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Amaral SC, Pruski BB, de Freitas SB, Dos Santos LM, Hartwig DD. Biofilm formation in drug-resistant Acinetobacter baumannii and Acinetobacter nosocomialis isolates obtained from a university hospital in Pelotas, RS, Brazil. Lett Appl Microbiol 2023; 76:ovad094. [PMID: 37563082 DOI: 10.1093/lambio/ovad094] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2023] [Revised: 06/29/2023] [Accepted: 08/03/2023] [Indexed: 08/12/2023]
Abstract
This study aimed to investigate the antibiotic resistance and biofilm formation of Acinetobacter calcoaceticus-A. baumannii (ACB) complex isolates recovered from a university hospital in Pelotas, RS, Brazil. The species were confirmed using gyrB multiplex and blaOXA-51-like genes PCR. The presence of the bfmRS virulence gene was evaluated by the PCR, and the isolates were classified based on their biofilm-forming ability on polystyrene (PO) and glass surfaces (TM). Out of 50 ACB complex isolates evaluated, 41 were identified as A. baumannii and nine as A. nosocomialis. The bfmRS gene was detected in 97.6% (40/41) of A. baumannii and 33.3% (3/9) of A. nosocomialis species. Forty-nine isolates exhibited a multidrug-resistant (MDR) profile, while one A. nosocomialis isolate presented an extensively drug-resistant (XDR) profile. All isolates were able of forming biofilms on PO surfaces and 98% (49/50) on TM surfaces. A significant correlation was observed between biofilm production on PO and TM surfaces (P < 0.05). However, no correlation was found between biofilms forming and the presence of the bfmRS gene or displaying a certain antibiotic resistance profile. In conclusion, A. baumannii and A. nosocomialis are frequent species causing nosocomial infections in a hospital in Pelotas, RS, Brazil, and both are capable of forming biofilms.
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Affiliation(s)
- Suélen Cavalheiro Amaral
- Laboratory of Bacteriology and Bioassays (LaBBio), Department of Microbiology and Parasitology, Biology Institute, Federal University of Pelotas, Pelotas, 96010900, RS, Brazil
- Center of Technological Development, Biotechnology, Federal University of Pelotas, Pelotas, 96010900, RS, Brazil
| | - Beatriz Bohns Pruski
- Laboratory of Bacteriology and Bioassays (LaBBio), Department of Microbiology and Parasitology, Biology Institute, Federal University of Pelotas, Pelotas, 96010900, RS, Brazil
| | - Stella Buchhorn de Freitas
- Laboratory of Bacteriology and Bioassays (LaBBio), Department of Microbiology and Parasitology, Biology Institute, Federal University of Pelotas, Pelotas, 96010900, RS, Brazil
| | - Lucas Moreira Dos Santos
- Center of Technological Development, Biotechnology, Federal University of Pelotas, Pelotas, 96010900, RS, Brazil
| | - Daiane Drawanz Hartwig
- Laboratory of Bacteriology and Bioassays (LaBBio), Department of Microbiology and Parasitology, Biology Institute, Federal University of Pelotas, Pelotas, 96010900, RS, Brazil
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Abatedaga I, Perez Mora B, Tuttobene M, Müller G, Biancotti D, Borsarelli CD, Valle L, Mussi MA. Characterization of BLUF-photoreceptors present in Acinetobacter nosocomialis. PLoS One 2022; 17:e0254291. [PMID: 35442978 PMCID: PMC9020721 DOI: 10.1371/journal.pone.0254291] [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] [Received: 06/05/2021] [Accepted: 03/01/2022] [Indexed: 11/18/2022] Open
Abstract
Acinetobacter nosocomialis is a Gram-negative opportunistic pathogen, whose ability to cause disease in humans is well recognized. Blue light has been shown to modulate important physiological traits related to persistence and virulence in this microorganism. In this work, we characterized the three Blue Light sensing Using FAD (BLUF) domain-containing proteins encoded in the A. nosocomialis genome, which account for the only canonical light sensors present in this microorganism. By focusing on a light-modulated bacterial process such as motility, the temperature dependence of light regulation was studied, as well as the expression pattern and spectroscopic characteristics of the different A. nosocomialis BLUFs. Our results show that the BLUF-containing proteins AnBLUF65 and AnBLUF46 encode active photoreceptors in the light-regulatory temperature range when expressed recombinantly. In fact, AnBLUF65 is an active photoreceptor in the temperature range from 15°C to 37°C, while AnBLUF46 between 15°C to 32°C, in vitro. In vivo, only the Acinetobacter baumannii BlsA’s ortholog AnBLUF65 was expressed in A. nosocomialis cells recovered from motility plates. Moreover, complementation assays showed that AnBLUF65 is able to mediate light regulation of motility in A. baumannii ΔblsA strain at 30°C, confirming its role as photoreceptor and in modulation of motility by light. Intra-protein interactions analyzed using 3D models built based on A. baumannii´s BlsA photoreceptor, show that hydrophobic/aromatic intra-protein interactions may contribute to the stability of dark/light- adapted states of the studied proteins, reinforcing the previous notion on the importance of these interactions in BLUF photoreceptors. Overall, the results presented here reveal the presence of BLUF photoreceptors in A. nosocomialis with idiosyncratic characteristics respect to the previously characterized A. baumannii’s BlsA, both regarding the photoactivity temperature-dependency as well as expression patterns, contributing thus to broaden our knowledge on the BLUF family.
