1
|
Dung TTN, Phat VV, Vinh C, Lan NPH, Phuong NLN, Ngan LTQ, Thwaites G, Thwaites L, Rabaa M, Nguyen ATK, Duy PT. Development and validation of multiplex real-time PCR for simultaneous detection of six bacterial pathogens causing lower respiratory tract infections and antimicrobial resistance genes. BMC Infect Dis 2024; 24:164. [PMID: 38326753 PMCID: PMC10848345 DOI: 10.1186/s12879-024-09028-2] [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: 06/17/2023] [Accepted: 01/18/2024] [Indexed: 02/09/2024] Open
Abstract
BACKGROUND Klebsiella pneumoniae, Acinetobacter baumannii, Pseudomonas aeruginosa, Escherichia coli, Streptococcus pneumoniae and Staphylococcus aureus are major bacterial causes of lower respiratory tract infections (LRTIs) globally, leading to substantial morbidity and mortality. The rapid increase of antimicrobial resistance (AMR) in these pathogens poses significant challenges for their effective antibiotic therapy. In low-resourced settings, patients with LRTIs are prescribed antibiotics empirically while awaiting several days for culture results. Rapid pathogen and AMR gene detection could prompt optimal antibiotic use and improve outcomes. METHODS Here, we developed multiplex quantitative real-time PCR using EvaGreen dye and melting curve analysis to rapidly identify six major pathogens and fourteen AMR genes directly from respiratory samples. The reproducibility, linearity, limit of detection (LOD) of real-time PCR assays for pathogen detection were evaluated using DNA control mixes and spiked tracheal aspirate. The performance of RT-PCR assays was subsequently compared with the gold standard, conventional culture on 50 tracheal aspirate and sputum specimens of ICU patients. RESULTS The sensitivity of RT-PCR assays was 100% for K. pneumoniae, A. baumannii, P. aeruginosa, E. coli and 63.6% for S. aureus and the specificity ranged from 87.5% to 97.6%. The kappa correlation values of all pathogens between the two methods varied from 0.63 to 0.95. The limit of detection of target bacteria was 1600 CFU/ml. The quantitative results from the PCR assays demonstrated 100% concordance with quantitative culture of tracheal aspirates. Compared to culture, PCR assays exhibited higher sensitivity in detecting mixed infections and S. pneumoniae. There was a high level of concordance between the detection of AMR gene and AMR phenotype in single infections. CONCLUSIONS Our multiplex quantitative RT-PCR assays are fast and simple, but sensitive and specific in detecting six bacterial pathogens of LRTIs and their antimicrobial resistance genes and should be further evaluated for clinical utility.
Collapse
Affiliation(s)
- Tran Thi Ngoc Dung
- Molecular Epidemiology Group, Oxford University Clinical Research Unit, 764 Vo Van Kiet Street, Ward 1, District 5, Ho Chi Minh City, Vietnam
| | - Voong Vinh Phat
- Molecular Epidemiology Group, Oxford University Clinical Research Unit, 764 Vo Van Kiet Street, Ward 1, District 5, Ho Chi Minh City, Vietnam
| | - Chau Vinh
- Molecular Epidemiology Group, Oxford University Clinical Research Unit, 764 Vo Van Kiet Street, Ward 1, District 5, Ho Chi Minh City, Vietnam
| | | | | | | | - Guy Thwaites
- Molecular Epidemiology Group, Oxford University Clinical Research Unit, 764 Vo Van Kiet Street, Ward 1, District 5, Ho Chi Minh City, Vietnam
- Centre for Tropical Medicine and Global Health, Nuffield Department of Clinical Medicine, Oxford University, Oxford, UK
| | - Louise Thwaites
- Molecular Epidemiology Group, Oxford University Clinical Research Unit, 764 Vo Van Kiet Street, Ward 1, District 5, Ho Chi Minh City, Vietnam
- Centre for Tropical Medicine and Global Health, Nuffield Department of Clinical Medicine, Oxford University, Oxford, UK
| | - Maia Rabaa
- Molecular Epidemiology Group, Oxford University Clinical Research Unit, 764 Vo Van Kiet Street, Ward 1, District 5, Ho Chi Minh City, Vietnam
- Centre for Tropical Medicine and Global Health, Nuffield Department of Clinical Medicine, Oxford University, Oxford, UK
| | - Anh T K Nguyen
- Molecular Epidemiology Group, Oxford University Clinical Research Unit, 764 Vo Van Kiet Street, Ward 1, District 5, Ho Chi Minh City, Vietnam
- Hospital for Tropical Diseases, Ho Chi Minh City, Vietnam
| | - Pham Thanh Duy
- Molecular Epidemiology Group, Oxford University Clinical Research Unit, 764 Vo Van Kiet Street, Ward 1, District 5, Ho Chi Minh City, Vietnam.
- Centre for Tropical Medicine and Global Health, Nuffield Department of Clinical Medicine, Oxford University, Oxford, UK.
| |
Collapse
|
2
|
Kogilathota Jagirdhar GS, Rama K, Reddy ST, Pattnaik H, Qasba RK, Elmati PR, Kashyap R, Schito M, Gupta N. Efficacy of Cefoperazone Sulbactam in Patients with Acinetobacter Infections: A Systematic Review of the Literature. Antibiotics (Basel) 2023; 12:antibiotics12030582. [PMID: 36978449 PMCID: PMC10044834 DOI: 10.3390/antibiotics12030582] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2023] [Revised: 03/13/2023] [Accepted: 03/13/2023] [Indexed: 03/17/2023] Open
Abstract
Introduction: Acinetobacter baumannii (AB) is a multidrug-resistant pathogen commonly associated with nosocomial infections. The resistance profile and ability to produce biofilm make it a complicated organism to treat effectively. Cefoperazone sulbactam (CS) is commonly used to treat AB, but the associated data are scarce. Methods: We conducted a systematic review of articles downloaded from Cochrane, Embase, PubMed, Scopus, and Web of Science (through June 2022) to study the efficacy of CS in treating AB infections. Our review evaluated patients treated with CS alone and CS in combination with other antibiotics separately. The following outcomes were studied: clinical cure, microbiological cure, and mortality from any cause. Results: We included 16 studies where CS was used for the treatment of AB infections. This included 11 studies where CS was used alone and 10 studies where CS was used in combination. The outcomes were similar in both groups. We found that the pooled clinical cure, microbiological cure, and mortality with CS alone for AB were 70%, 44%, and 20%, respectively. The pooled clinical cure, microbiological cure, and mortality when CS was used in combination with other antibiotics were 72%, 43%, and 21%, respectively. Conclusions: CS alone or in combination needs to be further explored for the treatment of AB infections. There is a need for randomized controlled trials with comparator drugs to evaluate the drug’s effectiveness.
