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Genomic Analysis of Acinetobacter baumannii Isolates Carrying OXA-23 and OXA-58 Genes from Animals Reveals ST1 and ST25 as Major Clonal Lineages. Antibiotics (Basel) 2022; 11:antibiotics11081045. [PMID: 36009914 PMCID: PMC9404926 DOI: 10.3390/antibiotics11081045] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Revised: 07/26/2022] [Accepted: 07/26/2022] [Indexed: 02/04/2023] Open
Abstract
Acinetobacter baumannii is increasingly being recognized as a relevant pathogen for animals with a putative zoonotic impact. This study aimed at identifying and characterizing carbapenemase-producing A. baumannii from animals. Among 503 A. baumannii, mainly isolated from dogs/cats (75.7%) between 2013 and 2018, 42 isolates from 22 veterinary clinics (VCs) harboured blaOXA-58 (n = 29) or blaOXA-23 (n = 13). The blaOXA-58 gene was located on plasmids (11.4–21.1 kb) within different genetic surroundings (patterns A–D). BlaOXA-23 was embedded in Tn2006 on the chromosome (n = 4; pattern a) or Tn2008 on plasmids (n = 9; 41.2–71.3 kb; patterns b–e). The predominant IC1-ST1P-OXA-58 (66.7%; 96.4% cgMLST complex type (CT)-1808) was disseminated among 11 VCs in Germany. Resistance islands AbaR3-like (n = 15) and AbaR10 (n = 1) have emerged among ST1-isolates since 2016. IC7-ST25P-OXA-23 isolates (21.4%) occurred in seven VCs in Germany, France and Italy and differed in their resistance gene patterns from those of OXA-58 isolates. They were separated into six CTs, basically according to their regional origin. Other STs observed were ST10, ST578 and ST602. In conclusion, OXA-23 and OXA-58 were linked with ST1 and ST25, two globally distributed lineages in humans. The suggested transmission of certain lineages within and among VCs together with the acquisition of AbaR islands hints at a successful dissemination of multidrug-resistant strains in the VC environment.
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Mirza S, Trivedi P, Gandham N, Das N, Misra R, Kharel R, Joe S. Environmental colonization and transmission of carbapenem-resistant Enterobacteriaceae and carbapenem-resistant acinetobacter baumannii in intensive care unit. MEDICAL JOURNAL OF DR. D.Y. PATIL VIDYAPEETH 2022. [DOI: 10.4103/mjdrdypu.mjdrdypu_210_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Katip W, Uitrakul S, Oberdorfer P. Clinical Efficacy and Nephrotoxicity of the Loading Dose Colistin for the Treatment of Carbapenem-Resistant Acinetobacter baumannii in Critically Ill Patients. Pharmaceutics 2021; 14:pharmaceutics14010031. [PMID: 35056926 PMCID: PMC8780224 DOI: 10.3390/pharmaceutics14010031] [Citation(s) in RCA: 34] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2021] [Revised: 12/09/2021] [Accepted: 12/22/2021] [Indexed: 01/01/2023] Open
Abstract
Carbapenem-resistant Acinetobacter baumannii (CRAB) is one of the most common causes of nosocomial infections in critically ill patients. Colistin methanesulfonate (CMS), an inactive prodrug, has been considered as a last-resort treatment for CRAB infection in critically ill patients. The objective of this study was to assess 30-day survival and nephrotoxicity in critically ill patients who received non-loading dose (LD) versus LD of CMS for CRAB infection treatment. Between 2012 and 2017, this retrospective cohort analysis was performed at Chiang Mai University Hospital (CMUH), focusing on critically ill patients with CRAB infection who received either non-LD or LD of CMS. A total of 383 patients met the criteria for inclusion. At the 30th day of treatment, the survival rate of patients in the LD CMS group was 1.70 times (adjusted HR) of those in the non-LD group (95% CI = 1.17-2.50, p = 0.006). Clinical response was significantly higher in the LD CMS group than non-LD CMS group (aHR, 1.35, 95% CI, 1.01-1.82, p = 0.046). In addition, a microbiological response-eradication of pre-treatment isolated pathogens in post-treatment cultures-in patients with LD CMS was 1.57 times that of patients with non-LD CMS (95% CI, 1.15-2.15, p = 0.004). Additionally, there was a significant difference in nephrotoxicity between LD CMS and non-LD CMS (aHR, 1.57, 95% CI, 1.14-2.17, p = 0.006). Based on these results, LD CMS should be used to increase the opportunity of patients to achieve favourable outcomes. However, LD CMS was found associated with an increase in nephrotoxicity, so renal function should be closely monitored when LD colistin was administered.
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Affiliation(s)
- Wasan Katip
- Department of Pharmaceutical Care, Faculty of Pharmacy, Chiang Mai University, Chiang Mai 50200, Thailand
- Epidemiology Research Group of Infectious Disease (ERGID), Chiang Mai University, Chiang Mai 50200, Thailand;
- Correspondence: ; Tel.: +66-(53)-9443423; Fax: +66-(53)-222741
| | - Suriyon Uitrakul
- Department of Pharmaceutical Care, School of Pharmacy, Walailak University, Nakhon Si Thammarat 80160, Thailand;
| | - Peninnah Oberdorfer
- Epidemiology Research Group of Infectious Disease (ERGID), Chiang Mai University, Chiang Mai 50200, Thailand;
- Department of Pediatrics, Division of Infectious Diseases, Faculty of Medicine, Chiang Mai University, Chiang Mai 50200, Thailand
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4
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Kearney A, Boyle MA, Curley GF, Humphreys H. Preventing infections caused by carbapenemase-producing bacteria in the intensive care unit - Think about the sink. J Crit Care 2021; 66:52-59. [PMID: 34438134 DOI: 10.1016/j.jcrc.2021.07.023] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2021] [Revised: 07/27/2021] [Accepted: 07/28/2021] [Indexed: 10/20/2022]
Abstract
OBJECTIVE Outbreaks caused by carbapenemase-producing bacteria (CPB) are challenging to manage in critical care settings and can be protracted due to inadvertent and ubiquitous ecological niches within the built unit environment, such as handwashing sinks. We discuss evidence from a narrative review on transmission pathways and interventions for critical care practitioners. METHODS A literature review was undertaken using Pubmed, CINAHL and Embase and included outbreaks of CPB, and equivalent bacteria in critical care units, between 1998 and May 2020. Intervention studies targeting elements of sinks that were employed in response to outbreaks in critical care units were included (n = 30). FINDINGS We found control measures included sink removal, use of physical barriers or design modification to protect patients from sinks, engineering controls to mitigate bacterial dispersal and administrative controls. A multi-disciplinary approach involving practitioners from critical care, infection prevention and control, engineering and other staff, should be involved in ongoing measures and in outbreak control activities. Ascertaining the optimal method to end CPB outbreaks in critical care is challenging due to the lack of prospective studies available. However, the literature suggests that sinks can and do serve as reservoirs of CPB near critically ill patients, and should be considered hazardous, especially when sub-optimally designed or used.
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Affiliation(s)
- A Kearney
- Department of Clinical Microbiology, the Royal College of Surgeons in Ireland, Ireland.
| | - M A Boyle
- Department of Clinical Microbiology, the Royal College of Surgeons in Ireland, Ireland
| | - G F Curley
- Department of Anaesthesia and Critical Care, the Royal College of Surgeons in Ireland, Ireland
| | - H Humphreys
- Department of Clinical Microbiology, the Royal College of Surgeons in Ireland, Ireland; Department of Microbiology, Beaumont Hospital, Dublin, Ireland
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A systematic review of the effectiveness of cohorting to reduce transmission of healthcare-associated C. difficile and multidrug-resistant organisms. Infect Control Hosp Epidemiol 2021; 41:691-709. [PMID: 32216852 DOI: 10.1017/ice.2020.45] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
BACKGROUND Cohorting of patients and staff is a control strategy often used to prevent the spread of infection in healthcare institutions. However, a comprehensive evaluation of cohorting as a prevention approach is lacking. METHODS We performed a systematic review of studies that used cohorting as part of an infection control strategy to reduce hospital-acquired infections. We included studies published between 1966 and November 30, 2019, on adult populations hospitalized in acute-care hospitals. RESULTS In total, 87 studies met inclusion criteria. Study types were quasi-experimental "before and after" (n = 35), retrospective (n = 49), and prospective (n = 3). Case-control analysis was performed in 7 studies. Cohorting was performed with other infection control strategies in the setting of methicillin-resistant Staphylococcus aureus (MRSA, n = 22), Clostridioides difficile infection (CDI, n = 6), vancomycin-resistant Enterococcus (VRE, n = 17), carbapenem-resistant Enterobacteriaceae infections (CRE, n = 22), A. baumannii (n = 15), and other gram-negative infections (n = 5). Cohorting was performed either simultaneously (56 of 87, 64.4%) or in phases (31 of 87, 35.6%) to help contain transmission. In 60 studies, both patients and staff were cohorted. Most studies (77 of 87, 88.5%) showed a decline in infection or colonization rates after a multifaceted approach that included cohorting as part of the intervention bundle. Hand hygiene compliance improved in approximately half of the studies (8 of 15) during the respective intervention. CONCLUSION Cohorting of staff, patients, or both is a frequently used and reasonable component of an enhanced infection control strategy. However, determining the effectiveness of cohorting as a strategy to reduce transmission of MDRO and C. difficile infections is difficult, particularly in endemic situations.
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Smith AR, Vowles M, Horth RZ, Smith L, Rider L, Wagner JM, Sangster A, Young EL, Schuckel H, Stewart J, Gruninger RJ, Rossi A, Oakeson KF, Nakashima AK. Infection control response to an outbreak of OXA-23 carbapenemase-producing carbapenem-resistant Acinetobacter baumannii in a skilled nursing facility in Utah. Am J Infect Control 2021; 49:792-799. [PMID: 33217512 DOI: 10.1016/j.ajic.2020.11.012] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2020] [Revised: 11/10/2020] [Accepted: 11/10/2020] [Indexed: 12/16/2022]
Abstract
BACKGROUND Antibiotic-resistant Acinetobacter species are a growing public health threat, yet are not nationally notifiable, and most states do not mandate reporting. Additionally, there are no standardized methods to detect Acinetobacter species colonization. METHODS An outbreak of carbapenem-resistant Acinetobacter baumannii (CRAB) was identified at a Utah ventilator unit in a skilled nursing facility. An investigation was conducted to identify transmission modes in order to control spread of CRAB. Culture-based methods were used to identify patient colonization and environmental contamination in the facility. RESULTS Of the 47 patients screened, OXA-23-producing CRAB were detected in 10 patients (21%), with 7 patients (15%) having been transferred from out-of-state facilities. Of patients who screened positive, 60% did not exhibit any signs or symptoms of active infection by chart review. A total of 38 environmental samples were collected and CRAB was recovered from 37% of those samples. Whole genome sequencing analyses of patient and environmental isolates suggested repeated CRAB introduction into the facility and highlighted the role of shared equipment in transmission. CONCLUSIONS The investigation demonstrated this ventilated skilled nursing facility was an important reservoir for CRAB in the community and highlights the need for improved surveillance, strengthened infection control and inter-facility communication within and across states.
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Duployez C, Le Guern R, Milliere L, Caplan M, Loïez C, Ledoux G, Jaillette E, Favory R, Mathieu D, Wallet F. One Outbreak Could Hide Another. Jpn J Infect Dis 2020; 74:367-368. [PMID: 33250491 DOI: 10.7883/yoken.jjid.2020.705] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is currently a major worldwide concern. Guidelines have been issued regarding precautions for healthcare workers caring for SARS-CoV-2-infected patients. Despite accurate observance of infection control measures, including contact precautions, we encountered an OXA-23-producing Acinetobacter baumannii outbreak in 5 intensive care units of 10 beds each in our tertiary care teaching hospital.
