logistic regression was performed to identify risk factors of AB infections.Multivariate analysis revealed that long duration of hospital stay (odds ratio = 1.091 [95% CI: 1.010-1.178], P = .027) and the absence of coinfection (odds ratio = 0.507 [95% CI: 0.265-0.970], P = .040) were independent risk factors for AB infections. Same pattern of risk factors was identified for the drug-sensitive group (long duration of hospital stay: odds ratio = 1.119 [95% CI: 1.016-1.232], P = .022; absence of coinfection: odds ratio = 0.328 [95% CI: 0.135-0.797], P = .014), while high blood urea nitrogen (odds ratio: 1.382 [95% CI: 1.042-1.833], P = .025) was the only significant risk factor for drug-resistant AB infection.Long duration of hospital stay and the absence of coinfection might predict AB infections in hospitalized patients. Antimicrobial drug-resistant and drug-sensitive AB infections possess different risk factor profiles. A poor kidney function may be predictive of drug-resistant AB infection. Further prospective studies are required to validate our findings.
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Evaluating the antimicrobial resistance patterns and molecular frequency of bla oxa-48 and bla GES-2 genes in Pseudomonas aeruginosa and Acinetobacter baumannii strains isolated from burn wound infection in Tehran, Iran. New Microbes New Infect 2020; 37:100686. [PMID: 32774866 PMCID: PMC7394744 DOI: 10.1016/j.nmni.2020.100686] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2019] [Revised: 02/23/2020] [Accepted: 04/16/2020] [Indexed: 02/08/2023] Open
Abstract
The aim of this study is to evaluate the antimicrobial resistance patterns and molecular frequency of blaGES-2 and blaoxa-48 genes in Pseudomonas aeruginosa and Acinetobacter baumannii strains isolated from burn wound infection in Tehran, Iran. In this study, 50 isolates of A. baumannii and 48 isolates of P. aeruginosa were collected from the Burn Unit of Shahid Motahari Hospital at Tehran, Iran. Antibiotic susceptibility tests of all isolates were carried out using the disc diffusion method, and the production of extended-spectrum β-lactamases (ESBLs) in isolates was surveyed by the double disc synergy method and based on CLSI (2019 AST M100) criteria. Finally, the frequency of blaGES-2 and blaoxa-48 genes was surveyed by PCR. Antibiotic susceptibility tests showed that 48/48 (100%) of P. aeruginosa isolates and 49/50 (98%) of A. baumannii isolates were resistant to ceftriaxone and cefotaxime, respectively. Ceftazidime exhibited the lowest (26/48; 54.1%) resistance rates against P. aeruginosa isolates. The production of ESBLs was seen in 8/48 (16.6%) and 3/50 (6%) of P. aeruginosa and A. baumannii isolates, respectively. On the basis of conventional PCR and sequencing, the frequencies of the blaGES-2 gene among P. aeruginosa and A. baumannii was 87.5% and 58%, respectively. Moreover, blaoxa-48 gene was detected in 70.83% and 92% of P. aeruginosa and A. baumannii isolates, respectively. Results suggest that antibiotic-resistant A. baumannii and P. aeruginosa strains isolated from burn patients are frequently found; therefore, it is absolutely necessary to implement continuous screening and follow-up programmes for detecting antimicrobial resistance.
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Kumar S, Singhal L, Ray P, Gautam V. In vitro and in vivo fitness of clinical isolates of carbapenem-resistant and -susceptible Acinetobacter baumannii. Indian J Med Microbiol 2020; 38:52-57. [PMID: 32719209 DOI: 10.4103/ijmm.ijmm_19_468] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Context Acinetobacter baumannii is one among the leading nosocomial pathogens in the healthcare settings worldwide. Limited data on relative fitness and virulence of carbapenem-resistant A. baumannii (CRAB) are known. New methods are required to curb the rapidly rising antimicrobial resistance of this bug. Aims We aimed to study the comparative in vitro and in vivo fitness of clinical isolates of CRAB and carbapenem-susceptible A. baumannii (CSAB). Settings and Design A total of nine A. baumannii isolates were included in this study. CSAB ATCC-19606 was taken as a reference control strain. Subjects and Methods Matrix-assisted laser desorption ionisation-time of flight mass spectrometry and gyrB and blaOXA-51PCR were used for species identification. Antimicrobial susceptibility was performed using Kirby-Bauer disk-diffusion method. Minimum inhibitory concentration for carbapenems (imipenem, meropenem and doripenem) was determined using agar dilution method. End point analysis, competitive index (CI), growth kinetics and generation time were determined for CRAB and CSAB isolates. In vivo fitness of CRAB and CSAB was determined using Caenorhabditis elegans host model. Multilocus sequence typing was performed to see the genetic relatedness of the isolates under study. Results End point analysis, in vitro CI and growth kinetics experiments showed better fitness of clinical isolates of CRAB over CSAB ones. In vivo'nematode fertility assay' using C. elegans also supported the in vitro results. Conclusions To the best of our knowledge, this is the first study of its kind from India showing difference in fitness of clinical isolates of CRAB and CSAB.
