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Yang Y, Li H, Wang D, Shi D, Yang Z, Zhou S, Yang D, Chen T, Li J, Chen J, Jin M. Metagenomics of high-altitude groundwater reveal different health risks associated with antibiotic-resistant pathogens and bacterial resistome in the latitudinal gradient. WATER RESEARCH 2024; 262:122032. [PMID: 39024671 DOI: 10.1016/j.watres.2024.122032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/03/2024] [Revised: 06/10/2024] [Accepted: 07/01/2024] [Indexed: 07/20/2024]
Abstract
Groundwater on the Tibetan Plateau is a critical water resource to people in Asia. However, its prevalence of antibiotic-resistant pathogens (ARPs), bacterial resistome and their driving factors remain unknown. Using metagenomics analysis, a hotspot of antibiotic-resistance genes (ARGs) and last-resort ARGs (LARGs) with a total of 639 subtypes was identified in the groundwater. Importantly, 164 metagenome-assembled genomes (MAGs) which possessed both ARGs and virulence factors (VFs) were assigned as potential ARPs, with the most abundant species being Acinetobacter johnsonii and Acinetobacter pittii. A total of 157 potential ARPs, involving Escherichia coli, were predicted as "natural" ARGs supercarriers. Thirty-six ARPs dominated by the genus Acinetobacter and Pseudomonas were found to harbour LARGs. Co-localizations of the ARG-mobile genetic elements (MGEs) showed that MGEs were significantly associated with ARGs in the ARPs, which suggests ARPs play a prominent role in ARG dissemination. Notably, latitudinal gradient is a driving factor in the occurrence of ARGs and ARPs. The average abundances of ARGs and ARP decreased as the latitude increased, with the highest abundance occurring in the region between 28.6◦N and 29.5◦N. MetaCompare further revealed health risks associated with the resistome decreased as the latitudes increased. These findings indicated different health risks associated with ARPs and bacterial resistome in latitudinal gradient groundwater. They raise the concerns of mitigating ARPs risk in groundwater on the Tibetan Plateau.
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Affiliation(s)
- Yidi Yang
- Department of Environment and Health, Tianjin Institute of Environmental & Operational Medicine, Key Laboratory of Risk Assessment and Control for Environment & Food Safety, Tianjin, 300050, China
| | - Haibei Li
- Department of Environment and Health, Tianjin Institute of Environmental & Operational Medicine, Key Laboratory of Risk Assessment and Control for Environment & Food Safety, Tianjin, 300050, China
| | - Dongshuai Wang
- Department of Environment and Health, Tianjin Institute of Environmental & Operational Medicine, Key Laboratory of Risk Assessment and Control for Environment & Food Safety, Tianjin, 300050, China
| | - Danyang Shi
- Department of Environment and Health, Tianjin Institute of Environmental & Operational Medicine, Key Laboratory of Risk Assessment and Control for Environment & Food Safety, Tianjin, 300050, China
| | - Zhongwei Yang
- Department of Environment and Health, Tianjin Institute of Environmental & Operational Medicine, Key Laboratory of Risk Assessment and Control for Environment & Food Safety, Tianjin, 300050, China
| | - Shuqing Zhou
- Department of Environment and Health, Tianjin Institute of Environmental & Operational Medicine, Key Laboratory of Risk Assessment and Control for Environment & Food Safety, Tianjin, 300050, China
| | - Dong Yang
- Department of Environment and Health, Tianjin Institute of Environmental & Operational Medicine, Key Laboratory of Risk Assessment and Control for Environment & Food Safety, Tianjin, 300050, China
| | - Tianjiao Chen
- Department of Environment and Health, Tianjin Institute of Environmental & Operational Medicine, Key Laboratory of Risk Assessment and Control for Environment & Food Safety, Tianjin, 300050, China
| | - Junwen Li
- Department of Environment and Health, Tianjin Institute of Environmental & Operational Medicine, Key Laboratory of Risk Assessment and Control for Environment & Food Safety, Tianjin, 300050, China
| | - Jingyuan Chen
- Department of Environment and Health, Tianjin Institute of Environmental & Operational Medicine, Key Laboratory of Risk Assessment and Control for Environment & Food Safety, Tianjin, 300050, China.
| | - Min Jin
- Department of Environment and Health, Tianjin Institute of Environmental & Operational Medicine, Key Laboratory of Risk Assessment and Control for Environment & Food Safety, Tianjin, 300050, China.
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Bello-López E, Escobedo-Muñoz AS, Guerrero G, Cruz-Córdova A, Garza-González E, Hernández-Castro R, Zarain PL, Morfín-Otero R, Volkow P, Xicohtencatl-Cortes J, Cevallos MA. Acinetobacter pittii: the emergence of a hospital-acquired pathogen analyzed from the genomic perspective. Front Microbiol 2024; 15:1412775. [PMID: 38989032 PMCID: PMC11233732 DOI: 10.3389/fmicb.2024.1412775] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2024] [Accepted: 05/22/2024] [Indexed: 07/12/2024] Open
Abstract
Acinetobacter pittii has increasingly been associated with several types of hospital-acquired severe infections. Genes implicated in carbapenem resistance, tigecycline resistance, or genes encoding extended spectrum cephalosporinases, such as blaADC, are commonly found in isolates implicated in these infections. A. pittii strains that are pandrug resistant have occasionally been identified. Food for human consumption, animals and plants are environmental sources of this pathogen. An alarming situation is that A. pitti has been identified as responsible for outbreaks in different regions worldwide. In this study, 384 genomes of A. pittii were analyzed, comprising sequences from clinical and non-clinical origins from 32 countries. The objective was to investigate if clinical strains possess genetic traits facilitating hospital adaptation. Results indicate significant genomic variability in terms of size and gene content among A. pittii isolates. The core genome represents a small portion (25-36%) of each isolate's genome, while genes associated with antibiotic resistance and virulence predominantly belong to the accessory genome. Notably, antibiotic resistance genes are encoded by a diverse array of plasmids. As the core genome between environmental and hospital isolates is the same, we can assume that hospital isolates acquired ARGs due to a high selective pressure in these settings. The strain's phylogeographic distribution indicates that there is no geographical bias in the isolate distribution; isolates from different geographic regions are dispersed throughout a core genome phylogenetic tree. A single clade may include isolates from extremely distant geographical areas. Furthermore, strains isolated from the environment or animal, or plant sources frequently share the same clade as hospital isolates. Our analysis showed that the clinical isolates do not already possess specific genes, other than antibiotic-resistant genes, to thrive in the hospital setting.
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Affiliation(s)
- Elena Bello-López
- Universidad Nacional Autónoma de México, Centro de Ciencias Genómicas, Programa de Genómica Evolutiva, Cuernavaca, Mexico
| | - Ana Sofía Escobedo-Muñoz
- Universidad Nacional Autónoma de México, Centro de Ciencias Genómicas, Programa de Genómica Evolutiva, Cuernavaca, Mexico
| | - Gabriela Guerrero
- Universidad Nacional Autónoma de México, Centro de Ciencias Genómicas, Unidad de Análisis Bioinformáticos, Cuernavaca, Mexico
| | - Ariadnna Cruz-Córdova
- Unidad de Enfermedades Infecciosas, Laboratorio de Investigación en Bacteriología Intestinal, Hospital Infantil de México Federico Gómez, Ciudad de México, Mexico
| | - Elvira Garza-González
- Universidad Autónoma de Nuevo León, Facultad de Medicina/Hospital Universitario Dr. José Eleuterio González, Departamento de Bioquímica y Medicina Molecular, Monterrey, Mexico
| | - Rigoberto Hernández-Castro
- Departamento de Ecología de Agentes Patógenos, Hospital General Dr. Manuel Gea González, Ciudad de México, Mexico
| | - Patricia Lozano Zarain
- Benemérita Universidad Autónoma de Puebla, Instituto de Ciencias, Centro de Investigaciones en Ciencias Microbiológicas, Laboratorio de Microbiología Hospitalaria y de la Comunidad, Puebla, Mexico
| | - Rayo Morfín-Otero
- Instituto de Patología Infecciosa y Experimental, Universidad de Guadalajara, Guadalajara, Mexico
| | - Patricia Volkow
- Instituto Nacional de Cancerología, Departamento de Enfermedades Infecciosas, Ciudad de México, Mexico
| | - Juan Xicohtencatl-Cortes
- Unidad de Enfermedades Infecciosas, Laboratorio de Investigación en Bacteriología Intestinal, Hospital Infantil de México Federico Gómez, Ciudad de México, Mexico
| | - Miguel A Cevallos
- Universidad Nacional Autónoma de México, Centro de Ciencias Genómicas, Programa de Genómica Evolutiva, Cuernavaca, Mexico
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Sadeeva Z, Novikova I, Alyabieva N, Lazareva A, Komiagina T, Karaseva O, Verschinina M, Fisenko A. ACINETOBACTER BAUMANNII IN BLOOD-BORNE AND CENTRAL NERVOUS SYSTEM INFECTIONS IN INTENSIVE CARE UNIT CHILDREN: MOLECULAR AND GENETIC CHARACTERISTICS AND CLINICAL SIGNIFICANCE. RUSSIAN JOURNAL OF INFECTION AND IMMUNITY 2023. [DOI: 10.15789/2220-7619-abi-2091] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/22/2023]
Abstract
Acinetobacter baumannii is a representative of the peak priority nosocomial pathogens capable of causing infections with high mortality and economic treatment costs. The purpose of our study was to determine a role of A. baumannii in blood-borne and central nervous system infections in children. We conducted a retrospective study of A. baumannii associated cases of bacteremia and CNS infection in children. A. baumannii strains were isolated from 17 children followed up with surgical pathology (congenital heart defects 24%, abdominal pathology 29%, severe combined trauma 29%) and with somatic diseases accompanied by antibacterial and/or glucocorticosteroid therapy 18%. The minimum inhibitory concentrations of antibiotics were determined by the broth microdilution method. Carbapenemase genes were detected by real time polymerase chain reaction. Biofilm formation genes were determined by PCR. Biofilms were grown using flat-bottomed polystyrene tablets, followed by coloring, fixation, elution and detection. Population diversity was assessed by the multilocus sequence typing. About a quarter of cases of bacteremia and central nervous system infection caused by A. baumannii had an unfavorable outcome. Resistance to carbapenems, aminoglycosides, fluoroquinolones was more than 70%. Carbapenemases of the OXA-23 (24%) and OXA-40 (41%) groups were identified. The study of biofilm production showed that A. baumannii isolates formed biofilms of varying intensity: weak biofilms (59%), moderate (35%) and strong (6%). During determining the sensitivity to meropenem for biofilm and planktonic forms of cultures, it was determined that the minimum inhibitory concentrations of meropenem were significantly higher for biofilms than for planktonic forms. The minimum inhibitory concentrations of meropenem for plankton cells ranged from 0.5 to 512 mg/l. While in biofilms the same microorganisms had in vitro minimum inhibitory concentrations of meropenem within 128 to 512 mg/l and higher. All isolates bore biofilm formation regulating genes: bfmR, bap and katE. The ompA gene was found in 94% strains, and the csuA/B gene was found in 88%. The population pattern of A. baumannii isolated from blood and cerebrospinal fluid of children was represented by nine different sequence types. Most of the isolates were represented by genotypes: ST944Oxf, ST1550Oxf, ST1104Oxf belonging to the international clonal line ICL6, and ST450Oxf, ST2063Oxf and ST1102Oxf of the international clonal line ICL2. Blood-borne and central nervous system infections associated with A. baumannii have a great importance in clinical practice. This microorganism is able to persist for a long time on biotic and abiotic surfaces, has a wide natural and acquired antibiotics resistance.
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Pulami D, Kämpfer P, Glaeser SP. High diversity of the emerging pathogen Acinetobacter baumannii and other Acinetobacter spp. in raw manure, biogas plants digestates, and rural and urban wastewater treatment plants with system specific antimicrobial resistance profiles. THE SCIENCE OF THE TOTAL ENVIRONMENT 2023; 859:160182. [PMID: 36395844 DOI: 10.1016/j.scitotenv.2022.160182] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/01/2022] [Revised: 11/09/2022] [Accepted: 11/10/2022] [Indexed: 06/16/2023]
Abstract
Carbapenem-resistant Acinetobacter baumannii causing immense treatment problems in hospitals. There is still a knowledge gap on the abundance and stability of acquired resistances and the diversity of resistant Acinetobacter in the environment. The aim of the study was to investigate the diversity and antimicrobial resistances of Acinetobacter spp. released from livestock and human wastewater into the environment. Raw and digested manure of small scale on farm biogas plants as well as untreated and treated wastewater and sewage sludge of rural and urban wastewater treatment plants (WWTPs) were studied comparatively. A total of 132 Acinetobacter isolates were phylogenetically identified (16S rRNA gene and rpoB sequence analyses) and 14 different phylotypes were detected. Fiftytwo isolates represented A. baumannii which were cultured from raw and digested manure of different biogas plants, and most stages of the rural WWTP (no hospital wastewater receiving) and the two studied urban WWTPs receiving veterinarian and human hospital wastewater. Multi-locus sequence typing (Pasteur_MLST) identified 23 novel and 12 known STs of A. baumannii. Most novel STs (18/23) were cultured from livestock samples and the rural WWTP. A. baumannii isolates from livestock and the rural WWTP were susceptible to carbapenems, colistin, ciprofloxacin, ceftazidime, and piperacillin. In contrast, A. baumannii isolates from the two urban WWTPs showed clinical linkage with respect to MLST and were multi-drug resistant (MDR). The presence of viable A. baumannii in digested manure and sewage sludge confirmed the survival of the strict aerobic bacteria during anoxic conditions. The study indicated the spread of diverse Acinetobacter from anthropogenic sources into the environment with a strong linkage of clinial associated MDR A. baumannii strains to the inflow of hospital wastewater to WWTPs. A more frequent detection of Acinetobacter in sewage sludge than effluent waters indicated that particle-attachment of Acinetobacter must be considered by the risk assessment of these bacteria.
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Affiliation(s)
- Dipen Pulami
- Institut for Applied Microbiology, Justus-Liebig-University Giessen, Germany
| | - Peter Kämpfer
- Institut for Applied Microbiology, Justus-Liebig-University Giessen, Germany
| | - Stefanie P Glaeser
- Institut for Applied Microbiology, Justus-Liebig-University Giessen, Germany.
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Wohlfarth E, Kresken M, Higgins PG, Stefanik D, Wille J, Hafner D, Körber-Irrgang B, Seifert H, Kniehl E, Funke G, Schumacher U, Wichelhaus TA, Hörauf A, Peters G, Becker K, Mellmann A, Weißer H, Siegel E, MacKenzie C, Holfelder M, Eigner U, Schubert S, Podbielski A, Diefenbach A, Göbel U, Straube E, Pfister W, Rödel J, Schneider W, Jantsch J, Ziesing S. The evolution of carbapenem resistance determinants and major epidemiological lineages among carbapenem-resistant Acinetobacter baumannii isolates in Germany, 2010-2019. Int J Antimicrob Agents 2022; 60:106689. [PMID: 36375774 DOI: 10.1016/j.ijantimicag.2022.106689] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2022] [Revised: 07/03/2022] [Accepted: 11/06/2022] [Indexed: 11/13/2022]
Abstract
The aim of this study was to investigate and compare the molecular epidemiology and carbapenem resistance determinants in clinical Acinetobacter baumannii isolates collected during four multicentre surveillance studies conducted by the Paul-Ehrlich-Society for Infection Therapy. Isolates were collected prospectively from hospital in-patients at 17 medical centres in Germany over four periods of three- to six-months starting in October of each of 2010, 2013, 2016 and 2019. Species identification was performed by MALDI-TOF, gyrB multiplex polymerase chain reaction (PCR), and detection of the intrinsic blaOXA-51-like gene. Minimum inhibitory concentrations were determined by broth microdilution. The prevalence of carbapenemase-encoding genes was investigated by OXA-multiplex PCR and whole-genome sequencing. Molecular epidemiology was examined by rep-PCR and core-genome multi-locus sequence typing. A total of 302 A. baumannii isolates were collected. Resistance to imipenem and/or meropenem was detected in 58 isolates (19.2%) from 14 centres. The proportion of carbapenem-resistant isolates increased from 21.3% in 2010 to 33.3% in 2013, and then decreased to 13.8% in 2016 and 12.3% in 2019. Forty-six of these isolates were associated with the international clonal lineage IC2 and five with IC1. The most prevalent carbapenemase gene detected was blaOXA-23-like (n=51). Further carbapenem-resistance determinants were blaOXA-40-like (n=1), blaOXA-58-like (n=3) and blaNDM-1 (n=2). In one isolate, ISAba1 was detected upstream of blaOXA-51-like. In conclusion, IC2 was the most prevalent clonal lineage detected in this study. Interestingly, in Germany, carbapenem resistance seems to have decreased in A. baumannii between 2013 and 2019.