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Affiliation(s)
- Claire Duployez
- Laboratory of Bacteriology, Institute of Microbiology, Lille University Hospital, France.,University of Lille, France
| | - Rémi Le Guern
- Laboratory of Bacteriology, Institute of Microbiology, Lille University Hospital, France.,University of Lille, France
| | - Laurine Milliere
- Laboratory of Bacteriology, Institute of Microbiology, Lille University Hospital, France
| | - Morgan Caplan
- Department of Intensive Care, Lille University Hospital, France
| | - Caroline Loïez
- Laboratory of Bacteriology, Institute of Microbiology, Lille University Hospital, France
| | - Geoffrey Ledoux
- Department of Intensive Care, Lille University Hospital, France
| | | | - Raphaël Favory
- University of Lille, France.,Department of Intensive Care, Lille University Hospital, France
| | - Daniel Mathieu
- University of Lille, France.,Department of Intensive Care, Lille University Hospital, France
| | - Frédéric Wallet
- Laboratory of Bacteriology, Institute of Microbiology, Lille University Hospital, France
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Wareth G, Linde J, Hammer P, Nguyen NH, Nguyen TNM, Splettstoesser WD, Makarewicz O, Neubauer H, Sprague LD, Pletz MW. Phenotypic and WGS-derived antimicrobial resistance profiles of clinical and non-clinical Acinetobacter baumannii isolates from Germany and Vietnam. Int J Antimicrob Agents 2020; 56:106127. [PMID: 32750418 DOI: 10.1016/j.ijantimicag.2020.106127] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2020] [Revised: 06/02/2020] [Accepted: 07/29/2020] [Indexed: 12/15/2022]
Abstract
OBJECTIVES This study aimed to combine in vitro phenotyping analysis and whole-genome-sequencing (WGS) to characterise the phenotype and genetic determinants associated with intrinsic resistance in 100 clinical and non-clinical Acinetobacter baumannii strains originating from Germany and Vietnam. Moreover, it aimed to assess whether powdered milk as a food source functions as a potential reservoir of antibiotic resistance and possesses similar antimicrobial resistance (AMR) genes as in clinical strains isolated from Germany. METHODS Antimicrobial susceptibility testing was performed using the broth microdilution method and the minimum inhibitory concentration (MIC) was determined for 18 antibiotics. The WGS data from all isolates were mapped to intrinsic genes known to be associated with phenotypic AMR. RESULTS The highest resistance frequency was observed for chloramphenicol (100%), followed by fosfomycin (96%) and cefotaxime (95%). The lowest resistant rates were observed for colistin (3%), trimethoprim/sulfamethoxazole (17%), tigecycline (19%), and amikacin (19%). Thirty-five percent of tested strains displayed resistance to at least one of the carbapenems. Resistance to fluoroquinolones, aminoglycosides, tigecycline, penicillins, trimethoprim/sulfamethoxazole, and fourth-generation cephalosporins was determined only in human strains. About one-quarter of isolates (24%) was multidrug-resistant (MDR) and all were of human origin. Among them, 16 isolates were extensively drug resistant (XDR) and 10 from those 16 isolates showed resistance to all tested antibiotics except colistin. In silico detection of intrinsic AMR genes revealed the presence of 36 β-lactamases and 24 non-β-lactamase resistance genes. Two colistin-resistant and 10 ertapenem-resistant strains were isolated from powdered milk produced in Germany. Thirty-eight AMR genes associated with resistance to antibiotics were found in isolates recovered from milk powder. Several resistance mechanisms towards many classes of antibiotics existed in A. baumannii including β-lactamases, multidrug efflux pumps and aminoglycoside-modifying enzymes. CONCLUSION The use of WGS for routine public health surveillance is a reliable method for the rapid detection of emerging AMR in A. baumannii isolates. Milk powder poses a risk to contain MDR Acinetobacter strains or resistance genes in Germany.
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Affiliation(s)
- Gamal Wareth
- Friedrich-Loeffler-Institut, Institute of Bacterial Infections and Zoonoses (IBIZ), Jena, Germany; Institute for Infectious Diseases and Infection Control, Jena University Hospital, Jena, Germany.
| | - Jörg Linde
- Friedrich-Loeffler-Institut, Institute of Bacterial Infections and Zoonoses (IBIZ), Jena, Germany
| | - Philipp Hammer
- Department of Safety and Quality of Milk and Fish Products, Max Rubner-Institut, Kiel, Germany
| | - Ngoc H Nguyen
- The Center of Training and Direction of Healthcare Activities, General Hospital of Phutho, Vietnam; Department of Health, General Hospital of Phutho, Phutho, Vietnam
| | - Tuan N M Nguyen
- The Center of Training and Direction of Healthcare Activities, General Hospital of Phutho, Vietnam
| | - Wolf D Splettstoesser
- Department of Microbiology & Hygiene, LADR GmbH, Medical Laboratory Braunschweig, Germany
| | - Oliwia Makarewicz
- Institute for Infectious Diseases and Infection Control, Jena University Hospital, Jena, Germany; Research Campus Infectognostics, Jena, Germany
| | - Heinrich Neubauer
- Friedrich-Loeffler-Institut, Institute of Bacterial Infections and Zoonoses (IBIZ), Jena, Germany
| | - Lisa D Sprague
- Friedrich-Loeffler-Institut, Institute of Bacterial Infections and Zoonoses (IBIZ), Jena, Germany
| | - Mathias W Pletz
- Institute for Infectious Diseases and Infection Control, Jena University Hospital, Jena, Germany; Research Campus Infectognostics, Jena, Germany
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Ayobami O, Willrich N, Suwono B, Eckmanns T, Markwart R. The epidemiology of carbapenem-non-susceptible Acinetobacter species in Europe: analysis of EARS-Net data from 2013 to 2017. Antimicrob Resist Infect Control 2020; 9:89. [PMID: 32560670 PMCID: PMC7304165 DOI: 10.1186/s13756-020-00750-5] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2019] [Accepted: 06/04/2020] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Due to limited therapeutic options and their association with high mortality and morbidity, carbapenem-non-susceptible Acinetobacter spp. (CNA) are of significant public health importance. This study aimed to describe current epidemiological trends of CNA proportions in Europe and to identify factors that are associated with carbapenem non-susceptibility of isolates from patients with invasive Acinetobacter spp. infections. METHODS Data from routine carbapenem susceptibility testing of 18,412 invasive clinical Acinetobacter spp. isolates from 30 European countries in 2013-2017 were analysed using descriptive statistical analyses and uni- and multivariable regression analyses. These data were obtained from the European Antimicrobial Resistance Surveillance Network (EARS-Net). RESULTS The population-weighted mean proportion of carbapenem-non-susceptible Acinetobacter spp. in Europe is 35.6% (95% confidence interval [CI] 29.7-42.0%). With CNA proportions of 75.5% (95% CI 71.2-79.4%) and 71.5% (95% CI 66.7-75.9%) the burden of CNA is particularly high in Southern and Eastern European regions. In contrast, Northern and Western European regions recorded CNA proportions of 2.8% (95% CI 1.2-6.0%) and 6.3% (95% CI 4.5-8.9%), respectively. Population-weighted mean CNA proportions are especially high in Acinetobacter spp. isolates from intensive care units (54.0% [95% CI 47.6-60.3%]). Male gender, age above 20 years and ICU admission were identified as independent factors associated with an increased likelihood of CNA. CONCLUSION The burden of carbapenem-non-susceptible Acinetobacter spp. is particularly high in Southern and Eastern Europe. There is a risk that resistance could spread to other parts of Europe. Therefore, increased efforts in infection control and antibiotic stewardship, particularly in Intensive Care Units, are necessary to combat the spread of CNA in Europe.
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Affiliation(s)
- Olaniyi Ayobami
- Department 3: Infectious Disease Epidemiology, Unit 37: Healthcare-associated Infections, Surveillance of Antibiotic Resistance and Consumption, Robert Koch Institute, Nordufer 20, 13353, Berlin, Germany
| | - Niklas Willrich
- Department 3: Infectious Disease Epidemiology, Unit 37: Healthcare-associated Infections, Surveillance of Antibiotic Resistance and Consumption, Robert Koch Institute, Nordufer 20, 13353, Berlin, Germany
| | - Beneditta Suwono
- Department 3: Infectious Disease Epidemiology, Unit 37: Healthcare-associated Infections, Surveillance of Antibiotic Resistance and Consumption, Robert Koch Institute, Nordufer 20, 13353, Berlin, Germany.,Federal Institute for Risk Assessment, Unit Epidemiology, Zoonoses and Antimicrobial Resistance Department Biology Safety, Berlin, Germany
| | - Tim Eckmanns
- Department 3: Infectious Disease Epidemiology, Unit 37: Healthcare-associated Infections, Surveillance of Antibiotic Resistance and Consumption, Robert Koch Institute, Nordufer 20, 13353, Berlin, Germany
| | - Robby Markwart
- Department 3: Infectious Disease Epidemiology, Unit 37: Healthcare-associated Infections, Surveillance of Antibiotic Resistance and Consumption, Robert Koch Institute, Nordufer 20, 13353, Berlin, Germany.
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10
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Ayobami O, Willrich N, Harder T, Okeke IN, Eckmanns T, Markwart R. The incidence and prevalence of hospital-acquired (carbapenem-resistant) Acinetobacter baumannii in Europe, Eastern Mediterranean and Africa: a systematic review and meta-analysis. Emerg Microbes Infect 2020; 8:1747-1759. [PMID: 31805829 PMCID: PMC6913636 DOI: 10.1080/22221751.2019.1698273] [Citation(s) in RCA: 80] [Impact Index Per Article: 20.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Due to therapeutic challenges, hospital-acquired infections (HAIs) caused by Acinetobacter baumannii (HA-AB), particularly carbapenem-resistant strains (HA-CRAB) pose a serious health threat to patients worldwide. This systematic review sought to summarize recent data on the incidence and prevalence of HA-AB and HA-CRAB infections in the WHO-defined regions of Europe (EUR), Eastern Mediterranean (EMR) and Africa (AFR). A comprehensive literature search was performed using MEDLINE, EMBASE and GMI databases (01/2014-02/2019). Random-effects meta-analyses were performed to determine the pooled incidence of HA-AB and HA-CRAB infections as well as the proportions of A. baumannii among all HAIs. 24 studies from 3,340 records were included in this review (EUR: 16, EMR: 6, AFR: 2). The pooled estimates of incidence and incidence density of HA-AB infection in intensive care units (ICUs) were 56.5 (95% CI 33.9-92.8) cases per 1,000 patients and 4.4 (95% CI 2.9-6.6) cases per 1,000 patient days, respectively. Five studies conducted at a hospital-wide level or in specialized clinical departments/wards (ICU + non-ICU patients) showed HA-AB incidences between 0.85 and 5.6 cases per 1,000 patients. For carbapenem-resistant A. baumannii infections in ICUs, the pooled incidence and incidence density were 41.7 (95% CI 21.6-78.7) cases per 1,000 patients and 2.1 (95% CI 1.2-3.7) cases per 1,000 patient days, respectively. In ICUs, A. baumannii and carbapenem-resistant A. baumannii strains accounted for 20.9% (95% CI 16.5-26.2%) and 13.6% (95% CI 9.7-18.7%) of all HAIs, respectively. Our study highlights the persistent clinical significance of hospital-acquired A. baumannii infections in the studied WHO regions, particularly in ICUs.
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Affiliation(s)
- Olaniyi Ayobami
- Unit 37: Nosocomial Infections, Surveillance of Antimicrobial Resistance and Consumption, Robert Koch-Institute, Berlin, Germany
| | - Niklas Willrich
- Unit 37: Nosocomial Infections, Surveillance of Antimicrobial Resistance and Consumption, Robert Koch-Institute, Berlin, Germany
| | - Thomas Harder
- Unit 37: Nosocomial Infections, Surveillance of Antimicrobial Resistance and Consumption, Robert Koch-Institute, Berlin, Germany
| | - Iruka N Okeke
- Department of Pharmaceutical Microbiology, Faculty of Pharmacy, University of Ibadan, Ibadan, Nigeria
| | - Tim Eckmanns
- Unit 37: Nosocomial Infections, Surveillance of Antimicrobial Resistance and Consumption, Robert Koch-Institute, Berlin, Germany
| | - Robby Markwart
- Unit 37: Nosocomial Infections, Surveillance of Antimicrobial Resistance and Consumption, Robert Koch-Institute, Berlin, Germany
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Spatio-Temporal Distribution of Acinetobacter baumannii in Germany-A Comprehensive Systematic Review of Studies on Resistance Development in Humans (2000-2018). Microorganisms 2020; 8:microorganisms8030375. [PMID: 32155886 PMCID: PMC7143851 DOI: 10.3390/microorganisms8030375] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2020] [Revised: 03/03/2020] [Accepted: 03/03/2020] [Indexed: 12/16/2022] Open
Abstract
Acinetobacter (A.) baumannii has gained global notoriety as a significant nosocomial pathogen because it is frequently associated with multi-drug resistance and hospital-based outbreaks. There is a substantial difference in the incidence of A. baumannii infections between different countries and within Germany. However, its continuous spread within Germany is a matter of concern. A systematic literature search and analysis of the literature published between 2000 and 2018 on A. baumannii in humans was performed. Forty-four studies out of 216 articles met the criteria for inclusion, and were selected and reviewed. The number of published articles is increasing over time gradually. Case reports and outbreak investigations are representing the main body of publications. North Rhine-Westphalia, Hesse and Baden-Wuerttemberg were states with frequent reports. Hospitals in Cologne and Frankfurt were often mentioned as specialized institutions. Multiresistant strains carrying diverse resistance genes were isolated in 13 of the 16 German states. The oxacillinase blaOXA-23-like, intrinsic blaOXA-51-like, blaOXA-58 variant, blaNDM-1, blaGES-11, blaCTX-M and blaTEM are the most predominant resistance traits found in German A. baumannii isolates. Five clonal lineages IC-2, IC-7, IC-1, IC-4 and IC-6 and six sequence types ST22, ST53, ST195, ST218, ST944/ST78 and ST348/ST2 have been reported. Due to multidrug resistance, colistin, tigecycline, aminoglycosides, fosfomycin, ceftazidime/avibactam and ceftolozan/tazobactam were often reported to be the only effective antibiotics left to treat quadruple multi-resistant Gram-negative (4MRGN) A. baumannii. Dissemination and infection rates of A. baumannii are on the rise nationwide. Hence, several aspects of resistance development and pathogenesis are not fully understood yet. Increased awareness, extensive study of mechanisms of resistance and development of alternative strategies for treatment are required. One-Health genomic surveillance is needed to understand the dynamics of spread, to identify the main reservoirs and routes of transmission and to develop targeted intervention strategies.
