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Mauri C, Consonni A, Briozzo E, Giubbi C, Meroni E, Tonolo S, Luzzaro F. The Molecular Mouse System: A New Useful Tool for Guiding Antimicrobial Therapy in Critically Ill Septic Patients. Antibiotics (Basel) 2024; 13:517. [PMID: 38927183 PMCID: PMC11200723 DOI: 10.3390/antibiotics13060517] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/29/2024] [Revised: 05/24/2024] [Accepted: 05/28/2024] [Indexed: 06/28/2024] Open
Abstract
Bloodstream infections (BSI) caused by multidrug-resistant (MDR) bacteria, pose a major threat for patients, especially for those who are immunosuppressed. Rapid pathogen detection and characterization from positive blood cultures are crucial in the management of patients with BSI to enable an adequate and timely antimicrobial therapy. This study aimed to investigate the potential role of the Molecular Mouse system, a new CE IVD molecular test designed to rapidly detect the causative agents of bacteremia and their resistance determinants, in the management of the therapy in critically ill patients. Agreement between the results of the Molecular Mouse and the conventional routine method was also considered. Overall, 100 positive blood cultures were collected from septic critically ill patients from May 2023 to January 2024 and analyzed with Molecular Mouse and routine protocols. The new instrument consistently agreed with the routine protocols in the case of monomicrobial blood cultures, while some discrepancies were obtained in the polymicrobial samples. Antimicrobial resistance genes were detected in 35 samples, with vanA and CTX-M-1/9 groups being the most frequently detected targets. Therapy was adjusted in 42 critically ill patients confirming the importance of new rapid molecular tests in the management of positive blood cultures, to adjust empirical therapy and use new antibiotics accurately.
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Müller C, Reuter S, Wille J, Xanthopoulou K, Stefanik D, Grundmann H, Higgins PG, Seifert H. A global view on carbapenem-resistant Acinetobacter baumannii. mBio 2023; 14:e0226023. [PMID: 37882512 PMCID: PMC10746149 DOI: 10.1128/mbio.02260-23] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2023] [Accepted: 09/12/2023] [Indexed: 10/27/2023] Open
Abstract
IMPORTANCE Carbapenem-resistant Acinetobacter baumannii are of increasing public health importance, as they are resistant to last-line antibiotics. International clones with well-characterized resistance genes dominate globally; however, locally, other lineages with different properties may be of importance to consider. This study investigated isolates from a broad geographic origin from 114 hospitals in 47 countries and from five world regions ensuring the greatest possible diversity in an organism known for its propensity for clonal epidemic spread and reflecting the current global epidemiology of carbapenem-resistant A. baumannii. In Latin America, a lineage different from other geographic regions circulates, with a different resistance gene profile. This knowledge is important to adjust local infection prevention measures. In a global world with migration and increasing use of antimicrobials, multidrug-resistant bacteria will continue to adapt and challenge our healthcare systems worldwide.
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Affiliation(s)
- Carina Müller
- Institute for Medical Microbiology, Immunology and Hygiene, Faculty of Medicine and University Hospital Cologne, University of Cologne, Goldenfelsstr, Cologne, Germany
- German Center for Infection Research (DZIF), Partner Site Bonn-Cologne, Cologne, Germany
| | - Sandra Reuter
- Institute for Infection Prevention and Hospital Epidemiology, Medical Centre–University of Freiburg, Freiburg, Germany
| | - Julia Wille
- Institute for Medical Microbiology, Immunology and Hygiene, Faculty of Medicine and University Hospital Cologne, University of Cologne, Goldenfelsstr, Cologne, Germany
- German Center for Infection Research (DZIF), Partner Site Bonn-Cologne, Cologne, Germany
| | - Kyriaki Xanthopoulou
- Institute for Medical Microbiology, Immunology and Hygiene, Faculty of Medicine and University Hospital Cologne, University of Cologne, Goldenfelsstr, Cologne, Germany
- German Center for Infection Research (DZIF), Partner Site Bonn-Cologne, Cologne, Germany
| | - Danuta Stefanik
- Institute for Medical Microbiology, Immunology and Hygiene, Faculty of Medicine and University Hospital Cologne, University of Cologne, Goldenfelsstr, Cologne, Germany
| | - Hajo Grundmann
- Institute for Infection Prevention and Hospital Epidemiology, Medical Centre–University of Freiburg, Freiburg, Germany
| | - Paul G. Higgins
- Institute for Medical Microbiology, Immunology and Hygiene, Faculty of Medicine and University Hospital Cologne, University of Cologne, Goldenfelsstr, Cologne, Germany
- German Center for Infection Research (DZIF), Partner Site Bonn-Cologne, Cologne, Germany
| | - Harald Seifert
- Institute for Medical Microbiology, Immunology and Hygiene, Faculty of Medicine and University Hospital Cologne, University of Cologne, Goldenfelsstr, Cologne, Germany
- German Center for Infection Research (DZIF), Partner Site Bonn-Cologne, Cologne, Germany
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Segatore B, Piccirilli A, Cherubini S, Principe L, Alloggia G, Mezzatesta ML, Salmeri M, Di Bella S, Migliavacca R, Piazza A, Meroni E, Fazii P, Visaggio D, Visca P, Cortazzo V, De Angelis G, Pompilio A, Perilli M. In Vitro Activity of Sulbactam-Durlobactam against Carbapenem-Resistant Acinetobacter baumannii Clinical Isolates: A Multicentre Report from Italy. Antibiotics (Basel) 2022; 11:antibiotics11081136. [PMID: 36010006 PMCID: PMC9404735 DOI: 10.3390/antibiotics11081136] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2022] [Revised: 08/18/2022] [Accepted: 08/19/2022] [Indexed: 11/16/2022] Open
Abstract
In the present study, the in vitro activity of the sulbactam-durlobactam (SUL-DUR) combination was evaluated against 141 carbapenem-resistant A. baumannii (CRAb) clinical strains collected from six Italian laboratories. Over half (54.6%) of these isolates were resistant to colistin. The SUL-DUR combination was active against these CRAb isolates with MIC50 and MIC90 values of 0.5 mg/L and 4 mg/L, respectively. Only eleven isolates were resistant to SUL-DUR with MIC values ranging from 8 to 128 mg/L. The SUL-DUR resistant A. baumannii exhibited several antimicrobial resistance genes (ARGs) such as blaOXA-20, blaOXA-58, blaOXA-66, blaADC-25, aac(6')-Ib3 and aac(6')-Ib-cr and mutations in gyrA (S81L) and parC (V104I, D105E). However, in these isolates, mutations Q488K and Y528H were found in PBP3. Different determinants were also identified in these CRAb isolates, including adeABC, adeFGH, adeIJK, abeS, abaQ and abaR, which encode multidrug efflux pumps associated with resistance to multiple antibacterial agents. This is the first report on the antimicrobial activity of SUL-DUR against carbapenem-resistant A. baumannii isolates selected from multiple regions in Italy.
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Affiliation(s)
- Bernardetta Segatore
- Department of Biotechnological and Applied Clinical Sciences, University of L’Aquila, 67100 L’Aquila, Italy
| | - Alessandra Piccirilli
- Department of Biotechnological and Applied Clinical Sciences, University of L’Aquila, 67100 L’Aquila, Italy
| | - Sabrina Cherubini
- Department of Biotechnological and Applied Clinical Sciences, University of L’Aquila, 67100 L’Aquila, Italy
| | - Luigi Principe
- Clinical Pathology and Microbiology Unit, “S. Giovanni di Dio” Hospital, 88900 Crotone, Italy
- Correspondence:
| | - Giovanni Alloggia
- Department of Biotechnological and Applied Clinical Sciences, University of L’Aquila, 67100 L’Aquila, Italy
| | - Maria Lina Mezzatesta
- Department of Biomedical and Biotechnological Sciences, Section of Microbiology, University of Catania, 95131 Catania, Italy
| | - Mario Salmeri
- Department of Biomedical and Biotechnological Sciences, Section of Microbiology, University of Catania, 95131 Catania, Italy
| | - Stefano Di Bella
- Clinical Department of Medical, Surgical and Health Sciences, University of Trieste, 34129 Trieste, Italy
| | - Roberta Migliavacca
- Unit of Microbiology and Clinical Microbiology, Department of Clinical-Surgical, Diagnostic and Pediatric Sciences, University of Pavia, 27100 Pavia, Italy
| | - Aurora Piazza
- Unit of Microbiology and Clinical Microbiology, Department of Clinical-Surgical, Diagnostic and Pediatric Sciences, University of Pavia, 27100 Pavia, Italy
| | - Elisa Meroni
- Clinical Microbiology and Virology Unit, “A. Manzoni” Hospital, 23900 Lecco, Italy
| | - Paolo Fazii
- Clinical Microbiology and Virology Unit, Spirito Santo Hospital, 65122 Pescara, Italy
| | - Daniela Visaggio
- Department of Science, Roma Tre University, Viale G. Marconi 446, 00146 Rome, Italy
- Santa Lucia Foundation IRCCS, 00179 Rome, Italy
| | - Paolo Visca
- Department of Science, Roma Tre University, Viale G. Marconi 446, 00146 Rome, Italy
- Santa Lucia Foundation IRCCS, 00179 Rome, Italy
| | - Venere Cortazzo
- Dipartimento di Scienze Biotecnologiche di Base, Cliniche Intensivologiche e Perioperatorie, Università Cattolica del Sacro Cuore, 00168 Rome, Italy
| | - Giulia De Angelis
- Dipartimento di Scienze Biotecnologiche di Base, Cliniche Intensivologiche e Perioperatorie, Università Cattolica del Sacro Cuore, 00168 Rome, Italy
| | - Arianna Pompilio
- Department of Medical, Oral and Biotechnological Sciences, “G. d’Annunzio” University of Chieti-Pescara, 66100 Chieti, Italy
- Center of Advanced Studies and Technology (CAST), “G. d’Annunzio” University of Chieti-Pescara, 66100 Chieti, Italy
| | - Mariagrazia Perilli
- Department of Biotechnological and Applied Clinical Sciences, University of L’Aquila, 67100 L’Aquila, Italy
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Kim D, Yoon EJ, Hong JS, Choi MH, Kim HS, Kim YR, Kim YA, Uh Y, Shin KS, Shin JH, Park JS, Park KU, Won EJ, Kim SH, Shin JH, Kim JW, Lee S, Jeong SH. Major Bloodstream Infection-Causing Bacterial Pathogens and Their Antimicrobial Resistance in South Korea, 2017-2019: Phase I Report From Kor-GLASS. Front Microbiol 2022; 12:799084. [PMID: 35069503 PMCID: PMC8770956 DOI: 10.3389/fmicb.2021.799084] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2021] [Accepted: 11/29/2021] [Indexed: 12/13/2022] Open
Abstract
To monitor national antimicrobial resistance (AMR), the Korea Global AMR Surveillance System (Kor-GLASS) was established. This study analyzed bloodstream infection (BSI) cases from Kor-GLASS phase I from January 2017 to December 2019. Nine non-duplicated Kor-GLASS target pathogens, including Staphylococcus aureus, Enterococcus faecalis, Enterococcus faecium, Streptococcus pneumoniae, Escherichia coli, Klebsiella pneumoniae, Pseudomonas aeruginosa, Acinetobacter spp., and Salmonella spp., were isolated from blood specimens from eight sentinel hospitals. Antimicrobial susceptibility testing, AMR genotyping, and strain typing were carried out. Among the 20,041 BSI cases, 15,171 cases were caused by one of the target pathogens, and 12,578 blood isolates were collected for the study. Half (1,059/2,134) of S. aureus isolates were resistant to cefoxitin, and 38.1% (333/873) of E. faecium isolates were resistant to vancomycin. Beta-lactamase-non-producing ampicillin-resistant and penicillin-resistant E. faecalis isolates by disk diffusion method were identified, but the isolates were confirmed as ampicillin-susceptible by broth microdilution method. Among E. coli, an increasing number of isolates carried the bla CTX-M-27 gene, and the ertapenem resistance in 1.4% (30/2,110) of K. pneumoniae isolates was mostly (23/30) conferred by K. pneumoniae carbapenemases. A quarter (108/488) of P. aeruginosa isolates were resistant to meropenem, and 30.5% (33/108) of those carried acquired carbapenemase genes. Over 90% (542/599) of A. baumannii isolates were imipenem-resistant, and all except one harbored the bla OXA-23 gene. Kor-GLASS provided comprehensive AMR surveillance data, and the defined molecular mechanisms of resistance helped us to better understand AMR epidemiology. Comparative analysis with other GLASS-enrolled countries is possible owing to the harmonized system provided by GLASS.
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Affiliation(s)
- Dokyun Kim
- Department of Laboratory Medicine and Research Institute of Bacterial Resistance, Yonsei University College of Medicine, Seoul, South Korea
| | - Eun-Jeong Yoon
- Department of Laboratory Medicine and Research Institute of Bacterial Resistance, Yonsei University College of Medicine, Seoul, South Korea.,National Institute of Health, Korea Disease Control and Prevention Agency, Cheongju, South Korea
| | - Jun Sung Hong
- Department of Laboratory Medicine and Research Institute of Bacterial Resistance, Yonsei University College of Medicine, Seoul, South Korea
| | - Min Hyuk Choi
- Department of Laboratory Medicine and Research Institute of Bacterial Resistance, Yonsei University College of Medicine, Seoul, South Korea
| | - Hyun Soo Kim
- Department of Laboratory Medicine, Hallym University Dongtan Sacred Heart Hospital, Hallym University College of Medicine, Hwaseong, South Korea
| | - Young Ree Kim
- Department of Laboratory Medicine, Jeju National University School of Medicine, Jeju, South Korea
| | - Young Ah Kim
- Department of Laboratory Medicine, National Health Insurance Service Ilsan Hospital, Goyang, South Korea
| | - Young Uh
- Department of Laboratory Medicine, Yonsei University Wonju College of Medicine, Wonju, South Korea
| | - Kyeong Seob Shin
- Department of Laboratory Medicine, College of Medicine, Chungbuk National University, Cheongju, South Korea
| | - Jeong Hwan Shin
- Department of Laboratory Medicine and Paik Institute for Clinical Research, Inje University College of Medicine, Busan, South Korea
| | - Jeong Su Park
- Department of Laboratory Medicine, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, South Korea
| | - Kyoung Un Park
- Department of Laboratory Medicine, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, South Korea
| | - Eun Jeong Won
- Department of Laboratory Medicine, Chonnam National University Medical School, Gwangju, South Korea
| | - Soo Hyun Kim
- Department of Laboratory Medicine, Chonnam National University Medical School, Gwangju, South Korea
| | - Jong Hee Shin
- Department of Laboratory Medicine, Chonnam National University Medical School, Gwangju, South Korea
| | - Jung Wook Kim
- National Institute of Health, Korea Disease Control and Prevention Agency, Cheongju, South Korea
| | - SungYoung Lee
- National Institute of Health, Korea Disease Control and Prevention Agency, Cheongju, South Korea
| | - Seok Hoon Jeong
- Department of Laboratory Medicine and Research Institute of Bacterial Resistance, Yonsei University College of Medicine, Seoul, South Korea
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Petropoulou D, Siopi M, Vourli S, Pournaras S. Activity of Sulbactam-Durlobactam and Comparators Against a National Collection of Carbapenem-Resistant Acinetobacter baumannii Isolates From Greece. Front Cell Infect Microbiol 2022; 11:814530. [PMID: 35127562 PMCID: PMC8812809 DOI: 10.3389/fcimb.2021.814530] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2021] [Accepted: 12/28/2021] [Indexed: 02/01/2023] Open
Abstract
Background Acinetobacter baumannii is a leading cause of healthcare-associated infections worldwide, due to both its persistence in the hospital setting and ability to acquire high levels of antibiotic resistance. Carbapenem-resistant A. baumannii isolates (CRAB) limit the activity of current antimicrobial regimens and new alternatives or adjuncts to traditional antibiotics are urgently needed. Durlobactam is a novel broad-spectrum inhibitor of serine-type β-lactamases that restores sulbactam (SUL) activity against A. baumannii. The sulbactam-durlobactam (SD) combination has recently completed Phase 3 testing in the global ATTACK trial. Objectives The aim of this study is to evaluate the in vitro activity of SD versus comparators against a representative nationwide collection of CRAB isolates. Methods One hundred ninety CRAB isolates were collected from clinical samples of patients hospitalized in 11 hospitals throughout Greece during 2015. In vitro activities of SD and comparators (SUL alone, amikacin, minocycline, imipenem, meropenem, colistin, SD and imipenem combined with SD) were determined by broth microdilution. Results Durlobactam restored sulbactam activity against the majority of the strains tested, with SD exhibiting the lowest MIC90 (8 μg/ml) relative to the other single comparators tested; 87.9% of the isolates had SD MICs ≤4/4 µg/ml. The most active comparator was colistin (MIC90 = 16 μg/ml). The addition of imipenem further lowered the MIC90 of SD by one two-fold dilution. Conclusions This study demonstrated the potential utility of SD for the treatment of infections caused by A. baumannii. If its clinical efficacy is confirmed, SD may be an important therapeutic option for CRAB infections.