Collapse
Affiliation(s)
| | - Kaanthi Rama
- Gandhi Medical College and Hospital, Secunderabad 500003, Telangana, India
| | - Shiva Teja Reddy
- Gandhi Medical College and Hospital, Secunderabad 500003, Telangana, India
| | | | | | - Praveen Reddy Elmati
- Interventional Pain Medicine, University of Louisville, Louisville, KY 40208, USA
| | - Rahul Kashyap
- Critical Care Medicine, Department of Anesthesiology, Mayo Clinic, Rochester, MN 55092, USA
| | - Marco Schito
- CURE Drug Repurposing Collaboratory (CDRC), Critical Path Institute, 1730 E River Rd, Tucson, AZ 85718, USA
| | - Nitin Gupta
- Department of Infectious Disease, Kasturba Medical College, Manipal, Manipal Academy of Higher Education, Manipal 576104, India
- Correspondence:
| |
Collapse
|
3
|
Woon JJ, Teh CSJ, Chong CW, Abdul Jabar K, Ponnampalavanar S, Idris N. Molecular Characterization of Carbapenem-Resistant Acinetobacter baumannii Isolated from the Intensive Care Unit in a Tertiary Teaching Hospital in Malaysia. Antibiotics (Basel) 2021; 10:antibiotics10111340. [PMID: 34827278 PMCID: PMC8615160 DOI: 10.3390/antibiotics10111340] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2021] [Revised: 10/21/2021] [Accepted: 10/26/2021] [Indexed: 12/31/2022] Open
Abstract
The emergence of carbapenem-resistant Acinetobacter baumannii (CRAB) has now become a global sentinel event. CRAB infections often instigate severe clinical complications and are potentially fatal, especially for debilitated patients. The present study aimed to conduct molecular characterization on CRAB isolated from patients in the intensive care unit from 2015 to 2016 and determine the risk factors associated with patients’ mortality. One hundred CRAB isolates were retrospectively selected and included in this study. Antimicrobial susceptibility testing showed that all isolates remained susceptible to colistin, even though 62% of them conferred resistance to all other classes of antibiotics tested. OXA carbapenemase gene was found to be the predominant carbapenemase gene, with 99% of the isolates coharbouring blaOXA-23-like and blaOXA-51-like carbapenemase genes. All isolates were carrying intact CarO genes, with the presence of various degree of nucleotide insertion, deletion and substitution. Overall, PFGE subtyped the isolates into 13 distinct pulsotypes, with the presence of 2 predominant pulsotypes. Univariate analysis implied that age, infection/colonization by CRAB, ethnicity, comorbidity and CRAB specimen source were significantly associated with in-hospital mortality. Multivariate analysis identified a higher risk of mortality for patients who are of Chinese ethnicity with diabetes as an underlying disease. As CRAB infection could lead to high rate of mortality, comprehensive infection control measures are needed to minimize the spread of this pathogen.
Collapse
Affiliation(s)
- Jia Jie Woon
- Department of Medical Microbiology, Faculty of Medicine, University of Malaya, Kuala Lumpur 50603, Malaysia; (J.J.W.); (C.S.J.T.); (K.A.J.)
| | - Cindy Shuan Ju Teh
- Department of Medical Microbiology, Faculty of Medicine, University of Malaya, Kuala Lumpur 50603, Malaysia; (J.J.W.); (C.S.J.T.); (K.A.J.)
| | - Chun Wie Chong
- School of Pharmacy, Monash University Malaysia, Subang Jaya 47500, Malaysia
- Correspondence: (C.W.C.); (N.I.); Tel.: +60-379-676-671 (N.I.)
| | - Kartini Abdul Jabar
- Department of Medical Microbiology, Faculty of Medicine, University of Malaya, Kuala Lumpur 50603, Malaysia; (J.J.W.); (C.S.J.T.); (K.A.J.)
| | - Sasheela Ponnampalavanar
- Department of Infectious Diseases, University of Malaya Medical Centre, Kuala Lumpur 50603, Malaysia;
| | - Nuryana Idris
- Department of Medical Microbiology, Faculty of Medicine, University of Malaya, Kuala Lumpur 50603, Malaysia; (J.J.W.); (C.S.J.T.); (K.A.J.)
- Correspondence: (C.W.C.); (N.I.); Tel.: +60-379-676-671 (N.I.)
| |
Collapse
|
4
|
Wang L, Chen Y, Han R, Huang Z, Zhang X, Hu F, Yang F. Sulbactam Enhances in vitro Activity of β-Lactam Antibiotics Against Acinetobacter baumannii. Infect Drug Resist 2021; 14:3971-3977. [PMID: 34611414 PMCID: PMC8487265 DOI: 10.2147/idr.s332160] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2021] [Accepted: 09/08/2021] [Indexed: 01/09/2023] Open
Abstract
Purpose To evaluate in vitro activities of β-lactam antibiotics alone and in combination with sulbactam at different ratios against Acinetobacter baumannii clinical strains from China. Methods A total of 300 clinical isolates of A. baumannii were collected from 29 hospitals across China in 2018. Susceptibility to common antibiotics was assessed, and β-lactamase genes were detected. In vitro activity of ampicillin, cefoperazone and imipenem was tested alone and in combination with sulbactam at the ratios of 2:1, 1:1, 1:1.5, 1:2, 1:2.5 and 1:3. Results High resistant rates for common antibiotics were observed except tigecycline and polymyxin B. Among carbapenem-resistant A. baumannii, 97.3% isolates harbored blaOXA-23. MIC50 and MIC90 values for sulbactam were 32 mg/L and 64 mg/L, respectively. High resistant rates for ampicillin, cefoperazone and imipenem were observed (92.3%, 93% and 85.3%, respectively). A stepwise increase in the ratio of sulbactam to partner β-lactam antibiotics led to a stepwise decrease in the MICs and a stepwise increase in the susceptible rates. The susceptible rates for imipenem-sulbactam 1:3, ampicillin-sulbactam 1:3 and cefoperazone-sulbactam 1:3 reached 16.3%, 58.3% and 91%, respectively. Conclusion The increasing proportion of sulbactam could enhance antimicrobial activities of imipenem-sulbactam, ampicillin-sulbactam and cefoperazone-sulbactam combinations against A. baumannii clinical strains in China, with cefoperazone-sulbactam as the most potent compound.
Collapse
Affiliation(s)
- Leilei Wang
- Institute of Antibiotics, Huashan Hospital, Fudan University, Shanghai, People's Republic of China.,Key Laboratory of Clinical Pharmacology of Antibiotics, Ministry of Health, Shanghai, People's Republic of China
| | - Yuancheng Chen
- Institute of Antibiotics, Huashan Hospital, Fudan University, Shanghai, People's Republic of China.,Key Laboratory of Clinical Pharmacology of Antibiotics, Ministry of Health, Shanghai, People's Republic of China.,Phase I Clinical Research Center, Huashan Hospital, Fudan University, Shanghai, People's Republic of China
| | - Renru Han
- Institute of Antibiotics, Huashan Hospital, Fudan University, Shanghai, People's Republic of China.,Key Laboratory of Clinical Pharmacology of Antibiotics, Ministry of Health, Shanghai, People's Republic of China
| | - Zhiwei Huang
- Institute of Antibiotics, Huashan Hospital, Fudan University, Shanghai, People's Republic of China.,Key Laboratory of Clinical Pharmacology of Antibiotics, Ministry of Health, Shanghai, People's Republic of China.,Phase I Clinical Research Center, Huashan Hospital, Fudan University, Shanghai, People's Republic of China
| | - Xuefei Zhang
- Institute of Antibiotics, Huashan Hospital, Fudan University, Shanghai, People's Republic of China.,Key Laboratory of Clinical Pharmacology of Antibiotics, Ministry of Health, Shanghai, People's Republic of China
| | - Fupin Hu
- Institute of Antibiotics, Huashan Hospital, Fudan University, Shanghai, People's Republic of China.,Key Laboratory of Clinical Pharmacology of Antibiotics, Ministry of Health, Shanghai, People's Republic of China
| | - Fan Yang
- Institute of Antibiotics, Huashan Hospital, Fudan University, Shanghai, People's Republic of China.,Key Laboratory of Clinical Pharmacology of Antibiotics, Ministry of Health, Shanghai, People's Republic of China
| |
Collapse
|
5
|
Assessment of the Bacterial Pollution and Detection of Antibiotic Resistance Genes in Benin: Case of the Hydrographic Channel Complex Cotonou-Nokoué Lake. JOURNAL OF ENVIRONMENTAL AND PUBLIC HEALTH 2021; 2021:6664816. [PMID: 34285697 PMCID: PMC8275426 DOI: 10.1155/2021/6664816] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/18/2020] [Revised: 06/09/2021] [Accepted: 06/28/2021] [Indexed: 11/28/2022]
Abstract
The study aims to document the level of contamination of the aquatic ecosystem of the Cotonou-Lake Nokoué canal hydrographic complex by multidrug-resistant bacteria and their resistance genes. For this purpose, water samples were taken from several points of the complex and from the sediments at the depth of the lake. Samples of several species of freshly caught fish products from the lake were also collected. Bacteriological analyses were carried out according to the AFNOR standard (NF U: 47–100). The identification of the different bacterial species isolated was then carried out using the API 20E gallery and specific biochemical tests. The antibiogram of the strains was performed according to the recommendations of the EUCAST. Molecular characterization of the identified strains was carried out by searching for resistance and virulence genes. The results obtained revealed the presence of several bacterial species in water samples and in sediment and intestine samples of fishery products with a predominance of Gram-negative bacilli. The resistance profile of Gram-negative bacilli showed a total resistance to metronidazole (100%). 23% of the strains were also resistant to ciprofloxacin, 41% to amoxicillin, and 60% to aztreonam. Of the Gram-positive cocci identified, 66% was resistant to vancomycin, 7.5% to ciprofloxacin, 71% to erythromycin, and 22% to tetracycline. Regarding the genes sought, blaTEM (46%), blaSHV (24%), and blaCTX-M-15 (31%) were present in the genome of Gram-negative bacilli as resistance genes and fimH (41%) as virulence gene. As for Gram-positive cocci, the van B gene was completely absent. The van A was present at 6.25% in Staphylococcus aureus and mecA at 21.88 and 33.33%, respectively, in Staphylococcus aureus and coagulase-negative staphylococci strains. The high resistance of isolated bacterial strains is a matter of concern and calls for a rational use of antibiotics in order to avoid the transmission of antibiotic resistance from the environment to humans.