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12
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Identification of Acinetobacter baumannii and its carbapenem-resistant gene bla OXA-23-like by multiple cross displacement amplification combined with lateral flow biosensor. Sci Rep 2019; 9:17888. [PMID: 31784652 PMCID: PMC6884502 DOI: 10.1038/s41598-019-54465-8] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2018] [Accepted: 11/14/2019] [Indexed: 12/25/2022] Open
Abstract
Acinetobacter baumannii is a frequent cause of the nosocomial infections. Herein, a novel isothermal amplification technique, multiple cross displacement amplification (MCDA) is employed for detecting all A. baumannii strains and identifying the strains harboring blaOXA-23-like gene. The duplex MCDA assay, which targets the pgaD and blaOXA-23-like genes, could identify the A. baumannii isolates and differentiate these isolates harboring blaOXA-23-like gene. The disposable lateral flow biosensors (LFB) were used for analyzing the MCDA products. A total of sixty-eight isolates, include fifty-three A. baumannii strains and fifteen non-A. baumannii strains, were employed to optimize MCDA methods and determine the sensitivity, specificity and feasibility. The optimal reaction condition is found to be 63 °C within 1 h, with limit of detection at 100 fg templates per tube for pgaD and blaOXA-23-like genes in pure cultures. The specificity of this assay is 100%. Moreover, the practical application of the duplex MCDA-LFB assay was evaluated using clinical samples, and the results obtained from duplex MCDA-LFB method were consistent with conventional culture-based technique. In sum, the duplex MCDA-LFB assay appears to be a reliable, rapid and specific technique to detect all A. baumannii strains and identify these strains harboring blaOXA-23-like gene for appropriate antibiotic therapy.
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Köhler AT, Rodloff AC, Labahn M, Reinhardt M, Truyen U, Speck S. Evaluation of disinfectant efficacy against multidrug-resistant bacteria: A comprehensive analysis of different methods. Am J Infect Control 2019; 47:1181-1187. [PMID: 31060869 DOI: 10.1016/j.ajic.2019.04.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2019] [Revised: 04/01/2019] [Accepted: 04/01/2019] [Indexed: 12/28/2022]
Abstract
BACKGROUND Multidrug-resistant gram-negative bacteria (MDR-GNB) constitute a threat to health care worldwide. Disinfectants are used to prevent and control the spread of MDR-GNB in a hospital setting but their efficacy might be impaired by bacterial mechanisms that may act on both antimicrobials and disinfectants. Determination of minimum inhibitory concentrations is mainly used to determine bacterial susceptibility against disinfectants, but practical tests on surfaces might be more suitable to predict in-use conditions. Our objective was to compare and evaluate 4 different methods widely used to assess surface disinfectant efficacy. METHODS The efficacy of benzalkonium chloride (BAC), peracetic acid (PAA), and ethanol (ETH) against multidrug-resistant Acinetobacter, Pseudomonas, and Klebsiella strains was assessed by minimum inhibitory concentration determinations, quantitative suspension tests, qualitative suspension tests, and carrier tests. Test results were compared to ascertain the most appropriate method. RESULTS ETH, PAA, and BAC were highly effective against MDR-GNB, but we observed marked differences in efficacious concentrations (up to 100-fold) as a function of the test method applied. Minimum inhibitory concentration determination was not reliable for evaluating susceptibility or resistance to BAC. CONCLUSIONS Surface tests should be used to determine bacterial susceptibility against disinfectants. Moreover, suitable guidelines are needed that allow for the standardization and comparison of bactericidal values obtained by different investigators.
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Verhasselt HL, Radke J, Schmidt D, Killengray D, Scharmann U, Rickerts V, Hansen W, Seidel D, Falces‐Romero I, Buer J, Rath P, Steinmann J. Comparison of genotyping methods forCunninghamella bertholletiae. Mycoses 2019; 62:519-525. [DOI: 10.1111/myc.12908] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2018] [Revised: 01/30/2019] [Accepted: 02/18/2019] [Indexed: 11/29/2022]
Affiliation(s)
- Hedda Luise Verhasselt
- Institute of Medical Microbiology University Hospital Essen University of Duisburg‐Essen Essen Germany
| | - Julia Radke
- Institute of Medical Microbiology University Hospital Essen University of Duisburg‐Essen Essen Germany
| | - Dirk Schmidt
- Institute of Medical Microbiology University Hospital Essen University of Duisburg‐Essen Essen Germany
| | - David Killengray
- Institute of Medical Microbiology University Hospital Essen University of Duisburg‐Essen Essen Germany
| | - Ulrike Scharmann
- Institute of Medical Microbiology University Hospital Essen University of Duisburg‐Essen Essen Germany
| | - Volker Rickerts
- FG 16: Erreger von Pilz‐, und Parasiteninfektionen und Mykobakteriosen, Konsiliarlabor für Kryptokokkose und seltene Systemmykosen Robert Koch‐Institut Berlin Germany
| | - Wiebke Hansen
- Institute of Medical Microbiology University Hospital Essen University of Duisburg‐Essen Essen Germany
| | - Danila Seidel
- Department I of Internal Medicine University Hospital of Cologne Cologne Germany
| | - Iker Falces‐Romero
- Clinical Microbiology Department Hospital Universitario La Paz Madrid Spain
| | - Jan Buer
- Institute of Medical Microbiology University Hospital Essen University of Duisburg‐Essen Essen Germany
| | - Peter‐Michael Rath
- Institute of Medical Microbiology University Hospital Essen University of Duisburg‐Essen Essen Germany
| | - Joerg Steinmann
- Institute of Medical Microbiology University Hospital Essen University of Duisburg‐Essen Essen Germany
- Institute of Clinical Hygiene, Medical Microbiology and Infectiology Hospital Nuremberg Paracelsus Medical University Nuremberg Germany
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Arruda MC, de Aguiar RS, Jardim WM, Melo LH, Mendonça T, Cavalcanti AB, de França PHC. Cohorting to prevent acquisition of multidrug-resistant bacteria: An interrupted time series study. Am J Infect Control 2019; 47:180-185. [PMID: 30253905 DOI: 10.1016/j.ajic.2018.07.025] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2018] [Revised: 07/27/2018] [Accepted: 07/28/2018] [Indexed: 10/28/2022]
Abstract
BACKGROUND Grouping patients who acquired resistant microorganisms within a single area (cohorting) has been used to prevent cross-transmission. We aimed to assess cohorting effectiveness in the absence of an outbreak. METHODS An interrupted time series study was performed in a general hospital considering patients admitted to wards. In the first year, patients who acquired multidrug-resistant (MDR) bacteria were isolated without physical transfer. In the second year, cohorting was implemented, and patients with mixed MDR bacteria were transferred to individual rooms in a specific isolation unit. Cultures were requested upon clinician orders, and surveillance or routine cultures were not performed. The effect of cohorting on the incidence density of MDR bacteria acquisition was assessed using segmented regression analysis. RESULTS In the first and second years, 2.0 and 2.8 cases per 1,000 patient-days acquired MDR bacteria. The length of hospitalization and mortality rate were similar between phases. There was a linear increase of the monthly incidence densities of MDR bacteria acquisition in the first year (β1: 0.11; 95% confidence interval [CI]: -0.02 to 0.24), though without an immediate impact of cohorting (β2: -1.32; 95% CI: -3.81 to 1.16) or a change in the temporal trend (β3: 0.04; 95% CI: -0.14 to 0.23) from the first to second phase. CONCLUSION Cohorting may not reduce the incidence density of MDR bacteria acquisition in the absence of an outbreak.
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Moelling K, Broecker F, Willy C. A Wake-Up Call: We Need Phage Therapy Now. Viruses 2018; 10:E688. [PMID: 30563034 PMCID: PMC6316858 DOI: 10.3390/v10120688] [Citation(s) in RCA: 68] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2018] [Revised: 11/27/2018] [Accepted: 12/03/2018] [Indexed: 12/11/2022] Open
Abstract
The rise of multidrug-resistant bacteria has resulted in an increased interest in phage therapy, which historically preceded antibiotic treatment against bacterial infections. To date, there have been no reports of serious adverse events caused by phages. They have been successfully used to cure human diseases in Eastern Europe for many decades. More recently, clinical trials and case reports for a variety of indications have shown promising results. However, major hurdles to the introduction of phage therapy in the Western world are the regulatory and legal frameworks. Present regulations may take a decade or longer to be fulfilled. It is of urgent need to speed up the availability of phage therapy.
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Affiliation(s)
- Karin Moelling
- Institute of Medical Microbiology, University of Zurich, 8006 Zurich, Switzerland.
- Max Planck Institute for molecular Genetics, 14195 Berlin, Germany.
| | - Felix Broecker
- Department of Microbiology, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA.
| | - Christian Willy
- Department Trauma & Orthopedic Surgery, Septic & Reconstructive Surgery, Research and Treatment Center for Complex Combat Injuries, Military Hospital Berlin, 10115 Berlin, Germany.
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18
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Ben-Chetrit E, Wiener-Well Y, Lesho E, Kopuit P, Broyer C, Bier L, Assous MV, Benenson S, Cohen MJ, McGann PT, Snesrud E, Levin PD. An intervention to control an ICU outbreak of carbapenem-resistant Acinetobacter baumannii: long-term impact for the ICU and hospital. CRITICAL CARE : THE OFFICIAL JOURNAL OF THE CRITICAL CARE FORUM 2018; 22:319. [PMID: 30463589 PMCID: PMC6249923 DOI: 10.1186/s13054-018-2247-y] [Citation(s) in RCA: 41] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/10/2018] [Accepted: 10/24/2018] [Indexed: 01/07/2023]
Abstract
Background Following a fatal intensive care unit (ICU) outbreak of carbapenem-resistant Acinetobacter baumanii (CRAB) in 2015, an aggressive infection control intervention was instituted. We outline the intervention and long-term changes in the incidence and prevalence of CRAB. Methods The infection control intervention included unit closure (3 days), environmental cleaning, hand hygiene interventions, and environmental culturing. CRAB acquisition and prevalence and colistin use were compared for the 1 year before and 2 years after the intervention. Results Following the intervention, ICU CRAB acquisition decreased significantly from 54.6 (preintervention) to 1.9 (year 1) to 5.6 cases (year 2)/1000 admissions (p < 0.01 for comparisons with preintervention period.). Unexpectedly, ICU CRAB admission prevalence also decreased from 56.5 to 5.8 to 13 cases/1000 admissions (p < 0.001) despite the infection control intervention’s being directed at the ICU alone. In parallel, hospital CRAB prevalence decreased from 4.4 to 2.4 to 2.5 cases/1000 admissions (p < 0.001), possibly as a result of decreased discharge of CRAB carriers from the ICU to the wards (58.5 to 1.9 to 7.4 cases/1000 admissions; p < 0.001). ICU colistin consumption decreased from 200 to 132 to 75 defined daily dose (DDD)/1000 patient-days (p < 0.05). Hospital colistin consumption decreased from 21.2 to 19.4 to 14.1 DDD/1000 patient-days (p < 0.05). Conclusions The ICU infection control intervention was highly effective, long-lasting, and associated with a decrease in last-line antibiotic use. The intervention was associated with the unexpected finding that hospital CRAB prevalence also decreased.
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Affiliation(s)
- Eli Ben-Chetrit
- Infectious Diseases Unit, Shaare Zedek Medical Center, Hebrew University, Jerusalem, Israel
| | - Yonit Wiener-Well
- Infectious Diseases Unit, Shaare Zedek Medical Center, Hebrew University, Jerusalem, Israel
| | - Emil Lesho
- Infectious Diseases Unit, Rochester Regional Health, Rochester, NY, USA
| | - Puah Kopuit
- Infectious Diseases Unit, Shaare Zedek Medical Center, Hebrew University, Jerusalem, Israel
| | - Chaya Broyer
- General Intensive Care Unit, Shaare Zedek Medical Center, Hebrew University, Jerusalem, Israel
| | - Liora Bier
- Infectious Diseases Unit, Shaare Zedek Medical Center, Hebrew University, Jerusalem, Israel
| | - Marc V Assous
- Clinical and Microbiology Laboratory, Shaare Zedek Medical Center, Hebrew University, Jerusalem, Israel
| | - Shmuel Benenson
- Infectious Diseases Unit, Hadassah Hebrew University Medical Center, Jerusalem, Israel
| | - Matan J Cohen
- Clalit Health Services, Jerusalem, Israel.,Hebrew University, Jerusalem, Israel
| | - Patrick T McGann
- Multidrug-Resistant Organism Repository and Surveillance Network, Walter Reed Army Institute of Research, Silver Spring, MD, USA
| | - Erik Snesrud
- Multidrug-Resistant Organism Repository and Surveillance Network, Walter Reed Army Institute of Research, Silver Spring, MD, USA
| | - Phillip D Levin
- General Intensive Care Unit, Shaare Zedek Medical Center, Hebrew University, Jerusalem, Israel.