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Affiliation(s)
- Inés Abatedaga
- Instituto de Bionanotecnología del NOA (INBIONATEC-CONICET), Universidad Nacional de Santiago del Estero (UNSE), Santiago del Estero, Argentina
| | - Bárbara Perez Mora
- Centro de Estudios Fotosintéticos y Bioquímicos (CEFOBI-CONICET), Universidad Nacional de Rosario (UNR), Rosario, Argentina
| | - Marisel Tuttobene
- Centro de Estudios Fotosintéticos y Bioquímicos (CEFOBI-CONICET), Universidad Nacional de Rosario (UNR), Rosario, Argentina
| | - Gabriela Müller
- Centro de Estudios Fotosintéticos y Bioquímicos (CEFOBI-CONICET), Universidad Nacional de Rosario (UNR), Rosario, Argentina
| | - Daiana Biancotti
- Centro de Estudios Fotosintéticos y Bioquímicos (CEFOBI-CONICET), Universidad Nacional de Rosario (UNR), Rosario, Argentina
| | - Claudio D. Borsarelli
- Instituto de Bionanotecnología del NOA (INBIONATEC-CONICET), Universidad Nacional de Santiago del Estero (UNSE), Santiago del Estero, Argentina
- Instituto de Ciencias Químicas (ICQ), Facultad de Agronomía y Agroindustrias (FAyA), UNSE, Santiago del Estero, Argentina
| | - Lorena Valle
- Instituto de Bionanotecnología del NOA (INBIONATEC-CONICET), Universidad Nacional de Santiago del Estero (UNSE), Santiago del Estero, Argentina
- Instituto de Ciencias Químicas (ICQ), Facultad de Agronomía y Agroindustrias (FAyA), UNSE, Santiago del Estero, Argentina
- * E-mail: (MAM); (LV)
| | - Maria A. Mussi
- Centro de Estudios Fotosintéticos y Bioquímicos (CEFOBI-CONICET), Universidad Nacional de Rosario (UNR), Rosario, Argentina
- * E-mail: (MAM); (LV)
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In vitro synergistic activity of colistin and teicoplanin combination against multidrug-resistant Acinetobacter spp. J Antibiot (Tokyo) 2022; 75:181-184. [PMID: 35091666 PMCID: PMC8816723 DOI: 10.1038/s41429-022-00509-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2021] [Revised: 11/01/2021] [Accepted: 12/12/2021] [Indexed: 11/21/2022]
Abstract
Drug combinations may have a crucial role in treating infections due to multidrug resistant Acinetobacter spp. One suggested combination is colistin with teicoplanin. The effect of colistin on Acinetobacter spp. outer membrane can permit teicoplanin to its target in the cell wall. The aim of this study was to evaluate the synergistic activity of colistin and teicoplanin combination against 29 multidrug resistant isolates of Acinetobacter spp. The antimicrobial activity of colistin alone and in combination with teicoplanin was assessed using MIC and time–kill assays. The combination of 1 mg/l colistin and 10 mg/l teicoplanin showed in vitro synergism against all tested Acinetobacter isolates except one (Acinetobacter lowffii). The combination of 1 mg/l colistin and 10 mg/l teicoplanin was bactericidal at 6 h against 100% of Acinetobacter baumannii isolates with no bacterial regrowth at 24 h. The same combination was bactericidal against three out of seven non-baumannii Acinetobacter isolates. The increased concentration of teicoplanin (20 mg/l) was synergistic but still not bactericidal against the four remaining isolates. The combination of colistin and teicoplanin was synergistic against all tested Acinetobacter spp It is therefore recommended that clinical trials are conducted to clarify the therapeutic potential of the combination.
