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Rocha IV, Martins LR, Pimentel MIS, Mendes RPG, Lopes ACDS. Genetic profile and characterization of antimicrobial resistance in Acinetobacter baumannii post-COVID-19 pandemic: a study in a tertiary hospital in Recife, Brazil. J Appl Microbiol 2024; 135:lxae148. [PMID: 38886125 DOI: 10.1093/jambio/lxae148] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2024] [Revised: 05/22/2024] [Accepted: 06/14/2024] [Indexed: 06/20/2024]
Abstract
AIMS To investigate the genetic profile and characterize antimicrobial resistance, including the main β-lactam antibiotic resistance genes, in Acinetobacterbaumannii isolates from a tertiary hospital in Recife-PE, Brazil, in the post-COVID-19 pandemic period. METHODS AND RESULTS Acinetobacter baumannii isolates were collected between 2023 and 2024 from diverse clinical samples. Antimicrobial resistance testing followed standardized protocols, with β-lactamase-encoding genes detected via PCR and sequencing. Investigation into ISAba1 upstream of blaOXA-carbapenemase and blaADC genes was also conducted. Genetic diversity was assessed through ERIC-PCR. Among the 78 A. baumannii, widespread resistance to multiple antimicrobials was evident. Various acquired β-lactamase-encoding genes (blaOXA-23,-24,-58,-143, blaVIM, and blaNDM) were detected. Furthermore, this is the first report of blaVIM-2 in A. baumannii isolates harboring either the blaOXA-23-like or the blaOXA-143 gene in Brazil. Molecular typing revealed a high genetic heterogeneity among the isolates, and multi-clonal dissemination. CONCLUSION The accumulation of genetic resistance determinants underscores the necessity for stringent infection control measures and robust antimicrobial stewardship programs to curb multidrug-resistant strains.
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Affiliation(s)
- Igor Vasconcelos Rocha
- Federal University of Pernambuco-UFPE, Microbiology Laboratory. Department of Tropical Medicine. Center for Medical Sciences, Recife - PE, 50670-901, Brazil
| | - Lamartine Rodrigues Martins
- Federal University of Pernambuco-UFPE, Microbiology Laboratory. Department of Tropical Medicine. Center for Medical Sciences, Recife - PE, 50670-901, Brazil
| | - Maria Izabely Silva Pimentel
- Federal University of Pernambuco-UFPE, Microbiology Laboratory. Department of Tropical Medicine. Center for Medical Sciences, Recife - PE, 50670-901, Brazil
| | - Renata Pessôa Germano Mendes
- Aggeu Magalhães Institute, Oswaldo Cruz Foundation-FIOCRUZ-PE, Department of Virology and Experimental Therapy, Recife - PE, 50740-465, Brazil
| | - Ana Catarina de Souza Lopes
- Federal University of Pernambuco-UFPE, Microbiology Laboratory. Department of Tropical Medicine. Center for Medical Sciences, Recife - PE, 50670-901, Brazil
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Shelenkov A, Akimkin V, Mikhaylova Y. International Clones of High Risk of Acinetobacter Baumannii-Definitions, History, Properties and Perspectives. Microorganisms 2023; 11:2115. [PMID: 37630675 PMCID: PMC10459012 DOI: 10.3390/microorganisms11082115] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Revised: 05/24/2023] [Accepted: 08/10/2023] [Indexed: 08/27/2023] Open
Abstract
Acinetobacter baumannii is a Gram-negative coccobacillus with exceptional survival skills in an unfavorable environment and the ability to rapidly acquire antibiotic resistance, making it one of the most successful hospital pathogens worldwide, representing a serious threat to public health. The global dissemination of A. baumannii is driven by several lineages named 'international clones of high risk' (ICs), two of which were first revealed in the 1970s. Epidemiological surveillance is a crucial tool for controlling the spread of this pathogen, which currently increasingly involves whole genome sequencing. However, the assignment of a particular A. baumannii isolate to some IC based on its genomic sequence is not always straightforward and requires some computational skills from researchers, while the definitions found in the literature are sometimes controversial. In this review, we will focus on A. baumannii typing tools suitable for IC determination, provide data to easily determine IC assignment based on MLST sequence type (ST) and intrinsic blaOXA-51-like gene variants, discuss the history and current spread data of nine known ICs, IC1-IC9, and investigate the representation of ICs in public databases. MLST and cgMLST profiles, as well as OXA-51-like presence data are provided for all isolates available in GenBank. The possible emergence of a novel A. baumannii international clone, IC10, will be discussed.
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Affiliation(s)
- Andrey Shelenkov
- Central Research Institute of Epidemiology, Novogireevskaya Str., 3a, 111123 Moscow, Russia
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Firoozeh F, Nikibakhsh M, Badmasti F, Zibaei M, Nikbin VS. Clonal relatedness of carbapenem-resistant Acinetobacter baumannii: high prevalence of ST136 pas in a burn center. Ann Clin Microbiol Antimicrob 2023; 22:34. [PMID: 37149598 PMCID: PMC10164327 DOI: 10.1186/s12941-023-00589-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2022] [Accepted: 04/27/2023] [Indexed: 05/08/2023] Open
Abstract
BACKGROUND Carbapenem-resistant Acinetobacter baumannii (CRAB) is a global health crisis. This study aimed to determine the clonal relatedness of antibiotic-resistant A. baumannii isolates in hospitalized patients who suffered from burn wound infection. METHODS One hundred and six A. baumannii isolates from 562 patients with burn wound infections, were identified and examined for antimicrobial susceptibility. Detection and characterization of carbapenem-hydrolyzing class D OXA-type beta-lactamases (CHDLs) were performed by PCR assays. The clonal relatedness of A. baumannii isolates was determined by multilocus sequence typing (MLST) according to the Pasteur scheme, dual-sequence typing of blaOXA-51-like and ampC genes, and RAPD-PCR method. RESULTS All isolates were carbapenem-resistant while susceptible to colistin, minocycline, doxycycline, and ampicillin-sulbactam. The intrinsic blaOXA-51-like was detected in all isolates, and blaOXA-23-like was identified in 92.5% of isolates. However, blaOXA-143-like and blaOXA-58-like genes were not detected among isolates. Four distinct blaOXA-51-like alleles were determined as follows: blaOXA-317 (67.0%), blaOXA-90 (9.4%), blaOXA-69 (17.0%), and blaOXA-64 (6.6%) and four ampC (blaADC) allele types including ampC-25 (6.6%), ampC-39 (9.4%), ampC-1 (17.0%), and blaADC-88 (67.0%) were identified. MLST (Pasteur scheme) analysis revealed four ST types including ST136 (singleton), ST1 (CC1), ST25 (CC25), and ST78 (singleton) in 71, 18, 7, and 10 of A. baumannii strains, respectively. Five RAPD clusters including A (1.9%), B (26.4%), C (57.5%), D (7.5%), and E (1.9%) were characterized and 5 (4.7%) strains were found to be singletons. CONCLUSION The present study demonstrated that there was a high prevalence of blaOXA-23-like producing CRAB in the clinical setting. The majority of isolates belonged to ST136 (singleton). However, blaOXA-23-like producing multi-drug resistant international clones including ST1, and emerging lineages (e.g. ST25 and ST78) were also identified. Interestingly, in this study ST2 was not detected.