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Efficacy of sodium hypochlorite against multidrug-resistant Gram-negative bacteria. J Hosp Infect 2018; 100:e40-e46. [PMID: 30026008 DOI: 10.1016/j.jhin.2018.07.017] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2018] [Accepted: 07/10/2018] [Indexed: 12/16/2022]
Abstract
BACKGROUND Increased antimicrobial resistance has been observed among many bacteria leading to treatment failures in human and veterinary medicine. Disinfection is a prerequisite for infection control and prevention in healthcare settings. Chlorine compounds are cost-effective and accessible worldwide. AIM To determine the efficacy of sodium hypochlorite (NaOCl) against multidrug-resistant Gram-negative bacteria (MDR-GNB). METHODS Minimum inhibitory concentrations (MICs) were determined using broth macro-dilution. Bactericidal efficacy was measured by qualitative and quantitative suspension tests followed by practical tests without mechanical action on stainless steel carriers. The guidelines of the German Association for Applied Hygiene were followed. FINDINGS Results varied remarkably depending on the method. MICs were 0.1% or 0.2% NaOCl. Qualitative suspension tests revealed up to 500-fold lower bactericidal concentrations. Pseudomonas aeruginosa (P = 0.0025) was significantly less susceptible in these tests whereas quantitative suspension tests revealed no significant differences between strains (P > 0.05). Practical tests determined bactericidal concentrations of 0.8-0.32% NaOCl at 1 min of contact and even lower concentrations for longer contact times. At 1 min, five Klebsiella were significantly less susceptible (P = 0.0124), whereas the lower susceptibility of P. aeruginosa was not confirmed. Organic load inhibited bactericidal activity significantly, whereas contact time had a marginal effect. Differing test results underline that MIC determination and qualitative suspension tests may be insufficient approaches to evaluate bacterial susceptibility or resistance. CONCLUSION NaOCl efficiently reduced Pseudomonas aeruginosa, Acinetobacter spp., and Klebsiella spp., most notably in the absence of organic matter. Strain- and species-specific differences in susceptibility were noticed, but in general MDR-GNB revealed no higher tolerance to NaOCl.
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Salehi B, Goudarzi H, Nikmanesh B, Houri H, Alavi-Moghaddam M, Ghalavand Z. Emergence and characterization of nosocomial multidrug-resistant and extensively drug-resistant Acinetobacter baumannii isolates in Tehran, Iran. J Infect Chemother 2018; 24:515-523. [PMID: 29555392 DOI: 10.1016/j.jiac.2018.02.009] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2017] [Revised: 02/01/2018] [Accepted: 02/19/2018] [Indexed: 10/17/2022]
Abstract
RATIONALE Acinetobacter baumannii is one of the antibiotic-resistant superbugs that threatens hospitalized patients. Emergence and spread of the multidrug-resistant (MDR) and extensively drug-resistant (XDR) clones cause erratic outbreaks following environmental contamination of hospital settings. OBJECTIVE The present study intended to characterize the antimicrobial resistant profiles and the genotypes of clinical and environmental isolates of A. baumannii as a result of dissemination of resistant strains. METHODS Clinical and environmental isolates of A. baumannii were obtained from patients, staff, and environment of an educational hospital in Tehran. Antimicrobial susceptibility testing was carried out using the disk diffusion and E-test methods. Multiplex PCR was performed for detection of OXA-type genes (blaOXA-23-like, blaOXA-24-like, blaOXA-58-like, and blaOXA-51-like). Genotypic relatedness of the isolates was achieved using repetitive extragenic palindromic element PCR (Rep-PCR) technique. RESULTS All the isolates were found to be susceptible to colistin and most of them (77%) were non-susceptible to tigecycline. A majority of the clinical and environmental isolates (97%) were considered as MDR strains and 41% as XDR. In multiplex detection, blaOXA-23-like was found in 54% of the isolates, which was the most frequent OXA-type gene. In addition, the frequency of the carbapenem-resistant A. baumannii (CRAB) was observed to be high (96%). In addition, molecular typing showed different Rep patterns of clinical isolates and clonal spread of environmental isolates. CONCLUSION The present study highlights the circulation of drug-resistant A. baumannii strains in different wards of hospitals principally in intensive care unit (ICU) as a nosocomial pathogen due to unwise managements.
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Affiliation(s)
- Bahare Salehi
- Department of Microbiology, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Hossein Goudarzi
- Department of Microbiology, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Bahram Nikmanesh
- Department of Medical Laboratory Sciences, School of Allied Medical Sciences, Tehran University of Medical Sciences, Tehran, Iran
| | - Hamidreza Houri
- Department of Microbiology, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | | | - Zohreh Ghalavand
- Department of Microbiology, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
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Munier AL, Biard L, Rousseau C, Legrand M, Lafaurie M, Lomont A, Donay JL, de Beaugrenier E, Flicoteaux R, Mebazaa A, Mimoun M, Molina JM. Incidence, risk factors, and outcome of multidrug-resistant Acinetobacter baumannii acquisition during an outbreak in a burns unit. J Hosp Infect 2017; 97:226-233. [PMID: 28751010 DOI: 10.1016/j.jhin.2017.07.020] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2017] [Accepted: 07/19/2017] [Indexed: 12/31/2022]
Abstract
BACKGROUND Multidrug-resistant Acinetobacter baumannii (MR-AB) can cause outbreaks in a burns unit. AIM To study the incidence, risk factors and outcome of MR-AB colonization during an outbreak. METHODS A prospective study was conducted from April to November 2014 in a burns unit in Paris. Weekly surveillance cultures of patients and their environment were performed. MR-AB acquisition, discharge, or death without MR-AB colonization were considered as competing events. To identify risk factors for colonization, baseline characteristics and time-dependent variables were investigated in univariate and multivariate analyses using Cox models. MR-AB strains were genotypically compared using multi-locus sequence typing. FINDINGS Eighty-six patients were admitted in the burns unit during the study period. Among 77 patients without MR-AB colonization at admission, 25 (32%) acquired MR-AB with a cumulative incidence of 30% at 28 days (95% CI: 20-40). Median time to MR-AB acquisition was 13 days (range: 5-34). In multivariate analysis, risk factors for MR-AB acquisition were ≥2 skin graft procedures performed [hazard ratio (HR): 2.97; 95% confidence interval (CI): 1.10-8.00; P = 0.032] and antibiotic therapy during hospitalization (HR: 4.42; 95% CI: 1.19-16.4; P = 0.026). A major sequence type of MR-AB (ST2) was found in 94% and 92% of patients and environmental strains, respectively, with all strains harbouring the blaOXA-23 gene. MR-AB colonization increased length of hospitalization (HR: 0.32; 95% CI: 0.17-0.58; P = 0.0002) by a median of 12 days. CONCLUSION A high incidence of MR-AB acquisition was seen during this outbreak with most strains from patients and their environment belonging to single sequence type. MR-AB colonization was associated with more skin graft procedures, antibiotic use, and prolonged hospitalization.
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Affiliation(s)
- A-L Munier
- Infectious Disease Department, St Louis Hospital, APHP and University Paris Diderot, Paris, France.
| | - L Biard
- Department of Biostatistics, St Louis Hospital, APHP and University Paris Diderot, Paris, France
| | - C Rousseau
- Microbiology Department, St Louis Hospital, APHP and EA4065, University Paris Descartes, Paris, France
| | - M Legrand
- Department of Anesthesiology, Critical Care and Burn Unit, St Louis Hospital, APHP and University Paris Diderot, Paris, France; INSERM U942, France
| | - M Lafaurie
- Infectious Disease Department, St Louis Hospital, APHP and University Paris Diderot, Paris, France
| | - A Lomont
- Microbiology Department, St Louis Hospital, APHP and EA4065, University Paris Descartes, Paris, France
| | - J-L Donay
- Microbiology Department, St Louis Hospital, APHP and EA4065, University Paris Descartes, Paris, France
| | - E de Beaugrenier
- Pharmacy Department, St Louis Hospital, APHP and University Paris Diderot, Paris, France
| | - R Flicoteaux
- Department of Biostatistics, St Louis Hospital, APHP and University Paris Diderot, Paris, France
| | - A Mebazaa
- Department of Anesthesiology, Critical Care and Burn Unit, St Louis Hospital, APHP and University Paris Diderot, Paris, France
| | - M Mimoun
- Plastic Surgery Department, St Louis Hospital, APHP and University Paris Diderot, Paris, France
| | - J-M Molina
- Infectious Disease Department, St Louis Hospital, APHP and University Paris Diderot, Paris, France
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22
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Smiljanic M, Kaase M, Ahmad-Nejad P, Ghebremedhin B. Comparison of in-house and commercial real time-PCR based carbapenemase gene detection methods in Enterobacteriaceae and non-fermenting gram-negative bacterial isolates. Ann Clin Microbiol Antimicrob 2017; 16:48. [PMID: 28693493 PMCID: PMC5504714 DOI: 10.1186/s12941-017-0223-z] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2016] [Accepted: 06/22/2017] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Carbapenemase-producing gram-negative bacteria are increasing globally and have been associated with outbreaks in hospital settings. Thus, the accurate detection of these bacteria in infections is mandatory for administering the adequate therapy and infection control measures. This study aimed to establish and evaluate a multiplex real-time PCR assay for the simultaneous detection of carbapenemase gene variants in gram-negative rods and to compare the performance with a commercial RT-PCR assay (Check-Direct CPE). METHODS 116 carbapenem-resistant Enterobacteriaceae, Pseudomonas aeruginosa and Acinetobacter baumannii isolates were genotyped for carbapenemase genes by PCR and sequencing. The defined isolates were used for the validation of the in-house RT-PCR by use of designed primer pairs and probes. RESULTS Among the carbapenem-resistant isolates the genes bla KPC, bla VIM, bla NDM or bla OXA were detected. Both RT-PCR assays detected all bla KPC, bla VIM and bla NDM in the isolates. The in-house RT-PCR detected 53 of 67 (79.0%) whereas the commercial assay detected only 29 (43.3%) of the OXA genes. The in-house sufficiently distinguished the most prevalent OXA types (23-like and 48-like) in the melting curve analysis and direct detection of the genes from positive blood culture vials. CONCLUSION The Check-Direct CPE and the in-house RT-PCR assay detected the carbapenem resistance from solid culture isolates. Moreover, the in-house assay enabled the identification of carbapenemase genes directly from positive blood-culture vials. However, we observed insufficient detection of various OXA genes in both assays. Nevertheless, the in-house RT-PCR detected the majority of the OXA type genes in Enterobacteriaceae and A. baumannii.
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Affiliation(s)
- M Smiljanic
- Center for Clinical and Translational Research, Institute for Medical Laboratory Diagnostics, HELIOS University Clinic Wuppertal; Witten/Herdecke University, Heusnerstr. 40, 42283, Wuppertal, Germany
| | - M Kaase
- Department of Medical Microbiology, Ruhr-University Bochum, Bochum, Germany.,Department of Infection Control, University Medical Center Göttingen, Göttingen, Germany
| | - P Ahmad-Nejad
- Center for Clinical and Translational Research, Institute for Medical Laboratory Diagnostics, HELIOS University Clinic Wuppertal; Witten/Herdecke University, Heusnerstr. 40, 42283, Wuppertal, Germany
| | - B Ghebremedhin
- Center for Clinical and Translational Research, Institute for Medical Laboratory Diagnostics, HELIOS University Clinic Wuppertal; Witten/Herdecke University, Heusnerstr. 40, 42283, Wuppertal, Germany.
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23
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Higgins PG, Prior K, Harmsen D, Seifert H. Development and evaluation of a core genome multilocus typing scheme for whole-genome sequence-based typing of Acinetobacter baumannii. PLoS One 2017; 12:e0179228. [PMID: 28594944 PMCID: PMC5464626 DOI: 10.1371/journal.pone.0179228] [Citation(s) in RCA: 94] [Impact Index Per Article: 13.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2017] [Accepted: 05/25/2017] [Indexed: 01/05/2023] Open
Abstract
We have employed whole genome sequencing to define and evaluate a core genome multilocus sequence typing (cgMLST) scheme for Acinetobacter baumannii. To define a core genome we downloaded a total of 1,573 putative A. baumannii genomes from NCBI as well as representative isolates belonging to the eight previously described international A. baumannii clonal lineages. The core genome was then employed against a total of fifty-three carbapenem-resistant A. baumannii isolates that were previously typed by PFGE and linked to hospital outbreaks in eight German cities. We defined a core genome of 2,390 genes of which an average 98.4% were called successfully from 1,339 A. baumannii genomes, while Acinetobacter nosocomialis, Acinetobacter pittii, and Acinetobacter calcoaceticus resulted in 71.2%, 33.3%, and 23.2% good targets, respectively. When tested against the previously identified outbreak strains, we found good correlation between PFGE and cgMLST clustering, with 0–8 allelic differences within a pulsotype, and 40–2,166 differences between pulsotypes. The highest number of allelic differences was between the isolates representing the international clones. This typing scheme was highly discriminatory and identified separate A. baumannii outbreaks. Moreover, because a standardised cgMLST nomenclature is used, the system will allow inter-laboratory exchange of data.