Collapse
|
6
|
Molecular characterization and antibiotic resistance of Acinetobacter baumannii in cerebrospinal fluid and blood. PLoS One 2021; 16:e0247418. [PMID: 33617547 PMCID: PMC7899338 DOI: 10.1371/journal.pone.0247418] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2020] [Accepted: 02/07/2021] [Indexed: 01/22/2023] Open
Abstract
The increasing prevalence of carbapenem-resistant Acinetobacter baumannii (CRAB) caused nosocomial infections generate significant comorbidity and can cause death among patients. Current treatment options are limited. These infections pose great difficulties for infection control and clinical treatment. To identify the antimicrobial resistance, carbapenemases and genetic relatedness of Acinetobacter baumannii isolates from cerebrospinal fluid (CSF) and blood, a total of 50 nonrepetitive CSF isolates and 44 blood isolates were collected. The resistance phenotypes were determined, and polymerase chain reaction (PCR) was performed to examine the mechanisms of carbapenem resistance. Finally, multilocus sequence typing (MLST) was conducted to determine the genetic relatedness of these isolates. It was observed that 88 of the 94 collected isolates were resistant to imipenem or meropenem. Among them, the blaOXA-23 gene was the most prevalent carbapenemase gene, with an observed detection rate of 91.5% (86/94), followed by the blaOXA-24 gene with a 2.1% detection rate (2/94). Among all carbapenem-resistant Acinetobacter baumannii (CRAB) observations, isolates with the blaOXA-23 gene were resistant to both imipenem and meropenem. Interestingly, isolates positive for the blaOXA-24 gene but negative for the blaOXA-23 gene showed an imipenem-sensitive but meropenem-resistant phenotype. The MLST analysis identified 21 different sequence types (STs), with ST195, ST540 and ST208 most frequently detected (25.5%, 12.8% and 11.7%, respectively). 80 of the 94 isolates (85.1%) were clustered into CC92 which showed a carbapenem resistance phenotype (except AB13). Five novel STs were detected, and most of them belong to CRAB. In conclusion, these findings provide additional observations and epidemiological data of CSF and blood A. baumannii strains, which may improve future infection-control measures and aid in potential clinical treatments in hospitals and other clinical settings.
Collapse
|
7
|
Khurshid M, Rasool MH, Ashfaq UA, Aslam B, Waseem M, Ali MA, Almatroudi A, Rasheed F, Saeed M, Guo Q, Wang M. Acinetobacter baumannii Sequence Types Harboring Genes Encoding Aminoglycoside Modifying Enzymes and 16SrRNA Methylase; a Multicenter Study from Pakistan. Infect Drug Resist 2020; 13:2855-2862. [PMID: 32884309 PMCID: PMC7443399 DOI: 10.2147/idr.s260643] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Accepted: 07/29/2020] [Indexed: 12/20/2022] Open
Abstract
Introduction The aminoglycosides are widely used for the therapeutic management of infections caused by gram-negative bacteria, including the Acinetobacter baumannii strains. However, the resistance to the members of the aminoglycoside family, such as amikacin, gentamicin, and tobramycin, is increasingly being common among the clinical isolates. Purpose This study aimed to investigate the presence of 16SrRNA methylases and aminoglycoside modifying enzymes (AMEs) genes among aminoglycoside resistant A. baumannii isolates and to study the genetic diversity of the clinical population of A. baumannii in local hospitals. Material and Methods The 143 A. baumannii clinical strains were analyzed for antimicrobial susceptibility, genetic screening for enzymes conferring aminoglycosides resistance followed by the multilocus sequence typing. Results The 133/143 (93%) isolates were non-susceptible to at least one of the tested aminoglycosides, including amikacin, gentamicin, and tobramycin. The MIC distribution has shown that 87.486.7% strains were resistant to amikacin and gentamicin, respectively. The aphA6, aadB, aacC1, and aphA1 were found in 74.1%, 59.4%, 16.1%, and 11.2% isolates, respectively, whereas the armA was found in 28% of the strains having a higher MIC value (MIC; ≥256µg/mL). The MLST data have shown that the ST589 and ST2 were the most common STs and corresponded to 51 (35.7%) and 38 (26.6%) isolates, respectively, and few of the isolates corresponding to these STs were found to harbor the armA gene with a variable genotypic profile for AMEs. Discussion The study has reported the incidence of various enzymes conferring aminoglycoside resistance among the A. baumannii clones for the first time from Pakistan. The findings suggest the possibility of transmission of aminoglycoside resistance determinants through the lateral gene transfer as well as clonal dissemination.