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Affiliation(s)
- Sunil Kumar
- Department of Medical Microbiology, Post Graduate Institute of Medical Education and Research, Chandigarh; Department of Biotechnology, Maharishi Markandeshwar Deemed to be University, Mullana (Ambala), Haryana, India
| | - Lipika Singhal
- Department of Microbiology, Government Medical College and Hospital, Sector -12, Chandigarh, India
| | - Pallab Ray
- Department of Medical Microbiology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Vikas Gautam
- Department of Medical Microbiology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
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Lazaretti WY, Dos Santos EL, da-Conceição Silva JL, Kadowaki MK, Gandra RF, Maller A, Simão RDCG. Upregulation of the clpB gene in response to heat shock and beta-lactam antibiotics in Acinetobacter baumannii. Mol Biol Rep 2019; 47:1499-1505. [PMID: 31786767 DOI: 10.1007/s11033-019-05209-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2019] [Accepted: 11/26/2019] [Indexed: 01/18/2023]
Abstract
The role of the clpB gene encoding HSP/chaperone ClpB was evaluated in the multiresistant antibiotic cells of Acinetobacter baumannii (RS4 strain) under stress-induced heat shock and different beta-lactams. The expression of the clpB gene was assessed by qPCR during heat shock at 45 °C and subinhibitory concentrations of ampicillin (30 μg mL-1), amoxicillin + sulbactam (8/12 μg mL-1), cefepime (30 μg mL-1), sulfamethoxazole + trimethoprim (120/8 μg mL-1) and meropenem (18 μg mL-1). The results indicated a transient increase in clpB transcription in all treatments except cefepime. Both in the presence of ampicillin and amoxicillin/sulbactam for 20 min, the mRNA-clpB synthesis was 1.4 times higher than that of the control at time zero. Surprisingly, the mRNA-clpB levels were more than 30-fold higher after 10 min of incubation with meropenem and more than eightfold higher in the presence of trimethoprim/sulfamethoxazole. In addition, western blot assays showed that the RS4 strain treated with meropenem showed a marked increase in ClpB protein expression. Our data indicate that during exposure to beta-lactams, A. baumannii adjusts the transcription levels of the clpB mRNA and protein to respond to stress, suggesting that the chaperone may act as a key cellular component in the presence of antibiotics in this bacterium.
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Affiliation(s)
- Waleska Yana Lazaretti
- Laboratório de Bioquímica Molecular, Centro de Ciências Médicas e Farmacêuticas, Universidade Estadual do Oeste do Paraná, UNIOESTE, Rua Universitária, 2069, Cascavel, PR, 85814-110, Brazil
| | - Elaine Luzia Dos Santos
- Laboratório de Bioquímica Molecular, Centro de Ciências Médicas e Farmacêuticas, Universidade Estadual do Oeste do Paraná, UNIOESTE, Rua Universitária, 2069, Cascavel, PR, 85814-110, Brazil
| | - José Luis da-Conceição Silva
- Laboratório de Bioquímica Molecular, Centro de Ciências Médicas e Farmacêuticas, Universidade Estadual do Oeste do Paraná, UNIOESTE, Rua Universitária, 2069, Cascavel, PR, 85814-110, Brazil
| | - Marina Kimiko Kadowaki
- Laboratório de Bioquímica Molecular, Centro de Ciências Médicas e Farmacêuticas, Universidade Estadual do Oeste do Paraná, UNIOESTE, Rua Universitária, 2069, Cascavel, PR, 85814-110, Brazil
| | - Rinaldo Ferreira Gandra
- Laboratório de Micologia Clínica, Hospital Universitário do Oeste do Paraná, Universidade Estadual do Oeste do Paraná, UNIOESTE, Cascavel, PR, Brazil
| | - Alexandre Maller
- Laboratório de Bioquímica Molecular, Centro de Ciências Médicas e Farmacêuticas, Universidade Estadual do Oeste do Paraná, UNIOESTE, Rua Universitária, 2069, Cascavel, PR, 85814-110, Brazil
| | - Rita de Cássia Garcia Simão
- Laboratório de Bioquímica Molecular, Centro de Ciências Médicas e Farmacêuticas, Universidade Estadual do Oeste do Paraná, UNIOESTE, Rua Universitária, 2069, Cascavel, PR, 85814-110, Brazil.
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