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Affiliation(s)
- Paul G. Higgins
- Institute for Medical Microbiology, Immunology and Hygiene, University of Cologne, Cologne, Germany
- German Centre for Infection Research (DZIF), partner site Bonn-Cologne, Cologne, Germany
- * E-mail:
| | - Karola Prior
- Department for Periodontology and Restorative Dentistry, University Hospital Muenster, Muenster, Germany
| | - Dag Harmsen
- Department for Periodontology and Restorative Dentistry, University Hospital Muenster, Muenster, Germany
| | - Harald Seifert
- Institute for Medical Microbiology, Immunology and Hygiene, University of Cologne, Cologne, Germany
- German Centre for Infection Research (DZIF), partner site Bonn-Cologne, Cologne, Germany
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Lee CR, Lee JH, Park M, Park KS, Bae IK, Kim YB, Cha CJ, Jeong BC, Lee SH. Biology of Acinetobacter baumannii: Pathogenesis, Antibiotic Resistance Mechanisms, and Prospective Treatment Options. Front Cell Infect Microbiol 2017; 7:55. [PMID: 28348979 PMCID: PMC5346588 DOI: 10.3389/fcimb.2017.00055] [Citation(s) in RCA: 491] [Impact Index Per Article: 70.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2016] [Accepted: 02/13/2017] [Indexed: 12/27/2022] Open
Abstract
Acinetobacter baumannii is undoubtedly one of the most successful pathogens responsible for hospital-acquired nosocomial infections in the modern healthcare system. Due to the prevalence of infections and outbreaks caused by multi-drug resistant A. baumannii, few antibiotics are effective for treating infections caused by this pathogen. To overcome this problem, knowledge of the pathogenesis and antibiotic resistance mechanisms of A. baumannii is important. In this review, we summarize current studies on the virulence factors that contribute to A. baumannii pathogenesis, including porins, capsular polysaccharides, lipopolysaccharides, phospholipases, outer membrane vesicles, metal acquisition systems, and protein secretion systems. Mechanisms of antibiotic resistance of this organism, including acquirement of β-lactamases, up-regulation of multidrug efflux pumps, modification of aminoglycosides, permeability defects, and alteration of target sites, are also discussed. Lastly, novel prospective treatment options for infections caused by multi-drug resistant A. baumannii are summarized.
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Affiliation(s)
- Chang-Ro Lee
- National Leading Research Laboratory of Drug Resistance Proteomics, Department of Biological Sciences, Myongji University Yongin, South Korea
| | - Jung Hun Lee
- National Leading Research Laboratory of Drug Resistance Proteomics, Department of Biological Sciences, Myongji University Yongin, South Korea
| | - Moonhee Park
- National Leading Research Laboratory of Drug Resistance Proteomics, Department of Biological Sciences, Myongji UniversityYongin, South Korea; DNA Analysis Division, Seoul Institute, National Forensic ServiceSeoul, South Korea
| | - Kwang Seung Park
- National Leading Research Laboratory of Drug Resistance Proteomics, Department of Biological Sciences, Myongji University Yongin, South Korea
| | - Il Kwon Bae
- Department of Dental Hygiene, College of Health and Welfare, Silla University Busan, South Korea
| | - Young Bae Kim
- Biotechnology Program, North Shore Community College Danvers, MA, USA
| | - Chang-Jun Cha
- Department of Systems Biotechnology, College of Biotechnology and Natural Resources, Chung-Ang University Anseong, South Korea
| | - Byeong Chul Jeong
- National Leading Research Laboratory of Drug Resistance Proteomics, Department of Biological Sciences, Myongji University Yongin, South Korea
| | - Sang Hee Lee
- National Leading Research Laboratory of Drug Resistance Proteomics, Department of Biological Sciences, Myongji University Yongin, South Korea
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Terzi HA, Atasoy AR, Aykan SB, Karakece E, Asık G, Ciftci IH. Association of doripenem resistance with OXA-type carbapenemases in Acinetobacter baumannii isolates. Saudi Med J 2017; 37:43-7. [PMID: 26739973 PMCID: PMC4724678 DOI: 10.15537/smj.2016.1.12529] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVES To evaluate the in vitro activity of doripenem in Acinetobacter baumannii (A. baumannii) clinical isolates that possess different OXA-type carbapenemases, and to evaluate the roles of these enzymes in the development of carbapenem resistance. METHODS This retrospective study was conducted with 25 A. baumannii isolates at Sakarya University Training and Research Hospital, Sakarya, Turkey from June to October 2014. Antibiotic susceptibility testing was carried out using the Vitek-2 automated system (bioMérieux, Marcy l'Etoile, France). Minimum inhibitory concentrations (MICs) were determined using Etest strips (bioMérieux, Marcy l'Etoile, France). Quantitative polymerase chain reaction was performed in a Fluorion Instrument (Iontek, Istanbul, Turkey). RESULTS Isolates were divided into 5 groups based on their susceptibility profiles and OXA-type carbapenemase positivity. Group 2 isolates whose MIC of both meropenem and doripenem are in the range of 4-32 µg/mL were negative for both blaOXA-23 and blaOXA-58. Group 3 isolates whose MIC of meropenem and doripenem is in the range of 4-32 µg/mL, blaOXA-23 is positive, and blaOXA-58 is negative. Group 5 isolates whose MIC of meropenem is more than 32 µg/mL, and that of doripenem is in the range of 16-32 µg/mL were positive for both blaOXA-23 and blaOXA-58. CONCLUSION The blaOXA-23 and blaOXA-58 gene combinations may confer resistance with a much greater MIC of both meropenem and doripenem. But the blaOXA-58 presence alone was not correlated with doripenem resistance.
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Affiliation(s)
- Huseyin-Agah Terzi
- Department of Medical Microbiology, Sakarya University Training and Research Hospital, Sakarya, Turkey. E-mail.
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Ning NZ, Liu X, Bao CM, Chen SM, Cui EB, Zhang JL, Huang J, Chen FH, Li T, Qu F, Wang H. Molecular epidemiology of bla OXA-23 -producing carbapenem-resistant Acinetobacter baumannii in a single institution over a 65-month period in north China. BMC Infect Dis 2017; 17:14. [PMID: 28056839 PMCID: PMC5217423 DOI: 10.1186/s12879-016-2110-1] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2016] [Accepted: 12/10/2016] [Indexed: 01/29/2023] Open
Abstract
BACKGROUND Carbapenem-resistant Acinetobacter baumannii poses a significant threat to hospitalized patients, as few therapeutic options remain. Thus, we investigated the molecular epidemiology and mechanism of resistance of carbapenem-resistant A.baumannii isolates in Beijing, China. METHODS Carbapenem-resistant A.baumannii isolates (n = 101) obtained between June 2009 and November 2014 were used. Multilocus sequence typing (MLST) and PCR assays for class C and D β-lactamase were performed on all isolates. S1 nuclease pulsed-field gel electrophoresis (PFGE) and Southern blot hybridization were performed to identify the resistance gene location. RESULTS All 101 A.baumannii isolates were highly resistant to frequently used antimicrobials, and were considered multidrug resistant. A total of 12 sequence types (STs) were identified, including 10 reported STs and 2 novel STs. Eighty-seven isolates were classified to clonal complex 92 (CC92), among which ST191 and ST195 were the most common STs. The bla OXA-23 gene was positive in most (n = 95) of the A.baumannii isolates. Using S1-nuclease digestion PFGE and Southern blot hybridization, 3 patterns of plasmids carrying bla OXA-23 were confirmed. ST191 and ST195 (both harboring bla OXA-23 ) caused outbreaks during the study period, and this is the first report of outbreaks caused by ST191 and ST195 in north China. CONCLUSION bla OXA-23 -producing A.baumannii ST191 and ST 195 isolates can disseminate in a hospital and are potential nosocomial outbreak strains. Surveillance of imipenem-resistant A.baumannii and antimicrobial stewardship should be strengthened.
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Affiliation(s)
- Nian-Zhi Ning
- State Key Laboratory of Pathogen and Biosecurity, Beijing Institute of Microbiology and Epidemiology, No.20 Dongda Street, Fengtai District, 100071, Beijing, China
| | - Xiong Liu
- State Key Laboratory of Pathogen and Biosecurity, Beijing Institute of Microbiology and Epidemiology, No.20 Dongda Street, Fengtai District, 100071, Beijing, China
| | - Chun-Mei Bao
- The Center of Clinical Diagnosis Laboratory, Beijing 302 Hospital, Beijing, 100039, China
| | - Su-Ming Chen
- The Center of Clinical Diagnosis Laboratory, Beijing 302 Hospital, Beijing, 100039, China
| | - En-Bo Cui
- The Center of Clinical Diagnosis Laboratory, Beijing 302 Hospital, Beijing, 100039, China
| | - Ju-Ling Zhang
- The Center of Clinical Diagnosis Laboratory, Beijing 302 Hospital, Beijing, 100039, China
| | - Jie Huang
- State Key Laboratory of Pathogen and Biosecurity, Beijing Institute of Microbiology and Epidemiology, No.20 Dongda Street, Fengtai District, 100071, Beijing, China
| | - Fang-Hong Chen
- State Key Laboratory of Pathogen and Biosecurity, Beijing Institute of Microbiology and Epidemiology, No.20 Dongda Street, Fengtai District, 100071, Beijing, China
| | - Tao Li
- State Key Laboratory of Pathogen and Biosecurity, Beijing Institute of Microbiology and Epidemiology, No.20 Dongda Street, Fengtai District, 100071, Beijing, China.
| | - Fen Qu
- The Center of Clinical Diagnosis Laboratory, Beijing 302 Hospital, Beijing, 100039, China.
| | - Hui Wang
- State Key Laboratory of Pathogen and Biosecurity, Beijing Institute of Microbiology and Epidemiology, No.20 Dongda Street, Fengtai District, 100071, Beijing, China.
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Vuotto C, Grosso F, Longo F, Balice MP, de Barros MC, Peixe L, Donelli G. Biofilm-Forming Ability and Clonality in Acinetobacter baumannii Strains Isolated from Urine Samples and Urinary Catheters in Different European Hospitals. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2017. [PMID: 28639245 DOI: 10.1007/5584_2017_70] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
OBJECTIVE Biofilm formation has been associated with the persistence of Acinetobacter baumannii in hospital settings and its propensity to cause infection. We investigated the adhesion ability and clonality of 128 A. baumannii isolates recovered from urine and urinary catheters of patients admitted to 5 European hospitals during 1991-2013. METHODS Isolates identification was confirmed by rpoB sequencing and by the presence of blaOXA-51. The presence of carbapenemases was detected by PCR. Clonality was determined by Sequence Group (SG) identification, Pulsed field gel electrophoresis (PFGE) and Multilocus sequence typing. Adhesion ability was defined by quantitative biofilm production assay and biofilms were characterized by Confocal Laser Microscopy and Scanning Electron Microscopy. RESULTS The 128 isolates, either resistant (85.9%) or susceptible (14.1%) to carbapenems, and belonging to 50 different PFGE types and 24 different STs, were distributed among SG1 (67.2%), SG2 (10.2%) and other allelic profiles (22.7%). ST218 was the most frequent ST, corresponding to 54,5% of the isolates collected between 2011 and 2013. Among the 109 isolates showing resistance to at least 1 carbapenem, 55% revealed the presence of an acquired carbapenem-hydrolyzing class D - lactamases (CHDL): blaOXA-23 were the most frequent gene detected from 2008 onwards (75%). Among all the clinical isolates, 42.2% were strong biofilm producers, with the older isolates having the highest adhesion ability. Most isolates recovered later, belonging to ST218 and harbouring blaOXA-23, were homogeneously less adhesive. CONCLUSIONS An evolution towards a decrease in adhesion ability and a CHDL content change was observed along the years in several European countries.
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Affiliation(s)
- Claudia Vuotto
- Microbial Biofilm Laboratory, IRCCS Fondazione Santa Lucia, Rome, Italy.
| | - Filipa Grosso
- REQUIMTE. Laboratório de Microbiologia, Faculdade de Farmácia, Universidade do Porto, Porto, Portugal
| | - Francesca Longo
- Microbial Biofilm Laboratory, IRCCS Fondazione Santa Lucia, Rome, Italy
| | - Maria Pia Balice
- Clinical Microbiology Laboratory, IRCCS Fondazione Santa Lucia, Rome, Italy
| | - Mariana Carvalho de Barros
- Microbial Biofilm Laboratory, IRCCS Fondazione Santa Lucia, Rome, Italy.,REQUIMTE. Laboratório de Microbiologia, Faculdade de Farmácia, Universidade do Porto, Porto, Portugal
| | - Luisa Peixe
- REQUIMTE. Laboratório de Microbiologia, Faculdade de Farmácia, Universidade do Porto, Porto, Portugal
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Hsu LY, Apisarnthanarak A, Khan E, Suwantarat N, Ghafur A, Tambyah PA. Carbapenem-Resistant Acinetobacter baumannii and Enterobacteriaceae in South and Southeast Asia. Clin Microbiol Rev 2017; 30:1-22. [PMID: 27795305 PMCID: PMC5217790 DOI: 10.1128/cmr.masthead.30-1] [Citation(s) in RCA: 89] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
Carbapenem-resistant Gram-negative bacteria, in particular the Acinetobacter baumannii-calcoaceticus complex and Enterobacteriaceae, are escalating global public health threats. We review the epidemiology and prevalence of these carbapenem-resistant Gram-negative bacteria among countries in South and Southeast Asia, where the rates of resistance are some of the highest in the world. These countries house more than a third of the world's population, and several are also major medical tourism destinations. There are significant data gaps, and the almost universal lack of comprehensive surveillance programs that include molecular epidemiologic testing has made it difficult to understand the origins and extent of the problem in depth. A complex combination of factors such as inappropriate prescription of antibiotics, overstretched health systems, and international travel (including the phenomenon of medical tourism) probably led to the rapid rise and spread of these bacteria in hospitals in South and Southeast Asia. In India, Pakistan, and Vietnam, carbapenem-resistant Enterobacteriaceae have also been found in the environment and community, likely as a consequence of poor environmental hygiene and sanitation. Considerable political will and effort, including from countries outside these regions, are vital in order to reduce the prevalence of such bacteria in South and Southeast Asia and prevent their global spread.