Collapse
Affiliation(s)
- Mohsin Khurshid
- Institute of Antibiotics, Huashan Hospital, Fudan University, Shanghai 200040, People's Republic of China.,Department of Microbiology, Government College University, Faisalabad, Pakistan
| | | | - Usman Ali Ashfaq
- Department of Bioinformatics & Biotechnology, Government College University, Faisalabad, Pakistan
| | - Bilal Aslam
- Department of Microbiology, Government College University, Faisalabad, Pakistan
| | - Muhammad Waseem
- Department of Microbiology, Government College University, Faisalabad, Pakistan
| | | | - Ahmad Almatroudi
- Department of Medical Laboratories, College of Applied Medical Sciences, Qassim University, Buraydah, Saudi Arabia
| | - Farhan Rasheed
- Allama Iqbal Medical College, Jinnah Hospital Lahore, Lahore, Pakistan
| | - Muhammad Saeed
- Department of Microbiology, Government College University, Faisalabad, Pakistan
| | - Qinglan Guo
- Institute of Antibiotics, Huashan Hospital, Fudan University, Shanghai 200040, People's Republic of China
| | - Minggui Wang
- Institute of Antibiotics, Huashan Hospital, Fudan University, Shanghai 200040, People's Republic of China
| |
Collapse
|
8
|
Araújo Lima AV, da Silva SM, do Nascimento Júnior JAA, Correia MDS, Luz AC, Leal-Balbino TC, da Silva MV, Lima JLDC, Maciel MAV, Napoleão TH, Oliveira MBMD, Paiva PMG. Occurrence and Diversity of Intra- and Interhospital Drug-Resistant and Biofilm-Forming Acinetobacter baumannii and Pseudomonas aeruginosa. Microb Drug Resist 2020; 26:802-814. [PMID: 31916896 DOI: 10.1089/mdr.2019.0214] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Acinetobacter baumannii and Pseudomonas aeruginosa are the most relevant Gram-negative bacteria associated with hospital and opportunistic infections. This study aimed to evaluate the dynamics of drug-resistant A. baumannii and P. aeruginosa and biofilm formers from two public hospitals in northeastern Brazil. One hundred isolates (35 from A. baumannii and 65 from P. aeruginosa) were identified using the automated Vitek®2 Compact method (bioMérieux) and confirmed using the MALDI-TOF (MS) mass spectrometry technique. Molecular experiments were performed by polymerase chain reaction (PCR) to detect the frequency of blaKPC, blaIMP, blaVIM, and blaSHV genes. The biofilm formation potential was evaluated using crystal violet in Luria Bertani Miller and trypticase soy broth culture media under the following conditions: at standard concentration, one quarter (25%) of the standard concentration and supplemented with 1% glucose. In addition, the genetic diversity of the isolates was verified by the ERIC-PCR technique. Isolates presented distinct resistance profiles with a high level of beta-lactam resistance. The highest index of genes detected was blaKPC (60%), followed by blaSHV (39%), blaVIM (8%), and blaIMP (1%). All the isolates were sensitive to the polymyxins tested and formed biofilms at different intensities. Twelve clones of A. baumannii and eight of P. aeruginosa were identified, of which few were indicative of intra- and interhospital dissemination. This study reveals the dispersion dynamics of these isolates in the hospital environment. The results demonstrate the importance of monitoring programs to combat the spread of these pathogens.
Collapse
Affiliation(s)
- Ana Vitoria Araújo Lima
- Departamento de Bioquímica, Centro de Biociências/Universidade Federal de Pernambuco, Recife, Brazil
| | - Sivoneide Maria da Silva
- Departamento de Bioquímica, Centro de Biociências/Universidade Federal de Pernambuco, Recife, Brazil
| | | | | | - Ana Carolina Luz
- Departamento de Microbiologia, FIOCRUZ Aggeu Magalhães, Recife, Brazil
| | | | - Márcia Vanusa da Silva
- Departamento de Bioquímica, Centro de Biociências/Universidade Federal de Pernambuco, Recife, Brazil
| | | | | | - Thiago Henrique Napoleão
- Departamento de Bioquímica, Centro de Biociências/Universidade Federal de Pernambuco, Recife, Brazil
| | | | | |
Collapse
|
9
|
Shooshtari FS, Navidifar T, Amin M, Goodarzi H. Coexistence of genes encoding aminoglycoside modifying enzymes among clinical Acinetobacter baumannii isolates in Ahvaz, Southwest Iran. Acta Microbiol Immunol Hung 2019; 67:33-41. [PMID: 31833384 DOI: 10.1556/030.66.2019.042] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2019] [Accepted: 10/16/2019] [Indexed: 11/19/2022]
Abstract
Aminoglycosides are widely recommended for treatment of Acinetobacter baumannii infections in combination with β-lactams or quinolones. This cross-sectional study was aimed to investigate the coexistence of aminoglycoside modifying enzyme (AME) genes among A. baumannii isolates from clinical samples in Ahvaz, Iran. A total of 85 clinical A. baumannii isolates typed by ERIC-PCR were investigated for the presence of AME genes, including ant(3″)-Ia, aac(6')-Ib, aac(3')-Ia, ant(2″)-Ia, and aph(3')-VIa by PCR. The resistance rates to aminoglycoside agents were evaluated by disk diffusion. In this study, 84 out of 85 A. baumannii isolates were resistant to at least one of the aminoglycosides and harbored at least one AME gene. The most common gene encoding AMEs was aph (3')VIa, followed by aac(3')-Ia, ant(3″)-Ia, ant (2″)-Ia, and aac(6')-Ib. The aminoglycoside-resistant genotypes were completely matched to resistant phenotypes to each one of the aminoglycoside agents. There was a clear association between AME gene types and the phenotype of resistance to aminoglycosides with their ERIC-PCR types. Our findings highlight the coexistence of AME genes and clonal dissemination of multiresistant A. baumannii in hospital setting.
Collapse
Affiliation(s)
- Farkhondeh Saleh Shooshtari
- 1 Department of Microbiology, School of Medicine, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
- 2 Infertility Research and Treatment Center of Jahad Daneshgahi, Ahvaz, Iran
| | - Tahereh Navidifar
- 1 Department of Microbiology, School of Medicine, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Mansour Amin
- 1 Department of Microbiology, School of Medicine, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
- 3 Infectious and Tropical Diseases Research Center, Health Research Institute, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Hamed Goodarzi
- 1 Department of Microbiology, School of Medicine, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| |
Collapse
|
10
|
Xu S, Li Y, Xu X, Su J, Zhu D, Hu F, Wang M. A Case-Control Study: Clinical Characteristics of Nosocomial Bloodstream Infections Versus Non-bloodstream Infections of Acinetobacter spp. Clin Infect Dis 2018; 67:S189-S195. [PMID: 30423050 DOI: 10.1093/cid/ciy671] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023] Open
Abstract
Background Acinetobacter spp. are among the most common causes of bacterial nosocomial infections, including pneumonia and bloodstream infections. Previous studies on the risk factors of bloodstream Acinetobacter spp. infections (BSAcIs) primarily compared uninfected patients to those with BSAcIs. However, the identified risk factors contribute to either BSIs or Acinetobacter spp. infections. To the best of our knowledge, this is the first study to analyze the risk factors of BSAcIs in comparison to non-bloodstream Acinetobacter infections (non-BSAcIs). Methods We retrospectively reviewed 10 years of medical records of BSAcIs from a teaching hospital in Shanghai. Clinical characteristics and treatment outcomes were compared between BSAcIs and non-BSAcIs. Treatment outcomes of carbapenem- and sulbactam-based regimens were also evaluated. Results Respiratory tract infections (43.1%, 44/102) were the most common source of BSAcIs. The in-hospital mortality rate of BSAcIs (22.5%, 23/102) was significantly higher than that of non-BSAcIs (10.8%, 24/204). Compared with non-BSAcIs, the previous use of corticoids, proton pump inhibitor (PPI) usage, and the implementation of intracranial drainage were independent risk factors for BSAcIs. The clinical efficacy rate of antimicrobial treatment of carbapenem-susceptible BSAcIs was significantly higher than that of carbapenem-non-susceptible (CNS) BSAcIs (74.0% vs 44.3%). Sulbactam-based regimens had similar clinical efficacy rates as carbapenem-based regimens for treating CNS-BSAcIs (50.0% vs 45.8%). Conclusions The in-hospital mortality rate of BSAcIs was significantly higher than that of non-BSAcIs. Glucocorticoids, PPI usage, and intracranial drainage were independent risk factors for BSAcIs. Sulbactam-based regimens had similar clinical efficacy rates as carbapenem-based regimens for treating CNS-BSAcIs.