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Affiliation(s)
| | - Michael Kresken
- Antiinfectives Intelligence GmbH, Cologne, Germany; Rheinische Fachhochschule Köln gGmbH, Cologne, Germany.
| | - Paul G Higgins
- Institute for Medical Microbiology, Immunology and Hygiene, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany; German Center for Infection Research (DZIF), Partner Site Bonn-Cologne, Cologne, Germany.
| | - Danuta Stefanik
- Institute for Medical Microbiology, Immunology and Hygiene, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Julia Wille
- Institute for Medical Microbiology, Immunology and Hygiene, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany; German Center for Infection Research (DZIF), Partner Site Bonn-Cologne, Cologne, Germany.
| | - Dieter Hafner
- Institute of Pharmacology and Clinical Pharmacology, University Hospital, Heinrich-Heine-University, Düsseldorf, Germany.
| | | | - Harald Seifert
- Institute for Medical Microbiology, Immunology and Hygiene, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany; German Center for Infection Research (DZIF), Partner Site Bonn-Cologne, Cologne, Germany.
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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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Ding Z, Li Z, Zhao Y, Hao J, Li T, Liu Y, Zeng Z, Liu J. Phenotypic and Genotypic Characteristics of a Tigecycline-Resistant Acinetobacter pittii Isolate Carrying bla NDM-1 and the Novel bla OXA Allelic Variant bla OXA-1045. Front Microbiol 2022; 13:868152. [PMID: 35602052 PMCID: PMC9116503 DOI: 10.3389/fmicb.2022.868152] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2022] [Accepted: 03/30/2022] [Indexed: 11/13/2022] Open
Abstract
A tigecycline-resistant Acinetobacter pittii clinical strain from pleural fluid carrying a blaNDM–1 gene and a novel blaOXA gene, blaOXA–1045, was isolated and characterized. The AP2044 strain acquired two copies of the blaNDM–1 gene and six antibiotic resistance genes (ARGs) from other pathogens. According to the whole-genome investigation, the GC ratios of ARGs (50–60%) were greater than those of the chromosomal backbone (39.46%), indicating that ARGs were horizontally transferred. OXA-1045 belonged to the OXA-213 subfamily and the amino acid sequence of OXA-1045 showed 89% similarity to the amino acid sequences of OXA-213. Then, blaOXA–1045 and blaOXA–213 were cloned and the minimum inhibitory concentrations (MICs) of β-lactams in the transformants were determined using the broth microdilution method. OXA-1045 was able to confer a reduced susceptibility to piperacillin and piperacillin-tazobactam compared to OXA-213. AP2044 strain exhibited low pathogenicity in Galleria mellonella infection models. The observation of condensed biofilm using the crystal violet staining method and scanning electron microscopy (SEM) suggested that the AP2044 strain was a weak biofilm producer. Quantitative reverse transcription-PCR (qRT-PCR) was used to detect the expression of resistance-nodulation-cell division (RND) efflux pump-related genes. The transcription level of adeB and adeJ genes increased significantly and was correlated with tigecycline resistance. Therefore, our genomic and phenotypic investigations revealed that the AP2044 strain had significant genome plasticity and natural transformation potential, and the emergence of antibiotic resistance in these unusual bacteria should be a concern for future investigations.
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Affiliation(s)
- Zixuan Ding
- Department of Laboratory Medicine, The Affiliated Hospital of Southwest Medical University, Luzhou, China
| | - Zhaoyinqian Li
- Department of Laboratory Medicine, The Affiliated Hospital of Southwest Medical University, Luzhou, China
| | - Yuanqing Zhao
- Department of Laboratory Medicine, The Affiliated Hospital of Southwest Medical University, Luzhou, China
| | - Jingchen Hao
- Department of Laboratory Medicine, The Affiliated Hospital of Southwest Medical University, Luzhou, China
| | - Tingting Li
- Department of Laboratory Medicine, The Affiliated Hospital of Southwest Medical University, Luzhou, China
| | - Yao Liu
- Department of Laboratory Medicine, The Affiliated Hospital of Southwest Medical University, Luzhou, China
| | - Zhangrui Zeng
- Department of Laboratory Medicine, The Affiliated Hospital of Southwest Medical University, Luzhou, China
| | - Jinbo Liu
- Department of Laboratory Medicine, The Affiliated Hospital of Southwest Medical University, Luzhou, China
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Petropoulou D, Siopi M, Vourli S, Pournaras S. Activity of Sulbactam-Durlobactam and Comparators Against a National Collection of Carbapenem-Resistant Acinetobacter baumannii Isolates From Greece. Front Cell Infect Microbiol 2022; 11:814530. [PMID: 35127562 PMCID: PMC8812809 DOI: 10.3389/fcimb.2021.814530] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2021] [Accepted: 12/28/2021] [Indexed: 02/01/2023] Open
Abstract
Background Acinetobacter baumannii is a leading cause of healthcare-associated infections worldwide, due to both its persistence in the hospital setting and ability to acquire high levels of antibiotic resistance. Carbapenem-resistant A. baumannii isolates (CRAB) limit the activity of current antimicrobial regimens and new alternatives or adjuncts to traditional antibiotics are urgently needed. Durlobactam is a novel broad-spectrum inhibitor of serine-type β-lactamases that restores sulbactam (SUL) activity against A. baumannii. The sulbactam-durlobactam (SD) combination has recently completed Phase 3 testing in the global ATTACK trial. Objectives The aim of this study is to evaluate the in vitro activity of SD versus comparators against a representative nationwide collection of CRAB isolates. Methods One hundred ninety CRAB isolates were collected from clinical samples of patients hospitalized in 11 hospitals throughout Greece during 2015. In vitro activities of SD and comparators (SUL alone, amikacin, minocycline, imipenem, meropenem, colistin, SD and imipenem combined with SD) were determined by broth microdilution. Results Durlobactam restored sulbactam activity against the majority of the strains tested, with SD exhibiting the lowest MIC90 (8 μg/ml) relative to the other single comparators tested; 87.9% of the isolates had SD MICs ≤4/4 µg/ml. The most active comparator was colistin (MIC90 = 16 μg/ml). The addition of imipenem further lowered the MIC90 of SD by one two-fold dilution. Conclusions This study demonstrated the potential utility of SD for the treatment of infections caused by A. baumannii. If its clinical efficacy is confirmed, SD may be an important therapeutic option for CRAB infections.
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Nguyen M, Joshi SG. Carbapenem resistance in Acinetobacter baumannii, and their importance in hospital-acquired infections: a scientific review. J Appl Microbiol 2021; 131:2715-2738. [PMID: 33971055 DOI: 10.1111/jam.15130] [Citation(s) in RCA: 87] [Impact Index Per Article: 29.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2020] [Revised: 03/30/2021] [Accepted: 05/04/2021] [Indexed: 02/05/2023]
Abstract
Carbapenem is an important therapy for serious hospital-acquired infections and for the care of patients affected by multidrug-resistant organisms, specifically Acinetobacter baumannii; however, with the global increase of carbapenem-resistant A. baumannii, this pathogen has significantly threatened public health. Thus, there is a pressing need to better understand this pathogen in order to develop novel treatments and control strategies for dealing with A. baumannii. In this review, we discuss an overview of carbapenem, including its discovery, development, classification and biological characteristics, and its importance in hospital medicine especially in critical care units. We also describe the peculiarity of bacterial pathogen, A. baumannii, including its commonly reported virulence factors, environmental persistence and carbapenem resistance mechanisms. In closing, we discuss various control strategies for overcoming carbapenem resistance in hospitals and for limiting outbreaks. With the appearance of strains that resist carbapenem, the aim of this review is to highlight the importance of understanding this increasingly problematic healthcare-associated pathogen that creates significant concern in the field of nosocomial infections and overall public health.
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Affiliation(s)
- M Nguyen
- Center for Surgical Infections, Drexel University School of Biomedical Engineering, Science & Health Systems, Philadelphia, PA, USA
| | - S G Joshi
- Center for Surgical Infections, Drexel University School of Biomedical Engineering, Science & Health Systems, Philadelphia, PA, USA.,Institute of Molecular Medicine and Infectious Diseases, Center for Surgical Infections, Drexel University, Philadelphia, PA, USA
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An Update on Wastewater Multi-Resistant Bacteria: Identification of Clinical Pathogens Such as Escherichia coli O25b:H4-B2-ST131-Producing CTX-M-15 ESBL and KPC-3 Carbapenemase-Producing Klebsiella oxytoca. Microorganisms 2021; 9:microorganisms9030576. [PMID: 33799747 PMCID: PMC8001128 DOI: 10.3390/microorganisms9030576] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2021] [Revised: 03/08/2021] [Accepted: 03/08/2021] [Indexed: 11/28/2022] Open
Abstract
Wastewater treatment plants (WWTPs) are significant reservoirs of bacterial resistance. This work aims to identify the determinants of resistance produced by Gram-negative bacteria in the influent and effluent of two WWTPs in Portugal. A total of 96 wastewater samples were obtained between 2016 and 2019. The numbers of total aerobic and fecal contamination bacteria were evaluated, and genomic features were searched by polymerase chain reaction (PCR) and Next-Generation Sequencing (NGS). Enterobacteriaceae corresponded to 78.6% (n = 161) of the 205 isolates identified by 16sRNA. The most frequent isolates were Escherichia spp. (57.1%, n = 117), followed by Aeromonas spp. (16.1%, n = 33) and Klebsiella spp. (12.7%, n = 26). The remaining 29 isolates (14.1%) were distributed across 10 different genera. Among the 183 resistant genes detected, 54 isolates produced extended spectrum β-lactamases (ESBL), of which blaCTX-M-15 was predominant (37 isolates; 68.5%). A KPC-3 carbapenemase-producing K. oxytoca was identified (n = 1), with blaKPC-3 included in a transposon Tn4401 isoform b. A higher number of virulence genes (VG) (19 genes) was found in the E. coli 5301 (O25b-ST131-B2) isolate compared with a commensal E. coli 5281 (O25b-ST410-A) (six genes). Both shared five VG [Enterobactin; Aerobactin, CFA/1 (clade α); Type1 (clade γ1); Type IV]. In conclusion, this work highlights the role of relevant clinical bacteria in WWTPs, such as KPC-3-producing K. oxytoca, and, for the first time, a CTX-M-15-producing Ochromobactrum intermedium, a human opportunistic pathogen, and a SED-1-producing Citrobacter farmeri, an uncommon CTX-M-type extended-spectrum beta-lactamase.
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Grisold AJ, Luxner J, Bedenić B, Diab-Elschahawi M, Berktold M, Wechsler-Fördös A, Zarfel GE. Diversity of Oxacillinases and Sequence Types in Carbapenem-Resistant Acinetobacter baumannii from Austria. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18042171. [PMID: 33672170 PMCID: PMC7926329 DOI: 10.3390/ijerph18042171] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/11/2021] [Revised: 02/17/2021] [Accepted: 02/18/2021] [Indexed: 12/20/2022]
Abstract
Carbapenem-resistant Acinetobacter baumannii is a significant health problem worldwide. A multicenter study on A. baumannii was performed to investigate the molecular epidemiology and genetic background of carbapenem resistance of A. baumannii isolates collected from 2014–2017 in Austria. In total, 117 non-repetitive Acinetobacter spp. assigned to A. baumannii (n = 114) and A. pittii (n = 3) were collected from four centers in Austria. The isolates were uniformly resistant to piperacillin/tazobactam, ceftazidime, and carbapenems, and resistance to imipenem and meropenem was 97.4% and 98.2%, respectively. The most prominent OXA-types were OXA-58-like (46.5%) and OXA-23-like (41.2%), followed by OXA-24-like (10.5%), with notable regional differences. Carbapenem-hydrolyzing class D carbapenemases (CHDLs) were the only carbapenemases found in A.baumannii isolates in Austria since no metallo-β-lactamases (MBLs) nor KPC or GES carbapenemases were detected in any of the isolates. One-third of the isolates harbored multiple CHDLs. The population structure of A. baumannii isolates from Austria was found to be very diverse, while a total of twenty-three different sequence types (STs) were identified. The most frequent was ST195 found in 15.8%, followed by ST218 and ST231 equally found in 11.4% of isolates. Two new ST types, ST2025 and ST2026, were detected. In one A. pittii isolate, blaOXA-143-like was detected for the first time in Austria.
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Affiliation(s)
- Andrea J. Grisold
- D&R Institute of Hygiene, Microbiology and Environmental Medicine, Medical University Graz, Neue Stiftingtalstrasse 6, A-8010 Graz, Austria; (J.L.); (G.E.Z.)
- Correspondence: ; Tel.: +43-316-385-73630
| | - Josefa Luxner
- D&R Institute of Hygiene, Microbiology and Environmental Medicine, Medical University Graz, Neue Stiftingtalstrasse 6, A-8010 Graz, Austria; (J.L.); (G.E.Z.)
| | - Branka Bedenić
- Department of Microbiology, University Hospital Center Zagreb, 10000 Zagreb, Croatia;
| | - Magda Diab-Elschahawi
- Department of Infection Control and Hospital Epidemiology, Medical University of Vienna, Waehringer Guertel 18-20, 1090 Vienna, Austria;
| | - Michael Berktold
- Institute of Hygiene and Microbiology, Medical University Innsbruck, Schöpfstrasse 41, A-6020 Innsbruck, Austria;
| | | | - Gernot E. Zarfel
- D&R Institute of Hygiene, Microbiology and Environmental Medicine, Medical University Graz, Neue Stiftingtalstrasse 6, A-8010 Graz, Austria; (J.L.); (G.E.Z.)
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Light Modulates Important Pathogenic Determinants and Virulence in ESKAPE Pathogens Acinetobacter baumannii, Pseudomonas aeruginosa, and Staphylococcus aureus. J Bacteriol 2021; 203:JB.00566-20. [PMID: 33288627 DOI: 10.1128/jb.00566-20] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2020] [Accepted: 12/03/2020] [Indexed: 02/07/2023] Open
Abstract
Light sensing has been extensively characterized in the human pathogen Acinetobacter baumannii at environmental temperatures. However, the influence of light on the physiology and pathogenicity of human bacterial pathogens at temperatures found in warm-blooded hosts is still poorly understand. In this work, we show that Staphylococcus aureus, Acinetobacter baumannii, and Pseudomonas aeruginosa (ESKAPE) priority pathogens, which have been recognized by the WHO and the CDC as critical, can also sense and respond to light at temperatures found in human hosts. Most interestingly, in these pathogens, light modulates important pathogenicity determinants as well as virulence in an epithelial infection model, which could have implications in human infections. In fact, we found that alpha-toxin-dependent hemolysis, motility, and growth under iron-deprived conditions are modulated by light in S. aureus Light also regulates persistence, metabolism, and the ability to kill competitors in some of these microorganisms. Finally, light exerts a profound effect on the virulence of these pathogens in an epithelial infection model, although the response is not the same in the different species; virulence was enhanced by light in A. baumannii and S. aureus, while in A. nosocomialis and P. aeruginosa it was reduced. Neither the BlsA photoreceptor nor the type VI secretion system (T6SS) is involved in virulence modulation by light in A. baumannii Overall, this fundamental knowledge highlights the potential use of light to control pathogen virulence, either directly or by manipulating the light regulatory switch toward the lowest virulence/persistence configuration.IMPORTANCE Pathogenic bacteria are microorganisms capable of producing disease. Dangerous bacterial pathogens, such as Staphylococcus aureus, Pseudomonas aeruginosa, and Acinetobacter baumannii, are responsible for serious intrahospital and community infections in humans. Therapeutics is often complicated due to resistance to multiple antibiotics, rendering them ineffective. In this work, we show that these pathogens sense natural light and respond to it by modulating aspects related to their ability to cause disease; in the presence of light, some of them become more aggressive, while others show an opposite response. Overall, we provide new understanding on the behavior of these pathogens, which could contribute to the control of infections caused by them. Since the response is distributed in diverse pathogens, this notion could prove a general concept.