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Affiliation(s)
- Farzaneh Firoozeh
- Department of Microbiology, School of Medicine, Alborz University of Medical Sciences, Karaj, Iran
- Evidence-based Phytotherapy and Complementary Medicine Research Center, Alborz University of Medical Sciences, Karaj, Iran
| | - Mahnaz Nikibakhsh
- Department of Microbiology, School of Medicine, Alborz University of Medical Sciences, Karaj, Iran
| | - Farzad Badmasti
- Department of Bacteriology, Pasteur Institute of Iran, Tehran, Iran.
| | - Mohammad Zibaei
- Department of Parasitology and Mycology, School of Medicine, Alborz University of Medical Sciences, Karaj, Iran
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Galani I, Papoutsaki V, Karaiskos I, Moustakas N, Galani L, Maraki S, Mavromanolaki VE, Legga O, Fountoulis K, Platsouka ED, Giannopoulou P, Papadogeorgaki H, Damala M, Chinou E, Pasxali A, Deliolanis I, Vagiakou H, Petinaki E, Chli A, Vagdatli E, Kazila P, Papaioannou V, Kontopoulou K, Ferke AN, Moraitou E, Antoniadou A, Giamarellou H. In vitro activities of omadacycline, eravacycline, cefiderocol, apramycin, and comparator antibiotics against Acinetobacter baumannii causing bloodstream infections in Greece, 2020-2021: a multicenter study. Eur J Clin Microbiol Infect Dis 2023:10.1007/s10096-023-04616-7. [PMID: 37133639 PMCID: PMC10155660 DOI: 10.1007/s10096-023-04616-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2023] [Accepted: 04/26/2023] [Indexed: 05/04/2023]
Abstract
Resistance of Acinetobacter baumannii to multiple clinically important antimicrobials has increased to very high rates in Greece, rendering most of them obsolete. The aim of this study was to determine the molecular epidemiology and susceptibilities of A. baumannii isolates collected from different hospitals across Greece. Single-patient A. baumannii strains isolated from blood cultures (n = 271), from 19 hospitals, in a 6-month period (November 2020-April 2021) were subjected to minimum inhibitory concentration determination and molecular testing for carbapenemase, 16S rRNA methyltransferase and mcr gene detection and epidemiological evaluation. 98.9% of all isolates produced carbapenemase OXA-23. The vast majority (91.8%) of OXA-23 producers harbored the armA and were assigned mainly (94.3%) to sequence group G1, corresponding to IC II. Apramycin (EBL-1003) was the most active agent inhibiting 100% of the isolates at ≤16 mg/L, followed by cefiderocol which was active against at least 86% of them. Minocycline, colistin and ampicillin-sulbactam exhibited only sparse activity (S <19%), while eravacycline was 8- and 2-fold more active than minocycline and tigecycline respectively, by comparison of their MIC50/90 values. OXA-23-ArmA producing A. baumannii of international clone II appears to be the prevailing epidemiological type of this organism in Greece. Cefiderocol could provide a useful alternative for difficult to treat Gram-negative infections, while apramycin (EBL-1003), the structurally unique aminoglycoside currently in clinical development, may represent a highly promising agent against multi-drug resistant A. baumanni infections, due to its high susceptibility rates and low toxicity.
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Affiliation(s)
- Irene Galani
- Infectious Diseases Laboratory, 4th Department of Internal Medicine, National and Kapodistrian University of Athens, School of Medicine, Athens, Greece.
| | | | - Ilias Karaiskos
- 1st Department of Internal Medicine-Infectious Diseases, Hygeia General Hospital, Athens, Greece
| | - Nikolaos Moustakas
- Infectious Diseases Laboratory, 4th Department of Internal Medicine, National and Kapodistrian University of Athens, School of Medicine, Athens, Greece
| | - Lamprini Galani
- 1st Department of Internal Medicine-Infectious Diseases, Hygeia General Hospital, Athens, Greece
| | - Sofia Maraki
- Department of Clinical Bacteriology, Parasitology, Zoonoses and Geographical Medicine, University Hospital of Heraklion, Heraklion, Greece
| | - Viktoria Eirini Mavromanolaki
- Department of Clinical Bacteriology, Parasitology, Zoonoses and Geographical Medicine, University Hospital of Heraklion, Heraklion, Greece
| | - Olga Legga
- Department of Microbiology, General Hospital of Lamia, Lamia, Greece
| | - Kimon Fountoulis
- Department of Clinical Microbiology, Evangelismos General Hospital, Athens, Greece
| | - Evangelia D Platsouka
- Department of Microbiology, General Hospital of Nea Ionia, "Konstantopouleio-Patission", Athens, Greece
| | | | | | - Maria Damala
- Microbiology Department, "Alexandra" General Hospital of Athens, Athens, Greece
| | - Efrosini Chinou
- Department of Microbiology, St Savvas Cancer Hospital, Athens, Greece
| | - Aggeliki Pasxali
- Microbiology Laboratory, General Hospital of Corfu, Corfu, Greece
| | | | - Helen Vagiakou
- Microbiology Laboratory, General Hospital of Athens "G. Gennimatas", Athens, Greece
| | - Efthymia Petinaki
- Department of Microbiology, University Hospital of Larissa, Larissa, Greece
| | - Anastasia Chli
- Microbiology Laboratory, General Hospital of Kavala, Kavala, Greece
| | - Eleni Vagdatli
- Microbiology Department, Hippokration General Hospital, Thessaloniki, Greece
| | - Polyzo Kazila
- Department of Clinical Chemistry, "THEAGENEIO" Cancer Hospital, Thessaloniki, Greece
| | | | - Konstantina Kontopoulou
- Department of Microbiology, General Hospital of Thessaloniki "G. Gennimatas", Thessaloniki, Greece
| | | | - Eleni Moraitou
- Department of Clinical Microbiology, Sotiria General Hospital of Chest Diseases, Athens, Greece
| | - Anastasia Antoniadou
- Infectious Diseases Laboratory, 4th Department of Internal Medicine, National and Kapodistrian University of Athens, School of Medicine, Athens, Greece
| | - Helen Giamarellou
- 1st Department of Internal Medicine-Infectious Diseases, Hygeia General Hospital, Athens, Greece
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Colistin Resistance Onset Strategies and Genomic Mosaicism in Clinical Acinetobacter baumannii Lineages. Pathogens 2021; 10:pathogens10111516. [PMID: 34832671 PMCID: PMC8623500 DOI: 10.3390/pathogens10111516] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2021] [Revised: 11/17/2021] [Accepted: 11/18/2021] [Indexed: 11/16/2022] Open
Abstract
The treatment of multidrug-resistant Gram-negative infections is based on colistin. As result, COL-resistance (COL-R) can develop and spread. In Acinetobacter baumannii, a crucial step is to understand COL-R onset and stability, still far to be elucidated. COL-R phenotypic stability, onset modalities, and phylogenomics were investigated in a clinical A. baumannii sample showing a COL resistant (COLR) phenotype at first isolation. COL-R was confirmed by Minimum-Inhibitory-Concentrations as well as investigated by Resistance-Induction assays and Population-Analysis-Profiles (PAPs) to determine: (i) stability; (ii) inducibility; (iii) heteroresistance. Genomics was performed by Mi-Seq Whole-Genome-Sequencing, Phylogenesis, and Genomic Epidemiology by bioinformatics. COLRA. baumannii were subdivided as follows: (i) 3 A. baumannii with stable and high COL MICs defining the “homogeneous-resistant” onset phenotype; (ii) 6 A. baumannii with variable and lower COL MICs displaying a “COL-inducible” onset phenotype responsible for adaptive-resistance or a “subpopulation” onset phenotype responsible for COL-heteroresistance. COL-R stability and onset strategies were not uniquely linked to the amount of LPS and cell envelope charge. Phylogenomics categorized 3 lineages clustering stable and/or unstable COL-R phenotypes with increasing genomic complexity. Likewise, different nsSNP profiling in genes already associated with COL-R marked the stable and/or unstable COL-R phenotypes. Our investigation finds out that A. baumannii can range through unstable or stable COLR phenotypes emerging via different “onset strategies” within phylogenetic lineages displaying increasing genomic mosaicism.