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Abdul-Mutakabbir JC, Griffith NC, Shields RK, Tverdek FP, Escobar ZK. Contemporary Perspective on the Treatment of Acinetobacter baumannii Infections: Insights from the Society of Infectious Diseases Pharmacists. Infect Dis Ther 2021; 10:2177-2202. [PMID: 34648177 PMCID: PMC8514811 DOI: 10.1007/s40121-021-00541-4] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2021] [Accepted: 09/23/2021] [Indexed: 01/10/2023] Open
Abstract
The purpose of this narrative review is to bring together the most recent epidemiologic, preclinical, and clinical findings to offer our perspective on best practices for managing patients with A. baumannii infections with an emphasis on carbapenem-resistant A. baumannii (CRAB). To date, the preferred treatment for CRAB infections has not been defined. Traditional agents with retained in vitro activity (aminoglycosides, polymyxins, and tetracyclines) are limited by suboptimal pharmacokinetic characteristics, emergence of resistance, and/or toxicity. Recently developed and US Food and Drug Administration (FDA)-approved β-lactam/β-lactamase inhibitor agents do not provide enhanced activity against CRAB. On balance, cefiderocol and eravacycline demonstrate potent in vitro activity and are well tolerated, but clinical data for patients with CRAB infections do not yet support widespread use. Given that CRAB has the capacity to infect vulnerable patients and preferred regimens have not been identified, we advocate for combination therapy. Our preferred regimen for critically ill patients infected, or considered to be at high risk for CRAB, includes meropenem, polymyxin B, and ampicillin/sulbactam. Importantly, site of infection, severity of illness, and local epidemiology are essential factors to be considered in selecting combination therapies. Molecular mechanisms of resistance may unveil preferred combinations at individual centers; however, such data are often unavailable to treating clinicians and have not been linked to improved clinical outcomes. Combination strategies may also pose an increased risk for antibiotic toxicity and Clostridioides difficile infection, and should therefore be balanced by understanding patient goals of care and underlying health conditions. Promising therapies that are in clinical development and/or under investigation include durlobactam-sulbactam, cefiderocol combination regimens, and bacteriophage therapy, which may over time eliminate the need for the continued use of polymyxins. Future goals for CRAB management include pathogen-focused treatment paradigms that are based on molecular mechanisms of resistance, local susceptibility rates, and the availability of well-tolerated, effective treatment options.
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Affiliation(s)
- Jacinda C Abdul-Mutakabbir
- Department of Pharmacy Practice, Loma Linda University School of Pharmacy, Loma Linda, CA, USA.
- Department of Basic Sciences, Loma Linda University School of Medicine, Loma Linda, CA, USA.
| | - Nicole C Griffith
- University of Illinois at Chicago College of Pharmacy, Chicago, IL, USA
| | - Ryan K Shields
- Department of Medicine, University of Pittsburgh, Pittsburgh, PA, USA
| | - Frank P Tverdek
- University of Washington, Seattle Cancer Care Alliance, Seattle, WA, USA
| | - Zahra Kassamali Escobar
- University of Washington Medicine, Valley Medical Center, University of Washington School of Pharmacy, Renton, WA, USA
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Ling W, Furuya-Kanamori L, Ezure Y, Harris PNA, Paterson DL. Adverse clinical outcomes associated with carbapenem-resistant Acinetobacter (CRA) infections: a systematic review and meta-analysis. JAC Antimicrob Resist 2021; 3:dlab157. [PMID: 34755112 PMCID: PMC8568848 DOI: 10.1093/jacamr/dlab157] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2021] [Accepted: 09/21/2021] [Indexed: 11/13/2022] Open
Abstract
Background Carbapenem-resistant Acinetobacter (CRA) infections have been associated with increased morbidity and mortality in hospitalized patients. This systematic review and meta-analysis aimed to quantify the association between CRA infections and adverse clinical outcomes. Methods Three databases (i.e. PubMed, EMBASE and Scopus) were searched for epidemiological studies that compared mortality, severe sepsis or shock, or bacteraemia among adult inpatients with CRA infections and those with carbapenem-susceptible Acinetobacter (CSA) infections. The pooled ORs for the three outcomes were estimated using the inverse variance heterogeneity model. Results Thirty-four studies were included. Patients with CRA infections had higher odds of mortality (31 studies, OR = 2.10, 95% CI: 1.58–2.79, I2=60.6%) and severe sepsis or septic shock (7 studies, OR = 1.51, 95% CI: 1.09–2.09, I2=0%) compared with CSA-infected patients. There was no difference in the odds of bacteraemia (four studies, OR = 1.39, 95% CI: 0.79–2.46, I2=38.1%). CRA-infected patients presented with worse comorbidity at admission (e.g. APACHE score) (eight studies, standardized mean difference = 0.25, 95% CI: −0.01 to 0.52) and had lower frequency of appropriate antibiotic therapy. Results were consistent when pooling 16 study-adjusted risk estimates for mortality. There was no difference in risk of mortality from CRA infection when compared across geographical regions, country income, median year of enrolment and day of mortality from infection onset. Conclusions CRA-infected patients had worse clinical outcomes. This might be due to delay in appropriate antibiotic therapy, patients being sicker at admission and CRA strains potentially being more virulent than CSA strains. Improving appropriateness of antibiotic therapy in CRA-infected patients could reduce adverse clinical outcomes.