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Serwecińska L, Kiedrzyńska E, Kiedrzyński M. A catchment-scale assessment of the sanitary condition of treated wastewater and river water based on fecal indicators and carbapenem-resistant Acinetobacter spp. THE SCIENCE OF THE TOTAL ENVIRONMENT 2021; 750:142266. [PMID: 33182211 DOI: 10.1016/j.scitotenv.2020.142266] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/16/2020] [Revised: 08/22/2020] [Accepted: 09/06/2020] [Indexed: 05/14/2023]
Abstract
Urbanization and population growth have created considerable sanitation challenges in cities and communities in many parts of Europe and the world. As such, it is imperative to identify the most environmentally-harmful microbiological and chemical sources of pollution, these being wastewater treatment plants (WWTPs) which release wastewater of low quality. In the present manuscript, an extensive study was performed of the sanitary conditions of river water and treated wastewater from seventeen WWTPs of various sizes along the Pilica River catchment in central Poland, with the aim of identifying "hot spots" in terms of most serious sources of sanitary hazards. The bacteriological risk for the river, including fecal indicator bacteria (FIB) such as coliforms, E.coli, enterococci, C. perfringens, and carbapenem-resistant Acinetobacter spp. (CRA) were assessed using classical microbiological methods, and the physicochemical parameters were also tested. The WWTPs, particularly the small ones (<2000 people equivalent, PE) demonstrated significant variation regarding the physicochemical parameters. Carbapenem-resistant Acinetobacter spp. bacteria growing at 42 °C were found in the effluent wastewaters of all tested municipal WWTPs, and in most of the Pilica River water samples, presenting a potential hazard to public health. A positive correlation was identified between E. coli and CRA abundance in treated wastewater; however, no such relationship was found in river water. It was found that seven small treatment plants discharged wastewater with very different microbiological parameters. Moreover, three small treatment plants serving only 0.56% of the population in the studied area continuously released extremely high microbiological contamination, constituting as much as 54-82% of fecal indicator bacteria loads in the area studied. Our findings show that this type of comprehensive analysis may enable assessment of the use of the entire catchment area, thus identifying the most serious threats to surface water quality and guiding the actions needed to improve the worst operating WWTPs.
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Affiliation(s)
- Liliana Serwecińska
- European Regional Centre for Ecohydrology of the Polish Academy of Sciences, Tylna 3, 90-364 Lodz, Poland
| | - Edyta Kiedrzyńska
- European Regional Centre for Ecohydrology of the Polish Academy of Sciences, Tylna 3, 90-364 Lodz, Poland; UNESCO Chair on Ecohydrology and Applied Ecology, Faculty of Biology and Environmental Protection, University of Lodz, Banacha 12/16, 90-237 Lodz, Poland.
| | - Marcin Kiedrzyński
- Department of Geobotany and Plant Ecology, Faculty of Biology and Environmental Protection, University of Lodz, Banacha12/16, 90-237 Lodz, Poland
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Carvalheira A, Silva J, Teixeira P. Acinetobacter spp. in food and drinking water - A review. Food Microbiol 2020; 95:103675. [PMID: 33397609 DOI: 10.1016/j.fm.2020.103675] [Citation(s) in RCA: 45] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2020] [Revised: 11/02/2020] [Accepted: 11/03/2020] [Indexed: 01/01/2023]
Abstract
Acinetobacter spp. has emerged as a pathogen of major public health concern due to their increased resistance to antibiotics and their association with a wide range of nosocomial infections, community-acquired infections and war and natural disaster-related infections. It is recognized as a ubiquitous organism however, information about the prevalence of different pathogenic species of this genus in food sources and drinking water is scarce. Since the implementation of molecular techniques, the role of foods as a source of several species, including the Acinetobacter baumannii group, has been elucidated. Multidrug resistance was also detected among Acinetobacter spp. isolated from food products. This highlights the importance of foods as potential sources of dissemination of Acinetobacter spp. between the community and clinical environments and reinforces the need for further investigations on the potential health risks of Acinetobacter spp. as foodborne pathogens. The aim of this review was to summarize the published data on the occurrence of Acinetobacter spp. in different food sources and drinking water. This information should be taken into consideration by those responsible for infection control in hospitals and other healthcare facilities.
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Affiliation(s)
- Ana Carvalheira
- Universidade Católica Portuguesa, CBQF - Centro de Biotecnologia e Química Fina - Laboratório Associado, Escola Superior de Biotecnologia, Rua Diogo Botelho 1327, 4169-005, Porto, Portugal
| | - Joana Silva
- Universidade Católica Portuguesa, CBQF - Centro de Biotecnologia e Química Fina - Laboratório Associado, Escola Superior de Biotecnologia, Rua Diogo Botelho 1327, 4169-005, Porto, Portugal
| | - Paula Teixeira
- Universidade Católica Portuguesa, CBQF - Centro de Biotecnologia e Química Fina - Laboratório Associado, Escola Superior de Biotecnologia, Rua Diogo Botelho 1327, 4169-005, Porto, Portugal.
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Eigenbrod T, Reuter S, Gross A, Kocer K, Günther F, Zimmermann S, Heeg K, Mutters NT, Nurjadi D. Molecular characterization of carbapenem-resistant Acinetobacter baumannii using WGS revealed missed transmission events in Germany from 2012-15. J Antimicrob Chemother 2020; 74:3473-3480. [PMID: 31504593 DOI: 10.1093/jac/dkz360] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2019] [Revised: 06/03/2019] [Accepted: 07/17/2019] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Infection and colonization with multi-resistant Acinetobacter baumannii causes therapeutic and economic problems in the nosocomial setting. Due to the sensitivity issue of screening schemes for A. baumannii, it is difficult to implement adequate transmission prevention measures. The high discriminatory power of WGS for transmission-chain analysis provides us with the necessary tool to study and identify transmission events. We retrospectively sequenced and analysed 39 A. baumannii isolates from 2012-15 to search for possible missed transmission events. METHODS Molecular typing by WGS was performed for non-repetitive (n=39) carbapenem-resistant A. baumannii. Retrospective assessment of patient records was performed to investigate and confirm possible transmission events. RESULTS Between July 2012 and September 2015, A. baumannii was isolated from 268 patients, of which 16% (42/268) were carbapenem resistant. Thirty-nine of these isolates were recoverable and sequenced. Fifteen percent (6/39) of these were resistant to all antibiotics tested. Most isolates belong to the circulating IC2 clonal type. SNP analysis revealed four potential outbreak clusters. Two of these clusters showed high concordance with the local spatio-temporal epidemiology, suggesting that transmission events were very likely. CONCLUSIONS Our data suggest that there were two independent transmission events, which would have been missed by conventional MLST owing to high clonality. The routine implementation of WGS can optimize surveillance and initiation of suitable containment measures. In addition, emerging resistance to salvage therapy is a major therapeutic problem and should be monitored closely.
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Affiliation(s)
- Tatjana Eigenbrod
- Department of Infectious Diseases, Medical Microbiology and Hygiene, Heidelberg University Hospital, Im Neuenheimer Feld 324, 69120, Heidelberg, Germany
| | - Sandra Reuter
- Medical Center - University of Freiburg, Institute for Infection Prevention and Hospital Epidemiology, Breisacher Strasse 115B, 79106, Freiburg, Germany
| | - Andrea Gross
- Medical Center - University of Freiburg, Institute for Infection Prevention and Hospital Epidemiology, Breisacher Strasse 115B, 79106, Freiburg, Germany
| | - Kaan Kocer
- Department of Infectious Diseases, Medical Microbiology and Hygiene, Heidelberg University Hospital, Im Neuenheimer Feld 324, 69120, Heidelberg, Germany.,Deutsches Zentrum für Infektionsforschung (DZIF), Department of Infectious Diseases, Heidelberg University Hospital, Im Neuenheimer Feld 324, 69120, Heidelberg, Germany
| | - Frank Günther
- Department of Infectious Diseases, Medical Microbiology and Hygiene, Heidelberg University Hospital, Im Neuenheimer Feld 324, 69120, Heidelberg, Germany.,Medical Microbiology and Hygiene, Marburg University Hospital, Hans-Meerwein-Straße 2, 35043, Marburg, Germany
| | - Stefan Zimmermann
- Department of Infectious Diseases, Medical Microbiology and Hygiene, Heidelberg University Hospital, Im Neuenheimer Feld 324, 69120, Heidelberg, Germany
| | - Klaus Heeg
- Department of Infectious Diseases, Medical Microbiology and Hygiene, Heidelberg University Hospital, Im Neuenheimer Feld 324, 69120, Heidelberg, Germany
| | - Nico T Mutters
- Department of Infectious Diseases, Medical Microbiology and Hygiene, Heidelberg University Hospital, Im Neuenheimer Feld 324, 69120, Heidelberg, Germany.,Medical Center - University of Freiburg, Institute for Infection Prevention and Hospital Epidemiology, Breisacher Strasse 115B, 79106, Freiburg, Germany
| | - Dennis Nurjadi
- Department of Infectious Diseases, Medical Microbiology and Hygiene, Heidelberg University Hospital, Im Neuenheimer Feld 324, 69120, Heidelberg, Germany
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Bello-López E, Rocha-Gracia RDC, Castro-Jaimes S, Cevallos MÁ, Vargas-Cruz M, Verdugo-Yocupicio R, Sáenz Y, Torres C, Gutiérrez-Cázarez Z, Arenas-Hernández MMDLP, Lozano-Zarain P. Antibiotic resistance mechanisms in Acinetobacter spp. strains isolated from patients in a paediatric hospital in Mexico. J Glob Antimicrob Resist 2020; 23:120-129. [PMID: 32916332 DOI: 10.1016/j.jgar.2020.08.014] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2020] [Revised: 08/06/2020] [Accepted: 08/18/2020] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVES The aim of this study was to identify Acinetobacter spp. strains from paediatric patients, to determine their genetic relationship, to detect antibiotic resistance genes and to evaluate the role of efflux pumps in antibiotic resistance. METHODS A total of 54 non-duplicate, non-consecutive Acinetobacter spp. isolates were collected from paediatric patients. Their genetic relationship, antibiotic resistance profile, efflux pump activity, antibiotic resistance genes and plasmid profile were determined. RESULTS The isolates were identified as 24 Acinetobacter haemolyticus, 24 Acinetobacter calcoaceticus-baumannii (Acb) complex and 1 strain each of Acinetobacter junii, Acinetobacter radioresistens, Acinetobacter indicus, Acinetobacter lwoffii, Acinetobacter ursingii and Acinetobacter venetianus. The 24 A. haemolyticus were considered genetically unrelated. One strain was resistant to carbapenems, two to cephalosporins, two to ciprofloxacin and sixteen to aminoglycosides. The antibiotic resistance genes blaOXA-214 (29%), blaOXA-215 (4%), blaOXA-264 (8%), blaOXA-265 (29%), blaNDM-1 (4%), aac(6')-Ig (38%) and the novel variants blaOXA-575 (13%), blaTEM-229 (75%), aac(6')-Iga (4%), aac(6')-Igb (13%) and aac(6')-Igc (42%) were detected. Among 24 Acb complex, 5 were multidrug-resistant, carbapenem-resistant strains carrying blaOXA-51 and blaOXA-23; they were genetically related and had the same plasmid profile. Other species were susceptible. In some strains of A. haemolyticus and Acb complex, the role of RND efflux pumps was evidenced by a decrease in the MICs for cefotaxime, amikacin and ciprofloxacin in the presence of an efflux pump inhibitor. CONCLUSIONS This study identified isolates of A. haemolyticus carrying new β-lactamase variants and shows for the first time the contribution of efflux pumps to antibiotic resistance in this species.
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Affiliation(s)
- Elena Bello-López
- Benemérita Universidad Autónoma de Puebla, Instituto de Ciencias, Posgrado en Microbiología, Centro de Investigaciones de Ciencias Microbiológicas, Puebla, Mexico
| | - Rosa Del Carmen Rocha-Gracia
- Benemérita Universidad Autónoma de Puebla, Instituto de Ciencias, Posgrado en Microbiología, Centro de Investigaciones de Ciencias Microbiológicas, Puebla, Mexico
| | - Semiramis Castro-Jaimes
- Programa de Genómica Evolutiva, Centro de Ciencias Genómicas, Universidad Nacional Autónoma de México, Cuernavaca, Morelos, Mexico
| | - Miguel Ángel Cevallos
- Programa de Genómica Evolutiva, Centro de Ciencias Genómicas, Universidad Nacional Autónoma de México, Cuernavaca, Morelos, Mexico
| | - Michelle Vargas-Cruz
- Benemérita Universidad Autónoma de Puebla, Instituto de Ciencias, Posgrado en Microbiología, Centro de Investigaciones de Ciencias Microbiológicas, Puebla, Mexico
| | - Ricardo Verdugo-Yocupicio
- Benemérita Universidad Autónoma de Puebla, Instituto de Ciencias, Posgrado en Microbiología, Centro de Investigaciones de Ciencias Microbiológicas, Puebla, Mexico
| | - Yolanda Sáenz
- Área de Microbiología Molecular, Centro de Investigación Biomédica de La Rioja (CIBIR), Logroño, Spain
| | - Carmen Torres
- Área Bioquímica y Biología Molecular, Universidad de La Rioja, Logroño, Spain
| | | | | | - Patricia Lozano-Zarain
- Benemérita Universidad Autónoma de Puebla, Instituto de Ciencias, Posgrado en Microbiología, Centro de Investigaciones de Ciencias Microbiológicas, Puebla, Mexico.
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Castro-Jaimes S, Bello-López E, Velázquez-Acosta C, Volkow-Fernández P, Lozano-Zarain P, Castillo-Ramírez S, Cevallos MA. Chromosome Architecture and Gene Content of the Emergent Pathogen Acinetobacter haemolyticus. Front Microbiol 2020; 11:926. [PMID: 32670207 PMCID: PMC7326120 DOI: 10.3389/fmicb.2020.00926] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2020] [Accepted: 04/20/2020] [Indexed: 11/25/2022] Open
Abstract
Acinetobacter haemolyticus is a Gammaproteobacterium that has been involved in serious diseases frequently linked to the nosocomial environment. Most of the strains causing such infections are sensitive to a wide variety of antibiotics, but recent reports indicate that this pathogen is acquiring very efficiently carbapenem-resistance determinants like the blaNDM-1 gene, all over the world. With this work we contribute with a collection set of 31 newly sequenced nosocomial A. haemolyticus isolates. Genome analysis of these sequences and others collected from RefSeq indicates that their chromosomes are organized in 12 syntenic blocks that contain most of the core genome genes. These blocks are separated by hypervariable regions that are rich in unique gene families, but also have signals of horizontal gene transfer. Genes involved in virulence or encoding different secretion systems are located inside syntenic regions and have recombination signals. The relative order of the synthetic blocks along the A. haemolyticus chromosome can change, indicating that they have been subject to several kinds of inversions. Genomes of this microorganism show large differences in gene content even if they are in the same clade. Here we also show that A. haemolyticus has an open pan-genome.