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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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Szczypta A, Talaga-Ćwiertnia K, Kielar M, Krzyściak P, Gajewska A, Szura M, Bulanda M, Chmielarczyk A. Investigation of Acinetobacter baumannii Activity in Vascular Surgery Units through Epidemiological Management Based on the Analysis of Antimicrobial Resistance, Biofilm Formation and Genotyping. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18041563. [PMID: 33562194 PMCID: PMC7915860 DOI: 10.3390/ijerph18041563] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/22/2020] [Revised: 02/01/2021] [Accepted: 02/02/2021] [Indexed: 12/17/2022]
Abstract
Background/Objectives: The genus Acinetobacter demonstrates resistance to antibiotics and has been shown to spread in the hospital environment causing epidemic outbreaks among hospitalized patients. The objectives of the present study was to investigate the antibiotic resistance, biofilm formation, and clonality among Acinetobacter baumannii strains. Materials and Methods: The study involved 6 (I Outbreak) and 3 (II Outbreak) A. baumannii strains isolated from patients hospitalized in vascular surgery unit. Results: All tested A. baumannii strains were extensively drug resistant (XDR) and all the isolates were carbapenem-resistant and among them, all carried the blaOXA-51 gene, the blaOXA-24 gene, as well as the blaOXA-23 gene. All of the investigated strains had the ability to form a biofilm, but all of them produced less biofilm than the reference strain. Multi-locus sequence typing (MLST) showed that all strains belonged to the ST2 clone. Pulsed-field gel electrophoresis (PFGE) divided the tested outbreak strains into two clones (A and B). Conclusion: This study shows a nosocomial spread of XDR A. baumannii ST2 having the blaOXA-51 gene, the blaOXA-24 gene, as well as the blaOXA-23 gene, low biofilm formers, that was prevalent in the vascular surgery unit. To identify the current situation of vascular surgery departments targeted epidemiological investigation was needed. Effective implementation of infection control prevented the spread of the epidemic outbreaks.
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Affiliation(s)
- Anna Szczypta
- Faculty of Medicine and Health Sciences, Andrzej Frycz Modrzewski Krakow University, 30-705 Kraków, Poland;
- The Bonifratri Order Hospital of St. John Grande, 31-061 Kraków, Poland;
| | - Katarzyna Talaga-Ćwiertnia
- Jagiellonian University Medical College, Faculty of Medicine, Chair of Microbiology, Department of Infection Control and Mycology, 31-008 Kraków, Poland; (P.K.); (M.B.)
- Correspondence: ; Tel.: +48-12-633-0877 (ext. 231)
| | - Małgorzata Kielar
- Medical Diagnostic Laboratory with a Bacteriological Unit, St. Louis Regional Specialised Children’s Hospital, 31-503 Kraków, Poland;
| | - Paweł Krzyściak
- Jagiellonian University Medical College, Faculty of Medicine, Chair of Microbiology, Department of Infection Control and Mycology, 31-008 Kraków, Poland; (P.K.); (M.B.)
| | | | - Mirosław Szura
- The Bonifratri Order Hospital of St. John Grande, 31-061 Kraków, Poland;
- Jagiellonian University Medical College, Department of Clinical and Experimental Surgery, 31-008 Kraków, Poland
| | - Małgorzata Bulanda
- Jagiellonian University Medical College, Faculty of Medicine, Chair of Microbiology, Department of Infection Control and Mycology, 31-008 Kraków, Poland; (P.K.); (M.B.)
| | - Agnieszka Chmielarczyk
- Jagiellonian University Medical College, Faculty of Medicine, Chair of Microbiology, Department of Bacteriology, Microbial Ecology and Parasitology, 31-008 Kraków, Poland;
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Endemicity of OXA-23 and OXA-72 in clinical isolates of Acinetobacter baumannii from three neighbouring countries in Southeast Europe. J Appl Genet 2021; 62:353-359. [PMID: 33502723 DOI: 10.1007/s13353-021-00612-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2020] [Revised: 12/20/2020] [Accepted: 01/11/2021] [Indexed: 10/22/2022]
Abstract
According to the World Health Organization, bacterium Acinetobacter baumannii is the first on the critical priority list of pathogens in urgent need for new antibiotics. The increasing resistance of A. baumannii to the last-line treatment options, including carbapenems, is a global problem. We report the molecular epidemiology of 12 carbapenem-resistant clinical isolates of A. baumannii collected from hospitalised patients in three neighbouring countries in Southeast Europe: Croatia, Serbia, and Bosnia and Herzegovina, giving an insight into the molecular characterisation and evolutionary history of the acquisition of resistance genes. Besides the blaOXA-23 gene, the endemic presence of OXA-72 oxacillinase of the same origin for more than a decade as the leading mechanism of carbapenem resistance in Southeast Europe was confirmed. To the best of our knowledge, this is the first paper that investigates and analyses the phylogenetic association of the most common mechanisms of resistance to carbapenems in clinical isolates of A. baumannii originating from three neighbouring countries in Southeast Europe.
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Hamidian M, Nigro SJ. Emergence, molecular mechanisms and global spread of carbapenem-resistant Acinetobacter baumannii. Microb Genom 2020; 5. [PMID: 31599224 PMCID: PMC6861865 DOI: 10.1099/mgen.0.000306] [Citation(s) in RCA: 158] [Impact Index Per Article: 39.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023] Open
Abstract
Acinetobacter baumannii is a nosocomial pathogen that has emerged as a global threat because of high levels of resistance to many antibiotics, particularly those considered to be last-resort antibiotics, such as carbapenems. Although alterations in the efflux pump and outer membrane proteins can cause carbapenem resistance, the main mechanism is the acquisition of carbapenem-hydrolyzing oxacillinase-encoding genes. Of these, oxa23 is by far the most widespread in most countries, while oxa24 and oxa58 appear to be dominant in specific regions. Historically, much of the global spread of carbapenem resistance has been due to the dissemination of two major clones, known as global clones 1 and 2, although new lineages are now common in some parts of the world. The analysis of all publicly available genome sequences performed here indicates that ST2, ST1, ST79 and ST25 account for over 71 % of all genomes sequenced to date, with ST2 by far the most dominant type and oxa23 the most widespread carbapenem resistance determinant globally, regardless of clonal type. Whilst this highlights the global spread of ST1 and ST2, and the dominance of oxa23 in both clones, it could also be a result of preferential selection of carbapenem-resistant strains, which mainly belong to the two major clones. Furthermore, ~70 % of the sequenced strains have been isolated from five countries, namely the USA, PR China, Australia, Thailand and Pakistan, with only a limited number from other countries. These genomes are a vital resource, but it is currently difficult to draw an accurate global picture of this important superbug, highlighting the need for more comprehensive genome sequence data and genomic analysis.