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Susceptibility Testing of Colistin for Acinetobacter baumannii: How Far Are We from the Truth? Antibiotics (Basel) 2021; 10:antibiotics10010048. [PMID: 33466515 PMCID: PMC7824894 DOI: 10.3390/antibiotics10010048] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2020] [Revised: 12/07/2020] [Accepted: 12/31/2020] [Indexed: 12/22/2022] Open
Abstract
Acinetobacter baumannii is involved in life-threatening nosocomial infections, mainly in the intensive care units (ICUs), and often colistin may represent the last therapeutic opportunity. The susceptibility to colistin of 51 epidemiologically typed A. baumannii strains isolated in 2017 from clinical samples of patients hospitalized in the ICU of a tertiary care academic hospital was investigated. All isolates were carbapenem-resistant due to the presence of the blaOXA-23 gene in sequence group 1 (international clonal lineage II) and sequence group 4 (related to international clonal lineage II) isolates, and to the blaOXA-24/40 gene in sequence group 2 (international clonal lineage I) isolates. Vitek®2, agar diffusion, and broth microdilution tests showed major discordancy (≥2 dilution factors) in the minimum inhibitory concentration (MIC) values for colistin in 24 out of 51 isolates, resulting in erroneous reporting of qualitative susceptibility data for eight isolates. In growth kinetics experiments in the presence of colistin, five isolates grew with drug concentrations above the susceptibility breakpoint when incubated for >12 h, and three isolates showed the presence of heteroresistant subpopulations. This study highlights that the high frequency of isolation of carbapenem-resistant A. baumannii strains in high-risk infectious wards requires an accurate application of methods for detecting susceptibility to antibiotics, in particular to colistin, so as to ensure a correct therapeutic approach.
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Overexpression of bla OXA-58 Gene Driven by IS Aba3 Is Associated with Imipenem Resistance in a Clinical Acinetobacter baumannii Isolate from Vietnam. BIOMED RESEARCH INTERNATIONAL 2020; 2020:7213429. [PMID: 32802871 PMCID: PMC7420922 DOI: 10.1155/2020/7213429] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/05/2020] [Revised: 06/02/2020] [Accepted: 06/29/2020] [Indexed: 02/06/2023]
Abstract
The aim of this study was to investigate genetic structures and expression of blaOXA-58 gene in five Acinetobacter baumannii clinical isolates recovered from two hospitals in southern Vietnam during 2012-2014. A. baumannii isolates were identified by automated microbiology systems and confirmed by PCR. All isolates were characterized as multidrug resistant by antimicrobial testing using the disk diffusion method. Four imipenem susceptible and one nonsusceptible isolates (MIC > 32 μg·ml−1) were identified by E-test. PCR amplification of blaOXA-58 gene upstream and downstream sequences revealed the presence of ISAba3 at both locations in one multidrug-resistant isolate. Semiquantitation of blaOXA-51 and blaOXA-58 gene expression was performed by the 2-ΔΔCt method. The blaOXA-51 gene expression of five isolates showed little difference, but the isolate bearing ISAba3-blaOXA-58-ISAba3 exhibited significantly higher blaOXA-58 mRNA level. Higher β-lactamases activity in periplasmic than cytoplasmic fraction was found in most isolates. The isolate overexpressing blaOXA-58 gene possessed very high periplasmic enzyme activity. In conclusion, the A. baumannii isolate bearing ISAba3-blaOXA-58 gene exhibited high resistance to imipenem, corresponding to an overexpression of blaOXA-58 gene and very high periplasmic β-lactamase activity.
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Gaiarsa S, Bitar I, Comandatore F, Corbella M, Piazza A, Scaltriti E, Villa L, Postiglione U, Marone P, Nucleo E, Pongolini S, Migliavacca R, Sassera D. Can Insertion Sequences Proliferation Influence Genomic Plasticity? Comparative Analysis of Acinetobacter baumannii Sequence Type 78, a Persistent Clone in Italian Hospitals. Front Microbiol 2019; 10:2080. [PMID: 31572316 PMCID: PMC6751323 DOI: 10.3389/fmicb.2019.02080] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2019] [Accepted: 08/23/2019] [Indexed: 01/23/2023] Open
Abstract
Acinetobacter baumannii is a known opportunistic pathogen, dangerous for public health mostly due to its ability to rapidly acquire antibiotic-resistance traits. Its genome was described as characterized by remarkable plasticity, with a high frequency of homologous recombinations and proliferation of Insertion Sequences (IS). The SMAL pulsotype is an A. baumannii strain currently isolated only in Italy, characterized by a low incidence and a high persistence over the years. In this present work, we have conducted a comparative genomic analysis on this clone. The genome of 15 SMAL isolates was obtained and characterized in comparison with 24 other assemblies of evolutionary related isolates. The phylogeny highlighted the presence of a monophyletic clade (named ST78A), which includes the SMAL isolates. ST78A isolates have a low rate of homologous recombination and low gene content variability when compared to two related clades (ST78B and ST49) and to the most common A. baumannii variants worldwide (International Clones I and II). Remarkably, genomes in the ST78A clade present a high number of IS, including classes mostly absent in the other related genomes. Among these IS, one copy of IS66 was found to interrupt the gene comEC/rec2, involved in the acquisition of exogenous DNA. The genomic characterization of SMAL isolates shed light on the surprisingly low genomic plasticity and the high IS proliferation present in this strain. The interruption of the gene comEC/rec2 by an IS in the SMAL genomes brought us to formulate an evolutionary hypothesis according to which the proliferation of IS is slowing the acquisition of exogenous DNA, thus limiting genome plasticity. Such genomic architecture could explain the epidemiological behavior of high persistence and low incidence of the clone and provides an interesting framework to compare ST78 with the highly epidemic International Clones, characterized by high genomic plasticity.
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Affiliation(s)
- Stefano Gaiarsa
- UOC Microbiologia e Virologia, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Ibrahim Bitar
- Dipartimento di Scienze Clinico-Chirurgiche, Diagnostiche e Pediatriche, Università degli Studi di Pavia, Pavia, Italy
| | - Francesco Comandatore
- Pediatric Clinical Research Center, Dipartimento di Scienze Biomediche e Cliniche “Luigi Sacco”, Università degli Studi di Milano, Milan, Italy
| | - Marta Corbella
- UOC Microbiologia e Virologia, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
- Servizio di Epidemiologia Clinica e Biometria, Direzione Scientifica, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Aurora Piazza
- Dipartimento di Scienze Clinico-Chirurgiche, Diagnostiche e Pediatriche, Università degli Studi di Pavia, Pavia, Italy
- Pediatric Clinical Research Center, Dipartimento di Scienze Biomediche e Cliniche “Luigi Sacco”, Università degli Studi di Milano, Milan, Italy
| | - Erika Scaltriti
- Risk Analysis and Genomic Epidemiology Unit, Istituto Zooprofilattico Sperimentale della Lombardia e dell’Emilia Romagna, Parma, Italy
| | - Laura Villa
- Dipartimento di Malattie Infettive, Parassitarie ed Immunomediate, Istituto Superiore di Sanitá, Rome, Italy
| | - Umberto Postiglione
- Dipartimento di Biologia e Biotecnologie “L. Spallanzani”, Università degli Studi di Pavia, Pavia, Italy
| | - Piero Marone
- UOC Microbiologia e Virologia, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Elisabetta Nucleo
- Dipartimento di Scienze Clinico-Chirurgiche, Diagnostiche e Pediatriche, Università degli Studi di Pavia, Pavia, Italy
| | - Stefano Pongolini
- Risk Analysis and Genomic Epidemiology Unit, Istituto Zooprofilattico Sperimentale della Lombardia e dell’Emilia Romagna, Parma, Italy
| | - Roberta Migliavacca
- Dipartimento di Scienze Clinico-Chirurgiche, Diagnostiche e Pediatriche, Università degli Studi di Pavia, Pavia, Italy
| | - Davide Sassera
- Dipartimento di Biologia e Biotecnologie “L. Spallanzani”, Università degli Studi di Pavia, Pavia, Italy
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Karampatakis T, Tsergouli K, Politi L, Diamantopoulou G, Iosifidis E, Antachopoulos C, Karyoti A, Sdougka M, Tsakris A, Roilides E. Polyclonal predominance of concurrently producing OXA-23 and OXA-58 carbapenem-resistant Acinetobacter baumannii strains in a pediatric intensive care unit. Mol Biol Rep 2019; 46:3497-3500. [PMID: 30989561 DOI: 10.1007/s11033-019-04744-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2018] [Accepted: 03/05/2019] [Indexed: 01/29/2023]
Abstract
We report a predominance (64.7%) of polyclonal carbapenem-resistant Acinetobacter baumannii (CRAB) strains concurrently producing OXA-23 and OXA-58 carbapenemases in a pediatric intensive care unit in an endemic area. This is the first report of emergence of such double-OXA CRAB strains in a single unit worldwide.
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Affiliation(s)
- Theodoros Karampatakis
- Infectious Disease Unit, 3rd Department of Pediatrics, Medical Faculty, Aristotle University School of Health Sciences, Hippokration General Hospital, Konstantinoupoleos 49, 546 42, Thessaloniki, Greece.,Microbiology Department, Hippokration General Hospital, Thessaloniki, Greece
| | - Katerina Tsergouli
- Microbiology Department, Hippokration General Hospital, Thessaloniki, Greece
| | - Lida Politi
- Microbiology Department, National and Kapodistrian University School of Medicine, Athens, Greece
| | - Georgia Diamantopoulou
- Microbiology Department, National and Kapodistrian University School of Medicine, Athens, Greece
| | - Elias Iosifidis
- Infectious Disease Unit, 3rd Department of Pediatrics, Medical Faculty, Aristotle University School of Health Sciences, Hippokration General Hospital, Konstantinoupoleos 49, 546 42, Thessaloniki, Greece.,Infection Control Committee, Hippokration General Hospital, Thessaloniki, Greece
| | - Charalampos Antachopoulos
- Infectious Disease Unit, 3rd Department of Pediatrics, Medical Faculty, Aristotle University School of Health Sciences, Hippokration General Hospital, Konstantinoupoleos 49, 546 42, Thessaloniki, Greece.,Infection Control Committee, Hippokration General Hospital, Thessaloniki, Greece
| | - Aggeliki Karyoti
- Microbiology Department, Hippokration General Hospital, Thessaloniki, Greece.,Infection Control Committee, Hippokration General Hospital, Thessaloniki, Greece
| | - Maria Sdougka
- Pediatric Intensive Care Unit, Hippokration General Hospital, Thessaloniki, Greece
| | - Athanassios Tsakris
- Microbiology Department, National and Kapodistrian University School of Medicine, Athens, Greece
| | - Emmanuel Roilides
- Infectious Disease Unit, 3rd Department of Pediatrics, Medical Faculty, Aristotle University School of Health Sciences, Hippokration General Hospital, Konstantinoupoleos 49, 546 42, Thessaloniki, Greece. .,Infection Control Committee, Hippokration General Hospital, Thessaloniki, Greece.
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Huang Y, Zhou Q, Wang W, Huang Q, Liao J, Li J, Long L, Ju T, Zhang Q, Wang H, Xu H, Tu M. Acinetobacter baumannii Ventilator-Associated Pneumonia: Clinical Efficacy of Combined Antimicrobial Therapy and in vitro Drug Sensitivity Test Results. Front Pharmacol 2019; 10:92. [PMID: 30814950 PMCID: PMC6381041 DOI: 10.3389/fphar.2019.00092] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2018] [Accepted: 01/23/2019] [Indexed: 01/25/2023] Open
Abstract
Objective: To evaluate therapeutic efficacy of different combined antimicrobial treatments against Acinetobacter baumannii ventilator-associated pneumonia (VAP). Methods: Clinical outcomes were retrospectively analyzed to elucidate the efficacy of four combined antimicrobial regimens. The chessboard and micro broth dilution methods determined the minimum inhibitory concentrations (MICs) of four antiseptic drugs singly used and combined two drugs against 36 isolates of multidrug-resistant (MDR) A. baumannii. Results: The incidence of VAP was approximately 6.9% (237/3424) between January 1, 2015 and December 31, and 35.9% (85/237) of the cases were caused by A. baumannii. Among these cases, 60 belonged to AB-VAP, for whom antimicrobial treatment plan was centralized and clinical data was complete. Moreover, all 60 strains of A. baumannii were MDR bacteria from reports microbiological laboratory. Resistance rate was lowest for amikacin (68.3%) and ampicillin sulbactam (71.7%). Resistance rate for imipenem increased from 63.2 to 90.9% during the 3 years. However, in these 60 cases of AB-VAP, the combination between 4 antibiotics was effective in most cases: the effective rate was 75% (18/24) for sulbactam combined with etilmicin, 71.4% (10/14) for sulbactam combined with levofloxacin, 72.7% (8/11) for meropenem combined with etilmicin, and 63.6% (7/11) for meropenem combined with levofloxacin. There was no statistical difference between four regimens (P > 0.05). Sulbactam combined with etilmicin decreased 1/2 of MIC50 and MIC90 of sulbactam while the decreases in etilmicin were more obviously than single drug. When adopting meropenem combined with levofloxacin or etilmicin, the MIC of meropenem reduced to 1/2 of that in applying single drug. As for sulbactam or meropenem combined with levofloxacin, it also lessened the MIC50 of levofloxacin to 1/2 of that for single drug. FIC results suggested that the effects of four combined antimicrobial regimens were additive or unrelated. When sulbactam was combined with etimicin, the additive effect was 63.89%. Conclusion: Drug combination sensitivity test in vitro may be helpful for choosing antimicrobial treatment plans. Sulbactam or meropenem as the basis of treatment regimens can function as the alternatives against AB-VAP. Sulbactam combined with etimicin has been regarded as a recommended regimen in Suizhou, Hubei, China.