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Affiliation(s)
- Semiramis Castro-Jaimes
- Centro de Ciencias Genómicas, Programa de Genómica Evolutiva, Universidad Nacional Autónoma de México, Cuernavaca, Mexico
| | - Elena Bello-López
- Centro de Investigaciones en Ciencias Microbiológicas, Posgrado en Microbiología, Instituto de Ciencias, Benemérita Universidad Autónoma de Puebla, Puebla, Mexico
| | | | | | - Patricia Lozano-Zarain
- Centro de Investigaciones en Ciencias Microbiológicas, Posgrado en Microbiología, Instituto de Ciencias, Benemérita Universidad Autónoma de Puebla, Puebla, Mexico
| | - Santiago Castillo-Ramírez
- Centro de Ciencias Genómicas, Programa de Genómica Evolutiva, Universidad Nacional Autónoma de México, Cuernavaca, Mexico
| | - Miguel Angel Cevallos
- Centro de Ciencias Genómicas, Programa de Genómica Evolutiva, Universidad Nacional Autónoma de México, Cuernavaca, Mexico
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Lukovic B, Gajic I, Dimkic I, Kekic D, Zornic S, Pozder T, Radisavljevic S, Opavski N, Kojic M, Ranin L. The first nationwide multicenter study of Acinetobacter baumannii recovered in Serbia: emergence of OXA-72, OXA-23 and NDM-1-producing isolates. Antimicrob Resist Infect Control 2020; 9:101. [PMID: 32631451 PMCID: PMC7338125 DOI: 10.1186/s13756-020-00769-8] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2020] [Accepted: 06/30/2020] [Indexed: 12/16/2022] Open
Abstract
Background The worldwide emergence and clonal spread of carbapenem-resistant Acinetobacter baumannii (CRAB) is of great concern. The aim of this nationwide study was to investigate the prevalence of CRAB isolates in Serbia and to characterize underlying resistance mechanisms and their genetic relatedness. Methods Non-redundant clinical samples obtained from hospitalized patients throughout Serbia were included in the prospective, observational, multicenter study conducted from January to June 2018. Samples were initially screened for the presence of Acinetobacter baumannii-calcoaceticus (Acb) complex using conventional bacteriological techniques. Acb complexes recovered from clinical samples obtained from inpatients with confirmed bacterial infections were further evaluated for the presence of A. baumannii. Identification to the species level was done by the detection of the blaOXA-51 gene and rpoB gene sequence analysis. Susceptibility testing was done by disk diffusion and broth microdilution method. CRAB isolates were tested for the presence of acquired carbapenemases (blaOXA-24-like, blaOXA-23-like,blaOXA-58-like, blaOXA-143-like, blaIMP, blaVIM, blaGIM, blaSPM, blaSIM, blaNDM) by PCR. Clonal relatedness was assessed by pulsed-field gel electrophoresis (PFGE) and multilocus sequence typing (MLST). Results Acb complex was isolated in 280 out of 2401 clinical samples (11.6%). Overall, A. baumannii was identified in 237 out of 280 Acb complex (84.6%). CRAB prevalence was found to be 93.7% (237/222). The MIC50/MIC90 for imipenem and meropenem were 8/> 32 μg/mL and 16/> 32 μg/mL, respectively. Although susceptibility was high for colistin (95.7%; n = 227) and tigecycline (75.1%; n = 178), ten isolates (4.3%) were classified as pandrug-resistant. The following carbapenemases-encoding genes were found: 98 (44.2%) blaOXA-24-like, 76 (34.5%) blaOXA-23-like, and 7 (3.2%) blaNDM-1. PFGE analysis revealed six different clusters. MLST analysis identified three STs: ST2 (n = 13), ST492 (n = 14), and ST636 (n = 10). Obtained results evaluated that circulating CRAB clones in Serbia were as follows: blaOXA66/blaOXA23/ST2 (32.4%), blaOXA66/blaOXA23/blaOXA72/ST2 (2.7%), blaOXA66/blaOXA72/ST492 (37.8%), and blaOXA66/blaOXA72/ST636 (27.1%). Conclusion This study revealed extremely high proportions of carbapenem resistance among A. baumannii clinical isolates due to the emergence of blaOXA-72, blaOXA-23, and blaNDM-1 genes among CRAB isolates in Serbia and their clonal propagation.
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Affiliation(s)
- Bojana Lukovic
- Institute of Microbiology and Immunology, Medical Faculty, University of Belgrade, Doktora Subotica starijeg 1, Belgrade, 11000, Serbia.
| | - Ina Gajic
- Institute of Microbiology and Immunology, Medical Faculty, University of Belgrade, Doktora Subotica starijeg 1, Belgrade, 11000, Serbia.
| | - Ivica Dimkic
- Faculty of Biology, University of Belgrade, Belgrade, Serbia
| | - Dusan Kekic
- Institute of Microbiology and Immunology, Medical Faculty, University of Belgrade, Doktora Subotica starijeg 1, Belgrade, 11000, Serbia
| | - Sanja Zornic
- Department of Microbiology, Clinical Center Kragujevac, Kragujevac, Serbia
| | - Tatjana Pozder
- Department of Microbiology, General Hospital Subotica, Subotica, Serbia
| | | | - Nataša Opavski
- Institute of Microbiology and Immunology, Medical Faculty, University of Belgrade, Doktora Subotica starijeg 1, Belgrade, 11000, Serbia
| | - Milan Kojic
- Laboratory for Molecular Microbiology, Institute of Molecular Genetics and Genetic Engineering, University of Belgrade, Belgrade, Serbia
| | - Lazar Ranin
- Institute of Microbiology and Immunology, Medical Faculty, University of Belgrade, Doktora Subotica starijeg 1, Belgrade, 11000, Serbia
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Zhang L, Fu Y, Han X, Xu Q, Weng S, Yan B, Liu L, Hua X, Chen Y, Yu Y. Phenotypic Variation and Carbapenem Resistance Potential in OXA-499-Producing Acinetobacter pittii. Front Microbiol 2020; 11:1134. [PMID: 32582088 PMCID: PMC7296048 DOI: 10.3389/fmicb.2020.01134] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2020] [Accepted: 05/05/2020] [Indexed: 12/17/2022] Open
Abstract
Acinetobacter pittii is increasingly recognized as a clinically important species. Here, we identified a carbapenem-non-resistant A. pittii clinical isolate, A1254, harboring blaOXA–499, blaOXA–826, and blaADC–221. The blaOXA–499 genetic environment in A1254 was identical to that of another OXA-499-producing, but carbapenem-resistant, A. pittii isolate, YMC2010/8/T346, indicating the existence of phenotypic variation among OXA-499-producing A. pittii strains. Under imipenem-selective pressure, the A1254 isolate developed resistance to carbapenems in 60 generations. Two carbapenem-resistant mutants (CAB009 and CAB010) with mutations in the blaOXA–499 promoter region were isolated from two independently evolved populations (CAB001 and CAB004). The CAB009 mutant, with a mutation at position −14 (A to G), exhibited a four-fold higher carbapenem minimum inhibitory concentration (MIC) and a 4.53 ± 0.19 log2 fold change higher expression level of blaOXA–499 than the ancestor strain, A1254. The other mutant, CAB010, with a mutation at position −42 (G to A), showed a two-fold higher carbapenem MIC and a 1.65 ± 0.25 log2 fold change higher blaOXA–499 expression level than the ancestor strain. The blaOXA–499 gene and its promoter region were amplified from the wild-type strain and two mutant isolates and then individually cloned into the pYMAb2-Hygr vector and expressed in Acinetobacter baumannii ATCC 17978, A. pittii LMG 1035, and A. pittii A1254. All the transformed strains were resistant to carbapenem, irrespective of whether they harbored the initial or an evolved promoter sequence, and transformed strains expressing the promoter from the most resistant mutant, CAB009, showed the highest carbapenem MICs, with values of 32–64 μg/ml for imipenem and 128 μg/ml for meropenem. RNA sequencing was performed to confirm the contribution of blaOXA–499 to the development of carbapenem resistance. Although the CAB009 and CAB010 transcriptional patterns were different, blaOXA–499 was the only differentially expressed gene shared by the two mutants. Our results indicate that carbapenem-non-resistant Acinetobacter spp. strains carrying blaOXA genes have the potential to develop carbapenem resistance and need to be further investigated and monitored to prevent treatment failure due to the development of resistance.
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Affiliation(s)
- Linyue Zhang
- Department of Infectious Diseases, Sir Run Run Shaw Hospital, College of Medicine, Zhejiang University, Hangzhou, China.,Key Laboratory of Microbial Technology and Bioinformatics of Zhejiang Province, Hangzhou, China
| | - Ying Fu
- Key Laboratory of Microbial Technology and Bioinformatics of Zhejiang Province, Hangzhou, China.,Department of Clinical Laboratory, Sir Run Run Shaw Hospital, College of Medicine, Zhejiang University, Hangzhou, China
| | - Xinhong Han
- Department of Infectious Diseases, Sir Run Run Shaw Hospital, College of Medicine, Zhejiang University, Hangzhou, China.,Key Laboratory of Microbial Technology and Bioinformatics of Zhejiang Province, Hangzhou, China
| | - Qingye Xu
- Department of Infectious Diseases, Sir Run Run Shaw Hospital, College of Medicine, Zhejiang University, Hangzhou, China.,Key Laboratory of Microbial Technology and Bioinformatics of Zhejiang Province, Hangzhou, China
| | - Shanshan Weng
- Department of Infectious Diseases, Sir Run Run Shaw Hospital, College of Medicine, Zhejiang University, Hangzhou, China.,Key Laboratory of Microbial Technology and Bioinformatics of Zhejiang Province, Hangzhou, China
| | - Biyong Yan
- Department of Laboratory Medicine, The Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, China
| | - Lilin Liu
- Department of Infectious Diseases, Sir Run Run Shaw Hospital, College of Medicine, Zhejiang University, Hangzhou, China.,Key Laboratory of Microbial Technology and Bioinformatics of Zhejiang Province, Hangzhou, China
| | - Xiaoting Hua
- Department of Infectious Diseases, Sir Run Run Shaw Hospital, College of Medicine, Zhejiang University, Hangzhou, China.,Key Laboratory of Microbial Technology and Bioinformatics of Zhejiang Province, Hangzhou, China
| | - Yan Chen
- Department of Infectious Diseases, Sir Run Run Shaw Hospital, College of Medicine, Zhejiang University, Hangzhou, China.,Key Laboratory of Microbial Technology and Bioinformatics of Zhejiang Province, Hangzhou, China
| | - Yunsong Yu
- Department of Infectious Diseases, Sir Run Run Shaw Hospital, College of Medicine, Zhejiang University, Hangzhou, China.,Key Laboratory of Microbial Technology and Bioinformatics of Zhejiang Province, Hangzhou, China
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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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Cosgaya C, Ratia C, Marí-Almirall M, Rubio L, Higgins PG, Seifert H, Roca I, Vila J. In vitro and in vivo Virulence Potential of the Emergent Species of the Acinetobacter baumannii (Ab) Group. Front Microbiol 2019; 10:2429. [PMID: 31708900 PMCID: PMC6821683 DOI: 10.3389/fmicb.2019.02429] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2019] [Accepted: 10/08/2019] [Indexed: 01/30/2023] Open
Abstract
The increased use of molecular identification methods and mass spectrometry has revealed that Acinetobacter spp. of the A. baumannii (Ab) group other than A. baumannii are increasingly being recovered from human samples and may pose a health challenge if neglected. In this study 76 isolates of 5 species within the Ab group (A. baumannii n = 16, A. lactucae n = 12, A. nosocomialis n = 16, A. pittii n = 20, and A. seifertii n = 12), were compared in terms of antimicrobial susceptibility, carriage of intrinsic resistance genes, biofilm formation, and the ability to kill Caenorhabditis elegans in an infection assay. In agreement with previous studies, antimicrobial resistance was common among A. baumannii while all other species were generally more susceptible. Carriage of genes encoding different efflux pumps was frequent in all species and the presence of intrinsic class D β-lactamases was reported in A. baumannii, A. lactucae (heterotypic synonym of A. dijkshoorniae) and A. pittii but not in A. nosocomialis and A. seifertii. A. baumannii and A. nosocomialis presented weaker pathogenicity in our in vitro and in vivo models than A. seifertii, A. pittii and, especially, A. lactucae. Isolates from the former species showed decreased biofilm formation and required a longer time to kill C. elegans nematodes. These results suggest relevant differences in terms of antibiotic susceptibility patterns among the members of the Ab group as well as highlight a higher pathogenicity potential for the emerging species of the group in this particular model. Nevertheless, the impact of such potential in the human host still remains to be determined.
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Affiliation(s)
- Clara Cosgaya
- ISGlobal, Hospital Clínic - University of Barcelona, Barcelona, Spain
| | - Carlos Ratia
- ISGlobal, Hospital Clínic - University of Barcelona, Barcelona, Spain
| | | | - Laia Rubio
- ISGlobal, Hospital Clínic - University of Barcelona, Barcelona, Spain
| | - Paul G Higgins
- Institute for Medical Microbiology, Immunology and Hygiene, University of Cologne, Cologne, Germany.,German Center for Infection Research (DZIF), Bonn, Germany
| | - Harald Seifert
- Institute for Medical Microbiology, Immunology and Hygiene, University of Cologne, Cologne, Germany.,German Center for Infection Research (DZIF), Bonn, Germany
| | - Ignasi Roca
- ISGlobal, Hospital Clínic - University of Barcelona, Barcelona, Spain
| | - Jordi Vila
- ISGlobal, Hospital Clínic - University of Barcelona, Barcelona, Spain
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22
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Sajjad R, Ahmad S, Azam SS. In silico screening of antigenic B-cell derived T-cell epitopes and designing of a multi-epitope peptide vaccine for Acinetobacter nosocomialis. J Mol Graph Model 2019; 94:107477. [PMID: 31654980 DOI: 10.1016/j.jmgm.2019.107477] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2019] [Revised: 08/20/2019] [Accepted: 10/10/2019] [Indexed: 12/14/2022]
Abstract
Globally, antibiotic-resistant and tolerated bacterial isolates of Acinetobacter species are imposing high financial cost on health care systems and as such, molecular targets with promising immune protection could provide substantive benefits to human healthcare. Here, we performed an in silico based proteome-wide screening for antigenic B-cell derived T-cell epitopes and their following use to design a multi-epitope peptide vaccine that can effectively engage the host immune system against Acinetobacter nosocomialis SSA3 strain. Epitopes of the fimbrial biogenesis outer membrane usher FimD protein: YQQGINNYL and YRTNYTTVG were revealed appropriate for multi-epitope peptide construct designing. This protein has no homology to the host, essential to the pathogen survival and is localized at the pathogen surface. The predicted epitopes have high affinity for the highly expressed DRB*0101 allele in humans based on the lowest IC50 value in MHCPred and have an exo-membrane topology for efficient immune system recognition. The designed multi-epitope peptide vaccine is composed of the mentioned shortlisted antigenic epitopes linked to each other through a GPGPG linker, and an EAAAK linker that joined the multi-epitope peptide to the Cholera B subunit from Vibrio cholera as an adjuvant to increase vaccine construct antigenicity. The vaccine construct was docked and simulated with a transmembrane toll-like receptor (TLR4) that revealed construct stable binding with the TLR4 through the adjuvant, allowing the epitopes exposed to the host immune system essential for generating effective innate and long-lasting adaptive immunity. The designed multi-epitope peptide vaccine may prompt the development of a vaccine to control refractory and deleterious A. nosocomialis infections.
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Affiliation(s)
- Rida Sajjad
- Computational Biology Lab, National Center for Bioinformatics, Quaid-i-Azam University, Islamabad, Pakistan.
| | - Sajjad Ahmad
- Computational Biology Lab, National Center for Bioinformatics, Quaid-i-Azam University, Islamabad, Pakistan.
| | - Syed Sikander Azam
- Computational Biology Lab, National Center for Bioinformatics, Quaid-i-Azam University, Islamabad, Pakistan.