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Affiliation(s)
- Li-Yang Hsu
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
- Tan Tock Seng Hospital, Singapore
| | | | - Erum Khan
- Aga Khan University, Karachi, Pakistan
| | - Nuntra Suwantarat
- Chulabhorn International College of Medicine, Thammasat University, Pathum Thani, Thailand
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Ewers C, Klotz P, Leidner U, Stamm I, Prenger-Berninghoff E, Göttig S, Semmler T, Scheufen S. OXA-23 and ISAba1-OXA-66 class D β-lactamases in Acinetobacter baumannii isolates from companion animals. Int J Antimicrob Agents 2016; 49:37-44. [PMID: 27890443 DOI: 10.1016/j.ijantimicag.2016.09.033] [Citation(s) in RCA: 56] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2016] [Revised: 09/15/2016] [Accepted: 09/17/2016] [Indexed: 10/20/2022]
Abstract
Acinetobacter baumannii is recognised as a major pathogen of nosocomial infections that frequently show resistance to last-resort antimicrobials. To investigate whether A. baumannii from companion animals harbour carbapenem resistance mechanisms, 223 clinical isolates obtained from veterinary clinics between 2000 and 2013 in Germany were screened for carbapenem-non-susceptibility employing meropenem-containing Mueller-Hinton agar plates. Minimum inhibitory concentration (MIC) data were obtained using the VITEK®2 system. Assignment to international clones (ICs) was done by multiplex PCR or repetitive sequence-based PCR employing the DiversiLab system. Clonality was studied using pulsed-field gel electrophoresis (PFGE) and multilocus sequence typing (MLST). Genes encoding carbapenemases and aminoglycoside-modifying enzymes were detected by PCR. In three samples from dogs, carbapenem-resistant A. baumannii carrying the blaOXA-23 gene on plasmids and located on transposon Tn2008 were identified. The isolates belonged to sequence type ST1P (clonal complex CC1/IC1/pulsotype II) and ST10P (CC10/IC8/pulsotype IV) according to the Pasteur MLST scheme, and to ST231Ox (CC109) and ST585Ox (CC447) following the Oxford scheme. Insertion sequence ISAba1 was identified upstream of blaOXA-66 in 58 A. baumannii isolates. MLST referred them to ST2P (CC2/IC2/pulsotypes I and III), ST208Ox, ST350Ox and ST556Ox (all CC118), respectively. PFGE suggested nosocomial spread of these highly related strains, which frequently demonstrated a multidrug-resistant phenotype, in one veterinary clinic. These data show that A. baumannii from companion animals reveal resistance determinants and clonal lineages of strains globally emerging in humans. This suggests an interspecies transmission and warrants molecular surveillance of A. baumannii in veterinary clinics to mitigate its further spread.
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Affiliation(s)
- Christa Ewers
- Institute of Hygiene and Infectious Diseases of Animals, Justus Liebig University Giessen, Frankfurter Str. 85-89, Giessen 35392, Germany.
| | - Peter Klotz
- Institute of Hygiene and Infectious Diseases of Animals, Justus Liebig University Giessen, Frankfurter Str. 85-89, Giessen 35392, Germany
| | - Ursula Leidner
- Institute of Hygiene and Infectious Diseases of Animals, Justus Liebig University Giessen, Frankfurter Str. 85-89, Giessen 35392, Germany
| | - Ivonne Stamm
- Division of IDEXX Laboratories, Vet Med Labor GmbH, Mörikestr. 28/3, Ludwigsburg 71636, Germany
| | - Ellen Prenger-Berninghoff
- Institute of Hygiene and Infectious Diseases of Animals, Justus Liebig University Giessen, Frankfurter Str. 85-89, Giessen 35392, Germany
| | - Stephan Göttig
- Institute for Medical Microbiology and Infection Control, Hospital of Johann Wolfgang Goethe University, Paul-Ehrlich-Str. 40, Frankfurt/Main 60596, Germany
| | | | - Sandra Scheufen
- Institute of Hygiene and Infectious Diseases of Animals, Justus Liebig University Giessen, Frankfurter Str. 85-89, Giessen 35392, Germany
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Lei J, Han S, Wu W, Wang X, Xu J, Han L. Extensively drug-resistant Acinetobacter baumannii outbreak cross-transmitted in an intensive care unit and respiratory intensive care unit. Am J Infect Control 2016; 44:1280-1284. [PMID: 27217347 DOI: 10.1016/j.ajic.2016.03.041] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2015] [Revised: 03/25/2016] [Accepted: 03/25/2016] [Indexed: 01/30/2023]
Abstract
BACKGROUND Extensively drug-resistant Acinetobacter baumannii (XDRAB) is a great threat in intensive care units (ICUs). The aim of this study was to describe an XDRAB outbreak which was cross-transmitted in the ICU and respiratory intensive care unit (RICU) in a tertiary care hospital from January-March 2013. METHODS Patient and environmental surveillances were performed. Isolates were tested for antimicrobial susceptibility. Genotypes were analyzed by multilocus sequence typing (MLST). A series of enhanced strategies were implemented to control the outbreak. RESULTS A total of 11 patients were infected by XDRAB strains during this outbreak. Three patients in the ICU were found positive for XDRAB at the onset of the outbreak. Thereafter, infections were detected in 6 patients in the RICU, followed by reappearance of this strain in the ICU in 2 patients. All A baumannii strains isolated from patients and the environment were extensively drug resistant. MLST revealed them as ST368. After 3 rounds of environmental screening and cleaning, the laminar flow system connecting the ICU and RICU was found as the source of transmission. Successful control of this outbreak was achieved through multifaceted intervention measures. CONCLUSIONS This study suggested the importance of thorough surveillance and disinfection of the environment, including concealed devices, in preventing the transmission of an outbreak.
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31
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Carbapenem-Resistant Acinetobacter baumannii and Enterobacteriaceae in South and Southeast Asia. Clin Microbiol Rev 2016. [PMID: 27795305 DOI: 10.1128/cmr.00042-16] [Citation(s) in RCA: 183] [Impact Index Per Article: 22.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
Abstract
Carbapenem-resistant Gram-negative bacteria, in particular the Acinetobacter baumannii-calcoaceticus complex and Enterobacteriaceae, are escalating global public health threats. We review the epidemiology and prevalence of these carbapenem-resistant Gram-negative bacteria among countries in South and Southeast Asia, where the rates of resistance are some of the highest in the world. These countries house more than a third of the world's population, and several are also major medical tourism destinations. There are significant data gaps, and the almost universal lack of comprehensive surveillance programs that include molecular epidemiologic testing has made it difficult to understand the origins and extent of the problem in depth. A complex combination of factors such as inappropriate prescription of antibiotics, overstretched health systems, and international travel (including the phenomenon of medical tourism) probably led to the rapid rise and spread of these bacteria in hospitals in South and Southeast Asia. In India, Pakistan, and Vietnam, carbapenem-resistant Enterobacteriaceae have also been found in the environment and community, likely as a consequence of poor environmental hygiene and sanitation. Considerable political will and effort, including from countries outside these regions, are vital in order to reduce the prevalence of such bacteria in South and Southeast Asia and prevent their global spread.
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32
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Ewers C, Klotz P, Scheufen S, Leidner U, Göttig S, Semmler T. Genome sequence of OXA-23 producing Acinetobacter baumannii IHIT7853, a carbapenem-resistant strain from a cat belonging to international clone IC1. Gut Pathog 2016; 8:37. [PMID: 27471549 PMCID: PMC4964143 DOI: 10.1186/s13099-016-0119-z] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2016] [Accepted: 07/17/2016] [Indexed: 11/25/2022] Open
Abstract
Background Multidrug resistance in Acinetobacter baumannii has dramatically increased in recent years worldwide. Thus, last-line antibiotics like carbapenems are increasingly being used which in turn further augments selection pressure for resistant strains. Resistance to carbapenems in A. baumannii is frequently mediated by carbapenemases, particularly OXA-23 and OXA-58. Carbapenemase-producing bacteria are mainly described in human patients and the intestinal tract represents a common source for such pathogens. In this study, we sequenced and analyzed the genome of A. baumannii IHIT7853, a carbapenem-resistant, OXA-23 producing strain isolated from cystitis in a cat in 2000 in Germany. Results Phylogenetic analysis revealed that IHIT7853 belonged to the globally distributed international clone IC1 and MLST type ST1/ST231 (Pasteur/Oxford MLST scheme). A phylogenetic tree based on the maximum common genome of 18 A. baumannii isolates placed IHIT7853 close to human clinical isolates, such as the multidrug-resistant (MDR) outbreak strain AYE that was isolated from a patient with pneumonia and cystitis in 2001 in France. The OXA-23 plasmid sequence could be determined as 53,995 bp in size, possessing resistance genes strA and strB in addition to blaOXA-23. Conclusions The analysis of the genome of IHIT7853 reveals that companion animals carry MDR A. baumannii that resemble relevant clonal lineages involved in severe infections in humans. As urinary tract infections are often caused by bacteria that reside in the intestinal tract, future studies should unveil, if the animal gut serves as a source for MDR A. baumannii.
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Affiliation(s)
- Christa Ewers
- Institute of Hygiene and Infectious Diseases of Animals, Justus-Liebig-University Giessen, Frankfurter Str. 85-89, 35392 Giessen, Germany
| | - Peter Klotz
- Institute of Hygiene and Infectious Diseases of Animals, Justus-Liebig-University Giessen, Frankfurter Str. 85-89, 35392 Giessen, Germany
| | - Sandra Scheufen
- Institute of Hygiene and Infectious Diseases of Animals, Justus-Liebig-University Giessen, Frankfurter Str. 85-89, 35392 Giessen, Germany
| | - Ursula Leidner
- Institute of Hygiene and Infectious Diseases of Animals, Justus-Liebig-University Giessen, Frankfurter Str. 85-89, 35392 Giessen, Germany
| | - Stephan Göttig
- Institute of Medical Microbiology and Infection Control, Hospital of the Johann Wolfgang von Goethe-University, Frankfurt am Main, Germany
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De Vos D, Pirnay JP, Bilocq F, Jennes S, Verbeken G, Rose T, Keersebilck E, Bosmans P, Pieters T, Hing M, Heuninckx W, De Pauw F, Soentjens P, Merabishvili M, Deschaght P, Vaneechoutte M, Bogaerts P, Glupczynski Y, Pot B, van der Reijden TJ, Dijkshoorn L. Molecular Epidemiology and Clinical Impact of Acinetobacter calcoaceticus-baumannii Complex in a Belgian Burn Wound Center. PLoS One 2016; 11:e0156237. [PMID: 27223476 PMCID: PMC4880317 DOI: 10.1371/journal.pone.0156237] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2015] [Accepted: 05/11/2016] [Indexed: 12/21/2022] Open
Abstract
Multidrug resistant Acinetobacter baumannii and its closely related species A. pittii and A. nosocomialis, all members of the Acinetobacter calcoaceticus-baumannii (Acb) complex, are a major cause of hospital acquired infection. In the burn wound center of the Queen Astrid military hospital in Brussels, 48 patients were colonized or infected with Acb complex over a 52-month period. We report the molecular epidemiology of these organisms, their clinical impact and infection control measures taken. A representative set of 157 Acb complex isolates was analyzed using repetitive sequence-based PCR (rep-PCR) (DiversiLab) and a multiplex PCR targeting OXA-51-like and OXA-23-like genes. We identified 31 rep-PCR genotypes (strains). Representatives of each rep-type were identified to species by rpoB sequence analysis: 13 types to A. baumannii, 10 to A. pittii, and 3 to A. nosocomialis. It was assumed that isolates that belonged to the same rep-type also belonged to the same species. Thus, 83.4% of all isolates were identified to A. baumannii, 9.6% to A. pittii and 4.5% to A. nosocomialis. We observed 12 extensively drug resistant Acb strains (10 A. baumannii and 2 A. nosocomialis), all carbapenem-non-susceptible/colistin-susceptible and imported into the burn wound center through patients injured in North Africa. The two most prevalent rep-types 12 and 13 harbored an OXA-23-like gene. Multilocus sequence typing allocated them to clonal complex 1 corresponding to EU (international) clone I. Both strains caused consecutive outbreaks, interspersed with periods of apparent eradication. Patients infected with carbapenem resistant A. baumannii were successfully treated with colistin/rifampicin. Extensive infection control measures were required to eradicate the organisms. Acinetobacter infection and colonization was not associated with increased attributable mortality.