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Affiliation(s)
- Yuqin Huang
- Intensive Care Unit, Suizhou Central Hospital, Hubei University of Medicine, Suizhou, China
| | - Quan Zhou
- Intensive Care Unit, Suizhou Central Hospital, Hubei University of Medicine, Suizhou, China
- Suixian People’s Hospital, Suizhou, China
| | - Wenguo Wang
- Intensive Care Unit, Suizhou Central Hospital, Hubei University of Medicine, Suizhou, China
| | - Qiang Huang
- Intensive Care Unit, Suizhou Central Hospital, Hubei University of Medicine, Suizhou, China
| | - Juan Liao
- Intensive Care Unit, Suizhou Central Hospital, Hubei University of Medicine, Suizhou, China
| | - Junyi Li
- Department of Gastroenterology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Lei Long
- Intensive Care Unit, Suizhou Central Hospital, Hubei University of Medicine, Suizhou, China
| | - Tao Ju
- Intensive Care Unit, Suizhou Central Hospital, Hubei University of Medicine, Suizhou, China
| | - Quan Zhang
- Intensive Care Unit, Suizhou Central Hospital, Hubei University of Medicine, Suizhou, China
| | - Hanqin Wang
- Center for Translational Medicine, Suizhou Central Hospital, Hubei University of Medicine, Suizhou, China
| | - Huaqiang Xu
- Intensive Care Unit, Suizhou Central Hospital, Hubei University of Medicine, Suizhou, China
| | - Mingli Tu
- Suixian People’s Hospital, Suizhou, China
- Department of Respiratory Medicine, Suizhou Central Hospital, Hubei University of Medicine, Suizhou, China
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11
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Girija As S, Priyadharsini J V. CLSI based antibiogram profile and the detection of MDR and XDR strains of Acinetobacter baumannii isolated from urine samples. Med J Islam Repub Iran 2019; 33:3. [PMID: 31086782 PMCID: PMC6505532 DOI: 10.34171/mjiri.33.3] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2018] [Indexed: 12/26/2022] Open
Abstract
Background: Acinetobacter baumannii is an emerging nosocomial pathogen causing serious complications due to the propensity of its multi-drug resistant property. Due to the indiscriminate and wide-spread use of antibiotics, A. baumannii strains emerge as MDR-Ab, XDR-Ab and in recent years pan-DR-Ab strains. Routine therapy incorporates the application of fewer antibiotics and antibiotic surveillance data is not monitored frequently. This study is thus an attempt to screen for the frequency of antibiotic resistance profile against different classes of antibiotics as per CLSI guidelines. Methods: Phenotypically and genotypically characterized 73 A. baumannii strains were utilized for the antibiogram profile using Group A, B, and U antibiotics as per CLSI recommendations using standard Kirby Bauer disc diffusion method. Interpretations of susceptible, intermediate and resistance were recorded by measuring zone diameter criteria. Results: Group A antibiogram profile showed highest non-susceptibility (n=73) (100%) to ampicillin-sulbactam, ceftazidime and imipenem followed by 82.19%, 79.45%, 67.12%, 56.16% and 49.31% non-susceptible isolates against ciprofloxacin, gentamicin, meropenem, tobramycin, and levofloxacin respectively. Group B antibiogram profile showed 100% non-susceptibility piperacillin-tazobactam and to amikacin, 91.78% (n=67) resistance against ceftriaxone. Among the cyclines, 19.71% and 6.84% of isolates were resistant to doxycycline and minocycline respectively. Under Group U, 76.71% showed resistance against tetracycline. The frequency of MDR (71.23%) and XDR (39.72%) A. baumannii isolates were detected. Conclusion: Periodical antibiotic surveillance is essential to curb the menace of the emergence of MDR and XDR A. baumannii in the hospital environment thus improving the patient care by the administration of alternate drug of choice or by combination therapy.
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Affiliation(s)
- Smiline Girija As
- Department of Microbiology, Saveetha Dental College and Hospitals, [SIMATS], Poonamallee High Road, Chennai-600 077, Tamilnadu, India
| | - Vijayashree Priyadharsini J
- DRC-BRULAC, Saveetha Dental College and Hospitals, [SIMATS], Poonamallee High Road, Chennai-600 077, Tamilnadu, India
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12
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Gentilini F, Turba ME, Pasquali F, Mion D, Romagnoli N, Zambon E, Terni D, Peirano G, Pitout JDD, Parisi A, Sambri V, Zanoni RG. Hospitalized Pets as a Source of Carbapenem-Resistance. Front Microbiol 2018; 9:2872. [PMID: 30574124 PMCID: PMC6291488 DOI: 10.3389/fmicb.2018.02872] [Citation(s) in RCA: 42] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2017] [Accepted: 11/08/2018] [Indexed: 12/24/2022] Open
Abstract
The massive and irrational use of antibiotics in livestock productions has fostered the occurrence and spread of resistance to “old class antimicrobials.” To cope with that phenomenon, some regulations have been already enforced in the member states of the European Union. However, a role of livestock animals in the relatively recent alerts on the rapid worldwide increase of resistance to last-choice antimicrobials as carbapenems is very unlikely. Conversely, these antimicrobials are increasingly administered in veterinary hospitals whose role in spreading bacteria or mobile genetic elements has not adequately been addressed so far. A cross-sectional study was carried out on 105 hospitalized and 100 non-hospitalized pets with the aim of measuring the prevalence of carbapenem-resistant Gram-negative bacteria (GNB) colonizing dogs and cats, either hospitalized or not hospitalized and estimating the relative odds. Stool samples were inoculated on MacConkey agar plates containing 1 mg/L imipenem which were then incubated aerobically at 37°C ± 1 for 48 h. Isolated bacteria were identified first by Matrix-assisted laser desorption/ionization time-of-flight mass spectrometry and were confirmed by 16S rRNA sequencing. The genetic basis of resistance was investigated using PCR methods, gene or whole genome sequencing (WGS). The prevalence of pets harboring carbapenem-resistant bacteria was 11.4 and 1.0% in hospitalized and not-hospitalized animals, respectively, with an odds ratio of 12.8 (p < 0.01). One pet carried two diverse isolates. Overall, 14 gram-negative non-fermenting bacteria, specifically, one Acinetobacter radioresistens, five Acinetobacter baumannii, six Pseudomonas aeruginosa and two Stenotrophomonas maltophilia were isolated. The Acinetobacter species carried acquired carbapenemases genes encoded by blaNDM-1 and blaOXA-23. In contrast, Pseudomonas phenotypic resistance was associated with the presence of mutations in the oprD gene. Notably, inherent carbapenem-resistant isolates of S. maltophilia were also resistant to the first-line recommended chemotherapeutic trimethoprim/sulfamethoxazole. This study estimates the risk of colonization by carbapenem-resistant non-fermenting GNB in pets hospitalized in veterinary tertiary care centers and highlights their potential role in spreading resistance genes among the animal and human community. Public health authorities should consider extending surveillance systems and putting the release of critical antibiotics under more strict control in order to manage the infection/colonization of pets in veterinary settings.
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Affiliation(s)
- Fabio Gentilini
- Department of Veterinary Medical Sciences, University of Bologna, Bologna, Italy
| | | | - Frederique Pasquali
- Department of Agricultural and Food Sciences, University of Bologna, Bologna, Italy
| | - Domenico Mion
- Department of Veterinary Medical Sciences, University of Bologna, Bologna, Italy
| | - Noemi Romagnoli
- Department of Veterinary Medical Sciences, University of Bologna, Bologna, Italy
| | - Elisa Zambon
- Ospedale: Veterinario I Portoni Rossi s.r.l., Bologna, Italy
| | - Daniele Terni
- Ospedale: Veterinario I Portoni Rossi s.r.l., Bologna, Italy
| | - Gisele Peirano
- Unit of Microbiology, University of Calgary and Calgary Laboratory Services, Calgary, AB, Canada
| | | | - Antonio Parisi
- Istituto Zooprofilattico Sperimentale della Puglia e della Basilicata, Foggia, Italy
| | - Vittorio Sambri
- The Great Romagna Hub Laboratory, Pievesestina, Italy.,Department of Experimental, Diagnostic and Specialty Medicine - DIMES, University of Bologna, Bologna, Italy
| | - Renato Giulio Zanoni
- Department of Veterinary Medical Sciences, University of Bologna, Bologna, Italy
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13
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Genomic insights into nitrofurantoin resistance mechanisms and epidemiology in clinical Enterobacteriaceae. Future Sci OA 2018; 4:FSO293. [PMID: 29796297 PMCID: PMC5961450 DOI: 10.4155/fsoa-2017-0156] [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: 11/27/2017] [Accepted: 01/23/2018] [Indexed: 11/18/2022] Open
Abstract
Aim: Multidrug-resistant enterobacteria are highly associated with invasive devices and intensive care units. Increasing resistance to carbapenems is leading to the use of older and neglected antibiotics such as nitrofurantoin (NFT). The genomics of NFT resistance was investigated. Results & conclusion: High-level resistance to NFT (minimum inhibitory concentration ≥128–512 mg/l) was recorded in 31/36 isolates (89.6%), many of which were from intensive care units (n = 20), urine (n = 17) or invasive procedures (n = 10). Efflux pump inhibitors had little effect on NFT's minimum inhibitory concentrations albeit oqxAB was prevalent in most isolates (n = 32). Various species- and clone-specific mutations mediating high-level NFT resistance were detected in nfsA, nfsB and ribE proteins through comparative genomics. Global phylogenomics showed local and independent emergence of NFT resistance in Enterobacteriaceae. NFT stewardship is advised. Nitrofurantoin (NFT) is an important antibiotic indicated for uncomplicated urinary tract infections. Resistance to NFT is slow and uncommon, making it an important drug for treating urinary tract infections resistant to common and last-resort antibiotics such as cephalosporins, fluoroquinolones, aminoglycosides and carbapenems. Increasing resistance to most antibiotics among uropathogens makes NFT a key choice for clinicians. Thus, the high-level NFT resistance in extradrug- and pandrug-resistant uropathogens found in this study is exceptionally worrying as treatment options will be extremely limited. Mutations in nfsA, nfsB and ribE genes in the same and different strains emerged locally and independently to confer NFT resistance.
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14
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Identification and Isolation of Insertion Sequences, in Carbapenem Resistant Clinical Isolates of Acinetobacter baumannii from Tehran Hospitals. Jundishapur J Microbiol 2017. [DOI: 10.5812/jjm.58251] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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15
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Uwingabiye J, Lemnouer A, Roca I, Alouane T, Frikh M, Belefquih B, Bssaibis F, Maleb A, Benlahlou Y, Kassouati J, Doghmi N, Bait A, Haimeur C, Louzi L, Ibrahimi A, Vila J, Elouennass M. Clonal diversity and detection of carbapenem resistance encoding genes among multidrug-resistant Acinetobacter baumannii isolates recovered from patients and environment in two intensive care units in a Moroccan hospital. Antimicrob Resist Infect Control 2017; 6:99. [PMID: 28959441 PMCID: PMC5615474 DOI: 10.1186/s13756-017-0262-4] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2017] [Accepted: 09/25/2017] [Indexed: 11/22/2022] Open
Abstract
Background Carbapenem-resistant Acinetobacter baumannii has recently been defined by the World Health Organization as a critical pathogen. The aim of this study was to compare clonal diversity and carbapenemase-encoding genes of A. baumannii isolates collected from colonized or infected patients and hospital environment in two intensive care units (ICUs) in Morocco. Methods The patient and environmental sampling was carried out in the medical and surgical ICUs of Mohammed V Military teaching hospital from March to August 2015. All A. baumannii isolates recovered from clinical and environmental samples, were identified using routine microbiological techniques and Matrix-Assisted Laser Desorption/Ionization Time-of-Flight Mass Spectrometry. Antimicrobial susceptibility testing was performed using disc diffusion method. The carbapenemase-encoding genes were screened for by PCR. Clonal relatedness was analyzed by digestion of the DNA with low frequency restriction enzymes and pulsed field gel electrophoresis (PFGE) and the multi locus sequence typing (MLST) was performed on two selected isolates from two major pulsotypes. Results A total of 83 multidrug-resistant A. baumannii isolates were collected: 47 clinical isolates and 36 environmental isolates. All isolates were positive for the blaOXA51-like and blaOXA23-like genes. The coexistence of blaNDM-1/blaOXA-23-like and blaOXA 24-like/blaOXA-23-like were detected in 27 (32.5%) and 2 (2.4%) of A. baumannii isolates, respectively. The environmental samples and the fecally-colonized patients were significantly identified (p < 0.05) as the most common sites of isolation of NDM-1-harboring isolates. PFGE grouped all isolates into 9 distinct clusters with two major groups (0007 and 0008) containing up to 59% of the isolates. The pulsotype 0008 corresponds to sequence type (ST) 195 while pulsotype 0007 corresponds to ST 1089.The genetic similarity between the clinical and environmental isolates was observed in 80/83 = 96.4% of all isolates, belonging to 7 pulsotypes. Conclusion This study shows that the clonal spread of environmental A. baumannii isolates is related to that of clinical isolates recovered from colonized or infected patients, being both associated with a high prevalence of the blaOXA23-like and blaNDM-1genes. These findings emphasize the need for prioritizing the bio-cleaning of the hospital environment to control and prevent the dissemination of A. baumannii clonal lineages. Electronic supplementary material The online version of this article (10.1186/s13756-017-0262-4) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Jean Uwingabiye
- Department of Clinical Bacteriology, Mohammed V Military Teaching Hospital, Research Team of Epidemiology and Bacterial Resistance, Faculty of Medicine and Pharmacy, Mohammed V University, Rabat, Morocco
| | - Abdelhay Lemnouer
- Department of Clinical Bacteriology, Mohammed V Military Teaching Hospital, Research Team of Epidemiology and Bacterial Resistance, Faculty of Medicine and Pharmacy, Mohammed V University, Rabat, Morocco
| | - Ignasi Roca
- Department of Clinical Microbiology and ISGlobal- Barcelona Ctr. Int. Health Res. CRESIB, Hospital Clínic - Universitat de Barcelona, Barcelona, Spain
| | - Tarek Alouane
- Medical Biotechnology Laboratory (Medbiotech), Faculty of Medicine and Pharmacy, Mohammed V University, Rabat, Morocco
| | - Mohammed Frikh
- Department of Clinical Bacteriology, Mohammed V Military Teaching Hospital, Research Team of Epidemiology and Bacterial Resistance, Faculty of Medicine and Pharmacy, Mohammed V University, Rabat, Morocco
| | - Bouchra Belefquih
- Department of Clinical Bacteriology, Mohammed V Military Teaching Hospital, Research Team of Epidemiology and Bacterial Resistance, Faculty of Medicine and Pharmacy, Mohammed V University, Rabat, Morocco
| | - Fatna Bssaibis
- Department of Clinical Bacteriology, Mohammed V Military Teaching Hospital, Research Team of Epidemiology and Bacterial Resistance, Faculty of Medicine and Pharmacy, Mohammed V University, Rabat, Morocco
| | - Adil Maleb
- Department of Clinical Bacteriology, Mohammed V Military Teaching Hospital, Research Team of Epidemiology and Bacterial Resistance, Faculty of Medicine and Pharmacy, Mohammed V University, Rabat, Morocco
| | - Yassine Benlahlou
- Department of Clinical Bacteriology, Mohammed V Military Teaching Hospital, Research Team of Epidemiology and Bacterial Resistance, Faculty of Medicine and Pharmacy, Mohammed V University, Rabat, Morocco
| | - Jalal Kassouati
- Department of Clinical Bacteriology, Mohammed V Military Teaching Hospital, Research Team of Epidemiology and Bacterial Resistance, Faculty of Medicine and Pharmacy, Mohammed V University, Rabat, Morocco
| | - Nawfal Doghmi
- Department of Intensive Care Units , Mohammed V Military Teaching Hospital, Faculty of Medicine and Pharmacy, Mohammed V University, Rabat, Morocco
| | - Abdelouahed Bait
- Department of Intensive Care Units , Mohammed V Military Teaching Hospital, Faculty of Medicine and Pharmacy, Mohammed V University, Rabat, Morocco
| | - Charki Haimeur
- Department of Intensive Care Units , Mohammed V Military Teaching Hospital, Faculty of Medicine and Pharmacy, Mohammed V University, Rabat, Morocco
| | - Lhoussain Louzi
- Department of Clinical Bacteriology, Mohammed V Military Teaching Hospital, Research Team of Epidemiology and Bacterial Resistance, Faculty of Medicine and Pharmacy, Mohammed V University, Rabat, Morocco
| | - Azeddine Ibrahimi
- Medical Biotechnology Laboratory (Medbiotech), Faculty of Medicine and Pharmacy, Mohammed V University, Rabat, Morocco
| | - Jordi Vila
- Department of Clinical Microbiology and ISGlobal- Barcelona Ctr. Int. Health Res. CRESIB, Hospital Clínic - Universitat de Barcelona, Barcelona, Spain
| | - Mostafa Elouennass
- Department of Clinical Bacteriology, Mohammed V Military Teaching Hospital, Research Team of Epidemiology and Bacterial Resistance, Faculty of Medicine and Pharmacy, Mohammed V University, Rabat, Morocco
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16
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Karampatakis T, Antachopoulos C, Tsakris A, Roilides E. Molecular epidemiology of carbapenem-resistant Acinetobacter baumannii in Greece: an extended review (2000–2015). Future Microbiol 2017; 12:801-815. [DOI: 10.2217/fmb-2016-0200] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Carbapenem-resistant Acinetobacter baumannii (CRAB) is endemic in Greece. CRAB initially emerged in 2000 and since then, carbapenemases still have a crucial role in CRAB appearance, except for a few cases resulting from efflux pump or outer-membrane protein mechanisms. OXA-type carbapenemases present the highest prevalence worldwide and bla OXA-23-like and bla OXA-58-like are the most important genes found; VIM-yielding CRAB have also been detected, while a single CRAB isolate producing NDM has quite recently emerged in Greece. The predominant OXA-23 producers are associated with multilocus sequence typing Pasteur scheme sequence type 2 clonal strains of the international clone II. The emergence of colistin-resistant CRAB has complicated the treatment of such infections and the interpretation of susceptibility data. Infection control measures and adjusted antimicrobial treatment strategies could confine CRAB spread. The aim of this review is to go through the molecular epidemiology of CRAB, in an endemic area and highlight its potential future evolution.