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Molecular Epidemiology of Emerging Carbapenem Resistance in Acinetobacter nosocomialis and Acinetobacter pittii in Taiwan, 2010 to 2014. Antimicrob Agents Chemother 2019; 63:AAC.02007-18. [PMID: 30670429 PMCID: PMC6496155 DOI: 10.1128/aac.02007-18] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2018] [Accepted: 01/03/2019] [Indexed: 01/06/2023] Open
Abstract
This study investigated the molecular epidemiology of carbapenem-resistant Acinetobacter nosocomialis and Acinetobacter pittii (ANAP). Clinical isolates of Acinetobacter spp. This study investigated the molecular epidemiology of carbapenem-resistant Acinetobacter nosocomialis and Acinetobacter pittii (ANAP). Clinical isolates of Acinetobacter spp. collected by the biennial nationwide Taiwan Surveillance of Antimicrobial Resistance program from 2010 to 2014 were subjected to species identification, antimicrobial susceptibility testing, and PCR for detection of carbapenemase genes. Whole-genome sequencing or PCR mapping was performed to study the genetic surroundings of the carbapenemase genes. Among 1,041 Acinetobacter isolates, the proportion of ANAP increased from 11% in 2010 to 22% in 2014. The rate of carbapenem resistance in these isolates increased from 7.5% (3/40) to 22% (14/64), with a concomitant increase in their resistance to other antibiotics. The blaOXA-72 and blaOXA-58 genes were highly prevalent in carbapenem-resistant ANAP. Various genetic structures were found upstream of blaOXA-58 in different plasmids. Among the plasmids found to contain blaOXA-72 flanked by XerC/XerD, pAB-NCGM253-like was identified in 8 of 10 isolates. Conjugations of plasmids carrying blaOXA-72 or blaOXA-58 to A. baumannii were successful. In addition, three isolates with chromosome-located blaOXA-23 embedded in AbGRI1-type structure with disruption of genes other than comM were detected. Two highly similar plasmids carrying class I integron containing blaIMP-1 and aminoglycoside resistance genes were also found. The universal presence of blaOXA-272/213-like on A. pittii chromosomes and their lack of contribution to carbapenem resistance indicate its potential to be a marker for species identification. The increase of ANAP, along with their diverse mechanisms of carbapenem resistance, may herald their further spread and warrants close monitoring.
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Villalón P, Ortega M, Sáez-Nieto JA, Carrasco G, Medina-Pascual MJ, Garrido N, Valdezate S. Dynamics of a Sporadic Nosocomial Acinetobacter calcoaceticus - Acinetobacter baumannii Complex Population. Front Microbiol 2019; 10:593. [PMID: 30967856 PMCID: PMC6440288 DOI: 10.3389/fmicb.2019.00593] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2018] [Accepted: 03/08/2019] [Indexed: 12/27/2022] Open
Abstract
Our objective was to improve current knowledge of sporadic (Spo) nosocomial Acinetobactercalcoaceticus-Acinetobacter baumannii (Acb) complex populations, and thus better understand the epidemiology of Spo and endemoepidemic (EE) strains. Between 1999 and 2010, 133 isolates of Spo Acb complex were obtained from a single hospital. Species were identified by gyrB-PCR, and via gyrB- and rpoB-sequencing. Clonal analysis was undertaken using pulsed-field gel electrophoresis (PFGE) and multilocus sequence typing. Susceptibility to antimicrobial agents was determined by microdilution and E-tests. Carbapenemase genes were detected by PCR. One hundred and one PFGE types were detected. A. baumannii was the most common (67/101 PFGE types), followed by Acinetobacter pittii (22/101), Acinetobacter lactucae (6/101), and Acinetobacter calcoaceticus (2/101). gyrB, rpoB1, and rpoB2 sequencing returned 49, 13, and 16 novel sequences, respectively. Sixty-three sequence types (STs) (38 new STs and 66 new alleles) were detected; the most common were ST2 (29/133 isolates) and ST132 (14/133). Twenty-six OXA-51 allelic variants were detected, nine of which were novel. The PFGE types were generally susceptible (88/101) to all the tested antimicrobials; 3/101 were carbapenem-resistant due to the presence of the genetic structure ISAba2-blaOXA-58-like-ISAba3, and 2/101 were multidrug-resistant. It can be concluded that the examined Spo Acb complex population was mainly composed of A. baumannii. Many different clones were detected (with ST2 clearly dominant), all largely susceptible to antimicrobials; multidrug resistance was rare. In contrast, a previously examined EE Acb population was composed of just four expanding, multidrug-resistant A. baumannii clones -ST2, ST3, ST15, and ST80-.
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Affiliation(s)
- Pilar Villalón
- Laboratorio de Referencia e Investigación en Taxonomía, Centro Nacional de Microbiología, Instituto de Salud Carlos III, Madrid, Spain
| | - Montserrat Ortega
- Laboratorio de Referencia e Investigación en Taxonomía, Centro Nacional de Microbiología, Instituto de Salud Carlos III, Madrid, Spain
| | - Juan A Sáez-Nieto
- Laboratorio de Referencia e Investigación en Taxonomía, Centro Nacional de Microbiología, Instituto de Salud Carlos III, Madrid, Spain
| | - Gema Carrasco
- Laboratorio de Referencia e Investigación en Taxonomía, Centro Nacional de Microbiología, Instituto de Salud Carlos III, Madrid, Spain
| | - María J Medina-Pascual
- Laboratorio de Referencia e Investigación en Taxonomía, Centro Nacional de Microbiología, Instituto de Salud Carlos III, Madrid, Spain
| | - Noelia Garrido
- Laboratorio de Referencia e Investigación en Taxonomía, Centro Nacional de Microbiología, Instituto de Salud Carlos III, Madrid, Spain
| | - Sylvia Valdezate
- Laboratorio de Referencia e Investigación en Taxonomía, Centro Nacional de Microbiología, Instituto de Salud Carlos III, Madrid, Spain
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A Prospective Study of Acinetobacter baumannii Complex Isolates and Colistin Susceptibility Monitoring by Mass Spectrometry of Microbial Membrane Glycolipids. J Clin Microbiol 2019; 57:JCM.01100-18. [PMID: 30567747 DOI: 10.1128/jcm.01100-18] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2018] [Accepted: 12/13/2018] [Indexed: 11/20/2022] Open
Abstract
Acinetobacter baumannii is a prevalent nosocomial pathogen with a high incidence of multidrug resistance. Treatment of infections due to this organism with colistin, a last-resort antibiotic of the polymyxin class, can result in the emergence of colistin-resistant strains. Colistin resistance primarily occurs via modifications of the terminal phosphate moieties of lipopolysaccharide-derived lipid A, which reduces overall membrane electronegativity. These modifications are readily identified by mass spectrometry (MS). In this study, we prospectively collected Acinetobacter baumannii complex clinical isolates from a hospital system in Pennsylvania over a 3-year period. All isolates were evaluated for colistin resistance using standard MIC testing by both agar dilution and broth microdilution, as well as genospecies identification and lipid A profiling using MS analyses. Overall, an excellent correlation between colistin susceptibility and resistance, determined by MIC testing, and the presence of a lipid A modification, determined by MS, was observed with a sensitivity of 92.9% and a specificity of 94.0%. Additionally, glycolipid profiling was able to differentiate A. baumannii complex organisms based on their membrane lipids. With the growth of MS use in clinical laboratories, a reliable MS-based glycolipid phenotyping method that identifies colistin resistance in A. baumannii complex clinical isolates, as well as other Gram-negative organisms, represents an alternative or complementary approach to existing diagnostics.
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26
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Wareth G, Neubauer H, Sprague LD. Acinetobacter baumannii - a neglected pathogen in veterinary and environmental health in Germany. Vet Res Commun 2018; 43:1-6. [PMID: 30591981 DOI: 10.1007/s11259-018-9742-0] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2018] [Accepted: 12/06/2018] [Indexed: 01/01/2023]
Abstract
The emergence and global spread of drug resistant Acinetobacter (A.) baumannii is a cause of great concern. The current knowledge on antibiotic resistance in A. baumannii from animal origin is mostly based on few internationally published case reports, investigations of strain collections and several whole genome analyses. This lack of data results in a somewhat sketchy picture on how to assess the possible impact of drug resistant A. baumannii strains on veterinary and public health in Germany. Consequently, there is an urgent need to intensify the surveillance of A. baumannii in pet animals, the farm animal population and wildlife.
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Affiliation(s)
- Gamal Wareth
- Institut für bakterielle Infektionen und Zoonosen, Friedrich-Loeffler-Institut, Jena, Germany
| | - Heinrich Neubauer
- Institut für bakterielle Infektionen und Zoonosen, Friedrich-Loeffler-Institut, Jena, Germany
| | - Lisa D Sprague
- Institut für bakterielle Infektionen und Zoonosen, Friedrich-Loeffler-Institut, Jena, Germany.
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Wendel AF, Malecki M, Otchwemah R, Tellez-Castillo CJ, Sakka SG, Mattner F. One-year molecular surveillance of carbapenem-susceptible A. baumannii on a German intensive care unit: diversity or clonality. Antimicrob Resist Infect Control 2018; 7:145. [PMID: 30505434 PMCID: PMC6260569 DOI: 10.1186/s13756-018-0436-8] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2018] [Accepted: 11/08/2018] [Indexed: 12/19/2022] Open
Abstract
Background A. baumannii is a common nosocomial pathogen known for its high transmission potential. A high rate of carbapenem-susceptible Acinetobacter calcoaceticus-Acinetobacter baumannii (ACB)-complex in clinical specimens led to the implementation of a pathogen-based surveillance on a 32-bed surgical intensive care unit (SICU) in a German tertiary care centre. Methods Between April 2017 and March 2018, ACB-complex isolates with an epidemiological link to the SICU were further assessed. Identification to the species level was carried out using a multiplex PCR targeting the gyrB gene, followed by RAPD, PFGE (ApaI) and whole genome sequencing (WGS, core genome MLST, SeqSphere+ software, Ridom). Additional infection prevention and control (IPC) measures were introduced as follows: epidemiological investigations, hand hygiene training, additional terminal cleaning and disinfection incl. UV-light, screening for carbapenem-susceptible A. baumannii and environmental sampling. Hospital-acquired infections were classified according to the CDC definitions. Results Fourty four patients were colonized/infected with one or two (different) carbapenem-susceptible ACB-complex isolates. Fourty three out of 48 isolates were classified as hospital-acquired (detection on or after 3rd day of admission). Nearly all isolates were identified as A. baumannii, only four as A. pittii. Twelve patients developed A. baumannii infections. Genotyping revealed two pulsotype clusters, which were confirmed to be cgMLST clonal cluster type 1770 (n = 8 patients) and type 1769 (n = 12 patients) by WGS. All other isolates were distinct from each other. Nearly all transmission events of the two clonal clusters were confirmed by conventional epidemiology. Transmissions stopped after a period of several months. Environmental sampling revealed a relevant dissemination of A. baumannii, but only a few isolates corresponded to clinical strains. Introduction of the additional screening revealed a significantly earlier detection of carbapenem-susceptible A. baumannii during hospitalization. Conclusions A molecular and infection surveillance of ACB-complex based on identification to the species level, classic epidemiology and genotyping revealed simultaneously occurring independent transmission events and clusters of hospital-acquired A. baumannii. This underlines the importance of such an extensive surveillance methodology in IPC programmes also for carbapenem-susceptible A. baumannii.
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Affiliation(s)
- Andreas F Wendel
- 1Institute of Hygiene, University Hospital I of Witten/Herdecke, Cologne Merheim Medical Centre, Cologne, Germany
| | - Monika Malecki
- 1Institute of Hygiene, University Hospital I of Witten/Herdecke, Cologne Merheim Medical Centre, Cologne, Germany
| | - Robin Otchwemah
- 1Institute of Hygiene, University Hospital I of Witten/Herdecke, Cologne Merheim Medical Centre, Cologne, Germany
| | | | - Samir G Sakka
- 3Department of Anesthesiology and Operative Intensive Care Medicine, University of Witten/Herdecke, Cologne Merheim Medical Centre, Cologne, Germany
| | - Frauke Mattner
- 1Institute of Hygiene, University Hospital I of Witten/Herdecke, Cologne Merheim Medical Centre, Cologne, Germany
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Singkham-In U, Chatsuwan T. Mechanisms of carbapenem resistance in Acinetobacter pittii and Acinetobacter nosocomialis isolates from Thailand. J Med Microbiol 2018; 67:1667-1672. [PMID: 30311872 DOI: 10.1099/jmm.0.000845] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
PURPOSE The emergence of carbapenem resistance in non-baumannii Acinetobacter has increased in clinical settings worldwide. We investigated the prevalence and mechanisms of carbapenem resistance in A. pittii and A. nosocomialis Thai isolates. METHODOLOGY Acinetobacter calcoaceticus-Acinetobacter baumannii (Acb) complex isolates were identified by gyrB mulitplex PCR. Carbapenem susceptibilities were studied by the agar dilution method and carbapenemase genes were detected by multiplex PCR. Reductions of the outer membrane proteins (OMPs) were evaluated by SDS-PAGE. Overexpressions of efflux pumps were detected by using efflux pump inhibitors and RT-PCR. RESULTS Of the 346 Acb isolates, 22 and 19 were A. pittii and A. nosocomialis, respectively. The carbapenem resistance rates were 22.7 % in A. pittii and 26.3 % in A. nosocomialis. Three carbapenem-resistant A. pittii carried blaOXA-23. One carbapenem-resistant A. pittii harboured blaOXA-58, while another isolate co-harboured blaOXA-58 and blaIMP-14a. blaOXA-58 was also found in three carbapenem-susceptible A. pittii. Five carbapenem-resistant A. nosocomialis carried blaOXA-23. Eighteen A. pittii isolates carried blaOXA-213-like. Reduced OMPs were found in carbapenem-resistant and -susceptible A. pittii carrying blaOXA-58, but were not detected in carbapenem-resistant A. nosocomialis isolates. Overexpression of adeE was found in carbapenem-resistant A. pittii. No efflux pump genes were present in carbapenem-resistant A. nosocomialis. CONCLUSION The major mechanisms of carbapenem resistance in A. pittii and A. nosocomialis were the production of OXA-23 and OXA-58. Overexpression of adeE played a role in carbapenem resistance in A. pittii. Since blaOXA-58 was found in carbapenem-susceptible A. pittii, using carbapenems in the treatment of A. pittii infection should be considered.
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Affiliation(s)
- Uthaibhorn Singkham-In
- 1Interdisciplinary Program of Medical Microbiology, Graduate School, Chulalongkorn University, Bangkok, Thailand
| | - Tanittha Chatsuwan
- 2Department of Microbiology, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
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Salimizand H, Zomorodi AR, Mansury D, Khakshoor M, Azizi O, Khodaparast S, Baseri Z, Karami P, Zamanlou S, Farsiani H, Amini Y, Moradi B, Meshkat Z, Salimizand H, Hasanzadeh S, Sadeghian H. Diversity of aminoglycoside modifying enzymes and 16S rRNA methylases in Acinetobacter baumannii and Acinetobacter nosocomialis species in Iran; wide distribution of aadA1 and armA. INFECTION GENETICS AND EVOLUTION 2018; 66:195-199. [PMID: 30292703 DOI: 10.1016/j.meegid.2018.09.028] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/24/2018] [Revised: 09/12/2018] [Accepted: 09/30/2018] [Indexed: 10/28/2022]
Abstract
PURPOSE Acinetobacter baumannii-calcoaceticus complex (ABC) make a great burden on health-care systems due to hospital-acquired infections and antibacterial resistance. Aminoglycoside in combination with other antibacterials used as treatment options. However, ABC species overcome this class of antibacterials in different ways. This study provides a comprehensive report on the distribution of aminoglycoside modifying enzymes (AMEs) and 16S rRNA methylase in Acinetobacter baumannii and Acinetobacter nosocomialis isolated from various provinces in Iran. METHODS During six month of study, from eight referral centers in seven provinces across the country, Iran, 178 A. baumannii and 43 A. nosocomialis isolates were collected. The minimum inhibitory concentration of amikacin, gentamicin, netilmicin, kanamycin and tobramycin were measured by microbroth dilution method. AMEs and 16S rRNA methylase variants were sought by PCR. RESULTS High rates of resistance were seen in all centers. MIC50 and MIC90 for all A. baumannii and A. nosocomialis isolates from different centers were > 512 mg/L. The most frequent AME was ant(3″)-Ia (aadA1) in both of A. baumannii (74.1%) and A. nosocomialis (86%). armA was detected in A. baumannii and A. nosocomialis at the frequency of 41.6% and 67.4%, respectively. rmtA, B, C, D, aac(3)-Ia (aacC1) and aac(6')-Im were not detected, neither in A. baumannii nor A. nosocomialis. Moreover, aac(6')-Ih was only found in A. baumannii isolates. The distribution of some of the ARGs was limited to a definite center. CONCLUSION The overall high-level carriage of ARGs in Acinetobacter species may limited usage of this class of antibacterials as a treatment option.