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Affiliation(s)
- Daniel De Vos
- Laboratory for Molecular and Cellular Technology, Queen Astrid Military Hospital, Brussels, Belgium
| | - Jean-Paul Pirnay
- Laboratory for Molecular and Cellular Technology, Queen Astrid Military Hospital, Brussels, Belgium
- * E-mail:
| | - Florence Bilocq
- Laboratory for Molecular and Cellular Technology, Queen Astrid Military Hospital, Brussels, Belgium
| | - Serge Jennes
- Burn Wound Center, Queen Astrid Military Hospital, Brussels, Belgium
| | - Gilbert Verbeken
- Laboratory for Molecular and Cellular Technology, Queen Astrid Military Hospital, Brussels, Belgium
| | - Thomas Rose
- Burn Wound Center, Queen Astrid Military Hospital, Brussels, Belgium
| | | | - Petra Bosmans
- Hospital Hygiene and Infection Control Team, Queen Astrid Military Hospital, Brussels, Belgium
| | - Thierry Pieters
- Hospital Hygiene and Infection Control Team, Queen Astrid Military Hospital, Brussels, Belgium
| | - Mony Hing
- Clinical Laboratory, Queen Astrid Military Hospital, Brussels, Belgium
| | - Walter Heuninckx
- Clinical Laboratory, Queen Astrid Military Hospital, Brussels, Belgium
| | - Frank De Pauw
- Medical Communication and Information Systems, ACOS WB/Health Division, Queen Astrid Military Hospital, Brussels, Belgium
| | - Patrick Soentjens
- Burn Wound Center, Queen Astrid Military Hospital, Brussels, Belgium
| | - Maia Merabishvili
- Laboratory for Molecular and Cellular Technology, Queen Astrid Military Hospital, Brussels, Belgium
- Laboratory Bacteriology Research, University of Ghent, Ghent, Belgium
| | - Pieter Deschaght
- Laboratory Bacteriology Research, University of Ghent, Ghent, Belgium
| | | | - Pierre Bogaerts
- Laboratoire de Bactériologie, CHU Mont-Godinne, Université Catholique de Louvain, Yvoir, Belgium
| | - Youri Glupczynski
- Laboratoire de Bactériologie, CHU Mont-Godinne, Université Catholique de Louvain, Yvoir, Belgium
| | - Bruno Pot
- Applied Maths, Sint-Martens-Latem, Belgium
| | - Tanny J. van der Reijden
- Department of Infectious Diseases C5-P, Leiden University Medical Center, Leiden, The Netherlands
| | - Lenie Dijkshoorn
- Department of Infectious Diseases C5-P, Leiden University Medical Center, Leiden, The Netherlands
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Rieber H, Frontzek A, Pfeifer Y. Molecular Investigation of Carbapenem-Resistant Acinetobacter spp. from Hospitals in North Rhine-Westphalia, Germany. Microb Drug Resist 2016; 23:25-31. [PMID: 27093111 DOI: 10.1089/mdr.2016.0035] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
Emergence of carbapenem-resistant Acinetobacter spp., especially Acinetobacter baumannii, in hospitals has been increasingly detected worldwide. In the present study, we analyzed carbapenem-resistant isolates (70 A. baumannii and one Acinetobacter pittii) collected in a period of 4 years (February 2008 to January 2012) in one diagnostic laboratory in Germany. All isolates were carbapenemase positive with OXA-23 as by far the most common enzyme (n = 66, 93%). Carbapenemases OXA-24-like and OXA-58 were not present in the isolates, but genes blaGIM-1 and ISAba1+blaOXA-80/82 were found to be the cause of carbapenem resistance in one and four isolates, respectively. Polymerase chain reaction typing revealed that the majority of A. baumannii isolates could be assigned to the very successful international clone 2. ApaI-macrorestriction and pulsed-field gel electrophoresis (PFGE) indicated clonal transmission of resistant strains (eight different PFGE types) within several hospitals. By multilocus sequence typing, the isolates were to be assigned to ST195 (n = 44), ST236 (n = 12), ST208 (n = 4), ST437 (n = 3), ST231 (n = 3), ST448 (n = 2), ST556 (n = 1), and ST945 (n = 1). The wide spread of carbapenem-resistant clones of A. baumannii is facilitated by international travelling and needs continuous surveillance in hospitals and diagnostic laboratories.
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Affiliation(s)
- Heime Rieber
- 1 Division of Microbiology , Medizinisches Versorgungszentrum Dr. Stein, Mönchengladbach, Germany
| | - Andre Frontzek
- 1 Division of Microbiology , Medizinisches Versorgungszentrum Dr. Stein, Mönchengladbach, Germany
| | - Yvonne Pfeifer
- 2 Robert Koch Institute , Nosocomial Pathogens and Antibiotic Resistance, Wernigerode, Germany
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The First Outbreak Caused by Acinetobacter baumannii ST208 and ST195 in China. BIOMED RESEARCH INTERNATIONAL 2016; 2016:9254907. [PMID: 27144176 PMCID: PMC4842041 DOI: 10.1155/2016/9254907] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/04/2015] [Revised: 02/25/2016] [Accepted: 03/17/2016] [Indexed: 02/05/2023]
Abstract
This study aimed to analyze the clinical characteristics of patients and molecular mechanisms of the first outbreak mainly caused by sequence types (STs) 208 multidrug resistant (MDR) Acinetobacter baumannii in China. A total of 10 clinical samples were collected from 5 patients who were involved in the outbreak. Bacterial identification and antibiotic sensitivity tests were performed by the VITEK-2 COMPACT automated system. MICs of tigecycline for clinical isolates were determined using broth microdilution. The clonal relatedness of A. baumannii clinical isolates in our local settings was determinated by pulsed-field gel electrophoresis (PFGE) and multilocus sequence typing (MLST). A total of 7 A. baumannii strains were isolated and all were MDR strains; two of them were carbapenem-nonsusceptible strains. bla OXA-23 was the only acquired carbapenemase gene in the isolates. The isolates belonged to a single clonal pulsotype determined by PFGE and two sequences types (STs) determined by MLST. The isolates belonged to the globally disseminated clonal complex 92, among which ST195 and ST208 were the most common sequence types (71.43% and 28.57%). The outbreak was successfully controlled by stringent infection control measures, especially improving the hand hygiene compliance and enhancing antimicrobial stewardship. In conclusion, this is the first description of an outbreak caused mainly by A. baumannii of ST208 in China. Infection control measures should be strengthened when infection outbreaks in hospital.
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Molter G, Seifert H, Mandraka F, Kasper G, Weidmann B, Hornei B, Öhler M, Schwimmbeck P, Kröschel P, Higgins PG, Reuter S. Outbreak of carbapenem-resistant Acinetobacter baumannii in the intensive care unit: a multi-level strategic management approach. J Hosp Infect 2015; 92:194-8. [PMID: 26778130 DOI: 10.1016/j.jhin.2015.11.007] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2015] [Accepted: 11/10/2015] [Indexed: 11/18/2022]
Abstract
An outbreak of carbapenem-resistant Acinetobacter baumannii (CRAb) occurred in an interdisciplinary intensive care unit, affecting 10 patients. Within hours of recognition of the spread of CRAb an intervention team was instituted for collection of available data, decision-making, communication and monitoring of all interventions performed, including cohorting, temporary stop of admissions, staff education, and enforcement of infection control measures. An area was defined for cohortation of patients colonized with CRAb, with a separate nursing team and a second set of mobile equipment. New transmissions were no longer observed after only four days into the institution of enhanced infection control measures.
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Affiliation(s)
- G Molter
- Department of Anaesthesiology and Intensive Care Medicine, Klinikum Leverkusen, Leverkusen, Germany
| | - H Seifert
- Institute for Medical Microbiology, Immunology and Hygiene, University Hospital of Cologne, Cologne, Germany; German Center for Infection Research, partner site Cologne-Bonn, Germany
| | - F Mandraka
- Department of Infectious Diseases and General Internal Medicine, Klinikum Leverkusen, Leverkusen, Germany
| | - G Kasper
- Department of Infection Control, Klinikum Leverkusen, Leverkusen, Germany
| | - B Weidmann
- Department of Cardiology and Intensive Care Medicine, Klinikum Leverkusen, Leverkusen, Germany
| | - B Hornei
- Synlab Laboratory Services, Leverkusen, Germany
| | - M Öhler
- Public Health Department of the City of Leverkusen, Germany
| | - P Schwimmbeck
- Department of Cardiology and Intensive Care Medicine, Klinikum Leverkusen, Leverkusen, Germany
| | - P Kröschel
- Institute of Clinical Pharmacology, Klinikum Leverkusen, Leverkusen, Germany
| | - P G Higgins
- Institute for Medical Microbiology, Immunology and Hygiene, University Hospital of Cologne, Cologne, Germany
| | - S Reuter
- Department of Infectious Diseases and General Internal Medicine, Klinikum Leverkusen, Leverkusen, Germany; Department of Infection Control, Klinikum Leverkusen, Leverkusen, Germany.
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Salimizand H, Noori N, Meshkat Z, Ghazvini K, Amel SJ. Prevalence of Acinetobacter baumannii harboring ISAba1/blaOXA-23-like family in a burn center. Burns 2015; 41:1100-6. [DOI: 10.1016/j.burns.2014.12.008] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2014] [Revised: 10/27/2014] [Accepted: 12/10/2014] [Indexed: 11/29/2022]
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Spread of OXA-23-producing Acinetobacter baumannii ST2 and ST246 in a hospital in Japan. J Med Microbiol 2015; 64:739-744. [DOI: 10.1099/jmm.0.000077] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
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Insufficient Discriminatory Power of Matrix-Assisted Laser Desorption Ionization Time-of-Flight Mass Spectrometry Dendrograms to Determine the Clonality of Multi-Drug-Resistant Acinetobacter baumannii Isolates from an Intensive Care Unit. BIOMED RESEARCH INTERNATIONAL 2015; 2015:535027. [PMID: 26101775 PMCID: PMC4458526 DOI: 10.1155/2015/535027] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/06/2014] [Accepted: 01/27/2015] [Indexed: 12/16/2022]
Abstract
While pulsed-field gel electrophoresis (PFGE) is recognized as the gold standard method for clonality analysis, MALDI-TOF MS has recently been spotlighted as an alternative tool for species identification. Herein, we compared the dendrograms of multi-drug-resistant (MDR) Acinetobacter baumannii isolates by using MALDI-TOF MS with those by using PFGE. We used direct colony and protein extraction methods for MALDI-TOF MS dendrograms. The isolates with identical PFGE patterns were grouped into different branches in MALDI-TOF MS dendrograms. Among the isolates that were classified as very close isolates in MALDI-TOF MS dendrogram, PFGE band patterns visually showed complete differences. We numeralized similarity among isolates by measuring distance levels. The Spearman rank correlation coefficient values were 0.449 and 0.297 between MALDI-TOF MS dendrogram using direct colony and protein extraction method versus PFGE, respectively. This study is the first paper focusing solely on the dendrogram function of MALDI-TOF MS compared with PFGE. Although MALDI-TOF MS is a promising tool to identify species in a rapid manner, our results showed that MALDI-TOF MS dendrograms could not substitute PFGE for MDR Acinetobacter baumannii clonality analysis.
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Lin MF, Lan CY. Antimicrobial resistance in Acinetobacter baumannii: From bench to bedside. World J Clin Cases 2014; 2:787-814. [PMID: 25516853 PMCID: PMC4266826 DOI: 10.12998/wjcc.v2.i12.787] [Citation(s) in RCA: 207] [Impact Index Per Article: 20.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2014] [Revised: 08/25/2014] [Accepted: 10/27/2014] [Indexed: 02/05/2023] Open
Abstract
Acinetobacter baumannii (A. baumannii) is undoubtedly one of the most successful pathogens in the modern healthcare system. With invasive procedures, antibiotic use and immunocompromised hosts increasing in recent years, A. baumannii has become endemic in hospitals due to its versatile genetic machinery, which allows it to quickly evolve resistance factors, and to its remarkable ability to tolerate harsh environments. Infections and outbreaks caused by multidrug-resistant A. baumannii (MDRAB) are prevalent and have been reported worldwide over the past twenty or more years. To address this problem effectively, knowledge of species identification, typing methods, clinical manifestations, risk factors, and virulence factors is essential. The global epidemiology of MDRAB is monitored by persistent surveillance programs. Because few effective antibiotics are available, clinicians often face serious challenges when treating patients with MDRAB. Therefore, a deep understanding of the resistance mechanisms used by MDRAB can shed light on two possible strategies to combat the dissemination of antimicrobial resistance: stringent infection control and antibiotic treatments, of which colistin-based combination therapy is the mainstream strategy. However, due to the current unsatisfying therapeutic outcomes, there is a great need to develop and evaluate the efficacy of new antibiotics and to understand the role of other potential alternatives, such as antimicrobial peptides, in the treatment of MDRAB infections.
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Merino M, Poza M, Roca I, Barba MJ, Sousa MD, Vila J, Bou G. Nosocomial Outbreak of a MultiresistantAcinetobacter baumanniiExpressing OXA-23 Carbapenemase in Spain. Microb Drug Resist 2014; 20:259-63. [DOI: 10.1089/mdr.2013.0127] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- María Merino
- Microbiology Department, Biomedical Research Institute-INIBIC, University Hospital A Coruña, A Coruña, Spain
| | - Margarita Poza
- Microbiology Department, Biomedical Research Institute-INIBIC, University Hospital A Coruña, A Coruña, Spain
| | - Ignasi Roca
- Barcelona Centre for International Health Research (CRESIB, Hospital Clínic-Universitat de Barcelona), Barcelona, Spain
| | - María José Barba
- Microbiology Department, Biomedical Research Institute-INIBIC, University Hospital A Coruña, A Coruña, Spain
| | | | - Jordi Vila
- Barcelona Centre for International Health Research (CRESIB, Hospital Clínic-Universitat de Barcelona), Barcelona, Spain
| | - Germán Bou
- Microbiology Department, Biomedical Research Institute-INIBIC, University Hospital A Coruña, A Coruña, Spain
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Krageschmidt DA, Kubly AF, Browning MS, Wright AJ, Lonneman JD, Detmer MJ, McCoy WF. A comprehensive water management program for multicampus healthcare facilities. Infect Control Hosp Epidemiol 2014; 35:556-63. [PMID: 24709725 DOI: 10.1086/675822] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVE Develop and implement an effective program for hazard analysis and control of waterborne pathogens at a multicampus hospital with clinics. DESIGN A longitudinal study. Several-year study including analysis of results from monitoring and tests of 26 building water systems. SETTING Outpatient and inpatient healthcare facilities network. METHODS The hazard analysis and critical control point (HACCP) process was used to develop a water management program (WMP) for the hospital campuses. The HACCP method systematically addressed 3 questions: (1) What are the potential waterborne hazards in the building water systems of these facilities? (2) How are the hazards being controlled? (3) How do we know that the hazards have been controlled? Microbiological and chemical tests of building water samples were used to validate the performance of the WMP; disease surveillance data further validated effective hazard control. RESULTS Hazard analysis showed that waterborne pathogens were generally in good control and that the water quality was good in all facilities. The hospital network has had several legionellosis cases that were identified as presumptive hospital acquired, but none was confirmed or substantiated by water testing in follow-up investigations. Building water system studies unrelated to these cases showed that pressure tanks and electronic automatic faucets required additional hazard control. CONCLUSIONS Application of the HACCP process for long-term building water systems management was practical and effective. The need for critical control point management of temperature, flow, and oxidant (chlorine) residual concentration was emphasized. The process resulted in discovery of water system components requiring additional hazard control.