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Affiliation(s)
- Theodoros Karampatakis
- Infectious Diseases Unit, 3rd Department of Pediatrics, Medical Faculty, School of Health Sciences, Aristotle University, Hippokration General Hospital, Thessaloniki, Greece
| | - Charalampos Antachopoulos
- Infectious Diseases Unit, 3rd Department of Pediatrics, Medical Faculty, School of Health Sciences, Aristotle University, Hippokration General Hospital, Thessaloniki, Greece
| | - Athanassios Tsakris
- Microbiology Department, National & Kapodistrian University School of Medicine, Athens, Greece
| | - Emmanuel Roilides
- Infectious Diseases Unit, 3rd Department of Pediatrics, Medical Faculty, School of Health Sciences, Aristotle University, Hippokration General Hospital, Thessaloniki, Greece
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17
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Pournaras S, Dafopoulou K, Del Franco M, Zarkotou O, Dimitroulia E, Protonotariou E, Poulou A, Zarrilli R, Tsakris A, Skoura L, Themeli-Digalaki K, Perivolioti E, Tsiplakou S, Karavassilis V, Panopoulou M, Orfanidou M, Hadjichristodoulou C, Levidiotou S, Gikas A. Predominance of international clone 2 OXA-23-producing- Acinetobacter baumannii clinical isolates in Greece, 2015: results of a nationwide study. Int J Antimicrob Agents 2017; 49:749-753. [DOI: 10.1016/j.ijantimicag.2017.01.028] [Citation(s) in RCA: 43] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2016] [Revised: 01/16/2017] [Accepted: 01/28/2017] [Indexed: 10/19/2022]
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18
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Shamsizadeh Z, Nikaeen M, Nasr Esfahani B, Mirhoseini SH, Hatamzadeh M, Hassanzadeh A. Detection of antibiotic resistant Acinetobacter baumannii in various hospital environments: potential sources for transmission of Acinetobacter infections. Environ Health Prev Med 2017; 22:44. [PMID: 29165152 PMCID: PMC5664838 DOI: 10.1186/s12199-017-0653-4] [Citation(s) in RCA: 54] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2016] [Accepted: 04/20/2017] [Indexed: 11/10/2022] Open
Abstract
Background Antibiotic resistant Acinetobacter baumannii has emerged as one of the most problematic hospital acquired pathogens around the world. This study was designed to investigate the presence of antibiotic resistant A. baumannii in various hospital environments. Methods Air, water and inanimate surface samples were taken in different wards of four hospitals and analyzed for the presence of A. baumannii. Confirmed A. baumannii isolates were analyzed for antimicrobial susceptibility and also screened for the presence of three most common OXA- type carbapenemase-encoding genes. Results A. baumannii was detected in 11% (7/64) of air samples with the highest recovery in intensive care units (ICUs). A. baumannii was also detected in 17% (7/42) and 2% (1/42) of surface and water samples, respectively. A total of 40 A. baumannii isolates were recovered and analysis of antimicrobial susceptibility showed the highest resistance towards ceftazidime (92.5%, 37/40). 85% (34/40) and 80% (32/40) of the isolates were also resistant to imipenem and gentamicin, respectively. Resistance genes analysis showed that 77.5% (31/40) strains contained OXA-23 and 5% (2/40) strains contained OXA-24, but OXA-58 was not detected in any of the strains. Conclusion Detection of antibiotic resistant A. baumannii in various samples revealed that hospital environments could act as a potential source for transmission of A. baumannii infections especially in ICUs. These results emphasize the importance of early detection and implementation of control measures to prevent the spread of A. baumannii in hospital environments.
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Affiliation(s)
- Zahra Shamsizadeh
- Department of Environmental Health Engineering, School of Health, Isfahan University of Medical Sciences, Hezar Jerib Avenue, Isfahan, Iran
| | - Mahnaz Nikaeen
- Department of Environmental Health Engineering, School of Health, Isfahan University of Medical Sciences, Hezar Jerib Avenue, Isfahan, Iran.
| | - Bahram Nasr Esfahani
- Department of Microbiology, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Seyed Hamed Mirhoseini
- Department of Environmental Health Engineering, School of Health, Arak University of Medical Sciences, Arak, Iran
| | - Maryam Hatamzadeh
- Department of Environmental Health Engineering, School of Health, Isfahan University of Medical Sciences, Hezar Jerib Avenue, Isfahan, Iran
| | - Akbar Hassanzadeh
- Department of Statistics and Epidemiology, School of Health, Isfahan University of Medical Sciences, Isfahan, Iran
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19
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Ganjo AR, Maghdid DM, Mansoor IY, Kok DJ, Severin JA, Verbrugh HA, Kreft D, Fatah MH, Alnakshabandi AA, Dlnya A, Hammerum AM, Ng K, Goessens W. OXA-Carbapenemases Present in Clinical Acinetobacter baumannii-calcoaceticus Complex Isolates from Patients in Kurdistan Region, Iraq. Microb Drug Resist 2016; 22:627-637. [PMID: 27003287 DOI: 10.1089/mdr.2015.0060] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023] Open
Abstract
In addition to intrinsic resistance in Acinetobacter baumannii, many different types of acquired resistance mechanisms have been reported, including the presence of VIM and IMP metallo β-lactamases and also of blaOXA-23-like and blaOXA-58-like enzymes. In the Kurdistan region of Iraq, the multiresistant A. baumannii-calcoaceticus complex is prevalent. We characterized the different mechanisms of resistance present in clinical isolates collected from different wards and different hospitals from the Kurdistan region. One hundred twenty clinical nonduplicate A. baumannii-calcoaceticus complex isolates were collected from four hospitals between January 2012 and October 2013. The identification of the isolates was confirmed by MALDI-TOF. The susceptibility to different antibiotics was determined by disk diffusion and analyzed in accordance to EUCAST guidelines. By PCR, the presence of blaOXA-51-like, blaOXA-23-like, blaOXA-24-like, and blaOXA-58-like genes was determined as well as the presence of the insertion element ISAba1. Clonal diversity was analyzed by pulsed-field gel electrophoresis (PFGE) using the restriction enzyme ApaI and, in addition, multilocus sequence typing (MLST) was performed on a selected subset of 15 isolates. All 120 A. baumannii isolates harbored blaOXA-51-like genes. One hundred one out of 110 (92%) imipenem (IMP)-resistant A. baumannii-calcoaceticus complex isolates additionally carried the blaOXA-23-like gene and four isolates (3%) were positive for blaOXA-24-like. All 101 blaOXA-23-like-positive isolates had the ISAba1 insertion sequence, 1,600 bp upstream of the blaOXA-23-like gene. The blaOXA-58-like gene was not detected in any of the 110 IMP-resistant strains. Eight different PFGE clusters were identified and distributed over the different hospitals. MLST analysis performed on a subset of 15 representative isolates revealed the presence of the international clone ST2 (Pasteur). Besides ST2 (Pasteur), also many other STs (Pasteur) were encountered such as ST136, ST94, ST623, ST792, and ST793, all carrying the blaOXA-23 gene. In clinical A. baumannii-calcoaceticus complex isolates from Kurdistan-Iraq, the blaOXA-23 gene in combination with the upstream ISAba1 insertion element is largely responsible for carbapenem resistance. Several small clusters of identical genotypes were found from patients admitted to the same ward and during overlapping time periods, suggesting transmission within the hospital. Identification of source(s) and limiting the transmission of these strains to patients needs to be prioritized.
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Affiliation(s)
- Aryann R Ganjo
- 1 College of Pharmacy, Hawler Medical University , Erbil, Iraq
| | - Delshad M Maghdid
- 2 Department of Medical Microbiology and Infectious Diseases, Erasmus MC, University Medical Center Rotterdam , Rotterdam, The Netherlands
| | - Isam Y Mansoor
- 3 College of Health Sciences, Hawler Medical University , Erbil, Iraq
| | - Dik J Kok
- 2 Department of Medical Microbiology and Infectious Diseases, Erasmus MC, University Medical Center Rotterdam , Rotterdam, The Netherlands
| | - Juliette A Severin
- 2 Department of Medical Microbiology and Infectious Diseases, Erasmus MC, University Medical Center Rotterdam , Rotterdam, The Netherlands
| | - Henri A Verbrugh
- 2 Department of Medical Microbiology and Infectious Diseases, Erasmus MC, University Medical Center Rotterdam , Rotterdam, The Netherlands
| | - Deborah Kreft
- 2 Department of Medical Microbiology and Infectious Diseases, Erasmus MC, University Medical Center Rotterdam , Rotterdam, The Netherlands
| | - M H Fatah
- 4 Kalar Technical Institute , Sulaimani, Iraq
| | | | - Asad Dlnya
- 5 School of Science, Sulaimani University , Sulaimani, Iraq
| | - Anette M Hammerum
- 6 Department of Microbiology & Infection Control, Statens Serum Institute , Copenhagen S, Denmark
| | - Kim Ng
- 6 Department of Microbiology & Infection Control, Statens Serum Institute , Copenhagen S, Denmark
| | - Wil Goessens
- 2 Department of Medical Microbiology and Infectious Diseases, Erasmus MC, University Medical Center Rotterdam , Rotterdam, The Netherlands
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Shoja S, Moosavian M, Rostami S, Abbasi F, Tabatabaiefar MA, Peymani A. Characterization of Oxacillinase and Metallo-β-Lactamas Genes and Molecular Typing of Clinical Isolates of Acinetobacter baumannii in Ahvaz, South-West of Iran. Jundishapur J Microbiol 2016; 9:e32388. [PMID: 27540456 PMCID: PMC4976075 DOI: 10.5812/jjm.32388] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2015] [Revised: 10/20/2015] [Accepted: 12/02/2015] [Indexed: 11/16/2022] Open
Abstract
Background: Carbapenem resistant Acinetobacter baumannii is an important nosocomial pathogen associated with a variety of infections. Objectives: The current study aimed to characterize the antimicrobial susceptibility, analyze the prevalence of oxacillinase and metallo-β-lactamase (MBL) genes and molecular typing of clinical isolates of A. baumannii. Materials and Methods: A total of 124 non-repetitive isolates of A. baumannii were collected from various clinical specimens in two teaching hospitals in Ahvaz, south-west of Iran. Antimicrobial susceptibility test was carried out by disk diffusion method. The minimum inhibitory concentrations (MICs) of imipenem, meropenem, colistin and tigecycline were determined using E-test. To screen for MBL production, double disk synergy (DDs) test and MBL E-test were performed. The presence of blaOXA-23-like, blaOXA-24-like, blaOXA-51-like, blaOXA-58-like, blaVIM, blaIMP and blaSPM genes was assessed by polymerase chain reaction (PCR). To identify clonal relatedness, all isolates were subjected to repetitive sequence-based PCR (rep-PCR) Results: Based on disk diffusion results, the highest rate of resistance was observed in rifampin (96.8%). Colistin and polymyxin-B were the most effective agents in vitro. According to the MIC results, the rate of resistance to imipenem, meropenem, colistin and tigecycline were 78.2%, 73.4%, 0.8% and 0, respectively. Metallo-β-lactamase production was positive in 42.3% and 79.4% of the isolates by DDs test and E-test, respectively. All isolates (100%) carried blaOXA-51-like gene. According to the results of multiplex PCR, blaOXA-23-like and blaOXA-24-like genes were detected in 85.6% and 6.2% of carbapenem resistant isolates, respectively. No blaOXA-58- like, blaVIM, blaIMP and blaSPM were detected. By rep-PCR, carbapenem resistant isolates were separated into six genotypes (A to F). Genotype A (30.9%) was the most prevalent (P value < 0.001). Genotypes B and C were found in 28.9% and 26.8% of the isolates, respectively. Conclusions: The rate of carbapenem resistant A. baumannii isolates were high in this study. Since, blaOXA-58-like or MBL genes were not detected, it seems that resistance to carbapenems is related to blaOXA-23-like and blaOXA-24-like. Moreover, blaOXA-23-like was the most prevalent oxacillinase (OXA) gene. Most of the isolates belonged to one of the four dominant genotypes indicating clonal dissemination in the hospitals under study. In order to control the spread of carbapenem-resistant A. baumannii, infection- control strategies are needed.