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Affiliation(s)
- Mohammad Hamidian
- The ithree institute, University of Technology Sydney, Ultimo, NSW 2007, Australia
| | - Steven J Nigro
- Communicable Diseases Branch, Health Protection NSW, St Leonards, NSW 2065, Australia
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D'Onofrio V, Conzemius R, Varda-Brkić D, Bogdan M, Grisold A, Gyssens IC, Bedenić B, Barišić I. Epidemiology of colistin-resistant, carbapenemase-producing Enterobacteriaceae and Acinetobacter baumannii in Croatia. INFECTION GENETICS AND EVOLUTION 2020; 81:104263. [PMID: 32105865 DOI: 10.1016/j.meegid.2020.104263] [Citation(s) in RCA: 32] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/11/2019] [Revised: 02/19/2020] [Accepted: 02/21/2020] [Indexed: 10/24/2022]
Abstract
Colistin is a last-resort antibiotic for the treatment of infections caused by multidrug and carbapenem-resistant Gram-negative bacteria. Colistin resistance has been emerging and multiple outbreaks have been reported in Europe and elsewhere. It has been most frequently reported in carbapenem-resistant K. pneumoniae. In this study, 24 multidrug and colistin-resistant clinical isolates (14 K. pneumoniae, one E. aerogenes, one E. cloacae, and eight A. baumannii) were collected from four hospitals in Croatia from 2013 to 2018, in order to analyse the molecular epidemiology and mechanisms of antibiotic resistance. β-lactamase and carbapenemase genes were detected by PCR. Genotyping was done on selected isolates by rep-PCR. Whole genome sequencing (WGS) was performed to discover possible molecular mechanisms for the observed colistin resistance. All isolates, except two K. pneumoniae isolates, were extensively drug resistant. Ten out of 16 (63%) K. pneumoniae isolates possessed blaOXA-48, which is the most common carbapenem resistance gene in Croatia and in other parts of Europe. All A. baumannii isolates possessed the OXA-23-like carbapenem hydrolysing oxacillinase and five turned out to be pandrug-resistant. Colistin resistance was most likely chromosomally mediated. After sequence analysis, none of the isolates were found to possess any of the mcr gene variants. Several previously reported mutations were found in PmrB, PhoP, PhoQ, and MgrB, which are associated with colistin resistance. In the global phylogenetic analysis, DNA mutations causing mutations in the MgrB protein were present mostly in lineages comprising colistin resistant isolates, and the second most prevalent mutation (K3X) was also encountered in our isolates. In addition, based on genotyping by rep-PCR, the spread of colistin resistance is most likely to be clonal. Most importantly, the presence of colistin resistance together with carbapenemase genes in extensively drug resistant isolates poses real threats in the use of carbapenems and colistin to fight infections.
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Affiliation(s)
- Valentino D'Onofrio
- Faculty of Medicine and Life Sciences, Hasselt University, 3500 Hasselt, Belgium.; Department of Infectious Diseases and Immunity, Jessa Hospital, 3500 Hasselt, Belgium; Department of Internal Medicine and Center for Infectious Diseases, Radboud University Medical Center, 6663 Nijmegen, The Netherlands
| | - Rick Conzemius
- AIT, Austrian Institute for Technology, 1210 Vienna, Austria
| | | | - Maja Bogdan
- Public Health Institute of Osijek-Baranja County, 31000 Osijek, Croatia; School of Medicine, University of Osijek, 31000 Osijek, Croatia
| | - Andrea Grisold
- Institute for Hygiene, Microbiology and Environmental Medicine, Medical University of Graz, Graz, Austria
| | - Inge C Gyssens
- Faculty of Medicine and Life Sciences, Hasselt University, 3500 Hasselt, Belgium.; Department of Internal Medicine and Center for Infectious Diseases, Radboud University Medical Center, 6663 Nijmegen, The Netherlands
| | - Branka Bedenić
- University Hospital Center Zagreb, 10000 Zagreb, Croatia; School of Medicine, University of Zagreb, 10000 Zagreb, Croatia
| | - Ivan Barišić
- AIT, Austrian Institute for Technology, 1210 Vienna, Austria.
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Lukić-Grlić A, Kos M, Žižek M, Luxner J, Grisold A, Zarfel G, Bedenić B. Emergence of Carbapenem-Hydrolyzing Oxacillinases in Acinetobacter baumannii in Children from Croatia. Chemotherapy 2019; 64:167-172. [PMID: 31707391 DOI: 10.1159/000503746] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2019] [Accepted: 09/26/2019] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Carbapenem resistance in Acinetobacter baumannii can be mediated by carbapenemases of class A, class B metallo-β-lactamases (MBLs), and class D carbapenem-hydrolyzing oxacillinases (CHDL). The aim of the study was to investigate the antimicrobial susceptibility and β-lactamase production of carbapenem-resistant A. baumannii isolates (CRAB) from the Children's Hospital Zagreb, Croatia. METHODS A total of 12 A. baumannii isolates collected between August 2016 and March 2018 were analyzed. Antibiotic susceptibility was determined by the broth microdilution method. The presence of MBLs was explored by combined disk test with EDTA. The presence of carbapenemases of class A, B, and D was explored by PCR. The occurrence of the ISAba1 upstream of the blaOXA-51-like or blaOXA-23-like was determined by PCR mapping. Epidemiological typing was performed by determination of sequence groups (SG). Genotyping was performed by SG determination, rep-PCR, and MLST. RESULTS All CRAB were resistant to piperacillin/tazobactam, ceftazidime, cefotaxime, ceftriaxone, cefepime, imipenem, meropenem, gentamicin, and ciprofloxacin. Moderate resistance rates were observed for ampicillin/sulbactam (67%) and tigecycline (42%). The isolates were uniformly susceptible to colistin. PCR revealed the presence of genes encoding OXA-24-like CHDL in nine and OXA-23-like CHDL in three isolates. blaOXA-51 genes were preceded by ISAba1. PCR for the common MBLs in Acinetobacter was negative. All isolates belonged to SG 1 corresponding to ICL (International Clonal Lineage) II. Rep-PCR identified four major clones. CONCLUSIONS The study found OXA-24-like β-lactamase to be the dominant CHDL among children'sCRAB. The predominant spread of OXA-24-like is in contrast with the recent global dissemination of OXA-23 reported all over the world. In contrast to the previous studies in which emergency of OXA-24-like positive isolates was monoclonal, we found considerable genetic diversity of the isolates.
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Affiliation(s)
- Amarela Lukić-Grlić
- School of Medicine, University of Zagreb, Zagreb, Croatia, .,Children's Hospital Zagreb, Zagreb, Croatia,
| | - Matea Kos
- Children's Hospital Zagreb, Zagreb, Croatia
| | - Marta Žižek
- Faculty of Health Sciences, University of Zagreb, Zagreb, Croatia
| | - Josefa Luxner
- Institute of Microbiology, Hygiene and Environmental Medicine, Medical University of Graz, Graz, Austria
| | - Andrea Grisold
- Institute of Microbiology, Hygiene and Environmental Medicine, Medical University of Graz, Graz, Austria
| | - Gernot Zarfel
- Institute of Microbiology, Hygiene and Environmental Medicine, Medical University of Graz, Graz, Austria
| | - Branka Bedenić
- School of Medicine, University of Zagreb, Zagreb, Croatia.,University Hospital Center, Zagreb, Croatia
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12
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Complete Genome Sequence of A388, an Antibiotic-Resistant Acinetobacter baumannii Global Clone 1 Isolate from Greece. Microbiol Resour Announc 2019; 8:8/41/e00971-19. [PMID: 31601668 PMCID: PMC6787325 DOI: 10.1128/mra.00971-19] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Acinetobacter baumannii isolate A388, recovered in Greece in 2002, represents a distinct antibiotic-resistant lineage of global clone 1 (GC1) producing the OXA-58 carbapenemase. We present the complete 4.332-Mbp genome sequence (chromosome plus 1 plasmid), generated by combining long (MinION) and short (Illumina HiSeq) read sequencing data. Acinetobacter baumannii isolate A388, recovered in Greece in 2002, represents a distinct antibiotic-resistant lineage of global clone 1 (GC1) producing the OXA-58 carbapenemase. We present the complete 4.332-Mbp genome sequence (chromosome plus 1 plasmid), generated by combining long (MinION) and short (Illumina HiSeq) read sequencing data.