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Pasanen T, Koskela S, Mero S, Tarkka E, Tissari P, Vaara M, Kirveskari J. Rapid molecular characterization of Acinetobacter baumannii clones with rep-PCR and evaluation of carbapenemase genes by new multiplex PCR in Hospital District of Helsinki and Uusimaa. PLoS One 2014; 9:e85854. [PMID: 24465749 PMCID: PMC3897539 DOI: 10.1371/journal.pone.0085854] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2013] [Accepted: 12/02/2013] [Indexed: 12/25/2022] Open
Abstract
Multidrug-resistant Acinetobacter baumannii (MDRAB) is an increasing problem worldwide. Prevalence of carbapenem resistance in Acinetobacter spp. due to acquired carbapenemase genes is not known in Finland. The purpose of this study was to examine prevalence and clonal spread of multiresistant A. baumannii group species, and their carbapenemase genes. A total of 55 Acinetobacter isolates were evaluated with repetitive PCR (DiversiLab) to analyse clonality of isolates, in conjunction with antimicrobial susceptibility profile for ampicillin/sulbactam, colistin, imipenem, meropenem, rifampicin and tigecycline. In addition, a new real-time PCR assay, detecting most clinically important carbapenemase genes just in two multiplex reactions, was developed. The assay detects genes for KPC, VIM, IMP, GES-1/-10, OXA-48, NDM, GIM-1, SPM-1, IMI/NMC-A, SME, CMY-10, SFC-1, SIM-1, OXA-23-like, OXA-24/40-like, OXA-58 and ISAbaI-OXA-51-like junction, and allows confident detection of isolates harbouring acquired carbapenemase genes. There was a time-dependent, clonal spread of multiresistant A. baumannii strongly correlating with carbapenamase gene profile, at least in this geographically restricted study material. The new carbapenemase screening assay was able to detect all the genes correctly suggesting it might be suitable for epidemiologic screening purposes in clinical laboratories.
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Affiliation(s)
- Tanja Pasanen
- Division of Clinical Microbiology, Helsinki University Hospital, Helsinki, Finland
- * E-mail:
| | - Suvi Koskela
- Division of Clinical Microbiology, Helsinki University Hospital, Helsinki, Finland
| | - Sointu Mero
- Division of Clinical Microbiology, Helsinki University Hospital, Helsinki, Finland
| | - Eveliina Tarkka
- Division of Clinical Microbiology, Helsinki University Hospital, Helsinki, Finland
| | - Päivi Tissari
- Division of Clinical Microbiology, Helsinki University Hospital, Helsinki, Finland
| | - Martti Vaara
- Division of Clinical Microbiology, Helsinki University Hospital, Helsinki, Finland
| | - Juha Kirveskari
- Division of Clinical Microbiology, Helsinki University Hospital, Helsinki, Finland
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Tacconelli E, Cataldo M, Dancer S, De Angelis G, Falcone M, Frank U, Kahlmeter G, Pan A, Petrosillo N, Rodríguez-Baño J, Singh N, Venditti M, Yokoe D, Cookson B. ESCMID guidelines for the management of the infection control measures to reduce transmission of multidrug-resistant Gram-negative bacteria in hospitalized patients. Clin Microbiol Infect 2014; 20 Suppl 1:1-55. [DOI: 10.1111/1469-0691.12427] [Citation(s) in RCA: 527] [Impact Index Per Article: 52.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2013] [Revised: 09/29/2013] [Accepted: 10/06/2013] [Indexed: 01/04/2023]
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Kaase M. [Carbapenemases in gram-negative bacteria. Current data and trends of resistance resulting from the work of national reference centres]. Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz 2013; 55:1401-4. [PMID: 23114438 DOI: 10.1007/s00103-012-1552-x] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
The spread of carbapenemase-producing gram-negative bacteria is one of the major challenges of the present. Since 2009, the National Reference Laboratory for gram-negative nosocomial pathogens has observed the molecular epidemiology of carbapenemases in Germany. In 2011, 1,454 referred bacterial isolates were tested for the presence of carbapenemases. Carbapenemase was found in 34.4% of Enterobacteriaceae isolates, in 19.9% of Pseudomonas aeruginosa isolates and in 96.3% of Acinetobacter baumannii isolates. The most frequent carbapenemases in Enterobacteriaceae were OXA-48, KPC and VIM-1; in P. aeruginosa it was VIM-2 and in A. baumannii OXA-23.
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Affiliation(s)
- M Kaase
- Abteilung für Medizinische Mikrobiologie, Ruhr-Universität Bochum, Universitätsstrasse 150, Bochum, Germany.
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Anti-fungal and anti-bacterial activities of ethanol extracts of selected traditional Chinese medicinal herbs. ASIAN PAC J TROP MED 2013; 6:673-81. [DOI: 10.1016/s1995-7645(13)60117-0] [Citation(s) in RCA: 63] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2013] [Revised: 07/15/2013] [Accepted: 08/15/2013] [Indexed: 11/18/2022] Open
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Gram-negative bacteria that produce carbapenemases causing death attributed to recent foreign hospitalization. Antimicrob Agents Chemother 2013; 57:3085-91. [PMID: 23612195 DOI: 10.1128/aac.00297-13] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
Overseas travel, as a risk factor for the acquisition of infections due to antimicrobial-resistant organisms, has recently been linked to carbapenemase-producing Gram-negative bacteria. Multiresistant Klebsiella pneumoniae, Escherichia coli, and Acinetobacter baumannii strains were isolated from a wound of a Canadian patient with a recent history of hospitalization in India. This resulted in the initiation of outbreak management that included surveillance cultures. Epidemiological and molecular investigations showed that NDM-1-producing K. pneumoniae ST16 and OXA-23-producing A. baumannii ST10 strains were transmitted to 5 other patients, resulting in the colonization of 4 patients and the death of 1 patient due to septic shock caused by the OXA-23-producing A. baumannii strain. The high rate of false positivity of the screening cultures resulted in additional workloads and increased costs for infection control and clinical laboratory work. We believe that this is the first report of an infection with carbapenemase-producing Gram-negative bacteria resulting in death attributed to a patient with recent foreign hospitalization. We recommend routine rectal and wound screening for colonization with multiresistant bacteria for patients who have recently been admitted to hospitals outside Canada.
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Song W, Lee J, Kim TK, Park MJ, Kim HS, Kim JS. Modified CHROMagar Acinetobacter medium for direct detection of multidrug-resistant Acinetobacter strains in nasal and rectal swab samples. Ann Lab Med 2013; 33:193-5. [PMID: 23667846 PMCID: PMC3646194 DOI: 10.3343/alm.2013.33.3.193] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2012] [Revised: 12/11/2012] [Accepted: 02/16/2013] [Indexed: 11/19/2022] Open
Abstract
This study aimed to investigate whether CHROMagar Acinetobacter medium (CHROMagar, France) in combination with an antimicrobial supplement (modified CHROMagar Acinetobacter; CHROMagar, France) can be used for detecting and isolating multidrug-resistant Acinetobacter species (MRA) in nasal and rectal surveillance cultures. Nasal and rectal swab samples were collected from patients in an intensive care unit at a teaching hospital. The samples were used to inoculate modified CHROMagar Acinetobacter plates, which were examined after 24 and 48 hr of incubation at 37℃. Their susceptibility against the antimicrobial agents meropenem, imipenem, ciprofloxacin, and amikacin was analyzed using the Etest (bioMerieux, France). A total of 406 paired samples (406 nasal swabs and 406 rectal swabs) were obtained from 226 patients, and 120 samples (28 nasal and 28 rectal cultures, 47 nasal cultures only, and 17 rectal cultures only) yielded MRA. Seventy-five MRA isolates (18.5%) were recovered from the 406 nasal samples, and 45 MRA isolates (11.1%) were recovered from the 406 rectal samples. Of the 120 MRA isolates, 3 (2.5%) were detected only after 48 hr of incubation. The use of modified CHROMagar Acinetobacter together with nasal and rectal swabs and 1-day incubation is an effective surveillance tool for detecting MRA colonization.
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Affiliation(s)
- Wonkeun Song
- Department of Laboratory Medicine, Hallym University College of Medicine, Chuncheon, Korea.
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Ho CM, Ho MW, Chi CY, Lin CD, Lin CW, Tseng SP, Teng LJ, Chang HY, Chang HL, Chang YF, Lin HH, Tien N, Lu JJ, Lai CH. Repeated colonization by multi-drug-resistant Acinetobacter calcoaceticus-A. baumannii complex and changes in antimicrobial susceptibilities in surgical intensive care units. Surg Infect (Larchmt) 2013; 14:43-8. [PMID: 23425282 DOI: 10.1089/sur.2012.044] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND A nosocomial outbreak of multi-drug-resistant Acinetobacter calcoaceticus-A. baumannii (MDR-ACB) complex infection occurred in a newly constructed building at a 2,500-bed tertiary medical center in Taiwan. METHODS An investigation was carried out by molecular approaches to trace the bacteria. Antimicrobial susceptibilities, risk factors, and the occurrence of nosocomial MDR-ACB infections were investigated. From January to December 2009, 53 patients were infected with MDR-ACB, and 23 environmental surveys were performed in two surgical intensive care units (ICUs) within the new building. Forty-two clinical isolates were obtained from patients and 22 samples from nine environmental surveys. RESULTS Forty clinical isolates (95.2%) and 18 environmental samples (81.8%) were positive for MDR-ACB of type A, the predominant outbreak strain. This strain was identical to that isolated in an outbreak in the old hospital in 2006, as proved by repetitive extragenic palindromic-based polymerase chain reaction and pulsed-field gel electrophoresis. Although the outbreak isolates contained blaOXA-23-like and blaOXA-51-like genes, analysis of the antimicrobial susceptibilities demonstrated increases in resistance to cefepime and imipenem-cilastatin in MDR-ACB isolated in the later outbreak. CONCLUSIONS Not only patients or healthcare workers, but also medical equipment, might have carried the predominant outbreak strain from the old district to the new building. Therefore, even in a new environment, infection control programs must be enforced continually, and healthcare providers must be educated repeatedly to prevent recurrent outbreaks of MDR-ACB infection in the hospital setting.
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Affiliation(s)
- Cheng-Mao Ho
- Graduate Institute of Clinical Medical Science, School of Medicine, China Medical University, Taichung, Taiwan
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Sand M, Mingote AI, Santos H, Müller V, Averhoff B. Mannitol, a compatible solute synthesized by Acinetobacter baylyi in a two-step pathway including a salt-induced and salt-dependent mannitol-1-phosphate dehydrogenase. Environ Microbiol 2013; 15:2187-97. [PMID: 23414076 DOI: 10.1111/1462-2920.12090] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2012] [Revised: 01/08/2013] [Accepted: 01/10/2013] [Indexed: 11/29/2022]
Abstract
The nutritionally versatile and naturally competent soil bacterium Acinetobacter baylyi copes with salt stress by the accumulation of compatible solutes. NMR analyses revealed that cells amassed glutamate and the rather unusual sugar alcohol mannitol upon an increase of the external NaCl concentration. To unravel the path of mannitol biosynthesis, the genome was inspected for genes potentially involved in its biosynthesis. A gene encoding a potential mannitol-1-phosphate dehydrogenase (mtlD) was identified in the genome of A. baylyi. Expression of mtlD was highly induced at high salinity. mtlD was overexpressed and the purified protein indeed produced mannitol-1-phosphate from fructose-6-phosphate. The enzyme preferred NADPH over NADH and the specific activity of fructose-6-phosphate reduction with NADPH was 130 U mg(-1) . Enzymatic activity was strictly salt-dependent. Deletion of mtlD resulted in a complete loss of salt-dependent mannitol biosynthesis. We provide clear evidence that osmo-induced synthesis of the compatible solute mannitol is by a two-step pathway and that the mannitol-1-phosphate dehydrogenase mediating the first step of this pathway is regulated by salinity on the transcriptional as well as on the activity level.
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Affiliation(s)
- Miriam Sand
- Molecular Microbiology & Bioenergetics, Institute of Molecular Biosciences, Goethe University Frankfurt, Frankfurt am Main, Germany
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