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Affiliation(s)
- Saeed Shoja
- Infectious and Tropical Diseases Research Center, Hormozgan University of Medical Sciences, Bandar Abbas, IR Iran
- Corresponding author: Saeed Shoja, Infectious and Tropical Diseases Research Center, Hormozgan University of Medical Sciences, P. O. Box: 7919693116, Bandar Abbas, IR Iran. Tel: +98-7633668357, E-mail:
| | - Mojtaba Moosavian
- Microbiology Department, Infectious and Tropical Diseases Research Center, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, IR Iran
| | - Soodabeh Rostami
- Nosocomial Infections Research Center, Isfahan University of Medical Sciences, Isfahan, IR Iran
| | - Fariba Abbasi
- Golestan Hospital, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, IR Iran
| | - Mohammad Amin Tabatabaiefar
- Department of Genetics and Molecular Biology, School of Medicine, Isfahan University of Medical Sciences, Isfahan, IR Iran
| | - Amir Peymani
- Microbiology Department, Qazvin University of Medical Sciences, Qazvin, IR Iran
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Alaei N, Aziemzadeh M, Bahador A. Antimicrobial resistance profiles and genetic elements involved in carbapenem resistance in Acinetobacter baumannii isolates from a referral hospital in Southern Iran. J Glob Antimicrob Resist 2016; 5:75-9. [PMID: 27436472 DOI: 10.1016/j.jgar.2015.12.005] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2015] [Revised: 11/18/2015] [Accepted: 12/22/2015] [Indexed: 11/19/2022] Open
Abstract
In this study, antimicrobial resistance patterns, carbapenemase production, carbapenem-hydrolysing class D OXA-type β-lactamase (CHDL)-encoding genes and ISAba insertion elements were characterised in Acinetobacter baumannii isolates from Southern Iran. A total of 85 A. baumannii isolates from patients in a tertiary care hospital were isolated. Antibiotic susceptibility profiles to 14 antimicrobials were determined by disc diffusion assay. Minimum inhibitory concentrations (MICs) to colistin and tigecycline were determined by the broth microdilution method. Isolates were analysed for OXA-type carbapenemase-encoding genes, ISAba elements upstream of blaOXA genes, and carbapenemase production by the CarbAcineto NP test. Of the 85 A. baumannii isolates, 73 (86%) were non-susceptible to imipenem. The MIC50 and MIC90 values for imipenem were 16mg/L and 64mg/L, respectively. Fourteen isolates (16%) were resistant to colistin. Among the 79 carbapenem-non-susceptible A. baumannii isolates, 77 (97%) were carbapenemase-producers as determined by the CarbAcineto NP test. The most frequently identified OXA-type carbapenemase gene was blaOXA-23-like, which was identified in 44 isolates (52%), followed by blaOXA-24-like with 13 isolates (15%). Statistical analysis showed that ISAba elements upstream of the blaOXA gene were significantly related to imipenem-non-susceptible isolates. The presence of blaOXA genes and ISAba1 and ISAba4 elements can explain the resistance of the isolates to carbapenems. The concerns raised following the emergence of colistin-resistant A. baumannii isolates highlight the need for a comprehensive national programme to collect and examine A. baumannii isolates from different parts of Iran.
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Affiliation(s)
- Najmeh Alaei
- Department of Microbiology, Faculty of Basic Sciences, Islamic Azad University, Karaj Branch, Karaj, Iran
| | - Masoud Aziemzadeh
- Department of Microbiology, School of Medicine, Bushehr University of Medical Sciences, Bushehr, Iran
| | - Abbas Bahador
- Department of Microbiology, School of Medicine, Tehran University of Medical Sciences, Keshavarz Blvd., 100 Poursina Ave., Tehran 14167-53955, Iran.
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Bahador A, Raoofian R, Pourakbari B, Taheri M, Hashemizadeh Z, Hashemi FB. Genotypic and Antimicrobial Susceptibility of Carbapenem-resistant Acinetobacter baumannii: Analysis of is Aba Elements and bla OXA-23-like Genes Including a New Variant. Front Microbiol 2015; 6:1249. [PMID: 26617588 PMCID: PMC4643144 DOI: 10.3389/fmicb.2015.01249] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2015] [Accepted: 10/27/2015] [Indexed: 01/08/2023] Open
Abstract
Carbapenem-resistant Acinetobacter baumannii (CR-AB) causes serious nosocomial infections, especially in ICU wards of hospitals, worldwide. Expression of blaOXA genes is the chief mechanism of conferring carbapenem resistance among CR-AB. Although some blaOXA genes have been studied among CR-AB isolates from Iran, their blaOXA-23-like genes have not been investigated. We used a multiplex-PCR to detect Ambler class A, B, and D carbapenemases of 85 isolates, and determined that 34 harbored blaOXA-23-like genes. Amplified fragment length polymorphism (AFLP) genotyping, followed by DNA sequencing of blaOXA-23-like amplicons of CR-AB from each AFLP group was used to characterize their blaOXA-23-like genes. We also assessed the antimicrobial susceptibility pattern of CR-AB isolates, and tested whether they harbored insertion sequences ISAba1 and ISAba4. Sequence comparison with reference strain A. baumannii (NCTC12156) revealed five types of mutations in blaOXA-23-like genes; including one novel variant and four mutants that were already reported from China and the USA. All of the blaOXA-23-like genes mutations were associated with increased minimum inhibitory concentrations (MICs) against imipenem. ISAba1 and ISAba4 sequences were detected upstream of blaOXA-23 genes in 19 and 7% of isolates, respectively. The isolation of CR-AB with new blaOXA-23 mutations including some that have been reported from the USA and China highlights CR-AB pervasive distribution, which underscores the importance of concerted national and global efforts to control the spread of CR-AB isolates worldwide.
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Affiliation(s)
- Abbas Bahador
- Department of Microbiology, School of Medicine, Tehran University of Medical Sciences Tehran, Iran
| | - Reza Raoofian
- Legal Medicine Research Center, Legal Medicine Organization Tehran, Iran ; Innovative Medical Research Center, Islamic Azad University Mashhad, Iran
| | - Babak Pourakbari
- Pediatrics Infectious Disease Research Center, School of Medicine, Tehran University of Medical Sciences Tehran, Iran
| | - Mohammad Taheri
- Department of Microbiology and Virology, Shiraz University of Medical Sciences Shiraz, Iran
| | - Zahra Hashemizadeh
- Department of Microbiology and Virology, Shiraz University of Medical Sciences Shiraz, Iran
| | - Farhad B Hashemi
- Department of Microbiology, School of Medicine, Tehran University of Medical Sciences Tehran, Iran
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23
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Ceccarelli G, Oliva A, d'Ettorre G, D'Abramo A, Caresta E, Barbara CS, Mascellino MT, Papoff P, Moretti C, Vullo V, Visca P, Venditti M. The role of vancomycin in addition with colistin and meropenem against colistin-sensitive multidrug resistant Acinetobacter baumannii causing severe infections in a Paediatric Intensive Care Unit. BMC Infect Dis 2015; 15:393. [PMID: 26424078 PMCID: PMC4589198 DOI: 10.1186/s12879-015-1133-3] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2015] [Accepted: 09/21/2015] [Indexed: 08/30/2023] Open
Abstract
Background Acinetobacter baumannii has been associated with high morbidity and mortality rates, even in pediatric patients. Therapeutic options are limited, especially when the strain is multidrug resistant. Methods Clinical and microbiological analyses of 4 cases of systemic infections caused by multi drug resistant A. baumannii treated with colistin/vancomycin combination at a Pediatric Intensive Care Unit were performed in order to explore the potential synergistic activity of colistin plus vancomycin. All the patients were treated with colistin, meropenem and vancomycin. Results Four severe infections due to MDR A. baumannii were observed. All patients treated with colistin/vancomycin combination had a positive outcome with no infection relapses. Most importantly, no significant adverse events related to the simultaneous administration of COL plus VAN were observed. In our in-vitro experiments, the synergistic effect of the combination COL plus VAN showed an early bactericidal activity even at VAN concentration of 16 mg/L, which reflects the serum trough concentrations obtained in patients. Discussion An antimicrobial strategy based on the activity of colistin plus vancomycin was in-vitro and in-vivo effective in life-threatening infections caused by multidrug-resistant A. baumannii in a Pediatric Intensive Care Unit, in the absence of adverse effects. Colistin plus vancomycin were highly synergic and bactericidal against carbapenem-resistant, colistin sensitive A. baumannii whereas the addition of meropenem did not enhance the in-vitro activity of colistin plus vancomycin. Conclusions Our results confirm existing data on the potential synergistic activity of a therapeutic strategy including colistin plus vancomycin and provide important new clinical information for its potential use as a therapeutic option against MDR A. baumannii infections, especially in the pediatric population. Electronic supplementary material The online version of this article (doi:10.1186/s12879-015-1133-3) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Giancarlo Ceccarelli
- Department of Public Health and Infectious Diseases, University of Rome "Sapienza", Viale del Policlinico 155, Rome, Italy. .,Azienda Policlinico Umberto I, Viale del Policlinico 155, Rome, Italy.
| | - Alessandra Oliva
- Department of Public Health and Infectious Diseases, University of Rome "Sapienza", Viale del Policlinico 155, Rome, Italy. .,Azienda Policlinico Umberto I, Viale del Policlinico 155, Rome, Italy.
| | - Gabriella d'Ettorre
- Department of Public Health and Infectious Diseases, University of Rome "Sapienza", Viale del Policlinico 155, Rome, Italy. .,Azienda Policlinico Umberto I, Viale del Policlinico 155, Rome, Italy.
| | - Alessandra D'Abramo
- Department of Public Health and Infectious Diseases, University of Rome "Sapienza", Viale del Policlinico 155, Rome, Italy. .,Azienda Policlinico Umberto I, Viale del Policlinico 155, Rome, Italy.
| | - Elena Caresta
- Pediatric Intensive Care Unit, Department of Pediatric Sciences, University of Rome "Sapienza", Viale del Policlinico 155, Rome, Italy. .,Azienda Policlinico Umberto I, Viale del Policlinico 155, Rome, Italy.
| | - Caterina Silvia Barbara
- Pediatric Intensive Care Unit, Department of Pediatric Sciences, University of Rome "Sapienza", Viale del Policlinico 155, Rome, Italy. .,Azienda Policlinico Umberto I, Viale del Policlinico 155, Rome, Italy.
| | - Maria Teresa Mascellino
- Department of Public Health and Infectious Diseases, University of Rome "Sapienza", Viale del Policlinico 155, Rome, Italy. .,Azienda Policlinico Umberto I, Viale del Policlinico 155, Rome, Italy.
| | - Paola Papoff
- Pediatric Intensive Care Unit, Department of Pediatric Sciences, University of Rome "Sapienza", Viale del Policlinico 155, Rome, Italy. .,Azienda Policlinico Umberto I, Viale del Policlinico 155, Rome, Italy.
| | - Corrado Moretti
- Pediatric Intensive Care Unit, Department of Pediatric Sciences, University of Rome "Sapienza", Viale del Policlinico 155, Rome, Italy. .,Azienda Policlinico Umberto I, Viale del Policlinico 155, Rome, Italy.
| | - Vincenzo Vullo
- Department of Public Health and Infectious Diseases, University of Rome "Sapienza", Viale del Policlinico 155, Rome, Italy. .,Azienda Policlinico Umberto I, Viale del Policlinico 155, Rome, Italy.
| | - Paolo Visca
- Department of Science, Roma Tre University, Viale G. Marconi 446, Rome, Italy.
| | - Mario Venditti
- Department of Public Health and Infectious Diseases, University of Rome "Sapienza", Viale del Policlinico 155, Rome, Italy. .,Azienda Policlinico Umberto I, Viale del Policlinico 155, Rome, Italy.
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24
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Zanganeh Z, Eftekhar F. Correlation of Oxacillinase Gene Carriage With the Genetic Fingerprints of Imipenem-Resistant Clinical Isolates of Acinetobacter baumannii. Jundishapur J Microbiol 2015; 8:e26545. [PMID: 26495112 PMCID: PMC4609178 DOI: 10.5812/jjm.26545] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2015] [Revised: 05/03/2015] [Accepted: 05/15/2015] [Indexed: 02/06/2023] Open
Abstract
Background: Emergence of multidrug-resistant Acinetobacter baumannii has resulted in the treatment failure of related infections and an increase in patient mortality. The presence of class D β-lactamases (oxacillinases) in this organism is an important mechanism underlying resistance to beta-lactam antibiotics. Objectives: The aim of this work was to investigate the correlation between oxacillinase gene carriage and genetic fingerprints in imipenem-resistant burn and non-burn isolates of A. baumannii. Materials and Methods: Fifty-eight A. baumannii isolates were collected from October 2011 to April 2012, which included 28 burn isolates from Shahid Motahari Hospital and 30 non-burn isolates from Imam Hossein Hospital. The minimum inhibitory and minimum bactericidal concentrations (MIC and MBC) of imipenem were measured by the broth microdilution method. The presence of oxacillinase genes (OXA-23-, OXA-24-, OXA-51-, and OXA-58-like genes) was shown using type-specific primers and PCR. Genetic profiles were generated by RAPD-PCR fingerprinting. Results: OXA-23 was observed in 81% of the isolates and its distribution was similar within the two groups. The presence of OXA-51 was shown in 58.6% of the isolates, of which most were burn isolates (67.6%). OXA-24 was present in 20.7% of the isolates, all belonging to the burn group; OXA-58 was not observed in any of the isolates. RAPD-PCR fingerprints revealed two clusters at a similarity level of 70% (A, B). At a similarity level of 85%, nine different groups were observed for burn and non-bun isolates. Conclusions: Our results showed that blaOXA-23 was the most prevalent gene, followed by blaOXA-51, among the burn and non-burn clinical isolates of A. baumannii. BlaOXA-24-like genes were detected at a lower level and were only found among the burn isolates, which also showed higher heterogeneity compared to the non-burn group.
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Affiliation(s)
- Zahra Zanganeh
- Department of Microbiology, Faculty of Biological Sciences, Shahid Beheshti University, Tehran, IR Iran
| | - Fereshteh Eftekhar
- Department of Microbiology, Faculty of Biological Sciences, Shahid Beheshti University, Tehran, IR Iran
- Corresponding author: Fereshteh Eftekhar, Department of Microbiology, Faculty of Biological Sciences, Shahid Beheshti University G. C., Tehran, IR Iran. Tel: +98-2129903208, Fax: +98-2122431664, E-mail:
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Wu W, He Y, Lu J, Lu Y, Wu J, Liu Y. Transition of blaOXA-58-like to blaOXA-23-like in Acinetobacter baumannii Clinical Isolates in Southern China: An 8-Year Study. PLoS One 2015; 10:e0137174. [PMID: 26340666 PMCID: PMC4560421 DOI: 10.1371/journal.pone.0137174] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2015] [Accepted: 08/14/2015] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND The prevalence of carbapenem-resistant Acinetobacter baumannii in hospitals has been increasing worldwide. This study aims to investigate the carbapenemase genes and the clonal relatedness among A. baumannii clinical isolates in a Chinese hospital. METHODS Carbapenemase genes and the upstream locations of insertion sequences were detected by polymerase chain reaction (PCR), and the clonal relatedness of isolates was determined by pulsed-field gel electrophoresis (PFGE) and multilocus sequence typing. RESULTS A total of 231 nonduplicate carbapenemase gene-harboring A. baumannii clinical isolates recovered from Shenzhen People's Hospital, were investigated between 2002 and 2009. blaOXA-23-like, blaOXA-58-like, blaOXA-40-like, and ISAba1-blaOXA-51-like were identified in 119, 107, 1, and 4 isolates, respectively. IS1008-ΔISAba3, ISAba3, and ISAba1 were detected upstream of the blaOXA-58-like gene in 69, 35, and 3 isolates, respectively. All blaOXA-23-like genes but one had an upstream insertion of ISAba1. blaOXA-58-like was the most common carbapenemase gene in A.baumannii before 2008, thereafter blaOXA-23-like became rapidly prevalent and replaced blaOXA-58-like in 2009. The majority of blaOXA-58-like-carrying isolates showed lower level of resistance to imipenem and meropenem (minimum inhibitory concentrations (MICs), 1 μg/ml to 16 μg/ml), compared with the majority of blaOXA-23-like-carrying isolates (MICs, 16 μg/ml to 64 μg/ml for both imipenem and meropenem). All 231 blaOXA carbapenemase gene-harboring isolates belonged to 14 PFGE types (A-N), and three dominant clones A, J, and H accounted for 43.3%, 42.0%, and 8.2% of the tested isolates, respectively. Clone A (sequence type ST92/ST208) with blaOXA-58-like was the most prevalent before 2008. Clone H (ST229) with blaOXA-23-like became striking between 2007 and 2008. Clone J (ST381) with blaOXA-23-like rapidly spread and replaced clones A and H in 2009. CONCLUSION This study is the first to reveal that the distinct blaOXA-23-like-carrying A. baumannii ST381 displaced the previously prevalent blaOXA-58-like-carrying A. baumannii ST92/ST208, resulting in the rapidly increasing resistance to carbapenems in A. baumannii in Shenzhen People's Hospital in 2009.