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13
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Nafplioti K, Galani I, Angelidis E, Adamou P, Moraitou E, Giannopoulou P, Chra P, Damala M, Vogiatzakis E, Trikka-Graphakos E, Baka V, Prifti E, Antoniadou A, Souli M. Dissemination of International Clone II Acinetobacter baumannii Strains Coproducing OXA-23 Carbapenemase and 16S rRNA Methylase ArmA in Athens, Greece. Microb Drug Resist 2019; 26:9-13. [PMID: 31393211 DOI: 10.1089/mdr.2019.0075] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
The aim of this study was to study the molecular epidemiology of 16S rRNA-methylase (RMT)-producing clinical Acinetobacter baumannii isolates from hospitals in Athens, Greece. Single-patient A. baumannii clinical isolates, coresistant to amikacin and gentamicin (n = 347), from five tertiary care hospitals, were submitted to minimum inhibitory concentration determination and molecular testing for carbapenemase and RMT genes. A. baumannii, resistant to amikacin and gentamicin, was isolated at participating institutions at a mean rate of 67.8%. Among them 93.7% harbored the armA. The vast majority (98.5%) of armA positive isolates were OXA-23 producers, assigned mainly (99.4%) to sequence group G1, corresponding to international clone (IC) II. Four isolates (all from the same hospital) were OXA-24 producers (1.2%), assigned to G6 corresponding to CC78 and only one isolate was OXA-58-producer, assigned to G2 (IC I). Apramycin was the most active agent inhibiting 99.7% of the isolates at ≤64 mg/L, whereas colistin, trimethoprim/sulfamethoxazole, minocycline, and tigecycline exhibited only sparse activity (S, <18%). RMT production is an emerging mechanism of resistance, capable of compromising the clinical efficacy of aminoglycosides. High prevalence of armA was observed among A. baumannii strains isolated in participating hospitals in Athens, which were mainly OXA-23 producers and belonged to IC II. Apramycin is a structurally unique aminoglycoside, currently used as a veterinary agent. Although it has not been evaluated for clinical use, apramycin appears worthy of further investigation for repurposing as a human therapeutic against difficult-to-treat pathogens.
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Affiliation(s)
- Konstantina Nafplioti
- 4th Department of Internal Medicine, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Irene Galani
- 4th Department of Internal Medicine, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece.,4th Department of Internal Medicine, "Attikon" University General Hospital, Athens, Greece
| | - Evdokia Angelidis
- 4th Department of Internal Medicine, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Panagiota Adamou
- 4th Department of Internal Medicine, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Eleni Moraitou
- Department of Clinical Microbiology, "Sotiria" General and Chest Diseases Hospital, Athens, Greece
| | | | - Paraskevi Chra
- Microbiology Department, Korgialenio Benakio Hellenic Red Cross Hospital, Athens, Greece
| | - Maria Damala
- Microbiology Department, "Alexandra" General Hospital of Athens, Athens, Greece
| | - Evangellos Vogiatzakis
- Department of Clinical Microbiology, "Sotiria" General and Chest Diseases Hospital, Athens, Greece
| | | | - Vasiliki Baka
- Microbiology Department, Korgialenio Benakio Hellenic Red Cross Hospital, Athens, Greece
| | - Eleni Prifti
- Microbiology Department, "Alexandra" General Hospital of Athens, Athens, Greece
| | - Anastasia Antoniadou
- 4th Department of Internal Medicine, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece.,4th Department of Internal Medicine, "Attikon" University General Hospital, Athens, Greece
| | - Maria Souli
- 4th Department of Internal Medicine, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
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14
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Jain M, Sharma A, Sen MK, Rani V, Gaind R, Suri JC. Phenotypic and molecular characterization of Acinetobacter baumannii isolates causing lower respiratory infections among ICU patients. Microb Pathog 2018; 128:75-81. [PMID: 30562602 DOI: 10.1016/j.micpath.2018.12.023] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2018] [Revised: 11/16/2018] [Accepted: 12/11/2018] [Indexed: 11/18/2022]
Abstract
BACKGROUND Multi-drug resistant Acinetobacter baumannii has emerged as important nosocomial pathogen associated with various infections including lower respiratory tract. Limited therapeutic options contribute to increased morbidity and mortality. Acinetobacter baumannii has the ability to persist in the environment for prolonged periods. Breach in infection control practices increases the chances of cross transmission between patients and inter/intraspecies transmission of resistance elements. The present prospective work was conducted among patients with lower respiratory tract infections (LRTI) in the intensive care unit (ICU) to study the etiology with special reference to Acinetobacter baumannii and the role of immediate patient environment in the ICU as possible source of infection. Acinetobacter baumannii were characterized for antimicrobial susceptibility, mechanism of carbapenem resistance and virulence determinants. Molecular typing of the clinical and environmental isolates was undertaken to study the probable modes of transmission. MATERIALS AND METHODS Appropriate respiratory samples from 107 patients with LRTI admitted to ICU during September 2016 to March 2017 were studied for likely bacterial pathogens. Environmental samples (n = 71) were also screened. All the samples were processed using conventional microbiological methods. Consecutive Acinetobacter spp. isolated from clinical and environmental (health care workers and environment from ICU) samples were included in the study. Antimicrobial susceptibility was performed as per CLSI guidelines. Carbapenem resistance, mediated by carbapenemase genes (blaOXA-23-like,blaOXA-24-like,blaOXA-58-like and blaNDM-1) were studied by PCR. Biofilm forming ability was tested phenotypically using microtitre plate method. Pulse Field Gel Electrophoresis (PFGE) was used to study clonality of the clinical and environmental isolates. RESULTS The prevalence of Acinetobacter baumannii was 26.2% (28/107) and 11.26% (8/71) among patients with LRTI and environmental samples respectively. The carbapenem resistance was high, 96.42% (27/28) and 87.5% (7/8) in clinical and environmental isolates respectively. The most common carbapenemase associated with resistance was blaOXA-23-like gene followed by blaNDM-1 among both the clinical and environmental isolates. All isolates were sensitive to colistin (MIC ≤ 1 μg/ml). Biofilm production was observed among all clinical (n = 28) and 87.5% (7/8) of the environmental isolates. Line listing of the cases suggests the occurrence of infections throughout the study period with no significant clustering. On PFGE, 12 clusters were observed and 16/36 isolates were present in one single cluster that included both clinical and environmental isolates which were either carbapenem resistant or sensitive. DISCUSSION Carbapenem resistant Acinetobacter baumannii (CRAB) is an important cause of LRTI in the ICU. PFGE suggests spread of carbapenem resistant isolates via cross transmission among patients and the environment. The detection of blaNDM-1 gene among Acinetobacter baumannii and existence of carbapenem resistant and sensitive isolates within the same clones suggests horizontal transmission of resistant genes among various bacterial species. The ability of Acinetobacter baumannii to form biofilms may contribute to its persistence in the environment. This along with breach in infection control practices are the likely factors contributing to this transmission. This information can be used to strengthen and monitor infection control (IC) and the hospital cleaning and disinfection practices to prevent spread of resistant organisms within the ICU. Colistin remains drug of choice for management of CRAB.