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Affiliation(s)
- Weiping Ling
- University of Queensland, Faculty of Medicine, UQ Centre for Clinical Research, Herston, Brisbane, Australia
| | - Luis Furuya-Kanamori
- University of Queensland, Faculty of Medicine, UQ Centre for Clinical Research, Herston, Brisbane, Australia
| | - Yukiko Ezure
- University of Queensland, Faculty of Medicine, UQ Centre for Clinical Research, Herston, Brisbane, Australia
| | - Patrick N A Harris
- University of Queensland, Faculty of Medicine, UQ Centre for Clinical Research, Herston, Brisbane, Australia.,Central Microbiology, Pathology Queensland, Royal Brisbane & Women's Hospital, Herston, Brisbane, Australia
| | - David L Paterson
- University of Queensland, Faculty of Medicine, UQ Centre for Clinical Research, Herston, Brisbane, Australia
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Knight DB, Rudin SD, Bonomo RA, Rather PN. Acinetobacter nosocomialis: Defining the Role of Efflux Pumps in Resistance to Antimicrobial Therapy, Surface Motility, and Biofilm Formation. Front Microbiol 2018; 9:1902. [PMID: 30186249 PMCID: PMC6111201 DOI: 10.3389/fmicb.2018.01902] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2018] [Accepted: 07/27/2018] [Indexed: 11/26/2022] Open
Abstract
Acinetobacter nosocomialis is a member of the Acinetobacter calcoaceticus-Acinetobacter baumannii (ACB) complex. Increasingly, reports are emerging of the pathogenic profile and multidrug resistance (MDR) phenotype of this species. To define novel therapies to overcome resistance, we queried the role of the major efflux pumps in A. nosocomialis strain M2 on antimicrobial susceptibility profiles. A. nosocomialis strains with the following mutations were engineered by allelic replacement; ΔadeB, ΔadeJ, and ΔadeB/adeJ. In these isogenic strains, we show that the ΔadeJ mutation increased susceptibility to beta-lactams, beta-lactam/beta-lactamase inhibitors, chloramphenicol, monobactam, tigecycline, and trimethoprim. The ΔadeB mutation had a minor effect on resistance to certain beta-lactams, rifampicin and tigecycline. In addition, the ΔadeJ mutation resulted in a significant decrease in surface motility and a minor decrease in biofilm formation. Our results indicate that the efflux pump, AdeIJK, has additional roles outside of antibiotic resistance in A. nosocomialis.