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Affiliation(s)
- Weiyuan Wu
- Department of Laboratory Medicine, Shenzhen People's Hospital, Second Clinical Medical College of Jinan University, Key Laboratory of Pathogenic Microorganism and Bacterial Resistance Surveillance in Shenzhen, Shenzhen, Guangdong, China
| | - Yi He
- Department of Infectious Disease, Third People's Hospital of Shenzhen, Shenzhen, Guangdong, China
| | - Jian Lu
- Department of Infectious Disease, Third People's Hospital of Shenzhen, Shenzhen, Guangdong, China
| | - Yuemei Lu
- Department of Laboratory Medicine, Shenzhen People's Hospital, Second Clinical Medical College of Jinan University, Key Laboratory of Pathogenic Microorganism and Bacterial Resistance Surveillance in Shenzhen, Shenzhen, Guangdong, China
| | - Jinsong Wu
- Department of Laboratory Medicine, Shenzhen People's Hospital, Second Clinical Medical College of Jinan University, Key Laboratory of Pathogenic Microorganism and Bacterial Resistance Surveillance in Shenzhen, Shenzhen, Guangdong, China
| | - Yingxia Liu
- Department of Infectious Disease, Third People's Hospital of Shenzhen, Shenzhen, Guangdong, China
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Sousa C, Botelho J, Grosso F, Silva L, Lopes J, Peixe L. Unsuitability of MALDI-TOF MS to discriminate Acinetobacter baumannii clones under routine experimental conditions. Front Microbiol 2015; 6:481. [PMID: 26042113 PMCID: PMC4436932 DOI: 10.3389/fmicb.2015.00481] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2015] [Accepted: 05/01/2015] [Indexed: 11/13/2022] Open
Abstract
MALDI-TOF MS (matrix-assisted laser desorption/ionization time-of-flight mass spectrometry) is now in the forefront for routine bacterial species identification methodologies, being its value for clonality assessment controversial. In this work we evaluated the potential of MALDI-TOF MS for assisting infection control by depicting Acinetobacter baumannii clones. Mass spectra of 58 A. baumannii clinical isolates belonging to the worldwide spread lineages (ST98, ST103, ST208, and ST218) isolated in our country, were obtained and analyzed with several chemometric tools (pseudo gel views, peakfind function, and partial least squares discriminant analysis). The clonal lineages were obtained using the “Oxford” scheme, belonging ST98, ST208, and ST218 to the international clone II and ST103 to an epidemic clonal lineage (SG5). Additionally, mass spectra of a highly diverse international collection of 38 isolates belonging to 22 sequence types (STs) were obtained for further comparisons. Pseudo gel views and direct peak pattern analysis did not allow the discrimination of A. baumannii isolates belonging to ST98, ST103, ST208, or ST218. Moreover, a partial least square discriminant analysis of the mass spectra considering two spectral ranges (2–20 kDa and 4–10 kDa) revealed a poor degree of discrimination with only 64.6 and 65.8% of correct ST assignments, respectively. Also, mass spectra of the international isolates (n = 38, 22STs) revealed a very congruent peak pattern among them as well as among the four lineages included in this work. Despite the increasing interest of MALDI-TOF MS for bacterial typing at different taxonomical levels, we demonstrated, using routine experimental conditions, the unsuitability of this methodology for A. baumannii clonal discrimination.
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Affiliation(s)
- Clara Sousa
- Centro de Engenharia Biológica, Universidade do Minho Braga, Portugal
| | - João Botelho
- UCIBIO/REQUIMTE, Laboratório de Microbiologia, Departamento de Ciências Biológicas, Faculdade de Farmácia, Universidade do Porto Porto, Portugal
| | - Filipa Grosso
- UCIBIO/REQUIMTE, Laboratório de Microbiologia, Departamento de Ciências Biológicas, Faculdade de Farmácia, Universidade do Porto Porto, Portugal
| | - Liliana Silva
- UCIBIO/REQUIMTE, Laboratório de Microbiologia, Departamento de Ciências Biológicas, Faculdade de Farmácia, Universidade do Porto Porto, Portugal
| | - João Lopes
- Departamento de Farmácia Galénica e Tecnologia Farmacêutica, Faculdade de Farmácia, Universidade de Lisboa Lisboa, Portugal
| | - Luísa Peixe
- UCIBIO/REQUIMTE, Laboratório de Microbiologia, Departamento de Ciências Biológicas, Faculdade de Farmácia, Universidade do Porto Porto, Portugal
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OXA-23 Carbapenemase in Multidrug-ResistantAcinetobacter baumanniiST2 Type: First Identification in L'Aquila Hospital (Italy). Microb Drug Resist 2015; 21:97-101. [DOI: 10.1089/mdr.2014.0056] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
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28
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Jeannot K, Diancourt L, Vaux S, Thouverez M, Ribeiro A, Coignard B, Courvalin P, Brisse S. Molecular epidemiology of carbapenem non-susceptible Acinetobacter baumannii in France. PLoS One 2014; 9:e115452. [PMID: 25517732 PMCID: PMC4269441 DOI: 10.1371/journal.pone.0115452] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2014] [Accepted: 11/24/2014] [Indexed: 01/27/2023] Open
Abstract
Carbapenem-resistant Acinetobacter baumannii have emerged globally. The objective of this study was to investigate the epidemiology, clonal diversity and resistance mechanisms of imipenem non-susceptible A. baumannii isolates in France. Between December 2010 and August 2011, 132 notifications were collected, including 37 outbreaks corresponding to 242 cases (2 to 55 per cluster). Multilocus sequence typing, pulsed-field gel electrophoresis (PFGE) and characterisation of carbapenemase-encoding genes were performed on 110 non-repetitive isolates. Gene blaOXA-23 was the most frequently detected (82%), followed by blaOXA-24 (11%) and blaOXA-58 (7%). Eleven sequence types (ST) were distinguished, among which sequence types ST1, ST2 (64%), ST20, ST25, ST85 and ST107. Isolates from epidemiological clusters had the same ST and resistance genes, indicating probable transmission within centres. In contrast, PFGE types of isolates differed among centres, arguing against transmission among centers. This study provides the first epidemiological snapshot of the population of A. baumannii with reduced susceptibility to carbapenems from France, and further underlines the predominance of international clones.
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Affiliation(s)
- Katy Jeannot
- Institut Pasteur, Centre National de Référence de la Résistance aux Antibiotiques, Unité des Agents Antibactériens, Paris, France
| | - Laure Diancourt
- Institut Pasteur, Genotyping of Pathogens and Public Health, Paris, France
| | - Sophie Vaux
- French Institute for Public Health Surveillance (InVS), Saint-Maurice, France
| | - Michelle Thouverez
- Laboratoire d'Epidémiologie et d'Hygiène Hospitalière, CHRU Jean Minjoz, Besançon, France
| | - Amandina Ribeiro
- Institut Pasteur, Centre National de Référence de la Résistance aux Antibiotiques, Unité des Agents Antibactériens, Paris, France
| | - Bruno Coignard
- French Institute for Public Health Surveillance (InVS), Saint-Maurice, France
| | - Patrice Courvalin
- Institut Pasteur, Centre National de Référence de la Résistance aux Antibiotiques, Unité des Agents Antibactériens, Paris, France
| | - Sylvain Brisse
- Institut Pasteur, Genotyping of Pathogens and Public Health, Paris, France
- Institut Pasteur, Microbial Evolutionary Genomics, Paris, France
- CNRS, UMR3525, Paris, France
- * E-mail:
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Moosavian M, Shoja S, Nashibi R, Ebrahimi N, Tabatabaiefar MA, Rostami S, Peymani A. Post Neurosurgical Meningitis due to Colistin Heteroresistant Acinetobacter baumannii. Jundishapur J Microbiol 2014; 7:e12287. [PMID: 25632326 PMCID: PMC4295316 DOI: 10.5812/jjm.12287] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2013] [Revised: 09/22/2013] [Accepted: 10/20/2013] [Indexed: 11/23/2022] Open
Abstract
Introduction: Recently Acinetobacter baumannii isolates have emerged as a problematic infectious agent that causes meningitis in neurosurgical patients. Colistin has been used successfully for the treatment of A. baumannii meningitis but colistin resistant isolates have been reported worldwide. Case Presentation: Two isolates of A. baumannii were cultured during a five-day period from cerebrospinal fluid (CSF) samples of a 20-year-old man with a gunshot trauma in the abdomen, which had exited from his back. Antimicrobial susceptibility tests of isolates were performed. Multiplex PCR was performed for detection of blaOXA-23-like, blaOXA-24-like and blaOXA-58-like genes. Metallo-β-lactamase genes such as: blaVIM, blaIMP, blaSPM and blaNDM were sought by singleplex PCR. In order to evaluate the genetic relationship, two isolates were examined by the repetitive extragenic palindromic-polymerase chain reaction (REP_PCR) method. Conclusions: E-test results showed that the isolates were sensitive to colistin and tigecycline with minimum inhibitory concentration of (MIC) 0.25 µg/mL and 1.5 µg/mL, respectively. Secondly the isolates were resistant to colistin with MIC > 256 µg/mL but remained sensitive to tigecycline with MIC 1.5 µg/mL. On the basis of the multiplex PCR, both of the isolates were positive for blaOXA-23-like. Other investigated genes such as blaOXA-24-like, blaOXA-58-like, blaVIM, blaIMP, blaSPM and blaNDM were negative. REP-PCR results showed that two isolates were derived from a single strain and both were the same. The results of our study revealed that the firs isolate of A. baumannii was colistin heteroresistant and was changed to completely resistant during therapy. Diagnosis and treatment of A. baumannii meningitis is very important and to avoid treatment failure we suggest that all A. baumannii isolates obtained from CSF should be evaluated properly for colistin heteroresistance.
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Affiliation(s)
- Mojtaba Moosavian
- Microbiology Department, Infectious and Tropical Diseases Research Center, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, IR Iran
| | - Saeed Shoja
- Microbiology Department, Infectious and Tropical Diseases Research Center, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, IR Iran
- Infectious and Tropical Diseases Research Center, Hormozgan University of Medical Sciences, Bandar Abbas, IR Iran
- Corresponding author: Saeed Shoja, Microbiology Department, Infectious and Tropical Diseases Research Center, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, IR Iran. Tel: +98-6113367543, Fax: +98-6113332036, E-mail:
| | - Roohangiz Nashibi
- Infectious and Tropical Diseases Research Center, Razi Hospital, Infectious and Tropical Disease Ward, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, IR Iran
| | - Nasim Ebrahimi
- Microbiology Department, Infectious and Tropical Diseases Research Center, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, IR Iran
| | | | - Soodabeh Rostami
- Microbiology Department, Infectious and Tropical Diseases Research Center, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, IR Iran
| | - Amir Peymani
- Microbiology Department, Qazvin University of Medical Sciences, Qazvin, IR Iran
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Gentile V, Frangipani E, Bonchi C, Minandri F, Runci F, Visca P. Iron and Acinetobacter baumannii Biofilm Formation. Pathogens 2014; 3:704-19. [PMID: 25438019 PMCID: PMC4243436 DOI: 10.3390/pathogens3030704] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2014] [Revised: 08/09/2014] [Accepted: 08/12/2014] [Indexed: 01/19/2023] Open
Abstract
Acinetobacter baumannii is an emerging nosocomial pathogen, responsible for infection outbreaks worldwide. The pathogenicity of this bacterium is mainly due to its multidrug-resistance and ability to form biofilm on abiotic surfaces, which facilitate long-term persistence in the hospital setting. Given the crucial role of iron in A. baumannii nutrition and pathogenicity, iron metabolism has been considered as a possible target for chelation-based antibacterial chemotherapy. In this study, we investigated the effect of iron restriction on A. baumannii growth and biofilm formation using different iron chelators and culture conditions. We report substantial inter-strain variability and growth medium-dependence for biofilm formation by A. baumannii isolates from veterinary and clinical sources. Neither planktonic nor biofilm growth of A. baumannii was affected by exogenous chelators. Biofilm formation was either stimulated by iron or not responsive to iron in the majority of isolates tested, indicating that iron starvation is not sensed as an overall biofilm-inducing stimulus by A. baumannii. The impressive iron withholding capacity of this bacterium should be taken into account for future development of chelation-based antimicrobial and anti-biofilm therapies.
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Affiliation(s)
- Valentina Gentile
- Department of Sciences, Roma Tre University, Viale Marconi 446, 00146 Rome, Italy.
| | - Emanuela Frangipani
- Department of Sciences, Roma Tre University, Viale Marconi 446, 00146 Rome, Italy.
| | - Carlo Bonchi
- Department of Sciences, Roma Tre University, Viale Marconi 446, 00146 Rome, Italy.
| | - Fabrizia Minandri
- Department of Sciences, Roma Tre University, Viale Marconi 446, 00146 Rome, Italy.
| | - Federica Runci
- Department of Sciences, Roma Tre University, Viale Marconi 446, 00146 Rome, Italy.
| | - Paolo Visca
- Department of Sciences, Roma Tre University, Viale Marconi 446, 00146 Rome, Italy.
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Epidemic diffusion of OXA-23-producing Acinetobacter baumannii isolates in Italy: results of the first cross-sectional countrywide survey. J Clin Microbiol 2014; 52:3004-10. [PMID: 24920776 DOI: 10.1128/jcm.00291-14] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Carbapenem-resistant Acinetobacter baumannii (CRAb) is emerging worldwide as a public health problem in various settings. The aim of this study was to investigate the prevalence of CRAb isolates in Italy and to characterize their resistance mechanisms and genetic relatedness. A countrywide cross-sectional survey was carried out at 25 centers in mid-2011. CRAb isolates were reported from all participating centers, with overall proportions of 45.7% and 22.2% among consecutive nonreplicate clinical isolates of A. baumannii from inpatients (n = 508) and outpatients (n = 63), respectively. Most of them were resistant to multiple antibiotics, whereas all remained susceptible to colistin, with MIC50 and MIC90 values of ≤ 0.5 mg/liter. The genes coding for carbapenemase production were identified by PCR and sequencing. OXA-23 enzymes (found in all centers) were by far the most common carbapenemases (81.7%), followed by OXA-58 oxacillinases (4.5%), which were found in 7 of the 25 centers. In 6 cases, CRAb isolates carried both bla(OXA-23-like) and bla(OXA-58-like) genes. A repetitive extragenic palindromic (REP)-PCR technique, multiplex PCRs for group identification, and multilocus sequence typing (MLST) were used to determine the genetic relationships among representative isolates (n = 55). Two different clonal lineages were identified, including a dominant clone of sequence type 2 (ST2) related to the international clone II (sequence group 1 [SG1], SG4, and SG5) and a clone of ST78 (SG6) previously described in Italy. Overall, our results demonstrate that OXA-23 enzymes have become the most prevalent carbapenemases and are now endemic in Italy. In addition, molecular typing profiles showed the presence of international and national clonal lineages in Italy.