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Affiliation(s)
- Himen Salimizand
- Liver and Digestive Research Center, Kurdistan University of Medical Sciences, Sanandaj, Iran; Department of Microbiology, Faculty of Medicine, Kurdistan University of medical Sciences, Sanandaj, Iran
| | - Abolfazl Raafati Zomorodi
- Department of Pathobiology, Faculty of Veterinary Medicine, Ferdowsi university of Mashhad, Mashhad, Iran
| | - Davood Mansury
- Student Research Committee, Faculty of Medicine, Mashhad, University of Medical Sciences, Mashhad, Iran; Antimicrobial Resistance Research Center, Avicenna Research Institute, Mashhad University of Medical Sciences, Mashhad, Iran; Department of Microbiology and Virology, Medical School, Mashhad University of medical Sciences, Mashhad, Iran
| | - Mostafa Khakshoor
- Microbiology Department, Faculty of science, Islamic Azad University of Tonekabon, Iran
| | - Omid Azizi
- Department of Laboratory Sciences, Torbat Heydariyeh University of Medical Sciences, Torbat Heydariyeh, Iran
| | - Sepideh Khodaparast
- Department of bacteriology, Faculty of Medical Sciences, Tarbiat Modares University, Tehran, Iran; Molecular laboratory, Shariati hospital, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Zohre Baseri
- Molecular laboratory, Shariati hospital, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Pezhman Karami
- Department of Microbiology, Faculty of Medicine, Hamadan University of Medical Sciences, Hamadan, Iran; Brucellosis Research Center, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Sajjad Zamanlou
- Department of Microbiology, Faculty of Medicine, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Hadi Farsiani
- Antimicrobial Resistance Research Center, Avicenna Research Institute, Mashhad University of Medical Sciences, Mashhad, Iran; Department of Microbiology and Virology, Medical School, Mashhad University of medical Sciences, Mashhad, Iran
| | - Yousef Amini
- Department of Microbiology, Medical school, Zahedan University of medical Sciences, Zahedan, Iran; Infectious Diseases and Tropical Medicine Research Center, Zahedan University of Medical Sciences, Zahedan, Iran
| | - Bagher Moradi
- Esfarayen University of Medical Sciences, Esfarayen, Iran
| | - Zahra Meshkat
- Antimicrobial Resistance Research Center, Avicenna Research Institute, Mashhad University of Medical Sciences, Mashhad, Iran; Department of Microbiology and Virology, Medical School, Mashhad University of medical Sciences, Mashhad, Iran
| | - Hana Salimizand
- Department of Biology, Sanandaj Branch, Islamic Azad University, Sanandaj, Iran
| | - Sepideh Hasanzadeh
- Student Research Committee, Faculty of Medicine, Mashhad, University of Medical Sciences, Mashhad, Iran; Antimicrobial Resistance Research Center, Avicenna Research Institute, Mashhad University of Medical Sciences, Mashhad, Iran; Department of Microbiology and Virology, Medical School, Mashhad University of medical Sciences, Mashhad, Iran
| | - Hamid Sadeghian
- Antimicrobial Resistance Research Center, Avicenna Research Institute, Mashhad University of Medical Sciences, Mashhad, Iran; Department of Laboratory Sciences, School of Paramedical Sciences, Mashhad University of Medical Sciences, Mashhad, Iran.
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Ramette A, Kronenberg A. Prevalence of carbapenem-resistant Acinetobacter baumannii from 2005 to 2016 in Switzerland. BMC Infect Dis 2018; 18:159. [PMID: 29614963 PMCID: PMC5883518 DOI: 10.1186/s12879-018-3061-5] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2017] [Accepted: 03/25/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND We describe the prevalence of invasive carbapenem-resistant Acinetobacter spp. isolated from 2005 to 2016 in different regions of Switzerland. METHODS Using the Swiss Antibiotic Resistance Centre (anresis) database that includes data from 70% of all hospitalized patients and one third of all ambulatory practitioners in Switzerland, we analysed the number of carbapenem-susceptible and resistant Acinetobacter spp. isolated from blood or cerebrospinal fluid, and further described their temporal and regional fluctuations. RESULTS From 2005 to 2016, 58 cases of resistant or intermediate strains to carbapenem were observed among 632 cases of invasive Acinetobacter. Multivariable analyses indicated that the number of carbapenem-resistant isolates (mean 4.8 ± sd 2.12) and carbapenem resistance rates per region per annum (8.4% ± 13.9%) were low and stable over the studied period. Large fluctuations were observed at the regional level, with e.g. the North East region displaying resistance rates twice as high as that found in other regions. CONCLUSION Despite a relatively stable number of carbapenem-resistant Acinetobacter isolates in Switzerland, our results suggest the existence of a diverse pool of A. baumannii species in hospital settings, and confirm the implication of carbapenem-resistant Acinetobacter calcoaceticus-Acinetobacter baumannii (ACB) complex in the vast majority of clinical infections and nosocomial outbreaks with notable regional fluctuations.
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Affiliation(s)
- A Ramette
- Institute for Infectious Diseases, University of Bern, Friedbühlstrasse 51, CH-3001, Bern, Switzerland.
| | - A Kronenberg
- Institute for Infectious Diseases, University of Bern, Friedbühlstrasse 51, CH-3001, Bern, Switzerland
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Acinetobacter pittii from Companion Animals Coharboring blaOXA-58, the tet(39) Region, and Other Resistance Genes on a Single Plasmid. Antimicrob Agents Chemother 2017; 62:AAC.01993-17. [PMID: 29109166 DOI: 10.1128/aac.01993-17] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Nowak J, Zander E, Stefanik D, Higgins PG, Roca I, Vila J, McConnell MJ, Cisneros JM, Seifert H. High incidence of pandrug-resistant Acinetobacter baumannii isolates collected from patients with ventilator-associated pneumonia in Greece, Italy and Spain as part of the MagicBullet clinical trial. J Antimicrob Chemother 2017; 72:3277-3282. [PMID: 28961773 PMCID: PMC5890771 DOI: 10.1093/jac/dkx322] [Citation(s) in RCA: 138] [Impact Index Per Article: 19.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2017] [Revised: 08/01/2017] [Accepted: 08/01/2017] [Indexed: 01/05/2023] Open
Abstract
OBJECTIVES To investigate the molecular epidemiology, antimicrobial susceptibility and carbapenem resistance determinants of Acinetobacter baumannii isolates from respiratory tract samples of patients diagnosed with ventilator-associated pneumonia (VAP) who were enrolled in the MagicBullet clinical trial. METHODS A. baumannii isolates were prospectively cultured from respiratory tract samples from 65 patients from 15 hospitals in Greece, Italy and Spain. Susceptibility testing was performed by broth microdilution. Carbapenem resistance determinants were identified by PCR and sequencing. Molecular epidemiology was investigated using rep-PCR (DiversiLab) and international clones (IC) were identified using our in-house database. RESULTS Of 65 isolates, all but two isolates (97%) were resistant to imipenem and these were always associated with an acquired carbapenemase, OXA-23 (80%), OXA-40 (4.6%), OXA-58 (1.5%) or OXA-23/58 (1.5%). Resistance to colistin was 47.7%. Twenty-two isolates were XDR, and 20 isolates were pandrug-resistant (PDR). The majority of isolates clustered with IC2 (n = 54) with one major subtype comprising isolates from 12 hospitals in the three countries, which included 19 XDR and 16 PDR isolates. CONCLUSIONS Carbapenem resistance rates were very high in A. baumannii recovered from patients with VAP. Almost half of the isolates were colistin resistant, and 42 (64.6%) isolates were XDR or PDR. Rep-PCR confirmed IC2 is the predominant clonal lineage in Europe and suggests the presence of an epidemic XDR/PDR A. baumannii clone that has spread in Greece, Italy and Spain. These data highlight the difficulty in empirical treatment of patients with A. baumannii VAP in centres with a high prevalence of carbapenem-resistant A. baumannii.
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Affiliation(s)
- J Nowak
- Institute for Medical Microbiology, Immunology and Hygiene, University of Cologne, Goldenfelsstraße 19-21, 50935 Cologne, Germany
| | - E Zander
- Institute for Medical Microbiology, Immunology and Hygiene, University of Cologne, Goldenfelsstraße 19-21, 50935 Cologne, Germany
| | - D Stefanik
- Institute for Medical Microbiology, Immunology and Hygiene, University of Cologne, Goldenfelsstraße 19-21, 50935 Cologne, Germany
| | - P G Higgins
- Institute for Medical Microbiology, Immunology and Hygiene, University of Cologne, Goldenfelsstraße 19-21, 50935 Cologne, Germany
- German Centre for Infection Research (DZIF), partner site Bonn-Cologne, Germany
| | - I Roca
- Department of Clinical Microbiology and ISGlobal, Barcelona Ctr. Int. Health Res. CRESIB, Hospital Clínic, Universitat de Barcelona, Barcelona, Spain
| | - J Vila
- Department of Clinical Microbiology and ISGlobal, Barcelona Ctr. Int. Health Res. CRESIB, Hospital Clínic, Universitat de Barcelona, Barcelona, Spain
| | - M J McConnell
- Clinical Unit of Infectious Diseases, Microbiology, and Preventive Medicine Infectious Diseases Research Group, Institute of Biomedicine of Seville (IBiS), University of Seville/CSIC/University Hospital Virgen del Rocío, Seville, Spain
| | - J M Cisneros
- Clinical Unit of Infectious Diseases, Microbiology, and Preventive Medicine Infectious Diseases Research Group, Institute of Biomedicine of Seville (IBiS), University of Seville/CSIC/University Hospital Virgen del Rocío, Seville, Spain
| | - H Seifert
- Institute for Medical Microbiology, Immunology and Hygiene, University of Cologne, Goldenfelsstraße 19-21, 50935 Cologne, Germany
- German Centre for Infection Research (DZIF), partner site Bonn-Cologne, Germany
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Wilharm G, Skiebe E, Higgins PG, Poppel MT, Blaschke U, Leser S, Heider C, Heindorf M, Brauner P, Jäckel U, Böhland K, Cuny C, Łopińska A, Kaminski P, Kasprzak M, Bochenski M, Ciebiera O, Tobółka M, Żołnierowicz KM, Siekiera J, Seifert H, Gagné S, Salcedo SP, Kaatz M, Layer F, Bender JK, Fuchs S, Semmler T, Pfeifer Y, Jerzak L. Relatedness of wildlife and livestock avian isolates of the nosocomial pathogenAcinetobacter baumanniito lineages spread in hospitals worldwide. Environ Microbiol 2017; 19:4349-4364. [DOI: 10.1111/1462-2920.13931] [Citation(s) in RCA: 44] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2016] [Accepted: 09/14/2017] [Indexed: 11/30/2022]
Affiliation(s)
- Gottfried Wilharm
- Wernigerode Branch; Robert Koch Institute, Burgstr. 37; Wernigerode D-38855 Germany
| | - Evelyn Skiebe
- Wernigerode Branch; Robert Koch Institute, Burgstr. 37; Wernigerode D-38855 Germany
| | - Paul G. Higgins
- Institute for Medical Microbiology, Immunology and Hygiene; University of Cologne; Cologne D-50935 Germany
- Partner site Bonn-Cologne; German Centre for Infection Research (DZIF); Germany
| | - Marie T. Poppel
- Wernigerode Branch; Robert Koch Institute, Burgstr. 37; Wernigerode D-38855 Germany
| | - Ulrike Blaschke
- Wernigerode Branch; Robert Koch Institute, Burgstr. 37; Wernigerode D-38855 Germany
| | - Sarah Leser
- Wernigerode Branch; Robert Koch Institute, Burgstr. 37; Wernigerode D-38855 Germany
| | - Christine Heider
- Wernigerode Branch; Robert Koch Institute, Burgstr. 37; Wernigerode D-38855 Germany
| | - Magdalena Heindorf
- Wernigerode Branch; Robert Koch Institute, Burgstr. 37; Wernigerode D-38855 Germany
| | - Paul Brauner
- Federal Institute for Occupational Safety and Health (BAuA), Nöldnerstr. 40-42; Berlin D-10317 Germany
| | - Udo Jäckel
- Federal Institute for Occupational Safety and Health (BAuA), Nöldnerstr. 40-42; Berlin D-10317 Germany
| | | | - Christiane Cuny
- Wernigerode Branch; Robert Koch Institute, Burgstr. 37; Wernigerode D-38855 Germany
| | - Andżelina Łopińska
- Faculty of Biological Sciences; University of Zielona Góra, Prof. Z. Szafrana Street 1; 65-561 Zielona Góra Poland
| | - Piotr Kaminski
- Faculty of Biological Sciences; University of Zielona Góra, Prof. Z. Szafrana Street 1; 65-561 Zielona Góra Poland
- Nicolaus Copernicus University in Toruń, Collegium Medicum in Bydgoszcz, Faculty of Medicine; Department of Medical Biology, Department of Ecology and Environmental Protection; M. Skłodowska-Curie St. 9, PL 85-094 Bydgoszcz Poland
| | - Mariusz Kasprzak
- Faculty of Biological Sciences; University of Zielona Góra, Prof. Z. Szafrana Street 1; 65-561 Zielona Góra Poland
| | - Marcin Bochenski
- Faculty of Biological Sciences; University of Zielona Góra, Prof. Z. Szafrana Street 1; 65-561 Zielona Góra Poland
| | - Olaf Ciebiera
- Faculty of Biological Sciences; University of Zielona Góra, Prof. Z. Szafrana Street 1; 65-561 Zielona Góra Poland
| | - Marcin Tobółka
- Institute of Zoology; Poznań University of Life Sciences, Wojska Polskiego 71C; 60-625 Poznań Poland
| | - Katarzyna M. Żołnierowicz
- Institute of Zoology; Poznań University of Life Sciences, Wojska Polskiego 71C; 60-625 Poznań Poland
| | | | - Harald Seifert
- Institute for Medical Microbiology, Immunology and Hygiene; University of Cologne; Cologne D-50935 Germany
- Partner site Bonn-Cologne; German Centre for Infection Research (DZIF); Germany
| | - Stéphanie Gagné
- Laboratory of Molecular Microbiology and Structural Biochemistry; University of Lyon, CNRS UMR 5086; Lyon F-69367 France
| | - Suzana P. Salcedo
- Laboratory of Molecular Microbiology and Structural Biochemistry; University of Lyon, CNRS UMR 5086; Lyon F-69367 France
| | - Michael Kaatz
- Vogelschutzwarte Storchenhof Loburg e.V, Chausseestr. 18; Loburg D-39279 Germany
| | - Franziska Layer
- Wernigerode Branch; Robert Koch Institute, Burgstr. 37; Wernigerode D-38855 Germany
| | - Jennifer K. Bender
- Wernigerode Branch; Robert Koch Institute, Burgstr. 37; Wernigerode D-38855 Germany
| | - Stephan Fuchs
- Wernigerode Branch; Robert Koch Institute, Burgstr. 37; Wernigerode D-38855 Germany
| | | | - Yvonne Pfeifer
- Wernigerode Branch; Robert Koch Institute, Burgstr. 37; Wernigerode D-38855 Germany
| | - Leszek Jerzak
- Faculty of Biological Sciences; University of Zielona Góra, Prof. Z. Szafrana Street 1; 65-561 Zielona Góra Poland
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Ladavac R, Bedenić B, Vranić-Ladavac M, Barišić N, Karčić N, Pompe K, Ferenčić A, Stojanović A, Seifert H, Katić S, Higgins PG. Emergence of different Acinetobacter baumannii clones in a Croatian hospital and correlation with antibiotic susceptibility. J Glob Antimicrob Resist 2017; 10:213-218. [PMID: 28735048 DOI: 10.1016/j.jgar.2017.07.001] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2017] [Revised: 06/07/2017] [Accepted: 07/09/2017] [Indexed: 10/19/2022] Open
Abstract
OBJECTIVES During routine diagnostic laboratory work, the clinical microbiologist observed an increase of Acinetobacter baumannii isolates with three different carbapenem susceptibility patterns: susceptible, intermediate and resistant. Isolates belonging to the same carbapenem susceptibility phenotype exhibited identical susceptibility/resistance patterns to non-β-lactam antibiotics. This prompted us to analyse the mechanisms of carbapenem-resistance and the molecular epidemiology of the isolates. A total of 59 A. baumannii isolates were analysed and grouped according to their susceptibility to imipenem: group 1 were susceptible (N=24), group 2 were intermediate (N=8) and group 3 were resistant (N=27) to imipenem. MATERIAL AND METHODS PCR and sequencing was used to detect resistance genes. Genotyping of the isolates was performed by PFGE and MLST. RESULTS Out of 27 resistant isolates, 20 harboured blaOXA-40-like and 7 blaOXA-23-like genes. ISAba1 was found upstream of blaOXA-51 and blaOXA-23 genes. PFGE genotyping demonstrated the existence of three major A. baumannii clones in GH Pula and determination of sequence groups showed that the isolates belonged to international clones commonly associated with multidrug-resistance. MLST (performed on six isolates) showed diverse population structure of isolates belonging to the same cluster, including ST 195, ST 231, ST 775 and ST 1095. CONCLUSIONS A previous study conducted in 2009-2010 showed that reduced susceptibility to carbapenems in GH Pula was only associated with upregulation of the intrinsic OXA-51 β-lactamase. In this study a shift to isolates with acquired oxacillinases, belonging to two major clones was reported.