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Affiliation(s)
- Daniel B Knight
- Research Service, Atlanta Veterans Affairs Medical Center, Decatur, GA, United States
| | - Susan D Rudin
- Research Service, Louis Stokes Cleveland Department of Veterans Affairs Medical Center, Cleveland, OH, United States.,Department of Medicine, Pharmacology and Molecular Biology and Microbiology, Case Western Reserve University School of Medicine, Cleveland, OH, United States.,Case Western Reserve University Veterans Affairs Center for Antimicrobial Resistance (Case-VA CARES), Cleveland, OH, United States
| | - Robert A Bonomo
- Research Service, Louis Stokes Cleveland Department of Veterans Affairs Medical Center, Cleveland, OH, United States.,Department of Medicine, Pharmacology and Molecular Biology and Microbiology, Case Western Reserve University School of Medicine, Cleveland, OH, United States.,Case Western Reserve University Veterans Affairs Center for Antimicrobial Resistance (Case-VA CARES), Cleveland, OH, United States
| | - Philip N Rather
- Research Service, Atlanta Veterans Affairs Medical Center, Decatur, GA, United States.,Department of Microbiology and Immunology, Emory University School of Medicine, Atlanta, GA, United States.,Emory Antibiotic Resistance Center, Emory University School of Medicine, Atlanta, GA, United States
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Leung CH, Liu CP. Diabetic status and the relationship of blood glucose to mortality in adults with carbapenem-resistant Acinetobacter baumannii complex bacteremia. JOURNAL OF MICROBIOLOGY, IMMUNOLOGY, AND INFECTION = WEI MIAN YU GAN RAN ZA ZHI 2018; 52:654-662. [PMID: 31446929 DOI: 10.1016/j.jmii.2018.06.005] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/28/2018] [Revised: 06/18/2018] [Accepted: 06/21/2018] [Indexed: 12/18/2022]
Abstract
BACKGROUND/PURPOSE Diabetes is associated with increased mortality in Acinetobacter baumannii (AB) complex infection. This study investigated the risk factors and relationship of diabetic status and glycemic indices to mortality in patients with carbapenem-resistant (CR) AB complex bacteremia. METHODS Relationship of glycemic indices to mortality were compared in adult diabetes (DM) and nondiabetes (non-DM) patients with CRAB complex bacteremia hospitalized from January 2010 to December 2015 in MacKay Memorial Hospital, Taiwan. RESULTS Of 317 patients with CRAB complex bacteremia, 146 (46.06%) had diabetes. DM patients were elderly (mean age of 69.23 years) and the mortality rate was higher (64.38% vs. 52.05%, p = 0.036) than in non-DM patients. By multivariate analysis, septic shock was associated with increased mortality in DM patients. Hypoglycemia was associated with increased mortality in non-DM patients only (100% vs. 50.33%, p = 0.006). The lowest mortality was for the blood glucose range 70-100 mg/dL in non-DM patients (43.24%) and 100-140 mg/dL for DM patients (56.52%). Increased glycemic variability (coefficient of variation (CV) > 40% compared to < 20%) was associated with increased mortality in non-DM patients (86.36% vs. 47.12%, p = 0.003). CONCLUSION Effects of dysglycemia on mortality due to CRAB complex bacteremia differ according to diabetic status. Mortality was higher in DM patients. In non-DM patients, hypoglycemia and increased CV were associated with increased mortality. The lowest mortality was for the blood glucose range 70-100 mg/dL in non-DM patients and 100-140 mg/dL for DM patients.
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Affiliation(s)
- Ching-Hsiang Leung
- Division of Endocrinology and Metabolism, Department of Internal Medicine, MacKay Memorial Hospital, Taipei, Taiwan
| | - Chang-Pan Liu
- Division of Infectious Diseases, Department of Internal Medicine, MacKay Memorial Hospital, Taipei, Taiwan; MacKay College of Medicine Nursing and Management, Taipei, Taiwan; Department of Medicine, MacKay Medical College, New Taipei City, Taiwan; Infection Control Committee, MacKay Memorial Hospital, Taipei, Taiwan.
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Yang YS, Chen HY, Hsu WJ, Chou YC, Perng CL, Shang HS, Hsiao YT, Sun JR. Overexpression of AdeABC efflux pump associated with tigecycline resistance in clinical Acinetobacter nosocomialis isolates. Clin Microbiol Infect 2018; 25:512.e1-512.e6. [PMID: 29906589 DOI: 10.1016/j.cmi.2018.06.012] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2018] [Revised: 06/01/2018] [Accepted: 06/06/2018] [Indexed: 10/14/2022]
Abstract
OBJECTIVES Tigecycline non-susceptible Acinetobacter nosocomialis (TNAN) has been discovered in clinical isolates. The resistance-nodulation-cell division (RND)-type efflux system plays a major role in tigecycline non-susceptible Acinetobacter baumannii, but the mechanism in A. nosocomialis remains unknown. Our aim was to analyse the contribution of efflux-based tigecycline resistance in clinical A. nosocomialis isolates collected from multiple medical centres in Taiwan. METHODS A total of 57 A. nosocomialis isolates, including 46 TNAN and 11 tigecycline-susceptible A. nosocomialis (TSAN) isolates, were analysed. Of these, 46 TNAN isolates were clustered to ST410 (43 isolates) and ST68 (three isolates) by multi-locus sequence typing. RESULTS The relationship between the RND efflux pump and tigecycline resistance was indirectly verified by successfully reducing tigecycline resistance with NMP, an efflux pump inhibitor. The three RND efflux systems (AdeABC, AdeIJK and AdeFGH) were detected in all clinical isolates. The transcript level of adeB gene increased significantly and was correlated with tigecycline resistance. Moreover, the AdeRS two-component system was further classified into four different types of AdeRS patterns considering the amino acid sequence. Further analysis showed that tigecycline resistance was related to the transcript level of adeB gene and the AdeRS pattern. CONCLUSION This study showed that the dissemination of TNAN isolates in Taiwan is attributable mainly to the spread of ST410. The AdeABC efflux pump appeared to play an important role in the tigecycline resistance of A. nosocomialis.