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Xia J, Zhang D, Xu Y, Gong M, Zhou Y, Fang X. A retrospective analysis of carbapenem-resistant Acinetobacter baumannii-mediated nosocomial pneumonia and the in vitro therapeutic benefit of cefoperazone/sulbactam. Int J Infect Dis 2014; 23:90-3. [DOI: 10.1016/j.ijid.2014.01.017] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2013] [Revised: 01/11/2014] [Accepted: 01/14/2014] [Indexed: 01/31/2023] Open
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Epidemiology of carbapenemase-producing Enterobacteriaceae and Acinetobacter baumannii in Mediterranean countries. BIOMED RESEARCH INTERNATIONAL 2014; 2014:305784. [PMID: 24955354 PMCID: PMC4052623 DOI: 10.1155/2014/305784] [Citation(s) in RCA: 111] [Impact Index Per Article: 11.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/08/2013] [Accepted: 04/22/2014] [Indexed: 01/17/2023]
Abstract
The emergence and global spread of carbapenemase-producing Enterobacteriaceae and Acinetobacter baumannii are of great concern to health services worldwide. These β-lactamases hydrolyse almost all β-lactams, are plasmid-encoded, and are easily transferable among bacterial species. They are mostly of the KPC, VIM, IMP, NDM, and OXA-48 types. Their current extensive spread worldwide in Enterobacteriaceae is an important source of concern. Infections caused by these bacteria have limited treatment options and have been associated with high mortality rates. Carbapenemase producers are mainly identified among Klebsiella pneumoniae, Escherichia coli, and A. baumannii and still mostly in hospital settings and rarely in the community. The Mediterranean region is of interest due to a great diversity and population mixing. The prevalence of carbapenemases is particularly high, with this area constituting one of the most important reservoirs. The types of carbapenemase vary among countries, partially depending on the population exchange relationship between the regions and the possible reservoirs of each carbapenemase. This review described the epidemiology of carbapenemases produced by enterobacteria and A. baumannii in this part of the world highlighting the worrisome situation and the need to screen and detect these enzymes to prevent and control their dissemination.
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Prevalence and Genetic Characterization of Carbapenem- and Polymyxin-Resistant Acinetobacter baumannii Isolated from a Tertiary Hospital in Terengganu, Malaysia. ISRN MICROBIOLOGY 2014; 2014:953417. [PMID: 25006521 PMCID: PMC3977555 DOI: 10.1155/2014/953417] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/05/2013] [Accepted: 02/09/2014] [Indexed: 11/29/2022]
Abstract
Nosocomial infection caused by Acinetobacter baumannii is of great concern due to its increasing resistance to most antimicrobials. In this study, 54 nonrepeat isolates of A. baumannii from the main tertiary hospital in Terengganu, Malaysia, were analyzed for their antibiograms and genotypes. Out of the 54 isolates, 39 (72.2%) were multidrug resistant (MDR) and resistant to carbapenems whereas 14 (25.9%) were categorized as extensive drug resistant (XDR) with additional resistance to polymyxin B, the drug of “last resort.” Pulsed-field gel electrophoresis analyses showed that the polymyxin-resistant isolates were genetically diverse while the carbapenem-resistant isolates were clonally related. The 14 XDR isolates were further investigated for mutations in genes known to mediate polymyxin resistance, namely, pmrCAB, and the lipopolysaccharide biosynthesis genes, lpxA, lpxC, lpxD, and lpsB. All 14 isolates had a P102H mutation in pmrA with no mutation detected in pmrC and pmrB. No mutation was detected in lpxA but each polymyxin-resistant isolate had 2–4 amino acid substitutions in lpxD and 1-2 substitutions in lpxC. Eight resistant isolates also displayed a unique H181Y mutation in lpsB. The extent of polymyxin resistance is of concern and the novel mutations discovered here warrant further investigations.
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Agodi A, Voulgari E, Barchitta M, Quattrocchi A, Bellocchi P, Poulou A, Santangelo C, Castiglione G, Giaquinta L, Romeo MA, Vrioni G, Tsakris A. Spread of a carbapenem- and colistin-resistant Acinetobacter baumannii ST2 clonal strain causing outbreaks in two Sicilian hospitals. J Hosp Infect 2014; 86:260-6. [PMID: 24680473 DOI: 10.1016/j.jhin.2014.02.001] [Citation(s) in RCA: 54] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2013] [Accepted: 02/01/2014] [Indexed: 11/30/2022]
Abstract
BACKGROUND Infections caused by multidrug-resistant (MDR) Acinetobacter baumannii have become an important healthcare-associated problem, particularly in intensive care units (ICUs). AIM To investigate the emergence of carbapenem- and colistin-resistant A. baumannii infections in two Sicilian hospitals. METHODS From October 2008 to May 2011, a period which included two Italian Nosocomial Infections Surveillance in ICUs network (SPIN-UTI) project surveys, all carbapenem-resistant A. baumannii isolates from the ICUs of two hospitals in Catania, Italy, were prospectively collected. Minimum inhibitory concentrations (MICs) were measured by agar dilution, and phenotypic testing for metallo-β-lactamase (MBL) production was performed. Carbapenem resistance genes and their genetic elements were identified by polymerase chain reaction and sequencing. Genotypic relatedness was assessed by pulsed-field gel electrophoresis (PFGE) and multi-locus sequence typing. Patient-based surveillance was conducted using the SPIN-UTI protocol and previous antibiotic consumption was recorded. FINDINGS Twenty-six carbapenem-resistant A. baumannii were identified. Imipenem and meropenem MICs ranged from 4 to >32 mg/L, and 15 isolates exhibited high-level colistin resistance (MICs >32 mg/L). PFGE demonstrated that all isolates belonged to a unique clonal type and were assigned to ST2 of the international clone II. They harboured an intrinsic blaOxA-51-like carbapenemase gene, blaOxA-82, which was flanked upstream by ISAba1. CONCLUSIONS The dissemination of clonally related isolates of carbapenem-resistant A. baumannii in two hospitals is described. Simultaneous resistance to colistin in more than half of the isolates is a problem for effective antibiotic treatment. Prior carbapenem and colistin consumption may have acted as triggering factors.
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Affiliation(s)
- A Agodi
- University of Catania, Department GF Ingrassia, Catania, Italy
| | - E Voulgari
- Department of Microbiology, Medical School, University of Athens, Athens, Greece
| | - M Barchitta
- University of Catania, Department GF Ingrassia, Catania, Italy
| | - A Quattrocchi
- University of Catania, Department GF Ingrassia, Catania, Italy
| | - P Bellocchi
- Azienda Ospedaliero - Universitaria 'Policlinico - Vittorio Emanuele', Catania, Italy
| | - A Poulou
- Department of Microbiology, Medical School, University of Athens, Athens, Greece
| | - C Santangelo
- Azienda Ospedaliero - Universitaria 'Policlinico - Vittorio Emanuele', Catania, Italy
| | - G Castiglione
- Azienda Ospedaliero - Universitaria 'Policlinico - Vittorio Emanuele', Catania, Italy
| | - L Giaquinta
- Azienda Ospedaliera Cannizzaro, Catania, Italy
| | - M A Romeo
- Azienda Ospedaliera Cannizzaro, Catania, Italy
| | - G Vrioni
- Department of Microbiology, Medical School, University of Athens, Athens, Greece
| | - A Tsakris
- Department of Microbiology, Medical School, University of Athens, Athens, Greece.
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Hojabri Z, Pajand O, Bonura C, Aleo A, Giammanco A, Mammina C. Molecular epidemiology of Acinetobacter baumannii in Iran: endemic and epidemic spread of multiresistant isolates. J Antimicrob Chemother 2014; 69:2383-7. [DOI: 10.1093/jac/dku045] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Genotyping of carbapenem resistant Acinetobacter baumannii isolated from tracheal tube discharge of hospitalized patients in intensive care units, Ahvaz, Iran. IRANIAN JOURNAL OF MICROBIOLOGY 2013; 5:315-22. [PMID: 25848498 PMCID: PMC4385154] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
BACKGROUND AND OBJECTIVES Carbapenem resistant A. baumannii is an emerging cause of nosocomial infections. The aims of this study were identification of the most prevalent of carbapenem resistant genes, molecular typing and antimicrobial evaluation of A.baumannii in intensive care units. MATERIALS AND METHODS Two hundred and six A. baumannii were isolated from tracheal tube discharge of hospitalized patients at different intensive care units in Ahvaz, Iran. Antimicrobial susceptibility test was done on all isolates. Multiplex and singleplex PCR were performed for detection of bla OXA-23-like, bla OXA-24-like, bla OXA-51-like, bla OXA-58-like, bla VIM, bla IMP, bla SPM and bla NDM genes. Genetic relationship of all isolates was determined by REP-PCR method. RESULTS Out of 206 examined isolates, 198 (96.1%) isolates were resistant to imipenem and meropenem. However 3.9% isolates were sensitive to these antibiotics. The bla OXA-23-like and bla OXA-24-like genes were detected in 85% and 8.7% of strains, respectively. No bla OXA-58- like, bla IMP, bla VIM, bla SPM and bla NDM were detected. REP-PCR results showed that isolates were belonged to five genotypes: Genotype A was the most prevalent (P- value < 0.001): it was observed in 75 of 206 strains (36.4%). Genotype B, and C were found in 28.6% and 27.7%, respectively. The rate of other genotypes was as follows: D (2.4%), E (1%). CONCLUSION Based on the obtained results, the rate of carbapenem resistance was high among of A. baumannii which was isolated from intensive care units patients and oxacillinase genes were the most prevalent carbapenem resistant genes. These results revealed that three clones, A, B and C of A.baumannii are common in our hospitals.
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Longitudinal Assessment of Antimicrobial Susceptibility among Gram-Negative and Gram-Positive Organisms Collected from Italy as Part of the Tigecycline Evaluation and Surveillance Trial between 2004 and 2011. Pharmaceuticals (Basel) 2013; 6:1381-406. [PMID: 24287463 PMCID: PMC3854017 DOI: 10.3390/ph6111381] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2013] [Revised: 10/22/2013] [Accepted: 10/30/2013] [Indexed: 11/19/2022] Open
Abstract
The Tigecycline Evaluation and Surveillance Trial (T.E.S.T.) was initiated in 2004 to longitudinally monitor the activity of the broad-spectrum glycylcycline antimicrobial tigecycline, and a suite of comparator agents, against an array of clinically important bacterial pathogens worldwide. In this report, we examine the activity of tigecycline and comparators against a collection of 13,245 clinical isolates, both Gram-positive (n = 4,078 and Gram-negative (n = 9,167), collected from 27 centres in Italy between 2004 and 2011. Susceptibility was established according to Clinical Laboratory Standards Institute guidelines. Tigecycline and linezolid exhibited very good activity against Gram-positive pathogens, with MIC90s ranging from 0.06 to 0.25 mg/L and 1–4 mg/L, respectively; vancomycin and the carbapenems also showed good activity against select Gram-positive pathogens. Tigecycline was the most active agent against Gram-negative pathogens (except P. aeruginosa), with MIC90s ranging from 0.25–2 mg/L (16 mg/L for P. aeruginosa). Amikacin and the carbapenems also possessed good activity against many Gram-negative pathogens here. ESBL-positive E. coli increased in prevalence from 2004 to 2011, while ESBL-positive Klebsiella spp., vancomycin-resistant enterococci and MRSA decreased in prevalence. Linezolid, tigecycline and vancomycin susceptibility were very stable over the course of this study, while susceptibility to ampicillin, piperacillin-tazobactam, ceftriaxone and levofloxacin varied over time according to pathogen; minocycline and cefepime susceptibility among several pathogens decreased during this study.
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Vranić-Ladavac M, Bedenić B, Minandri F, Ištok M, Bošnjak Z, Frančula-Zaninović S, Ladavac R, Visca P. Carbapenem resistance and acquired class D beta-lactamases in Acinetobacter baumannii from Croatia 2009–2010. Eur J Clin Microbiol Infect Dis 2013; 33:471-8. [DOI: 10.1007/s10096-013-1991-9] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2013] [Accepted: 09/27/2013] [Indexed: 11/28/2022]
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Bahador A, Taheri M, Pourakbari B, Hashemizadeh Z, Rostami H, Mansoori N, Raoofian R. Emergence of Rifampicin, Tigecycline, and Colistin-ResistantAcinetobacter baumanniiin Iran; Spreading of MDR Strains of Novel International Clone Variants. Microb Drug Resist 2013; 19:397-406. [DOI: 10.1089/mdr.2012.0233] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023] Open
Affiliation(s)
- Abbas Bahador
- Department of Microbiology, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Mohammad Taheri
- Diagnostic Laboratory Sciences and Technology Research Center, Faculty of Paramedical School, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Babak Pourakbari
- Pediatrics Infectious Disease Research Center, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Zahra Hashemizadeh
- Department of Microbiology and Virology, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Hossein Rostami
- Department of Microbiology, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Noormohamad Mansoori
- Department of Microbiology, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Reza Raoofian
- Department of Medical Genetics, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
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Lee Y, Kim YR, Kim J, Park YJ, Song W, Shin JH, Uh Y, Lee K, Lee SH, Cho JH, Yong D, Jeong SH, Lee K, Chong Y. Increasing prevalence of blaOXA-23-carrying Acinetobacter baumannii and the emergence of blaOXA-182-carrying Acinetobacter nosocomialis in Korea. Diagn Microbiol Infect Dis 2013; 77:160-3. [PMID: 23891219 DOI: 10.1016/j.diagmicrobio.2013.06.009] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2013] [Revised: 05/31/2013] [Accepted: 06/12/2013] [Indexed: 10/26/2022]
Abstract
Carbapenem-resistant Acinetobacter spp. have been increasingly reported worldwide with the production of OXA-type carbapenemases as the main mechanism of carbapenem resistance. The prevalent bla(OXA) genes are known to vary significantly depending on time and place of isolation. We investigated the prevalence of bla(OXA) genes by PCR in Acinetobacter spp. isolated in Korea. Among a total of 336 isolates collected from Hospital A from 2002 to 2011, the overall proportion of bla(OXA)-23-like, ISAba1-associated bla(OXA-51)-like, and bla(OXA-182) genes were 44.0%, 49.7%, and 5.1%, respectively. The bla(OXA-58)-like gene was detected in only 1 isolate. A drastic increase in Acinetobacter isolates with bla(OXA-23)-like genes and a decrease in isolates harboring ISAba1-associated bla(OXA-51)-like genes have been observed since the mid-2000s. The bla(OXA-23)-like genes were detected in all carbapenem-nonsusceptible isolates collected in 2011 from 9 hospitals. The OXA-182, which belongs to the fifth group of OXA-type carbapenemase, was detected in Acinetobacter baumannii isolates recovered as early as 2002. It is worrisome results that bla(OXA-182)-carrying Acinetobacter nosocomialis has emerged and caused outbreaks of infection.