Collapse
Affiliation(s)
- Su Xu
- Institute of Antibiotics, Huashan Hospital, Fudan University, Shanghai.,Key Laboratory of Clinical Pharmacology of Antibiotics, National Health and Family Planning Commission, China
| | - Ying Li
- Institute of Antibiotics, Huashan Hospital, Fudan University, Shanghai.,Key Laboratory of Clinical Pharmacology of Antibiotics, National Health and Family Planning Commission, China
| | - Xiaogang Xu
- Institute of Antibiotics, Huashan Hospital, Fudan University, Shanghai.,Key Laboratory of Clinical Pharmacology of Antibiotics, National Health and Family Planning Commission, China
| | - Jiachun Su
- Institute of Antibiotics, Huashan Hospital, Fudan University, Shanghai.,Key Laboratory of Clinical Pharmacology of Antibiotics, National Health and Family Planning Commission, China
| | - Demei Zhu
- Institute of Antibiotics, Huashan Hospital, Fudan University, Shanghai.,Key Laboratory of Clinical Pharmacology of Antibiotics, National Health and Family Planning Commission, China
| | - Fupin Hu
- Institute of Antibiotics, Huashan Hospital, Fudan University, Shanghai.,Key Laboratory of Clinical Pharmacology of Antibiotics, National Health and Family Planning Commission, China
| | - Minggui Wang
- Institute of Antibiotics, Huashan Hospital, Fudan University, Shanghai.,Key Laboratory of Clinical Pharmacology of Antibiotics, National Health and Family Planning Commission, China
| |
Collapse
|
11
|
Hu F, Zhu D, Wang F, Wang M. Current Status and Trends of Antibacterial Resistance in China. Clin Infect Dis 2018; 67:S128-S134. [PMID: 30423045 DOI: 10.1093/cid/ciy657] [Citation(s) in RCA: 189] [Impact Index Per Article: 31.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- Fupin Hu
- Institute of Antibiotics, Huashan Hospital, Fudan University, Shanghai, China
| | - Demei Zhu
- Institute of Antibiotics, Huashan Hospital, Fudan University, Shanghai, China
| | - Fu Wang
- Institute of Antibiotics, Huashan Hospital, Fudan University, Shanghai, China
| | - Minggui Wang
- Institute of Antibiotics, Huashan Hospital, Fudan University, Shanghai, China
| |
Collapse
|
12
|
A multiplex loop-mediated isothermal amplification assay for rapid screening of Acinetobacter baumannii and D carbapenemase OXA-23 gene. Biosci Rep 2018; 38:BSR20180425. [PMID: 30042168 PMCID: PMC6127667 DOI: 10.1042/bsr20180425] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2018] [Revised: 07/06/2018] [Accepted: 07/11/2018] [Indexed: 01/28/2023] Open
Abstract
Background: Acinetobacter baumannii is a health burden responsible for various nosocomial infections, and bacteremia in particular. The resistance of A. baumannii to most antibiotics including carbapenem has increased. OXA-23-producing A. baumannii is the chief source of nosocomial outbreaks with carbapenem-resistant A. baumannii. Successful antibiotic treatment relies on the accurate and rapid identification of infectious agents and drug resistance. Here, we describe a multiplex loop-mediated isothermal amplification (LAMP) assay for simultaneous and homogeneous identification for A. baumannii infection screening and drug-resistance gene detection. Methods: Four primer pairs were designed to amplify fragments of the recA gene of A. baumannii and the oxa-23 gene. The reaction with a 25 μl of final volume was performed at 63°C for 60 min. For comparative purposes, we used a traditional method of bacterial identification to evaluate assay efficacy. Results: The multiplex LAMP assay enables simultaneous and homogeneous detection of the recA gene of A. baumannii and the oxa-23 gene and requires less than 21 min with no pre-requisite for DNA purification prior to the amplification reaction. The detection is specific to A. baumannii, and the coincidence rate of the multiplex LAMP and the traditional method was 100%. Conclusions: Our data indicate that the multiplex LAMP assay is a rapid, sensitive, simultaneous and homogeneous method for screening of A. baumannii and its drug-resistance gene.
Collapse
|
13
|
Hu YF, Hou CJY, Kuo CF, Wang NY, Wu AYJ, Leung CH, Liu CP, Yeh HI. Emergence of carbapenem-resistant Acinetobacter baumannii ST787 in clinical isolates from blood in a tertiary teaching hospital in Northern Taiwan. JOURNAL OF MICROBIOLOGY, IMMUNOLOGY, AND INFECTION = WEI MIAN YU GAN RAN ZA ZHI 2017; 50:640-645. [PMID: 28711441 DOI: 10.1016/j.jmii.2016.08.025] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/04/2016] [Revised: 08/31/2016] [Accepted: 08/31/2016] [Indexed: 12/01/2022]
Abstract
BACKGROUND/PURPOSE The purpose of this study is to investigate the predominant clones of carbapenem-resistant Acinetobacter baumannii (CRAB) in our hospital in Taiwan by pulsed-field gel electrophoresis (PFGE) and multilocus sequence typing (MLST) technique. METHODS We collected 108 non-duplicate A. baumannii clinical blood isolates from January 2012 to December 2013 in MacKay Memorial Hospital. PFGE and MLST were used for typing the A. baumannii isolates and for investigation of the predominant clones. Bacteria isolates were screened by polymerase chain reaction for the presence of the carbapenemase-encoding genes. RESULTS All 108 isolates were classified as 33 pulsotypes by PFGE. The predominant clones were pulsotype 10 (12.04%) in 2012 and pulsotype 8 (16.67%) in 2013, respectively. The 31 predominant pulsotype isolates were typed by MLST, and ST787 (54.84%) and ST455 (45.16%) were identified. All isolates carried blaOXA-51-like genes, and blaOXA-23-like genes was founded in 101 isolates (93.52%). Other identified resistance genes included blaOXA-24-like and blaOXA-IMP. CONCLUSION To the best of our knowledge, this study is the first to describe the microbiological characteristics of CRAB ST787, which carried high genetic resistance to carbapenem, but remained susceptible to colistin. CRAB ST787 was the predominant clone in our hospital in the study period.
Collapse
Affiliation(s)
- Yi-Fan Hu
- Division of Infectious Diseases, Department of Internal Medicine, MacKay Memorial Hospital, Taipei, Taiwan
| | - Charles Jia-Yin Hou
- Division of Cardiology, Department of Internal Medicine, MacKay Memorial Hospital, Taipei, Taiwan; Division of Critical Care Medicine, MacKay Memorial Hospital, Taipei, Taiwan; MacKay Medical College, New Taipei City, Taiwan; MacKay Junior College of Medicine, Nursing and Management, Taipei, Taiwan
| | - Chien-Feng Kuo
- Division of Infectious Diseases, Department of Internal Medicine, MacKay Memorial Hospital, Taipei, Taiwan
| | - Nai-Yu Wang
- Department of Medical Research, MacKay Memorial Hospital, Taipei, Taiwan
| | - Alice Ying-Jung Wu
- Division of Infectious Diseases, Department of Internal Medicine, MacKay Memorial Hospital, Taipei, Taiwan
| | - Ching-Hsiang Leung
- Department of Medical Research, MacKay Memorial Hospital, Taipei, Taiwan; MacKay Medical College, New Taipei City, Taiwan
| | - Chang-Pan Liu
- Division of Infectious Diseases, Department of Internal Medicine, MacKay Memorial Hospital, Taipei, Taiwan; Department of Medical Research, MacKay Memorial Hospital, Taipei, Taiwan; MacKay Medical College, New Taipei City, Taiwan; MacKay Junior College of Medicine, Nursing and Management, Taipei, Taiwan; Infection Control Committee, MacKay Memorial Hospital, Taipei, Taiwan.