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Affiliation(s)
- Y-S Yang
- Division of Infectious Diseases and Tropical Medicine, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
| | - H-Y Chen
- Department of Medical Techniques, Taipei City Hospital Ren-Ai Branch, Taipei, Taiwan
| | - W-J Hsu
- Department of Medical Techniques, Taipei City Hospital Ren-Ai Branch, Taipei, Taiwan
| | - Y-C Chou
- School of Public Health, National Defense Medical Center, Taipei, Taiwan
| | - C-L Perng
- Division of Clinical Pathology, Department of Pathology, Tri-Service General Hospital, National Defence Medical Centre, Taipei, Taiwan
| | - H-S Shang
- Division of Clinical Pathology, Department of Pathology, Tri-Service General Hospital, National Defence Medical Centre, Taipei, Taiwan
| | - Y-T Hsiao
- Department of Medical Techniques, Taipei City Hospital Ren-Ai Branch, Taipei, Taiwan
| | - J-R Sun
- Division of Clinical Pathology, Department of Pathology, Tri-Service General Hospital, National Defence Medical Centre, Taipei, Taiwan; Institute of Preventive Medicine, National Defense Medical Center, Taipei, Taiwan.
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Multicenter Study of Clinical Features of Breakthrough Acinetobacter Bacteremia during Carbapenem Therapy. Antimicrob Agents Chemother 2017; 61:AAC.00931-17. [PMID: 28674056 DOI: 10.1128/aac.00931-17] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2017] [Accepted: 06/28/2017] [Indexed: 01/01/2023] Open
Abstract
Breakthrough Acinetobacter bacteremia during carbapenem therapy is not uncommon, and it creates therapeutic dilemmas for clinicians. This study was conducted to evaluate the clinical and microbiological characteristics of breakthrough Acinetobacter bacteremia during carbapenem therapy and to assess the efficacy of various antimicrobial therapies. We analyzed 100 adults who developed breakthrough Acinetobacter bacteremia during carbapenem therapy at 4 medical centers over a 6-year period. Their 30-day mortality rate was 57.0%, and the carbapenem resistance rate of their isolates was 87.0%. Among patients with carbapenem-resistant Acinetobacter bacteremia, breakthrough bacteremia during carbapenem therapy was associated with a significantly higher 14-day mortality (51.7% versus 37.4%, respectively; P = 0.025 by bivariate analysis) and a higher 30-day mortality (P = 0.037 by log rank test of survival analysis) than in the nonbreakthrough group. For the treatment of breakthrough Acinetobacter bacteremia during carbapenem therapy, tigecycline-based therapy was associated with a significantly higher 30-day mortality (80.0%) than those with continued carbapenem therapy (52.5%) and colistin-based therapy (57.9%) by survival analysis (P = 0.047 and 0.045 by log rank test, respectively). Cox regression controlling for confounders, including severity of illness indices, demonstrated that treatment with tigecycline-based therapy for breakthrough Acinetobacter bacteremia was an independent predictor of 30-day mortality (hazard ratio, 3.659; 95% confidence interval, 1.794 to 7.465; P < 0.001). Patients with breakthrough Acinetobacter bacteremia during carbapenem therapy posed a high mortality rate. Tigecycline should be used cautiously for the treatment of breakthrough Acinetobacter bacteremia that develops during carbapenem therapy.