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Affiliation(s)
- Manisha Jain
- Department of Microbiology, Vardhman Mahavir Medical College and Safdarjung Hospital, Delhi, India
| | - Amit Sharma
- Department of Microbiology, Vardhman Mahavir Medical College and Safdarjung Hospital, Delhi, India
| | - M K Sen
- Department of Pulmonary, Critical Care & Sleep Medicine, Vardhman Mahavir Medical College and Safdarjung Hospital, Delhi, India
| | - Vandana Rani
- Department of Microbiology, Vardhman Mahavir Medical College and Safdarjung Hospital, Delhi, India
| | - Rajni Gaind
- Department of Microbiology, Vardhman Mahavir Medical College and Safdarjung Hospital, Delhi, India.
| | - J C Suri
- Department of Pulmonary, Critical Care & Sleep Medicine, Vardhman Mahavir Medical College and Safdarjung Hospital, Delhi, India
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Benmahmod AB, Said HS, Ibrahim RH. Prevalence and Mechanisms of Carbapenem Resistance Among Acinetobacter baumannii Clinical Isolates in Egypt. Microb Drug Resist 2018; 25:480-488. [PMID: 30394846 DOI: 10.1089/mdr.2018.0141] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
The increasing number of carbapenem-resistant Acinetobacter baumannii clinical isolates is a major concern, which restricts therapeutic options for treatment of serious infections caused by this emerging pathogen. The aim of this work is to assess the antimicrobial resistance profile and identify the molecular mechanisms involved in carbapenem resistance in A. baumannii isolated from different clinical sources in Mansoura University Hospitals, Egypt. Antimicrobial susceptibility testing has shown that resistance to carbapenem has dramatically increased (98%) with concomitant elevated levels of resistance to quinolones, trimethoprim/sulfamethoxazole, and aminoglycosides. Polymyxin B and colistin are considered the last resort. Random amplified polymorphic DNA (RAPD) typing method revealed great diversity among A. baumannii isolates. Coexistence of diverse intrinsic and acquired carbapenem-hydrolyzing β-lactamases has been detected in the tested isolates: Ambler class A: blaKPC (56%) and blaGES (48%), and Ambler class B: blaNDM (30%), blaSIM (28%), blaVIM (20%), and blaIMP (10%). Most isolates (94%) carried blaOXA-23-like and blaOXA-51-like simultaneously. blaOXA-23-like was preceded by ISAba1 providing a potent promoter activity for its expression. Sequencing analysis revealed that ISAba1 has been also inserted in carbapenem resistance-associated outer membrane protein (OMP) (carO) gene in three isolates, two of which were clonal based on RAPD typing, leading to interruption of its expression as confirmed by SDS-PAGE analysis of OMP fractions. Carbapenem resistance genes are widely distributed among A. baumannii clinical isolates from different clinical sources. Therefore, enhanced infection control measures, effective barriers, and rational use of antimicrobials should be enforced in hospitals for minimizing the widespread resistance to carbapenems and all other antibiotics.
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Affiliation(s)
| | - Heba Shehta Said
- Department of Microbiology and Immunology, Faculty of Pharmacy, Mansoura University, Mansoura, Egypt
| | - Ramdan Hassan Ibrahim
- Department of Microbiology and Immunology, Faculty of Pharmacy, Mansoura University, Mansoura, Egypt
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16
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Zaki MES, Abou ElKheir N, Mofreh M. Molecular Study of Quinolone Resistance Determining Regions of gyrA Gene and parC Gene s in Clinical Isolates of Acintobacter baumannii Resistant to Fluoroquinolone. Open Microbiol J 2018; 12:116-122. [PMID: 29785218 PMCID: PMC5958293 DOI: 10.2174/1874285801812010116] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2018] [Revised: 04/15/2018] [Accepted: 04/16/2018] [Indexed: 12/21/2022] Open
Abstract
Introduction: Acinetobacterb aumannii (A. baumannii) is an important pathogen in health care associated infections. Quinolone resistance has emerged in this pathogen. Aims & Objectives: The aim of the present study was to determine the presence of mutations of gyrA gene and parC genes by Restriction Fragment Length Polymorphism Polymerase Chain Reaction (RFLP-PCR) among clinical isolates of A. baumanii. Materials and Methods: The study was carried out on 140 clinical isolates of A. baumannii. The isolates were subjected to molecular study of mutations of gyrA gene and parC genes by RFLP–PCR beside determination of Minimal Inhibitory Concentration (MIC) by macro dilution tube method. Results: The isolates of A. baumannii were resistant to ciprofloxacine and levofloxacin at MIC >4 µg/ml. The most isolates had MIC >128 µg/ml (42.3%). All resistant strains to ciprofloxacin of A. baumannii had mutations in gyrA and parC. The most frequent mutations were combined mutations in both genes (85.5%) and 5% had single mutation either in gyrA or parC. The most frequently combined mutations were associated with MIC >128 µg/ml (42.3%). Conclusion: From this study we can conclude that resistance to ciprofloxacin was common in clinical isolates of A. baumannii. The most frequent mutations were present in gyrA and parC. However, mutations in parC alone were not uncommon. Further large scale studies are required to elucidate the resistance pattern of A. baumannii and its molecular mechanisms.
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Affiliation(s)
- Maysaa El Sayed Zaki
- Clinical Pathology Department, Mansoura Faculty of Medicine, Mansoura University, Mansoura, Egypt
| | - Nermen Abou ElKheir
- Clinical Pathology Department, Mansoura Faculty of Medicine, Mansoura University, Mansoura, Egypt
| | - Mohamed Mofreh
- Clinical Pathology Department, Mansoura Faculty of Medicine, Mansoura University, Mansoura, Egypt
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Distribution and Molecular Characterization of Acinetobacter baumannii International Clone II Lineage in Japan. Antimicrob Agents Chemother 2018; 62:AAC.02190-17. [PMID: 29203489 DOI: 10.1128/aac.02190-17] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2017] [Accepted: 11/28/2017] [Indexed: 12/22/2022] Open
Abstract
Multidrug-resistant (MDR) Acinetobacter spp. have been globally disseminated in association with the successful clonal lineage Acinetobacter baumannii international clone II (IC II). Because the prevalence of MDR Acinetobacter spp. in Japan remains very low, we characterized all Acinetobacter spp. (n = 866) from 76 hospitals between October 2012 and March 2013 to describe the entire molecular epidemiology of Acinetobacter spp. The most prevalent species was A. baumannii (n = 645; 74.5%), with A. baumannii IC II (n = 245) accounting for 28.3% of the total. Meropenem-resistant isolates accounted for 2.0% (n = 17) and carried ISAba1-blaOXA-23-like (n = 10), blaIMP (n = 4), or ISAba1-blaOXA-51-like (n = 3). Multilocus sequence typing of 110 representative A. baumannii isolates revealed the considerable prevalence of domestic sequence types (STs). A. baumannii IC II isolates were divided into the domestic sequence type 469 (ST469) (n = 18) and the globally disseminated STs ST208 (n = 14) and ST219 (n = 4). ST469 isolates were susceptible to more antimicrobial agents, while ST208 and ST219 overproduced the intrinsic AmpC β-lactamase. A. baumannii IC II and some A. baumannii non-IC II STs (e.g., ST149 and ST246) were associated with fluoroquinolone resistance. This study revealed that carbapenem-susceptible A. baumannii IC II was moderately disseminated in Japan. The low prevalence of acquired carbapenemase genes and presence of domestic STs could contribute to the low prevalence of MDR A. baumannii A similar epidemiology might have appeared before the global dissemination of MDR epidemic lineages. In addition, fluoroquinolone resistance associated with A. baumannii IC II may provide insight into the significance of A. baumannii epidemic clones.