| | - Hung-I Yeh
- Division of Cardiology, Department of Internal Medicine, MacKay Memorial Hospital, Taipei, Taiwan; Department of Medical Research, MacKay Memorial Hospital, Taipei, Taiwan; MacKay Medical College, New Taipei City, Taiwan; MacKay Junior College of Medicine, Nursing and Management, Taipei, Taiwan; Infection Control Committee, MacKay Memorial Hospital, Taipei, Taiwan.
| |
Collapse
|
14
|
Li YJ, Pan CZ, Fang CQ, Zhao ZX, Chen HL, Guo PH, Zhao ZW. Pneumonia caused by extensive drug-resistant Acinetobacter baumannii among hospitalized patients: genetic relationships, risk factors and mortality. BMC Infect Dis 2017; 17:371. [PMID: 28558660 PMCID: PMC5450129 DOI: 10.1186/s12879-017-2471-0] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2016] [Accepted: 05/16/2017] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND The clonal spread of multiple drug-resistant Acinetobacter baumannii is an emerging problem in China. We analysed the molecular epidemiology of Acinetobacter baumanni isolates at three teaching hospitals and investigated the risk factors, clinical features, and outcomes of hospital-acquired pneumonia caused by extensive drug-resistant Acinetobacter baumannii (XDRAB) infection in Guangzhou, China. METHODS Fifty-two A. baumannii isolates were collected. Multilocus sequence typing (MLST) was used to assess the genetic relationships among the isolates. The bla OXA-51-like gene was amplified using polymerase chain reaction (PCR) and sequencing. The resistance phenotypes were determined using the disc diffusion method. A retrospective case-control study was performed to determine factors associated with XDRAB pneumonia. RESULTS Most of the 52 A. baumannii isolates (N = 37, 71.2%) were collected from intensive care units (ICUs). The respiratory system was the most common bodily site from which A. baumannii was recovered (N = 45, 86.5%). Disc diffusion classified the isolates into 17 multidrug-resistant (MDR) and 35 extensively drug-resistant (XDR) strains. MLST grouped the A. baumannii isolates into 5 existing sequence types (STs) and 7 new STs. ST195 and ST208 accounted for 69.2% (36/52) of the isolates. The clonal relationship analysis showed that ST195 and ST208 belonged to clonal complex (CC) 92. According to the sequence-based typing (SBT) of the bla OXA-51-like gene, 51 A. baumannii isolates carried OXA-66 and the rest carried OXA-199. There were no significant differences with respect to the resistance phenotype between the CC92 and non-CC92 strains (P = 0.767). The multivariate analysis showed that the APACHE II score, chronic obstructive pulmonary disease (COPD) and cardiac disease were independent risk factors for XDRAB pneumonia (P < 0.05). The mortality rate of XDRAB pneumonia was high (up to 42.8%), but pneumonia caused by XDRAB was not associated with in-hospital mortality (P = 0.582). CONCLUSIONS ST195 may be the most common ST in Guangzhou, China, and may serve as a severe epidemic marker. SBT of bla OXA-51-like gene variants may not result in sufficient dissimilarities to type isolates in a small-scale, geographically restricted study of a single region. XDRAB pneumonia was strongly related to systemic illnesses and the APACHE II score but was not associated with in-hospital mortality.
Collapse
Affiliation(s)
- Yu Jun Li
- The First Affiliated Hospital of Jinan University, the West of Huangpu Street, Guangzhou, China.,Department of Respiratory Medicine, Guangzhou First People's Hospital, Guangzhou Medical University, Panfu Road, Guangzhou, China
| | - Chu Zhi Pan
- Department of Hepatobiliary Surgery, the Third Affiliated Hospital of Sun Yat-sen University, Tian He Road, Guangzhou, China
| | - Chang Quan Fang
- Department of Respiratory Medicine, Guangzhou Red Cross Hospital, Tong Fu Zhong Road, Guangzhou, China
| | - Zhu Xiang Zhao
- Department of Respiratory Medicine, Guangzhou First People's Hospital, Guangzhou Medical University, Panfu Road, Guangzhou, China
| | - Hui Ling Chen
- Department of Clinic Laboratory, Guangzhou First People's Hospital, Guangzhou Medical University, Panfu Road, Guangzhou, China
| | - Peng Hao Guo
- Department of Clinic Laboratory, the First Affiliated Hospital of Sun Yat-sen University, Zhong Shan Er Road, Guangzhou, China
| | - Zi Wen Zhao
- Department of Respiratory Medicine, Guangzhou First People's Hospital, Guangzhou Medical University, Panfu Road, Guangzhou, China.
| |
Collapse
|
15
|
Lee CR, Lee JH, Park M, Park KS, Bae IK, Kim YB, Cha CJ, Jeong BC, Lee SH. Biology of Acinetobacter baumannii: Pathogenesis, Antibiotic Resistance Mechanisms, and Prospective Treatment Options. Front Cell Infect Microbiol 2017; 7:55. [PMID: 28348979 PMCID: PMC5346588 DOI: 10.3389/fcimb.2017.00055] [Citation(s) in RCA: 491] [Impact Index Per Article: 70.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2016] [Accepted: 02/13/2017] [Indexed: 12/27/2022] Open
Abstract
Acinetobacter baumannii is undoubtedly one of the most successful pathogens responsible for hospital-acquired nosocomial infections in the modern healthcare system. Due to the prevalence of infections and outbreaks caused by multi-drug resistant A. baumannii, few antibiotics are effective for treating infections caused by this pathogen. To overcome this problem, knowledge of the pathogenesis and antibiotic resistance mechanisms of A. baumannii is important. In this review, we summarize current studies on the virulence factors that contribute to A. baumannii pathogenesis, including porins, capsular polysaccharides, lipopolysaccharides, phospholipases, outer membrane vesicles, metal acquisition systems, and protein secretion systems. Mechanisms of antibiotic resistance of this organism, including acquirement of β-lactamases, up-regulation of multidrug efflux pumps, modification of aminoglycosides, permeability defects, and alteration of target sites, are also discussed. Lastly, novel prospective treatment options for infections caused by multi-drug resistant A. baumannii are summarized.