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Vila-Farrés X, Ferrer-Navarro M, Callarisa AE, Martí S, Espinal P, Gupta S, Rolain JM, Giralt E, Vila J. Loss of LPS is involved in the virulence and resistance to colistin of colistin-resistantAcinetobacter nosocomialismutants selectedin vitro. J Antimicrob Chemother 2015; 70:2981-6. [DOI: 10.1093/jac/dkv244] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2015] [Accepted: 07/14/2015] [Indexed: 11/15/2022] Open
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Pogue J, Kaye K, Cohen D, Marchaim D. Appropriate antimicrobial therapy in the era of multidrug-resistant human pathogens. Clin Microbiol Infect 2015; 21:302-12. [DOI: 10.1016/j.cmi.2014.12.025] [Citation(s) in RCA: 85] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2014] [Revised: 12/22/2014] [Accepted: 12/27/2014] [Indexed: 01/02/2023]
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12
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Wei HM, Hsu YL, Lin HC, Hsieh TH, Yen TY, Lin HC, Su BH, Hwang KP. Multidrug-resistant Acinetobacter baumannii infection among neonates in a neonatal intensive care unit at a medical center in central Taiwan. JOURNAL OF MICROBIOLOGY, IMMUNOLOGY, AND INFECTION = WEI MIAN YU GAN RAN ZA ZHI 2014; 48:531-9. [PMID: 25442873 DOI: 10.1016/j.jmii.2014.08.025] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/30/2014] [Revised: 08/29/2014] [Accepted: 08/31/2014] [Indexed: 01/30/2023]
Abstract
BACKGROUND Few studies have focused on multidrug-resistant Acinetobacter baumannii (MDRAB) infection in neonates. The aim of this study was to investigate risk factors for mortality in neonates with MDRAB infection. METHODS This retrospective case-series study was conducted at the Children's Hospital of China Medical University, Taichung, Taiwan. All patients hospitalized between January 2010 and December 2013 in the neonatal intensive care unit (NICU) with MDRAB infections were reviewed. RESULTS A total of 67 isolates from 59 neonatal patients were positive for MDRAB. Of the 67 isolates, 38 were from blood (56.72%), 16 from sputum (23.88%), seven from pus (10.45%), three from ascites (4.48%), two from cerebrospinal fluid (2.99%), and one from pleural fluid (1.49%). There were five episodes of MDRAB clusters consisting of 28 cases during the study period. The mortality rate due to MDRAB sepsis was 20.34% (12/59). The statistically significant risk factors for mortality due to MDRAB infection were being infected with MDRAB within 7 days of admission to the NICU, use of umbilical vein catheters, absolute neutrophil count < 1500/mm(3), platelet count < 100,000/mm(3), and a delay in initiating adequate antibiotic treatment. CONCLUSION MDRAB infection is responsible for a high mortality rate among neonates in the NICU, especially in those who have neutropenia or thrombocytopenia. Infection control and appropriateness of the initial antimicrobial agent with colistin play an important role in reducing mortality.
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Affiliation(s)
- Hsiu-Mei Wei
- Division of Infectious Diseases, Children's Hospital, China Medical University and China Medical University Hospital, Taichung, Taiwan
| | - Yu-Lung Hsu
- Division of Infectious Diseases, Children's Hospital, China Medical University and China Medical University Hospital, Taichung, Taiwan
| | - Hsiao-Chuan Lin
- Division of Infectious Diseases, College of Medicine and Department of Pediatrics, Children's Hospital of China Medical University and China Medical University Hospital, Taichung, Taiwan
| | - Tsung-Hsueh Hsieh
- Division of Infectious Diseases, Children's Hospital, China Medical University and China Medical University Hospital, Taichung, Taiwan
| | - Ting-Yu Yen
- Division of Infectious Diseases, Children's Hospital, China Medical University and China Medical University Hospital, Taichung, Taiwan
| | - Hung-Chih Lin
- Division of Neonatology, College of Medicine and Department of Pediatrics, Children's Hospital of China Medical University and China Medical University Hospital, Taichung, Taiwan
| | - Bai-Horng Su
- Division of Neonatology, College of Medicine and Department of Pediatrics, Children's Hospital of China Medical University and China Medical University Hospital, Taichung, Taiwan
| | - Kao-Pin Hwang
- Division of Infectious Diseases, College of Medicine and Department of Pediatrics, Children's Hospital of China Medical University and China Medical University Hospital, Taichung, Taiwan.