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Carbapenem-Resistant Acinetobacter baumannii: Concomitant Contamination of Air and Environmental Surfaces. Infect Control Hosp Epidemiol 2018; 37:777-81. [PMID: 27045768 DOI: 10.1017/ice.2016.69] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
OBJECTIVE To concomitantly determine the differential degrees of air and environmental contamination by Acinetobacter baumannii based on anatomic source of colonization and type of ICU layout (single-occupancy vs open layout). DESIGN Longitudinal prospective surveillance study of air and environmental surfaces in patient rooms. SETTING A 1,500-bed public teaching hospital in Miami, Florida. PATIENTS Consecutive A. baumannii-colonized patients admitted to our ICUs between October 2013 and February 2014. METHODS Air and environmental surfaces of the rooms of A. baumannii-colonized patients were sampled daily for up to 10 days. Pulsed-field gel electrophoresis (PFGE) was used to type and match the matching air, environmental, and clinical A. baumannii isolates. RESULTS A total of 25 A. baumannii-colonized patients were identified during the study period; 17 were colonized in the respiratory tract and 8 were colonized in the rectum. In rooms with rectally colonized patients, 38.3% of air samples were positive for A. baumannii; in rooms of patients with respiratory colonization, 13.1% of air samples were positive (P=.0001). In rooms with rectally colonized patients, 15.5% of environmental samples were positive for A. baumannii; in rooms of patients with respiratory colonization, 9.5% of environmental samples were positive (P=.02). The rates of air contamination in the open-layout and single-occupancy ICUs were 17.9% and 21.8%, respectively (P=.5). Environmental surfaces were positive in 9.5% of instances in open-layout ICUs versus 13.4% in single-occupancy ICUs (P=.09). CONCLUSIONS Air and environmental surface contaminations were significantly greater among rectally colonized patients; however, ICU layout did not influence the rate of contamination. Infect Control Hosp Epidemiol 2016;37:777-781.
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Arrival of carbapenem-hydrolyzing-oxacillinases in Acinetobacter baumannii in Bosnia and Herzegovina. INFECTION, GENETICS AND EVOLUTION : JOURNAL OF MOLECULAR EPIDEMIOLOGY AND EVOLUTIONARY GENETICS IN INFECTIOUS DISEASES 2017; 58:192-198. [PMID: 29277554 DOI: 10.1016/j.meegid.2017.12.021] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/08/2017] [Revised: 12/05/2017] [Accepted: 12/20/2017] [Indexed: 02/08/2023]
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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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Acinetobacter baumannii Biofilm Formation in Human Serum and Disruption by Gallium. Antimicrob Agents Chemother 2016; 61:AAC.01563-16. [PMID: 27799219 DOI: 10.1128/aac.01563-16] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2016] [Accepted: 10/26/2016] [Indexed: 01/21/2023] Open
Abstract
Biofilm-associated infections caused by Acinetobacter baumannii are extremely recalcitrant to antibiotic treatment. We report that A. baumannii develops a mature biofilm when grown in complement-free human serum (HS). We demonstrate that 16 μM gallium nitrate (GaN) drastically reduces A. baumannii growth and biofilm formation in HS, whereas 64 μM GaN causes massive disruption of preformed A. baumannii biofilm. These findings pave the way to the repurposing of GaN as an antibiofilm agent for A. baumannii.
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Dahdouh E, Hajjar M, Suarez M, Daoud Z. Acinetobacter baumannii Isolated from Lebanese Patients: Phenotypes and Genotypes of Resistance, Clonality, and Determinants of Pathogenicity. Front Cell Infect Microbiol 2016; 6:163. [PMID: 27933276 PMCID: PMC5122575 DOI: 10.3389/fcimb.2016.00163] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2016] [Accepted: 11/09/2016] [Indexed: 12/20/2022] Open
Abstract
Introduction:Acinetobacter baumannii is a nosocomial pathogen that usually affects critically ill patients. High mortality rates have been associated with MDR A. baumannii infections. Carbapenem resistance among these isolates is increasing worldwide and is associated with certain International Clones (ICs) and oxacillinases (OXAs). Moreover, this organism possesses a wide range of virulence factors, whose expression is not yet fully understood. In this study, clinical A. baumannii isolates are characterized in terms of antibiotic resistance, mechanisms of carbapenem resistance, clonality, and virulence. Materials and Methods:A. baumannii clinical isolates (n = 90) where obtained from a tertiary care center in Beirut, Lebanon. API 20NE strips in addition to the amplification of blaOXA−51−like were used for identification. Antibiotic susceptibility testing by disk diffusion was then performed in addition to PCRs for the detection of the most commonly disseminated carbapenemases. Clonality was determined by tri-locus PCR typing and doubling times were determined for isolates with varying susceptibility profiles. Biofilm formation, hemolysis, siderophore production, proteolytic activity, and surface motility was then determined for all the isolates. Statistical analysis was then performed for the determination of associations. Results and Discussion: 81 (90%) of the isolates were resistant to carbapenems. These high rates are similar to other multi-center studies in the country suggesting the need of intervention on a national level. 74 (91.3%) of the carbapenem resistant isolates harbored blaOXA−23−like including two that also harbored blaOXA−24−like. 88.9% of the A. baumannii isolates pertained to ICII and three other international clones were detected, showing the wide dissemination of clones into geographically distinct locations. Virulence profiles were highly diverse and no specific pattern was observed. Nevertheless, an association between motility, siderophore production, and biofilm formation was detected (p < 0.05). Conclusions: A very high rate of carbapenem resistance was detected, showing the need for immediate intervention. IC II and OXA-23-like were the most disseminated, reflecting their international dissemination. No specific associations were made between virulence and resistance, but instead associations among certain virulence factors were found. Investigating a more clonally diverse pool of isolates could help in the determination of associations between virulence and resistance.
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Affiliation(s)
- Elias Dahdouh
- Department of Animal Health, Faculty of Veterinary, Universidad Complutense de Madrid Madrid, Spain
| | - Micheline Hajjar
- Department of Clinical Microbiology, Faculty of Medicine, University of Balamand Balamand, Lebanon
| | - Monica Suarez
- Department of Animal Health, Faculty of Veterinary, Universidad Complutense de Madrid Madrid, Spain
| | - Ziad Daoud
- Department of Clinical Microbiology, Faculty of Medicine, University of Balamand Balamand, Lebanon
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A new trilocus sequence-based multiplex-PCR to detect major Acinetobacter baumannii clones. INFECTION GENETICS AND EVOLUTION 2016; 42:41-5. [PMID: 27125687 DOI: 10.1016/j.meegid.2016.04.031] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 01/13/2016] [Revised: 04/21/2016] [Accepted: 04/24/2016] [Indexed: 01/12/2023]
Abstract
A collection of 163 Acinetobacter baumannii isolates detected in a large Brazilian hospital, was potentially related with the dissemination of four clonal complexes (CC): 113/79, 103/15, 109/1 and 110/25, defined by University of Oxford/Institut Pasteur multilocus sequence typing (MLST) schemes. The urge of a simple multiplex-PCR scheme to specify these clones has motivated the present study. The established trilocus sequence-based typing (3LST, for ompA, csuE and blaOXA-51-like genes) multiplex-PCR rapidly identifies international clones I (CC109/1), II (CC118/2) and III (CC187/3). Thus, the system detects only one (CC109/1) out of four main CC in Brazil. We aimed to develop an alternative multiplex-PCR scheme to detect these clones, known to be present additionally in Africa, Asia, Europe, USA and South America. MLST, performed in the present study to complement typing our whole collection of isolates, confirmed that all isolates belonged to the same four CC detected previously. When typed by 3LST-based multiplex-PCR, only 12% of the 163 isolates were classified into groups. By comparative sequence analysis of ompA, csuE and blaOXA-51-like genes, a set of eight primers was designed for an alternative multiplex-PCR to distinguish the five CC 113/79, 103/15, 109/1, 110/25 and 118/2. Study isolates and one CC118/2 isolate were blind-tested with the new alternative PCR scheme; all were correctly clustered in groups of the corresponding CC. The new multiplex-PCR, with the advantage of fitting in a single reaction, detects five leading A. baumannii clones and could help preventing the spread in healthcare settings.