Collapse
Affiliation(s)
- Chang-Ro Lee
- National Leading Research Laboratory of Drug Resistance Proteomics, Department of Biological Sciences, Myongji University Yongin, South Korea
| | - Jung Hun Lee
- National Leading Research Laboratory of Drug Resistance Proteomics, Department of Biological Sciences, Myongji University Yongin, South Korea
| | - Moonhee Park
- National Leading Research Laboratory of Drug Resistance Proteomics, Department of Biological Sciences, Myongji UniversityYongin, South Korea; DNA Analysis Division, Seoul Institute, National Forensic ServiceSeoul, South Korea
| | - Kwang Seung Park
- National Leading Research Laboratory of Drug Resistance Proteomics, Department of Biological Sciences, Myongji University Yongin, South Korea
| | - Il Kwon Bae
- Department of Dental Hygiene, College of Health and Welfare, Silla University Busan, South Korea
| | - Young Bae Kim
- Biotechnology Program, North Shore Community College Danvers, MA, USA
| | - Chang-Jun Cha
- Department of Systems Biotechnology, College of Biotechnology and Natural Resources, Chung-Ang University Anseong, South Korea
| | - Byeong Chul Jeong
- National Leading Research Laboratory of Drug Resistance Proteomics, Department of Biological Sciences, Myongji University Yongin, South Korea
| | - Sang Hee Lee
- National Leading Research Laboratory of Drug Resistance Proteomics, Department of Biological Sciences, Myongji University Yongin, South Korea
| |
Collapse
|
16
|
Wang Y, Shen M, Yang J, Dai M, Chang Y, Zhang C, Luan G, Ling B, Jia X. Prevalence of carbapenemases among high-level aminoglycoside-resistant Acinetobacter baumannii isolates in a university hospital in China. Exp Ther Med 2016; 12:3642-3652. [PMID: 28101158 PMCID: PMC5228107 DOI: 10.3892/etm.2016.3828] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2015] [Accepted: 09/01/2016] [Indexed: 11/28/2022] Open
Abstract
The prevalence of aminoglycoside resistant enzymes has previously been reported and extended-spectrum β-lactamase among Acinetobacter baumannii. To track the risk of multidrug-resistant A. baumannii, the present study aimed to determine the prevalence of carbapenemases in high-level aminoglycoside resistant A. baumannii over two years. A total of 118 strains of A. baumannii were consecutively collected in the First Affiliated Hospital of Chengdu Medical College, Chengdu, China. These isolates were investigated on the genetic basis of their resistance to aminoglycosides. The results showed that 75 (63.56%) isolates were high-level resistant to aminoglycosides, including gentamicin and amikacin (minimum inhibitory concentration, ≥256 µg/ml). Aminoglycoside-resistant genes ant(2″)-Ia, aac(6′)-Ib, aph(3′)-Ia, aac(3)-Ia, aac(3)-IIa, armA, rmtA, rmtB, rmtC, rmtD, rmtE, rmtF, rmtG, rmtH and npmA, and carbapenem-resistant genes blaOXA-23, blaOXA-24, blaOXA-51, blaOXA-58, blaSIM, blaIMP, blaNDM-1 and blaKPC, were analyzed using polymerase chain reaction. The positive rate of ant(2″)-Ia, aac(6′)-Ib, aph(3′)-Ia, aac(3)-Ia and aac(3)-IIa was 66.95, 69.49, 42.37, 39.83 and 14.41%, respectively. armA was present in 72.0% (54/75) of A. baumannii isolates with high-level resistance to aminoglycosides. The remaining nine 16S ribosomal RNA methlyase genes (rmtA, rmtB, rmtC, rmtD, rmtE, rmtF, rmtG, rmtH and npmA) and aminoglycoside-modifying enzyme gene aac(6′)-Ib-cr were not detected. Among the 54 armA-positive isolates, the prevalence of the carbapenem resistant blaOXA-23 and blaOXA-51 genes was 79.63 and 100%, respectively. armA, ant(2″)-Ia and aac(6′)-Ib were positive in 43 isolates. The results of multilocus sequence typing revealed 31 sequence types (STs) in all clinical strains. Among these STs, the high-level aminoglycoside-resistant A. baumannii ST92, which mostly harbored blaOXA-23, was the predominant clone (29/75). In conclusion, A. baumannii harboring carbapenemases and aminoglycoside-resistant enzymes are extremely prevalent in western China, emphasizing the need to adopt surveillance programs to solve the therapeutic challenges that this presents.
Collapse
Affiliation(s)
- Yanhong Wang
- Non-Coding RNA and Drug Discovery Laboratory, Chengdu Medical College, Chengdu, Sichuan 610500, P.R. China
| | - Min Shen
- Non-Coding RNA and Drug Discovery Laboratory, Chengdu Medical College, Chengdu, Sichuan 610500, P.R. China
| | - Jingni Yang
- Non-Coding RNA and Drug Discovery Laboratory, Chengdu Medical College, Chengdu, Sichuan 610500, P.R. China
| | - Min Dai
- School of Laboratory Medicine, Chengdu Medical College, Chengdu, Sichuan 610500, P.R. China
| | - Yaowen Chang
- Small Molecule Drugs Sichuan Key Laboratory, Institute of Materia Medica, Chengdu Medical College, Chengdu, Sichuan 610500, P.R. China
| | - Chi Zhang
- Small Molecule Drugs Sichuan Key Laboratory, Institute of Materia Medica, Chengdu Medical College, Chengdu, Sichuan 610500, P.R. China
| | - Guangxin Luan
- Non-Coding RNA and Drug Discovery Laboratory, Chengdu Medical College, Chengdu, Sichuan 610500, P.R. China
| | - Baodong Ling
- Small Molecule Drugs Sichuan Key Laboratory, Institute of Materia Medica, Chengdu Medical College, Chengdu, Sichuan 610500, P.R. China
| | - Xu Jia
- Non-Coding RNA and Drug Discovery Laboratory, Chengdu Medical College, Chengdu, Sichuan 610500, P.R. China
| |
Collapse
|
17
|
Saavedra-Trujillo CH, Arias-León G, Gualtero-Trujillo SM, Leal AL, Saavedra-Rojas SY, Murcia MI. Factores de riesgo para infección o colonización por Acinetobacter baumannii resistente a carbapenémicos en pacientes adultos hospitalizados en Unidades de Cuidado Intensivo, Bogotá, Colombia. INFECTIO 2016. [DOI: 10.1016/j.infect.2015.11.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
|
18
|
Laboratory diagnosis, clinical management and infection control of the infections caused by extensively drug-resistant Gram-negative bacilli: a Chinese consensus statement. Clin Microbiol Infect 2015; 22 Suppl 1:S15-25. [PMID: 26627340 DOI: 10.1016/j.cmi.2015.11.004] [Citation(s) in RCA: 67] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2015] [Revised: 11/06/2015] [Accepted: 11/06/2015] [Indexed: 01/31/2023]
Abstract
Extensively drug-resistant (XDR) Gram-negative bacilli (GNB) are defined as bacterial isolates susceptible to two or fewer antimicrobial categories. XDR-GNB mainly occur in Enterobacteriaceae, Acinetobacter baumannii, Pseudomonas aeruginosa, and Stenotrophomonas maltophilia. The prevalence of XDR-GNB is on the rise in China and in other countries, and it poses a major public health threat as a result of the lack of adequate therapeutic options. A group of Chinese clinical experts, microbiologists and pharmacologists came together to discuss and draft a consensus on the laboratory diagnosis, clinical management and infection control of XDR-GNB infections. Lists of antimicrobial categories proposed for antimicrobial susceptibility testing were created according to documents from the Clinical Laboratory Standards Institute (CLSI), the European Committee on Antimicrobial Susceptibility Testing (EUCAST) and the United States Food and Drug Administration (FDA). Multiple risk factors of XDR-GNB infections are analyzed, with long-term exposure to extended-spectrum antimicrobials being the most important one. Combination therapeutic regimens are summarized for treatment of XDR-GNB infections caused by different bacteria based on limited clinical studies and/or laboratory data. Most frequently used antimicrobials used for the combination therapies include aminoglycosides, carbapenems, colistin, fosfomycin and tigecycline. Strict infection control measures including hand hygiene, contact isolation, active screening, environmental surface disinfections, decolonization and restrictive antibiotic stewardship are recommended to curb the XDR-GNB spread.