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Lai HH, Liou BH, Chang YY, Kuo SC, Lee YT, Chen TL, Fung CP. Risk factors and clinical outcome of sulbactam nonsusceptibility in monomicrobial Acinetobacter nosocomialis bacteremia. JOURNAL OF MICROBIOLOGY, IMMUNOLOGY, AND INFECTION = WEI MIAN YU GAN RAN ZA ZHI 2014; 49:371-7. [PMID: 25081987 DOI: 10.1016/j.jmii.2014.06.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/02/2014] [Revised: 06/19/2014] [Accepted: 06/19/2014] [Indexed: 10/25/2022]
Abstract
BACKGROUND Sulbactam is an effective antimicrobial agent against multidrug-resistant Acinetobacter spp. This retrospective study evaluated the risk factors of sulbactam nonsusceptibility (SNS) in monomicrobial Acinetobacter nosocomialis bacteremia and its related outcome. METHODS This 9-year retrospective study included 267 patients who were admitted to a large teaching hospital in Taiwan with monomicrobial A. nosocomialis bacteremia. A. nosocomialis was identified to the species level using molecular methods. Antimicrobial susceptibilities were determined by the agar dilution method. To identify the risk factors of acquiring resistant strains, significant clinical variables derived from univariate analysis were entered into multivariate analysis. Polymerase chain reaction was used to identify blaTEM. Clonality was determined by pulsed-field gel electrophoresis. RESULTS A total of 41 of the 267 patients (15.4%) had SNS A. nosocomialis bacteremia. Compared to those with susceptible strains, these patients had higher 14-day mortality (17.1% vs. 7.5%, p = 0.049), were more likely to have higher Acute Physiology and Chronic Health Evaluation (APACHE) II score, were more frequently admitted to the intensive care unit, and had previously received broad-spectrum antibiotics and underwent invasive procedures. In multivariate analysis, the independent risk factors were high APACHE II score and prior use of arterial line [odds ratio (OR), 1.048; 95% confidence interval (CI), 1.007-1.091; p = 0.022 and OR, 2.936; 95% CI, 1.339-6.441; p = 0.007, respectively]. No outbreak was identified and SNS isolates did not harbor blaTEM. CONCLUSION For monomicrobial A. nosocomialis bacteremia, the mortality of patients with SNS strains was higher. The SNS strains are more commonly recovered from patients with higher APACHE score and receiving more invasive procedures, especially arterial line.
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Affiliation(s)
- Hsin-Hao Lai
- Division of Infectious Diseases, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan; Department of Internal Medicine, Taipei City Hospital, Yang-Ming Branch, Taipei, Taiwan
| | - Bo-Huang Liou
- Division of Infectious Diseases, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Yea-Yuan Chang
- Division of Infectious Diseases, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Shu-Chen Kuo
- Division of Infectious Diseases, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan; Institute of Clinical Medicine, School of Medicine, National Yang-Ming University, Taipei, Taiwan; National Institute of Infectious Diseases and Vaccinology, National Health Research Institutes, Miaoli County, Taiwan.
| | - Yi-Tzu Lee
- Division of Infectious Diseases, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan; Institute of Clinical Medicine, School of Medicine, National Yang-Ming University, Taipei, Taiwan; Department of Emergency Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Te-Li Chen
- Division of Infectious Diseases, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan; Department of Medicine, Cheng Hsin General Hospital, Taipei, Taiwan
| | - Chang-Phone Fung
- Division of Infectious Diseases, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan; Institute of Clinical Medicine, School of Medicine, National Yang-Ming University, Taipei, Taiwan
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14
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Risk factors and outcomes for patients with bloodstream infection due to Acinetobacter baumannii-calcoaceticus complex. Antimicrob Agents Chemother 2014; 58:4630-5. [PMID: 24890594 DOI: 10.1128/aac.02441-14] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Identifying patients at risk for bloodstream infection (BSI) due to Acinetobacter baumannii-Acinetobacter calcoaceticus complex (ABC) and providing early appropriate therapy are critical for improving patient outcomes. A retrospective matched case-control study was conducted to investigate the risk factors for BSI due to ABC in patients admitted to the Detroit Medical Center (DMC) between January 2006 and April 2009. The cases were patients with BSI due to ABC; the controls were patients not infected with ABC. Potential risk factors were collected 30 days prior to the ABC-positive culture date for the cases and 30 days prior to admission for the controls. A total of 245 case patients were matched with 245 control patients. Independent risk factors associated with BSI due to ABC included a Charlson's comorbidity score of ≥ 3 (odds ratio [OR], 2.34; P = 0.001), a direct admission from another health care facility (OR, 4.63; P < 0.0001), a prior hospitalization (OR, 3.11; P < 0.0001), the presence of an indwelling central venous line (OR, 2.75; P = 0.011), the receipt of total parenteral nutrition (OR, 21.2; P < 0.0001), the prior receipt of β-lactams (OR, 3.58; P < 0.0001), the prior receipt of carbapenems (OR, 3.18; P = 0.006), and the prior receipt of chemotherapy (OR, 15.42; P < 0.0001). The median time from the ABC-positive culture date to the initiation of the appropriate antimicrobial therapy was 2 days (interquartile range [IQR], 1 to 3 days). The in-hospital mortality rate was significantly higher among case patients than among control patients (OR, 3.40; P < 0.0001). BSIs due to ABC are more common among critically ill and debilitated institutionalized patients, who are heavily exposed to health care settings and invasive devices.
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