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Affiliation(s)
- Yangsoon Lee
- Severance Hospital, Yonsei University College of Medicine, Seoul 120-752, South Korea; National Health Insurance Service Ilsan Hospital, Goyang 410-719, South Korea
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Globally expanding carbapenemase finally appears in Spain: nosocomial outbreak of acinetobacter baumannii producing plasmid-encoded OXA-23 in Barcelona, Spain. Antimicrob Agents Chemother 2013; 57:5155-7. [PMID: 23877694 DOI: 10.1128/aac.01486-13] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Resistance of Acinetobacter baumannii clinical isolates to carbapenems is on the rise worldwide mainly in association with the production of OXA-23. Until recently, however, OXA-23 was absent in Spain. In this work, we report the molecular characterization of a hospital outbreak of OXA-23-producing A. baumannii in Barcelona caused by a multidrug-resistant (MDR) clone belonging to international clone IC-II/sequence type ST85 between October 2010 and May 2011. blaOXA-23 was carried in a plasmid of 90 kb and located within the composite transposon Tn2006.
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Principe L, Capone A, Mazzarelli A, D'Arezzo S, Bordi E, Di Caro A, Petrosillo N. In vitro activity of doripenem in combination with various antimicrobials against multidrug-resistant Acinetobacter baumannii: possible options for the treatment of complicated infection. Microb Drug Resist 2013; 19:407-14. [PMID: 23659601 DOI: 10.1089/mdr.2012.0250] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
AIMS The aim of this study was to evaluate the in vitro activity of doripenem (DOR) alone and in combination with a variety of commonly used anti-Acinetobacter chemotherapeutic agents against 22 primary multidrug-resistant (MDR) Acinetobacter baumannii isolates (including 17 isolates that were resistant to DOR) from Intensive Care Unit patients. Antibiotic interactions were evaluated using the chequerboard method and the time-kill assay. RESULTS Considering all antimicrobials in combination with DOR, chequerboard analysis showed synergy in 13 A. baumannii strains (54.2%). Seven strains (29.2%) showed ≥2 synergistic interactions. DOR showed synergy in combination with tigecycline (TIG) (eight strains), colistin (COL) (eight strains), amikacin (AMK) (four strains), ampicillin/sulbactam (two strains), and rifampicin (one strain). Remarkably, synergistic effects were detected only in DOR nonsusceptible strains. Time-kill assays confirmed synergy in eight isolates (giving 10 synergistic interactions) for DOR in combination with TIG (n=4), COL (n=5), and AMK (n=1). No antagonistic interactions were observed with both methods. CONCLUSIONS This study demonstrates the in vitro synergistic activity of DOR in combination with TIG, COL, and AMK against DOR-resistant A. baumannii strains, opening the way to in vivo assessment of novel combination therapies for treatment of infections caused by MDR A. baumannii.
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Affiliation(s)
- Luigi Principe
- 1 Laboratory of Microbiology and Virology, Alessandro Manzoni Hospital , Lecco, Italy
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Migliavacca R, Espinal P, Principe L, Drago M, Fugazza G, Roca I, Nucleo E, Bracco S, Vila J, Pagani L, Luzzaro F. Characterization of resistance mechanisms and genetic relatedness of carbapenem-resistant Acinetobacter baumannii isolated from blood, Italy. Diagn Microbiol Infect Dis 2012; 75:180-6. [PMID: 23265293 DOI: 10.1016/j.diagmicrobio.2012.11.002] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2012] [Revised: 10/11/2012] [Accepted: 11/05/2012] [Indexed: 10/27/2022]
Abstract
The aim of this study was to characterize the resistance mechanisms and genetic relatedness of 21 carbapenem-resistant Acinetobacter baumannii blood isolates collected in Italy during a 1-year multicenter prospective surveillance study. Genes coding for carbapenemase production were identified by polymerase chain reaction (PCR) and sequencing. Pulsed-field gel electrophoresis (PFGE), multiplex PCRs for group identification, and multilocus sequence typing (MLST) were used to determine genetic relationships. Carbapenem resistance was consistently related to the production of oxacillinases, mostly the plasmid-mediated OXA-58 enzyme. Strains producing the OXA-23 enzyme (chromosomally mediated) were also detected. Seven PFGE clones were identified, some of which being related to international (ICL- I and ICL-II) or national clonal lineages. Multiplex PCRs identified 4 different groups (group 2 being dominant), further distinguishable in 6 sequence types by MLST. The heterogeneity of profiles highlights the diffusion of international and national clonal lineages in Italy. Continuous surveillance is needed for monitoring the spread of these worrisome strains equipped with multiple drug resistance mechanisms.
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Affiliation(s)
- Roberta Migliavacca
- Department of Clinical Surgical Diagnostic and Pediatric Sciences, Section of Microbiology, University of Pavia, Pavia, Italy
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Global evolution of multidrug-resistant Acinetobacter baumannii clonal lineages. Int J Antimicrob Agents 2012; 41:11-9. [PMID: 23127486 DOI: 10.1016/j.ijantimicag.2012.09.008] [Citation(s) in RCA: 359] [Impact Index Per Article: 29.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2012] [Accepted: 09/07/2012] [Indexed: 12/22/2022]
Abstract
The rapid expansion of Acinetobacter baumannii clinical isolates exhibiting resistance to carbapenems and most or all available antibiotics during the last decade is a worrying evolution. The apparent predominance of a few successful multidrug-resistant lineages worldwide underlines the importance of elucidating the mode of spread and the epidemiology of A. baumannii isolates in single hospitals, at a country-wide level and on a global scale. The evolutionary advantage of the dominant clonal lineages relies on the capability of the A. baumannii pangenome to incorporate resistance determinants. In particular, the simultaneous presence of divergent strains of the international clone II and their increasing prevalence in international hospitals further support the ongoing adaptation of this lineage to the hospital environment. Indeed, genomic and genetic studies have elucidated the role of mobile genetic elements in the transfer of antibiotic resistance genes and substantiate the rate of genetic alterations associated with acquisition in A. baumannii of various resistance genes, including OXA- and metallo-β-lactamase-type carbapenemase genes. The significance of single nucleotide polymorphisms and transposon mutagenesis in the evolution of A. baumannii has been also documented. Establishment of a network of reference laboratories in different countries would generate a more complete picture and a fuller understanding of the importance of high-risk A. baumannii clones in the international dissemination of antibiotic resistance.
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Zarrilli R, Di Popolo A, Bagattini M, Giannouli M, Martino D, Barchitta M, Quattrocchi A, Iula VD, de Luca C, Scarcella A, Triassi M, Agodi A. Clonal spread and patient risk factors for acquisition of extensively drug-resistant Acinetobacter baumannii in a neonatal intensive care unit in Italy. J Hosp Infect 2012; 82:260-5. [PMID: 23102814 DOI: 10.1016/j.jhin.2012.08.018] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2012] [Accepted: 08/23/2012] [Indexed: 12/12/2022]
Abstract
AIM To report an outbreak of extensively drug-resistant (XDR) Acinetobacter baumannii in the neonatal intensive care unit (NICU) of an Italian university hospital. Patient risk profiles for acquisition of A. baumannii and measures used to control the outbreak are described. METHODS Antibiotic susceptibility of strains was evaluated by microdilution. Genotyping was performed by pulsed-field gel electrophoresis (PFGE) and multi-locus sequence typing. Carbapenemase genes were analysed by polymerase chain reaction and DNA sequencing. A case-control study was designed to identify risk factors for acquisition of A. baumannii. FINDINGS A. baumannii was isolated from 22 neonates, six of whom were infected. One major PFGE type was identified, assigned to sequence type (ST) 2, corresponding to International Clone II; this was indistinguishable from isolates from the adult ICU in the same hospital. A. baumannii isolates were resistant to aminoglycosides, quinolones and classes of β-lactam antibiotics, but were susceptible to tigecycline and colistin. Carbapenem resistance was associated with the presence of transposon Tn2006 carrying the bla(OxA-23) gene. Length of NICU stay, length of exposure to A. baumannii, gestational age, use of invasive devices and length of exposure to invasive devices were significantly associated with acquisition of A. baumannii on univariate analysis, while length of exposure to central venous catheters and assisted ventilation were the only independent risk factors after multi-variate analysis. CONCLUSIONS This XDR A. baumannii outbreak in an NICU was probably caused by intrahospital transfer of bacteria via a colonized neonate whose mother was admitted to the adult ICU. Strengthened infection control measures were necessary to control the outbreak.
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Affiliation(s)
- R Zarrilli
- Department of Preventive Medical Sciences, Hygiene Section, University 'Federico II', Naples, Italy.
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First report of an OXA-23 carbapenemase-producing Acinetobacter baumannii clinical isolate related to Tn2006 in Spain. Antimicrob Agents Chemother 2012; 57:589-91. [PMID: 23070166 DOI: 10.1128/aac.01157-12] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
A carbapenem-resistant Acinetobacter baumannii clinical isolate belonging to European clone II and sequence type 2 was recovered from a patient in the Son Espases hospital in Mallorca, Spain. Genetic analysis showed the presence of the bla(OXA-23) gene in association with the widely disseminated transposon Tn2006. This is the first reported identification of A. baumannii carrying bla(OXA-23) in Spain.
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Ergin A, Hascelik G, Eser OK. Molecular characterization of oxacillinases and genotyping of invasive Acinetobacter baumannii isolates using repetitive extragenic palindromic sequence-based polymerase chain reaction in Ankara between 2004 and 2010. ACTA ACUST UNITED AC 2012; 45:26-31. [PMID: 22978782 DOI: 10.3109/00365548.2012.708782] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND Multidrug-resistant Acinetobacter baumannii (MDRAB) is an increasing problem worldwide. We aimed to determine the antibiotic susceptibility, diversity of oxacillinases, and molecular types of MDRAB. METHODS A total of 100 non-duplicate A. baumannii blood culture isolates were evaluated. Antimicrobial susceptibilities of the isolates were determined according to the standard Clinical and Laboratory Standards Institute (CLSI) broth microdilution method. Colistin, doripenem, and tigecycline susceptibilities were analyzed by E-test. The presence of bla(OXA-23-like), bla(OXA-24-like), bla(OXA-51-like), and bla(OXA-58-like) genes was investigated by multiplex polymerase chain reaction (PCR). Typing of A. baumannii isolates was performed using repetitive extragenic palindromic sequence-based PCR (rep-PCR; DiversiLab). RESULTS Most isolates were susceptible to colistin (98% susceptible) and tigecycline (94% susceptible), whereas fewer isolates were susceptible to imipenem, meropenem, and doripenem (17%, 17%, and 18% susceptible, respectively). Carbapenem resistance was associated with the presence of bla(OXA-23-like) (31% of isolates) and bla(OXA-58-like) (23% of isolates) genes. The occurrence of isolates carrying bla(OXA-58-like) genes increased between y 2004 and 2009, but decreased in 2010. In contrast, isolates with bla(OXA-23-like) genes increased during the 2008-2010 period. Out of 100 isolates, 62 were categorized into 13 major rep-PCR patterns, with the highest prevalence in pattern 1 (10 isolates), followed by patterns 2 and 3 (9 isolates each). CONCLUSIONS Carbapenem-resistant invasive A. baumannii isolates carrying the bla(OXA-23-like) gene became more prevalent and replaced isolates carrying the bla(OXA-58-like) carbapenemase gene through the 7 y. Rep-PCR genotyping of these strains confirmed that ongoing MDRAB resulted from a long-term persistence and mixture of several clusters.
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Affiliation(s)
- Alper Ergin
- Hacettepe University School of Health Services, Sıhhiye, Ankara, Turkey.
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Mammina C, Palma DM, Bonura C, Aleo A, Fasciana T, Sodano C, Saporito MA, Verde MS, Calà C, Cracchiolo AN, Tetamo R. Epidemiology and clonality of carbapenem-resistant Acinetobacter baumannii from an intensive care unit in Palermo, Italy. BMC Res Notes 2012; 5:365. [PMID: 22818424 PMCID: PMC3410802 DOI: 10.1186/1756-0500-5-365] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2012] [Accepted: 07/20/2012] [Indexed: 01/18/2023] Open
Abstract
Background Multidrug-resistant Acinetobacter baumannii, initially considered as having a poor clinical relevance, is frequently isolated from infection cases in intensive care units. We describe the epidemiology of carbapenem resistant A. baumannii (CRAB) in a general ICU in Palermo, Italy, from October 2010 to March 2011. Findings 58 of 61 isolates exhibited MICs for meropenem or imipenem ≥16 mg/L. Forty-nine carried blaOXA-23 and two blaOXA-58 genes. Five subtype clusters were detected by rep-PCR. Clusters D and E included 10 isolates that tested negative for the carbapenem resistance genes. MLST attributed all isolates, but two, with sequence type (ST)2, whereas the two remaining isolates with ST78. The respiratory tract was the most common site of infection (26 out of 36 cases. 72.2%). A high infection related mortality rate was observed (18 out of 35 patients, 51.4%). Nineteen patients tested positive for other multidrug resistant organisms in addition to CRAB. In eight cases isolates belonging to distinct subtype clusters and/or with distinct carbapenemase profiles were identified. Conclusions Carbapenem resistance was prominently driven by the dissemination of CRAB isolates belonging to ST2, carrying the carbapenemase gene blaOXA-23. The colonization/infection of some patients by multiple strains is suggestive of an endemic circulation of CRAB.
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Affiliation(s)
- Caterina Mammina
- Department of Sciences for Health Promotion G, D'Alessandro, Section of Hygiene, University of Palermo, Palermo, Italy.
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Extracellular stress and lipopolysaccharide modulate Acinetobacter baumannii surface-associated motility. J Microbiol 2012; 50:434-43. [PMID: 22752907 DOI: 10.1007/s12275-012-1555-1] [Citation(s) in RCA: 61] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2011] [Accepted: 02/07/2012] [Indexed: 10/28/2022]
Abstract
Acinetobacter baumannii is a nosocomial bacterial pathogen, and infections attributed to this species are further complicated by a remarkable ability to acquire antimicrobial resistance genes and to survive in a desiccated state. While the antibiotic resistance and biofilm formation of A. baumannii is well-documented, less is known about the virulence attributes of this organism. Recent studies reported A. baumannii strains display a motility phenotype, which appears to be partially dependent upon Type IV pili, autoinducer molecules, and the response to blue light. In this study, we wanted to determine the prevalence of this trait in genetically diverse clinical isolates, and any additional required factors, and environmental cues that regulate motility. When strains are subjected to a wide array of stress conditions, A. baumannii motility is significantly reduced. In contrast, when extracellular iron is provided or salinity is reduced, motility is significantly enhanced. We further investigated whether the genes required for the production of lipopolysaccharide (lpsB) and K1 capsule (epsA/ptk) are required for motility as demonstrated in other Gram-negative bacteria. Transposon mutagenesis resulted in reduced motility by the insertion derivatives of each of these genes. The presence of the parental allele provided in trans, in the insertion mutant background, could only restore motility in the lpsB mutant. The production of core LPS directly contributes to the motility phenotype, while capsular polysaccharide may have an indirect effect. Further, the data suggest motility is regulated by extracellular conditions, indicating that A. baumannii is actively sensing the environment and responding accordingly.
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