Collapse
|
19
|
Chang Y, Luan G, Xu Y, Wang Y, Shen M, Zhang C, Zheng W, Huang J, Yang J, Jia X, Ling B. Characterization of carbapenem-resistant Acinetobacter baumannii isolates in a Chinese teaching hospital. Front Microbiol 2015; 6:910. [PMID: 26388854 PMCID: PMC4555021 DOI: 10.3389/fmicb.2015.00910] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2015] [Accepted: 08/19/2015] [Indexed: 01/02/2023] Open
Abstract
Carbapenem-resistant Acinetobacter baumannii (CRAB) presents a serious therapeutic and infection control challenge. In this study, we investigated the epidemiological and molecular differences of CRAB and the threatening factors for contributing to increased CRAB infections at a hospital in western China. A total of 110 clinical isolates of A. baumannii, collected in a recent 2-year period, were tested for carbapenem antibiotic susceptibility, followed by a molecular analysis of carbapenemase genes. Genetic relatedness of the isolates was characterized by multilocus sequence typing. Sixty-seven of the 110 isolates (60.9%) were resistant to carbapenems, 80.60% (54/67) of which carried the blaOXA-23 gene. Most of these CRAB isolates (77.62%) were classified as clone complex 92 (CC92), and sequence type (ST) 92 was the most prevalent STs, followed by ST195, ST136, ST843, and ST75. One CRAB isolate of ST195 harbored plasmid pAB52 from a Chinese patient without travel history. This plasmid contains toxin–antitoxin elements related to adaptation for growth, which might have emerged as a common vehicle indirectly mediating the spread of OXA-23 in CRAB. Thus, CC92 A. baumannii carrying OXA-23 is a major drug-resistant strain spreading in China. Our findings indicate that rational application of antibiotics is indispensable for minimizing widespread of drug resistance.
Collapse
Affiliation(s)
- Yaowen Chang
- Small Molecule Drugs Sichuan Key Laboratory, Institute of Materia Medica, Chengdu Medical College Chengdu, China
| | - Guangxin Luan
- Non-coding RNA and Drug Discovery Laboratory, Chengdu Medical College Chengdu, China
| | - Ying Xu
- Clinical Laboratory, The First Affiliated Hospital, Chengdu Medical College Chengdu, China
| | - Yanhong Wang
- Non-coding RNA and Drug Discovery Laboratory, Chengdu Medical College Chengdu, China
| | - Min Shen
- Non-coding RNA and Drug Discovery Laboratory, Chengdu Medical College Chengdu, China
| | - Chi Zhang
- Small Molecule Drugs Sichuan Key Laboratory, Institute of Materia Medica, Chengdu Medical College Chengdu, China
| | - Wei Zheng
- Small Molecule Drugs Sichuan Key Laboratory, Institute of Materia Medica, Chengdu Medical College Chengdu, China
| | - Jinwei Huang
- Institute of Antibiotics, The Fifth Affiliated Hospital, Wenzhou Medical University Lishui, China
| | - Jingni Yang
- Non-coding RNA and Drug Discovery Laboratory, Chengdu Medical College Chengdu, China
| | - Xu Jia
- Non-coding RNA and Drug Discovery Laboratory, Chengdu Medical College Chengdu, China
| | - Baodong Ling
- Small Molecule Drugs Sichuan Key Laboratory, Institute of Materia Medica, Chengdu Medical College Chengdu, China
| |
Collapse
|
20
|
Zhu L, Shen D, Zhou Q, Li Z, Fang X, Li QZ. A locked nucleic acid (LNA)-based real-time PCR assay for the rapid detection of multiple bacterial antibiotic resistance genes directly from positive blood culture. PLoS One 2015; 10:e0120464. [PMID: 25775001 PMCID: PMC4361058 DOI: 10.1371/journal.pone.0120464] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2014] [Accepted: 01/22/2015] [Indexed: 11/18/2022] Open
Abstract
Bacterial strains resistant to various antibiotic drugs are frequently encountered in clinical infections, and the rapid identification of drug-resistant strains is highly essential for clinical treatment. We developed a locked nucleic acid (LNA)-based quantitative real-time PCR (LNA-qPCR) method for the rapid detection of 13 antibiotic resistance genes and successfully used it to distinguish drug-resistant bacterial strains from positive blood culture samples. A sequence-specific primer-probe set was designed, and the specificity of the assays was assessed using 27 ATCC bacterial strains and 77 negative blood culture samples. No cross-reaction was identified among bacterial strains and in negative samples, indicating 100% specificity. The sensitivity of the assays was determined by spiking each bacterial strain into negative blood samples, and the detection limit was 1–10 colony forming units (CFU) per reaction. The LNA-qPCR assays were first applied to 72 clinical bacterial isolates for the identification of known drug resistance genes, and the results were verified by the direct sequencing of PCR products. Finally, the LNA-qPCR assays were used for the detection in 47 positive blood culture samples, 19 of which (40.4%) were positive for antibiotic resistance genes, showing 91.5% consistency with phenotypic susceptibility results. In conclusion, LNA-qPCR is a reliable method for the rapid detection of bacterial antibiotic resistance genes and can be used as a supplement to phenotypic susceptibility testing for the early detection of antimicrobial resistance to allow the selection of appropriate antimicrobial treatment and to prevent the spread of resistant isolates.
Collapse
Affiliation(s)
- Lingxiang Zhu
- CAS Key Laboratory of Genome Sciences & Information, Beijing Institute of Genomics, Chinese Academy of Sciences, Beijing, China
- Department of Immunology, University of Texas Southwestern Medical Center at Dallas, Dallas, Texas, United States of America
| | - Dingxia Shen
- Department of Clinical Microbiology, General Hospital of People’s Liberation Army, Beijing, China
| | - Qiming Zhou
- State Key Laboratory of Mycology, Institute of Microbiology, Chinese Academy of Sciences, Beijing, China
| | - Zexia Li
- Department of Immunology, University of Texas Southwestern Medical Center at Dallas, Dallas, Texas, United States of America
| | - Xiangdong Fang
- CAS Key Laboratory of Genome Sciences & Information, Beijing Institute of Genomics, Chinese Academy of Sciences, Beijing, China
| | - Quan-Zhen Li
- Department of Immunology, University of Texas Southwestern Medical Center at Dallas, Dallas, Texas, United States of America
- * E-mail:
| |
Collapse
|
21
|
Lin MF, Lan CY. Antimicrobial resistance in Acinetobacter baumannii: From bench to bedside. World J Clin Cases 2014; 2:787-814. [PMID: 25516853 PMCID: PMC4266826 DOI: 10.12998/wjcc.v2.i12.787] [Citation(s) in RCA: 207] [Impact Index Per Article: 20.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2014] [Revised: 08/25/2014] [Accepted: 10/27/2014] [Indexed: 02/05/2023] Open
Abstract
Acinetobacter baumannii (A. baumannii) is undoubtedly one of the most successful pathogens in the modern healthcare system. With invasive procedures, antibiotic use and immunocompromised hosts increasing in recent years, A. baumannii has become endemic in hospitals due to its versatile genetic machinery, which allows it to quickly evolve resistance factors, and to its remarkable ability to tolerate harsh environments. Infections and outbreaks caused by multidrug-resistant A. baumannii (MDRAB) are prevalent and have been reported worldwide over the past twenty or more years. To address this problem effectively, knowledge of species identification, typing methods, clinical manifestations, risk factors, and virulence factors is essential. The global epidemiology of MDRAB is monitored by persistent surveillance programs. Because few effective antibiotics are available, clinicians often face serious challenges when treating patients with MDRAB. Therefore, a deep understanding of the resistance mechanisms used by MDRAB can shed light on two possible strategies to combat the dissemination of antimicrobial resistance: stringent infection control and antibiotic treatments, of which colistin-based combination therapy is the mainstream strategy. However, due to the current unsatisfying therapeutic outcomes, there is a great need to develop and evaluate the efficacy of new antibiotics and to understand the role of other potential alternatives, such as antimicrobial peptides, in the treatment of MDRAB infections.
Collapse
|