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Affiliation(s)
- Ranko Ladavac
- Department for Nephrology, General Hospital Pula, Pula, Croatia
| | - Branka Bedenić
- Department for Microbiology, School of Medicine, University of Zagreb, Zagreb, Croatia; Clinical Department for Clinical and Molecular Microbiology, University Hospital Center Zagreb, Zagreb, Croatia.
| | - Mirna Vranić-Ladavac
- Department for Microbiology, Public Health Institute of Istria County, Pula, Croatia
| | - Nada Barišić
- Department for Microbiology, Public Health Institute of Istria County, Pula, Croatia
| | - Natalie Karčić
- Department for Microbiology, Public Health Institute of Istria County, Pula, Croatia
| | - Karoline Pompe
- Institute for Medical Microbiology, Immunology and Hygiene, University of Cologne, Goldenfelsstrasse 19-21, Cologne, Germany
| | - Antun Ferenčić
- School of Medicin, University of Rijeka, Rijeka, Croatia
| | - Aleksandar Stojanović
- Department for Microbiology, Public Health Institute of Istria County, Pula, Croatia
| | - Harald Seifert
- Institute for Medical Microbiology, Immunology and Hygiene, University of Cologne, Goldenfelsstrasse 19-21, Cologne, Germany; German Centre for Infection Research (DZIF), Partner Site Bonn-Cologne, Cologne, Germany
| | - Stjepan Katić
- Clinical Department for Clinical and Molecular Microbiology, University Hospital Center Zagreb, Zagreb, Croatia
| | - Paul G Higgins
- Institute for Medical Microbiology, Immunology and Hygiene, University of Cologne, Goldenfelsstrasse 19-21, Cologne, Germany; German Centre for Infection Research (DZIF), Partner Site Bonn-Cologne, Cologne, Germany
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Pournaras S, Dafopoulou K, Del Franco M, Zarkotou O, Dimitroulia E, Protonotariou E, Poulou A, Zarrilli R, Tsakris A, Skoura L, Themeli-Digalaki K, Perivolioti E, Tsiplakou S, Karavassilis V, Panopoulou M, Orfanidou M, Hadjichristodoulou C, Levidiotou S, Gikas A. Predominance of international clone 2 OXA-23-producing- Acinetobacter baumannii clinical isolates in Greece, 2015: results of a nationwide study. Int J Antimicrob Agents 2017; 49:749-753. [DOI: 10.1016/j.ijantimicag.2017.01.028] [Citation(s) in RCA: 43] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2016] [Revised: 01/16/2017] [Accepted: 01/28/2017] [Indexed: 10/19/2022]
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First Report of the Carbapenemase Gene blaOXA-499 in Acinetobacter pittii. Antimicrob Agents Chemother 2017; 61:AAC.02676-16. [PMID: 28264850 DOI: 10.1128/aac.02676-16] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2016] [Accepted: 01/30/2017] [Indexed: 11/20/2022] Open
Abstract
We identified the carbapenemase gene blaOXA-499, a variant of blaOXA-143, from a clinical isolate of Acinetobacter pittii for the first time. OXA-499 shared 93.1% amino acid identity with OXA-143, and the gene was located on the chromosome. By cloning the OXA-499-encoding gene into the pWH1266 vector and transforming it into susceptible Acinetobacter spp., we were able to show that OXA-499 confers resistance to carbapenems.
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Altun Ş, Koçak Tufan Z, Altun B, Önde U, Kınıklı S, Demiröz AP. Growing OXA-23 type strains among carbapenem-resistant Acinetobacter baumannii and tigecycline as an alternate combination therapy. Turk J Med Sci 2016; 46:1894-1899. [PMID: 28081345 DOI: 10.3906/sag-1508-20] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2015] [Accepted: 03/26/2016] [Indexed: 11/03/2022] Open
Abstract
BACKGROUND/AIM The increasing prevalence and global spread of difficult-to-treat carbapenem-resistant Acinetobacter baumannii has become a serious problem. The aim of this study is to investigate the resistance patterns and tigecycline sensitivity of carbapenem-resistant A. baumannii strains. MATERIALS AND METHODS Acinetobacter strains that were carbapenem-resistant and collected mainly from intensive care units were included into this study. The antibiotic sensitivity/resistance of the strains to other antibiotics and tigecycline were noted. Presence of blaOXA-23, blaOXA-48, blaOXA-58, and NDM-1 was investigated by PCR. RESULTS In total, 44 carbapenem-resistant A. baumannii strains were detected. In addition, 57% (25/44) showed resistance to netilmicin and 2% (1/43) to tigecycline. All of the strains were susceptible to colistin. blaOXA-58 was found only in one (2%) strain while blaOXA-23 was found in 14 (32%) strains. All strains were negative for blaOXA-48 and NDM-1. CONCLUSION blaOXA-23 was the main resistance pattern in carbapenem-resistant A. baumannii strains. blaOXA-58 was present only in one strain and no blaOXA-48 was found. Tigecycline susceptibility is high and it can be a treatment option for a possible combination therapy of carbapenem-resistant A. baumannii, especially for those for whom colistin is contraindicated because of its toxicity.
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Affiliation(s)
- Şerife Altun
- Department of Infectious Diseases and Clinical Microbiology, Polatlı Duatepe State Hospital, Ankara, Turkey
| | - Zeliha Koçak Tufan
- Department of Infectious Diseases & Clinical Microbiology, Ankara Atatürk Training and Research Hospital, Yıldırım Beyazıt University, Ankara, Turkey
| | - Belgin Altun
- Center for Stem Cell Research and Development, Hacettepe University, Ankara, Turkey
| | - Ufuk Önde
- Department of Microbiology, Ankara Training and Research Hospital, Ankara, Turkey
| | - Sami Kınıklı
- Department of Infectious Diseases and Clinical Microbiology, Ankara Training and Research Hospital, Ankara, Turkey
| | - Ali Pekcan Demiröz
- Department of Infectious Diseases and Clinical Microbiology, Ankara Training and Research Hospital, Ankara, Turkey
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Kresken M, Körber-Irrgang B, Petrik C, Seifert H, Rodloff A, Becker K. Temporal trends of the in vitro activity of tigecycline and comparator antibiotics against clinical aerobic bacterial isolates collected in Germany, 2006-2014: results of the Tigecycline Evaluation and Surveillance Trial (TEST). GMS INFECTIOUS DISEASES 2016; 4:Doc07. [PMID: 30671321 PMCID: PMC6301736 DOI: 10.3205/id000025] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
Given the rapidly changing landscape of antimicrobial resistance, continuous monitoring of antimicrobial susceptibility in clinically relevant bacterial isolates plays an important role in the management of infectious diseases. The Tigecycline Evaluation and Surveillance Trial (TEST) is an ongoing worldwide surveillance programme monitoring the in vitro activity of tigecycline and a panel of representative comparator antibiotics. We report longitudinal susceptibility data on a large set of isolates (n=36,044) from clinically significant bacterial species collected in 25 microbiological laboratories from 2006 to 2014. Trends include a strong increase of carbapenem and levofloxacin resistance in Acinetobacter spp., and smaller increasing rates of ESBL-producing Escherichia coli and vancomycin-resistant enterococci. Across the reporting period, the tigecycline minimum inhibitory concentrations (MICs) at which 50% and 90% of isolates were inhibited remained stable and susceptibility rates were consistently high (93–100%) for all bacterial species.
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Affiliation(s)
- Michael Kresken
- Antiinfectives Intelligence GmbH, Rheinbach, Germany.,University of Applied Sciences gGmbH, Cologne, Germany
| | | | | | - Harald Seifert
- University Hospital Cologne, Institute for Medical Microbiology, Immunology and Hygiene, Cologne, Germany
| | - Arne Rodloff
- University Hospital Leipzig, Institute for Medical Microbiology and Epidemiology of Infectious Diseases, Leipzig, Germany
| | - Karsten Becker
- University Hospital Münster, Institute of Medical Microbiology, Münster, Germany
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Al Atrouni A, Hamze M, Rafei R, Eveillard M, Joly-Guillou ML, Kempf M. Diversity of Acinetobacter species isolated from different environments in Lebanon: a nationwide study. Future Microbiol 2016; 11:1147-56. [DOI: 10.2217/fmb-2016-0082] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
Aim: To investigate the extrahospital reservoirs of Acinetobacter spp. in Lebanon. Materials & methods: Two thousand three hundred and sixty-one samples from different ecological niches were analyzed by culture methods. Species identification was confirmed by rpoB-gene sequencing. Multilocus sequence typing was used to characterize the Acinetobacter baumannii clones. Results & conclusion: Acinetobacter spp. were detected in 14% of environmental samples and 8% of food samples. Furthermore, 9% of animals and 3.4% of humans were colonized. Non-baumannii Acinetobacter were the most common species isolated and newly susceptible A. baumannii clones were detected. Interestingly, 21 isolates were not identified at the species level and were considered as putative novel species. To our knowledge, this is the largest epidemiological study investigating the epidemiology of Acinetobacter spp. outside hospitals.
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Affiliation(s)
- Ahmad Al Atrouni
- Laboratoire Microbiologie Santé et Environnement (LMSE), Ecole Doctorale des Sciences et de Technologie et Faculté de Santé Publique, Université Libanaise, Tripoli, Liban
- ATOMycA, Inserm Atip-Avenir Team, CRCNA, Inserm U892, 6299 CNRS, University of Angers, France
| | - Monzer Hamze
- Laboratoire Microbiologie Santé et Environnement (LMSE), Ecole Doctorale des Sciences et de Technologie et Faculté de Santé Publique, Université Libanaise, Tripoli, Liban
| | - Rayane Rafei
- Laboratoire Microbiologie Santé et Environnement (LMSE), Ecole Doctorale des Sciences et de Technologie et Faculté de Santé Publique, Université Libanaise, Tripoli, Liban
| | - Matthieu Eveillard
- ATOMycA, Inserm Atip-Avenir Team, CRCNA, Inserm U892, 6299 CNRS, University of Angers, France
- Laboratoire de Bactériologie, Institut de Biologie en Santé – Centre Hospitalier Universitaire, Angers, France
| | - Marie-Laure Joly-Guillou
- ATOMycA, Inserm Atip-Avenir Team, CRCNA, Inserm U892, 6299 CNRS, University of Angers, France
- Laboratoire de Bactériologie, Institut de Biologie en Santé – Centre Hospitalier Universitaire, Angers, France
| | - Marie Kempf
- ATOMycA, Inserm Atip-Avenir Team, CRCNA, Inserm U892, 6299 CNRS, University of Angers, France
- Laboratoire de Bactériologie, Institut de Biologie en Santé – Centre Hospitalier Universitaire, Angers, France
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Yang Q, Rui Y. Two Multiplex Real-Time PCR Assays to Detect and Differentiate Acinetobacter baumannii and Non- baumannii Acinetobacter spp. Carrying blaNDM, blaOXA-23-Like, blaOXA-40-Like, blaOXA-51-Like, and blaOXA-58-Like Genes. PLoS One 2016; 11:e0158958. [PMID: 27391234 PMCID: PMC4938629 DOI: 10.1371/journal.pone.0158958] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2015] [Accepted: 06/26/2016] [Indexed: 01/01/2023] Open
Abstract
Nosocomial infections caused by Acinetobacter spp. resistant to carbapenems are increasingly reported worldwide. Carbapenem-resistant Acinetobacter (CRA) is becoming a serious concern with increasing patient morbidity, mortality, and lengths of hospital stay. Therefore, the rapid detection of CRA is essential for epidemiological surveillance. Polymerase chain reaction (PCR) has been extensively used for the rapid identification of most pathogens. In this study, we have developed two multiplex real-time PCR assays to detect and differentiate A. baumannii and non-A. baumannii Acinetobacter spp, and common carbapenemase genes, including blaNDM, blaOXA-23-like, blaOXA-40-like, blaOXA-51-like, and blaOXA-58-like. We demonstrate the potential utility of these assays for the direct detection of blaNDM-, blaOXA-23-like-, blaOXA-40-like-, blaOXA-51-like-, and blaOXA-58-like-positive CRA in clinical specimens. Primers were specifically designed, and two multiplex real-time PCR assays were developed: multiplex real-time PCR assay1 for the detection of Acinetobacter baumannii 16S–23S rRNA internal transcribed spacer sequence, the Acinetobacter recA gene, and class-B-metalloenzyme-encoding gene blaNDM; and multiplex real-time PCR assay2 to detect class-D-oxacillinase-encoding genes (blaOXA-23-like, blaOXA-40-like, blaOXA-51-like,and blaOXA-58-like). The assays were performed on an ABI Prism 7500 FAST Real-Time PCR System. CRA isolates were used to compare the assays with conventional PCR and sequencing. Known amounts of CRA cells were added to sputum and fecal specimens and used to test the multiplex real-time PCR assays. The results for target and nontarget amplification showed that the multiplex real-time PCR assays were specific, the limit of detection for each target was 10 copies per 20 μL reaction volume, the assays were linear over six log dilutions of the target genes (r2 > 0.99), and the Ct values of the coefficients of variation for intra- and interassay reproducibility were less than 5%. The multiplex real-time PCR assays showed 100% concordance with conventional PCR when tested against 400 CRA isolates and their sensitivity for the target DNA in sputum and fecal specimens was 102 CFU/mL. Therefore, these novel multiplex real-time PCR assays allow the sensitive and specific characterization and differentiation of blaNDM-, blaOXA-23-like-, blaOXA-40-like-, blaOXA-51-like-, and blaOXA-58-like-positive CRA, making them potential tools for the direct detection of CRA in clinical specimens and the surveillance of nosocomial infections.
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Affiliation(s)
- Qiu Yang
- Laboratory Medicine Center, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Yongyu Rui
- Laboratory Medicine Center, Nanfang Hospital, Southern Medical University, Guangzhou, China
- * E-mail:
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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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Effects of Saline, an Ambient Acidic Environment, and Sodium Salicylate on OXA-Mediated Carbapenem Resistance in Acinetobacter baumannii. Antimicrob Agents Chemother 2016; 60:3415-8. [PMID: 27001819 DOI: 10.1128/aac.03010-15] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2015] [Accepted: 03/13/2016] [Indexed: 01/29/2023] Open
Abstract
Different physiological conditions, such as NaCl, low pH, and sodium salicylate, have been shown to affect antibiotic resistance determinants in Acinetobacter baumannii isolates. Therefore, the aim of this study was to investigate the effects of NaCl, sodium salicylate, and low pH on the susceptibility of A. baumannii to carbapenem. We cloned genes encoding oxacillinases (OXA) of different subclasses, with their associated promoters, from carbapenem-resistant A. baumannii isolates into the same vector and transferred them to the A. baumannii reference strains ATCC 19606 and ATCC 17978. Carbapenem MICs were determined at least in triplicate by agar dilution under standard conditions, as well as in the presence of 200 mM NaCl or 16 mM sodium salicylate, or at pH 5.8. OXA-58-like gene expression was determined by reverse transcription-quantitative PCR (qRT-PCR). Under some experimental conditions, significant MIC reductions were shown for some transformants but not for others. Only in one instance were all transformants harboring the same OXA affected by the same condition: at pH 5.8, the imipenem and meropenem MICs for strains expressing OXA-58-like enzymes decreased from a resistant level (32 to 64 mg/liter) to an intermediate-susceptible level (8 mg/liter). However, blaOXA-58-like gene expression remained the same. MICs for both wild-type reference strains were not affected by the conditions tested. Our results indicate that the effects of the experimental conditions tested on OXA in vivo are mostly strain dependent. MICs were not reduced to wild-type levels, suggesting that the conditions tested do not lead to complete OXA inhibition in the bacterial cell.
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Abstract
The OXA β-lactamases were among the earliest β-lactamases detected; however, these molecular class D β-lactamases were originally relatively rare and always plasmid mediated. They had a substrate profile limited to the penicillins, but some became able to confer resistance to cephalosporins. From the 1980s onwards, isolates of Acinetobacter baumannii that were resistant to the carbapenems emerged, manifested by plasmid-encoded β-lactamases (OXA-23, OXA-40, and OXA-58) categorized as OXA enzymes because of their sequence similarity to earlier OXA β-lactamases. It was soon found that every A. baumannii strain possessed a chromosomally encoded OXA β-lactamase (OXA-51-like), some of which could confer resistance to carbapenems when the genetic environment around the gene promoted its expression. Similarly, Acinetobacter species closely related to A. baumannii also possessed their own chromosomally encoded OXA β-lactamases; some could be transferred to A. baumannii, and they formed the basis of transferable carbapenem resistance in this species. In some cases, the carbapenem-resistant OXA β-lactamases (OXA-48) have migrated into the Enterobacteriaceae and are becoming a significant cause of carbapenem resistance. The emergence of OXA enzymes that can confer resistance to carbapenems, particularly in A. baumannii, has transformed these β-lactamases from a minor hindrance into a major problem set to demote the clinical efficacy of the carbapenems.
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44
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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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Al Atrouni A, Joly-Guillou ML, Hamze M, Kempf M. Reservoirs of Non-baumannii Acinetobacter Species. Front Microbiol 2016; 7:49. [PMID: 26870013 PMCID: PMC4740782 DOI: 10.3389/fmicb.2016.00049] [Citation(s) in RCA: 127] [Impact Index Per Article: 15.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2015] [Accepted: 01/12/2016] [Indexed: 11/29/2022] Open
Abstract
Acinetobacter spp. are ubiquitous gram negative and non-fermenting coccobacilli that have the ability to occupy several ecological niches including environment, animals and human. Among the different species, Acinetobacter baumannii has evolved as global pathogen causing wide range of infection. Since the implementation of molecular techniques, the habitat and the role of non-baumannii Acinetobacter in human infection have been elucidated. In addition, several new species have been described. In the present review, we summarize the recent data about the natural reservoir of non-baumannii Acinetobacter including the novel species that have been described for the first time from environmental sources and reported during the last years.
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Affiliation(s)
- Ahmad Al Atrouni
- Laboratoire Microbiologie Santé et Environnement, Centre AZM pour la Recherche en Biotechnologie et ses Applications, Ecole Doctorale des Sciences et de Technologie, Université LibanaiseTripoli, Liban
- ATOMycA, Inserm Atip-Avenir Team, CRCNA, Inserm U892, 6299 Centre National de la Recherche Scientifique, University of AngersAngers, Lebanon
| | - Marie-Laure Joly-Guillou
- ATOMycA, Inserm Atip-Avenir Team, CRCNA, Inserm U892, 6299 Centre National de la Recherche Scientifique, University of AngersAngers, Lebanon
- Laboratoire de Bactériologie, Institut de Biologie en Santé – Centre Hospitalier UniversitaireAngers, France
| | - Monzer Hamze
- Laboratoire Microbiologie Santé et Environnement, Centre AZM pour la Recherche en Biotechnologie et ses Applications, Ecole Doctorale des Sciences et de Technologie, Université LibanaiseTripoli, Liban
- Faculté de Santé Publique, Université LibanaiseTripoli, Lebanon
| | - Marie Kempf
- ATOMycA, Inserm Atip-Avenir Team, CRCNA, Inserm U892, 6299 Centre National de la Recherche Scientifique, University of AngersAngers, Lebanon
- Laboratoire de Bactériologie, Institut de Biologie en Santé – Centre Hospitalier UniversitaireAngers, France
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Kim SW, Oh MH, Jun SH, Jeon H, Kim SI, Kim K, Lee YC, Lee JC. Outer membrane Protein A plays a role in pathogenesis of Acinetobacter nosocomialis. Virulence 2016; 7:413-26. [PMID: 26759990 DOI: 10.1080/21505594.2016.1140298] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
Abstract
Acinetobacter nosocomialis is an important nosocomial pathogen that causes a variety of human infections. However, the specific virulence factors of this microorganism have not yet been determined. We investigated the role of outer membrane protein A (OmpA) in the pathogenesis of A. nosocomialis. A ΔompA mutant of the A. nosocomialis ATCC 17903(T) strain was constructed using markerless gene deletion. The ΔompA mutant displayed reduced biofilm formation in polystyrene tubes and reduced adherence to A549 cells in comparison to the wild-type strain. These virulence traits of the ΔompA mutant strain were restored when the ompA gene was complemented. Cytotoxicity was not significantly different between the wild-type strain and the ΔompA mutant when A549 cells were infected with bacteria or treated with outer membrane vesicles (OMVs). However, OMVs from the wild-type strain induced cytotoxicity in HEp-2 cells, whereas OMVs from the ΔompA mutant did not induce cytotoxicity. Proteomic analysis of OMVs revealed that OmpA influenced the distribution of envelope and periplasmic proteins. Overall, this study is the first report that links OmpA to A. nosocomialis pathogenesis, and highlights OmpA as a putative target to develop anti-virulence agents or vaccines against A. nosocomialis infection.
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Affiliation(s)
- Sang Woo Kim
- a Department of Microbiology , Kyungpook National University School of Medicine , Daegu , Korea.,b Department of Orthopedic Surgery , Ulsan University Hospital, University of Ulsan College of Medicine , Ulsan , Korea
| | - Man Hwan Oh
- c Department of Nanobiomedical Science , Dankook University , Cheonan , Korea
| | - So Hyun Jun
- a Department of Microbiology , Kyungpook National University School of Medicine , Daegu , Korea
| | - Hyejin Jeon
- a Department of Microbiology , Kyungpook National University School of Medicine , Daegu , Korea
| | - Seung Il Kim
- d Division of Life Science, Korea Basic Science Institute , Daejeon , Korea
| | - Kwangho Kim
- b Department of Orthopedic Surgery , Ulsan University Hospital, University of Ulsan College of Medicine , Ulsan , Korea
| | - Yoo Chul Lee
- a Department of Microbiology , Kyungpook National University School of Medicine , Daegu , Korea
| | - Je Chul Lee
- a Department of Microbiology , Kyungpook National University School of Medicine , Daegu , Korea
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The changing epidemiology of Acinetobacter spp. producing OXA carbapenemases causing bloodstream infections in Brazil: a BrasNet report. Diagn Microbiol Infect Dis 2015; 83:382-5. [DOI: 10.1016/j.diagmicrobio.2015.08.006] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2015] [Revised: 08/05/2015] [Accepted: 08/09/2015] [Indexed: 11/20/2022]
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48
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Huang C, Long Q, Qian K, Fu T, Zhang Z, Liao P, Xie J. Resistance and integron characterization of Acinetobacter baumannii in a teaching hospital in Chongqing, China. New Microbes New Infect 2015; 8:103-8. [PMID: 26649184 PMCID: PMC4644259 DOI: 10.1016/j.nmni.2015.09.015] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2015] [Revised: 09/23/2015] [Accepted: 09/24/2015] [Indexed: 10/25/2022] Open
Abstract
A total of 189 Acinetobacter baumannii isolates were collected in 2011 from a teaching hospital in Chongqing, China. Susceptibility data showed strains carrying integrons were significantly more resistant to all tested antibiotics that strains lacking integrons. Five types of gene cassettes belonging to class I integrons were identified in this study, and for the first time two types of gene cassettes belonging to class II integrons are reported. Most of the cassettes belong to a class I integron (136/144) encoding arr3, aacA4, dfrA17, aadA5, aadB, cat, blaOXA10 , aadA1, aadA2, dfrA and aacC1. Isolates contained a class I gene cassette; AadA2-HP-dfrA was the prevalent strain in this hospital. A class II integron was detected in eight strains, which contained the type IV fimbriae expression regulatory gene pilR and sulfate adenylyltransferase, suggesting a possible role in multidrug resistance. The major epidemic strains from intensive care unit patients belong to international clone 2. In conclusion, the presence of integrons was significantly associated with multiple drug resistance of A. baumannii in this hospital, and class I integron isolates bearing AadA2-HP-dfrA were the prevalent strain in this hospital.
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Affiliation(s)
- C Huang
- Institute of Modern Biopharmaceuticals, State Key Laboratory Breeding Base of Eco-Environment and Bio-Resource of the Three Gorges Area, Key Laboratory of Eco-Environments in Three Gorges Reservoir Region, Ministry of Education, School of Life Sciences, Southwest University, Beibei, China ; The Fifth People's Hospital of Chongqing, Nanan, China
| | - Q Long
- The Key Laboratory of Molecular Biology of Infectious Diseases of the Chinese Ministry of Education, Chongqing Medical University, Yuzhong, Chongqing, China ; Chongqing Center for Clinical Laboratory, The Third People's Hospital of Chongqing, Yuzhong, Chongqing, China
| | - K Qian
- The Fifth People's Hospital of Chongqing, Nanan, China
| | - T Fu
- Institute of Modern Biopharmaceuticals, State Key Laboratory Breeding Base of Eco-Environment and Bio-Resource of the Three Gorges Area, Key Laboratory of Eco-Environments in Three Gorges Reservoir Region, Ministry of Education, School of Life Sciences, Southwest University, Beibei, China
| | - Z Zhang
- Institute of Modern Biopharmaceuticals, State Key Laboratory Breeding Base of Eco-Environment and Bio-Resource of the Three Gorges Area, Key Laboratory of Eco-Environments in Three Gorges Reservoir Region, Ministry of Education, School of Life Sciences, Southwest University, Beibei, China ; Chongqing Center for Clinical Laboratory, The Third People's Hospital of Chongqing, Yuzhong, Chongqing, China
| | - P Liao
- Chongqing Center for Clinical Laboratory, The Third People's Hospital of Chongqing, Yuzhong, Chongqing, China
| | - J Xie
- Institute of Modern Biopharmaceuticals, State Key Laboratory Breeding Base of Eco-Environment and Bio-Resource of the Three Gorges Area, Key Laboratory of Eco-Environments in Three Gorges Reservoir Region, Ministry of Education, School of Life Sciences, Southwest University, Beibei, China
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Pailhoriès H, Daure S, Eveillard M, Joly-Guillou ML, Kempf M. Using Vitek MALDI-TOF mass spectrometry to identify species belonging to the Acinetobacter calcoaceticus–Acinetobacter baumannii complex: a relevant alternative to molecular biology? Diagn Microbiol Infect Dis 2015. [DOI: 10.1016/j.diagmicrobio.2015.06.009] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
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50
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Chiu CH, Lee YT, Wang YC, Yin T, Kuo SC, Yang YS, Chen TL, Lin JC, Wang FD, Fung CP. A retrospective study of the incidence, clinical characteristics, identification, and antimicrobial susceptibility of bacteremic isolates of Acinetobacter ursingii. BMC Infect Dis 2015; 15:400. [PMID: 26423424 PMCID: PMC4590261 DOI: 10.1186/s12879-015-1145-z] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2015] [Accepted: 09/23/2015] [Indexed: 01/30/2023] Open
Abstract
BACKGROUND Acinetobacter ursingii bacteremia is rarely reported. We investigated the incidence and clinical features of A. ursingii bacteremia, performance of the identification system, and antimicrobial susceptibility of the isolates. Acinetobacter ursingii bacteremia patients were compared with A. baumannii bacteremia patients. METHODS In this 9-year retrospective study, A. ursingii was identified using 16S rRNA and 16S-23S rRNA internal transcribed spacer sequence analysis. The performances of the Vitek 2, Phoenix, and matrix-assisted laser desorption ionization time-of-flight (MALDI-TOF) mass spectrometer systems for identifying isolates were tested. Pulsed-field gel electrophoresis (PFGE) was used to determine the clonality of the isolates. The minimal inhibitory concentrations of the antimicrobials were determined using the Vitek 2 system. RESULTS Nineteen patients were identified. Acinetobacter ursingii was noted in 1.5-5.2 % of all Acinetobacter bacteremia cases. For the PFGE analysis, two isolates had smeared DNA, two had 93 % similarity, and 15 had similarity <80 %. Among 16 patients with complete medical records, 10 (62.5 %) had no identifiable source of A. ursingii bacteremia. Most patients (n = 12) had underlying malignant disease. Patients with A. ursingii bacteremia had lower Acute Physiology and Chronic Health Evaluation II scores than those with A. baumannii bacteremia (median [interquartile range], 17.1 [10.0-24.7] vs. 24.9 [14.6-35.1]). Patients with A. ursingii bacteremia were also less likely admitted to the intensive care unit than patients with A. baumannii bacteremia (18.8 % vs 63.5 %, p value < 0.01). About half of the patients with A. ursingii (50.8 %) and A. baumannii bacteremia (62.5 %) had received inappropriate antimicrobial therapy within 48 h after bacteremia onset. However, patients with A. ursingii bacteremia had significantly lower 14-day (6.25 % vs 29.8 %, p value = 0.04) and 28-day mortality rates (6.25 % vs 37.3 %, p value = 0.02) than patients with A. baumannii bacteremia. Nine isolates (47.4 %) were correctly identified as A. ursingii and the other 10 isolates (52.6 %) were incorrectly identified as A. lwoffii by the Vitek 2 system. The Phoenix system incorrectly identified all 19 isolates. The MALDI-TOF mass spectrometer system correctly identified all 19 isolates. All the A. ursingii isolates were resistant or showed intermediate susceptibility to ceftriaxone and ceftazidime, but were susceptible to levofloxacin and imipenem. CONCLUSIONS Acinetobacter ursingii is a rare pathogen that mostly caused primary bacteremia in patients with malignancies. Patients with A. ursingii bacteremia had significantly lower disease severity and mortality rates than patients with A. baumannii bacteremia.
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Affiliation(s)
- Chun-Hsiang Chiu
- Division of Infectious Diseases and Tropical Medicine, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan.
- Institute of Clinical Medicine, School of Medicine, National Yang-Ming University, No.155, Sec.2, Linong Street, Taipei, 112, Taiwan, Republic of China.
| | - Yi-Tzu Lee
- Institute of Clinical Medicine, School of Medicine, National Yang-Ming University, No.155, Sec.2, Linong Street, Taipei, 112, Taiwan, Republic of China.
- Emergency Department, Taipei Veterans General Hospital, Taipei, Taiwan.
| | - Yung-Chih Wang
- Division of Infectious Diseases and Tropical Medicine, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan.
- Institute of Clinical Medicine, School of Medicine, National Yang-Ming University, No.155, Sec.2, Linong Street, Taipei, 112, Taiwan, Republic of China.
| | - Ti Yin
- Department of Nursing, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan.
- School of Nursing, National Yang-Ming University, Taipei, Taiwan.
| | - Shu-Chen Kuo
- Institute of Clinical Medicine, School of Medicine, National Yang-Ming University, No.155, Sec.2, Linong Street, Taipei, 112, Taiwan, Republic of China.
- National Institute of Infectious Diseases and Vaccinology, National Health Research Institutes, Zhunan, Miaoli County, Taiwan.
| | - Ya-Sung Yang
- Division of Infectious Diseases and Tropical Medicine, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan.
| | - Te-Li Chen
- Institute of Clinical Medicine, School of Medicine, National Yang-Ming University, No.155, Sec.2, Linong Street, Taipei, 112, Taiwan, Republic of China.
| | - Jung-Chung Lin
- Division of Infectious Diseases and Tropical Medicine, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan.
| | - Fu-Der Wang
- Institute of Clinical Medicine, School of Medicine, National Yang-Ming University, No.155, Sec.2, Linong Street, Taipei, 112, Taiwan, Republic of China.
| | - Chang-Phone Fung
- Institute of Clinical Medicine, School of Medicine, National Yang-Ming University, No.155, Sec.2, Linong Street, Taipei, 112, Taiwan, Republic of China.
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