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Hasani A, Sheikhalizadeh V, Ahangarzadeh Rezaee M, Rahmati-Yamchi M, Hasani A, Ghotaslou R, Goli HR. Frequency of Aminoglycoside-Modifying Enzymes and ArmA Among Different Sequence Groups of Acinetobacter baumannii in Iran. Microb Drug Resist 2016; 22:347-53. [PMID: 26779992 DOI: 10.1089/mdr.2015.0254] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
We evaluated aminoglycoside resistance in 87 Acinetobacter baumannii strains isolated from four hospitals located in the North West region of Iran and typed them in sequence groups (SGs) using trilocus sequence-based scheme to compare their clonal relationships with international clones. Resistance toward aminoglycosides was assayed by minimum inhibitory concentration (MIC) and presence of aminoglycoside-modifying enzymes (AMEs), and ArmA-encoding genes were evaluated in different SGs. The majority of isolates belonged to SG1 (39%), SG2 (33.3%), and SG3 (12.6%), whereas the remaining ones were assigned to six novel variants of SGs. MIC determination revealed netilmicin as the most and kanamycin as the least active aminoglycosides against all groups. Among the varied SGs, isolates of SG2 showed more susceptibility toward all tested aminoglycosides. APH(3'')-VIa-encoding gene was predominant in SG1 (47%), SG2 (62%), and SG6-9 (100%). However, AAC(3')-Ia (100%) and ANT(2')-Ia (90.9%) were the dominant AMEs in SG3. There was significant association between harboring of aminoglycoside resistance genes and specific aminoglycosides: gene encoded by APH(3')-VIa was allied to resistance against amikacin and kanamycin, whereas ANT(2')-Ia was related to the resistance toward gentamicin and tobramycin in SG2. In SG1, tobramycin resistance was correlated with harboring of AAC(6')-Ib. Screening of armA demonstrated the presence of this gene in SG1 (58.8%), SG2 (10.3%), as well as SG3 (9%). Our results revealed definite correlation between the phenotypes and genotypes of aminoglycoside resistance in different clonal lineages of A. baumannii.
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Affiliation(s)
- Alka Hasani
- 1 Immunology Research Center, Tabriz University of Medical Sciences, Tabriz, Iran .,2 Department of Medical Microbiology, Faculty of Medicine, Tabriz University of Medical Sciences , Tabriz, Iran
| | - Vajihe Sheikhalizadeh
- 1 Immunology Research Center, Tabriz University of Medical Sciences, Tabriz, Iran .,2 Department of Medical Microbiology, Faculty of Medicine, Tabriz University of Medical Sciences , Tabriz, Iran
| | | | - Mohammad Rahmati-Yamchi
- 3 Department of Clinical Biochemistry and Laboratory Sciences, Faculty of Medicine, Tabriz University of Medical Sciences , Tabriz, Iran
| | - Akbar Hasani
- 3 Department of Clinical Biochemistry and Laboratory Sciences, Faculty of Medicine, Tabriz University of Medical Sciences , Tabriz, Iran
| | - Reza Ghotaslou
- 1 Immunology Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Hamid Reza Goli
- 1 Immunology Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
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25
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Chmielarczyk A, Pilarczyk-Żurek M, Kamińska W, Pobiega M, Romaniszyn D, Ziółkowski G, Wójkowska-Mach J, Bulanda M. Molecular Epidemiology and Drug Resistance of Acinetobacter baumannii Isolated from Hospitals in Southern Poland: ICU as a Risk Factor for XDR Strains. Microb Drug Resist 2016; 22:328-35. [PMID: 26745326 DOI: 10.1089/mdr.2015.0224] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
The objectives of the present study were to investigate the carbapenemase and metallo-beta-lactamase genes of Acinetobacter baumannii clinical isolates by polymerase chain reaction (PCR) and real time PCR and to determine the molecular epidemiology of the strains using the DiversiLab tool. From these data, correlations between drug resistance, resistance genes, and epidemiological clones may be revealed. The study was conducted on 125 A. baumannii collected over the 2013 year. The majority of the isolates from both intensive care unit (ICU) and non-ICU cases originated from pneumonia infections (79.2%), isolates from blood infections accounted for 17.6% and 3.2% were from meningitis infections. In the ICU cases compared with the non-ICU cases, bloodstream infections were more frequently diagnosed (19.2% vs. 11.5%). Sixty percent of A. baumannii strains were resistant to all the antimicrobials tested with the exception of colistin. All strains were susceptible to colistin and polymyxin B. Extensively drug-resistant (XDR) strains accounted for 80.8% of the isolates tested and these XDR strains were more frequently isolated from ICU cases than from non-ICU cases (93.9% vs. 30.8%). Among the 101 isolates of A. baumannii exhibiting the XDR pattern of resistance, 80 possessed the blaOXA-24 gene and 29 had the blaOXA-23 gene. Only two isolates possessed the blaVIM gene. The presence of the ISAba1element was confirmed among 10 strains from patients hospitalized in the ICU. Using repetitive extragenic palindromic sequence PCR (DiversiLab typing), six clones and 12 unique strains were identified, of which two clones dominated. Most isolates belonging to clone 1 (66.7%) and clone 2 (85.5%) were susceptible only to colistin. In summary, it is clear from our findings and those of other studies that carbapenem resistance among A. baumannii strains presents a serious clinical problem worldwide. Furthermore, the presence of XDR international clone II in ICUs poses a potential risk for future outbreaks of A. baumannii infection and controlling A. baumannii infections in hospitals presents a serious challenge.
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Affiliation(s)
| | | | - Wanda Kamińska
- 2 Department of Microbiology and Clinical Immunology, Microbiological Diagnostics Laboratory, The Children's Memorial Health Institute , Warsaw, Poland
| | - Monika Pobiega
- 1 Department of Microbiology, Jagiellonian University Medical College , Krakow, Poland
| | - Dorota Romaniszyn
- 1 Department of Microbiology, Jagiellonian University Medical College , Krakow, Poland
| | | | | | - Małgorzata Bulanda
- 1 Department of Microbiology, Jagiellonian University Medical College , Krakow, Poland
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Kamolvit W, Sidjabat HE, Paterson DL. Molecular Epidemiology and Mechanisms of Carbapenem Resistance ofAcinetobacterspp. in Asia and Oceania. Microb Drug Resist 2015; 21:424-34. [DOI: 10.1089/mdr.2014.0234] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Witchuda Kamolvit
- UQ Centre of Clinical Research, The University of Queensland, Brisbane, Australia
- Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Hanna E. Sidjabat
- UQ Centre of Clinical Research, The University of Queensland, Brisbane, Australia
| | - David L. Paterson
- UQ Centre of Clinical Research, The University of Queensland, Brisbane, Australia
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27
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Vali L, Dashti K, Opazo-Capurro AF, Dashti AA, Al Obaid K, Evans BA. Diversity of multi-drug resistant Acinetobacter baumannii population in a major hospital in Kuwait. Front Microbiol 2015; 6:743. [PMID: 26257720 PMCID: PMC4513246 DOI: 10.3389/fmicb.2015.00743] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2015] [Accepted: 07/06/2015] [Indexed: 11/13/2022] Open
Abstract
Acinetobacter baumannii is one of the most important opportunistic pathogens that causes serious health care associated complications in critically ill patients. In the current study we report on the diversity of the clinical multi-drug resistant (MDR) A. baumannii in Kuwait by molecular characterization. One hundred A. baumannii were isolated from one of the largest governmental hospitals in Kuwait. Following the identification of the isolates by molecular methods, the amplified blaOXA-51-like gene product of one isolate (KO-12) recovered from blood showed the insertion of the ISAba19 at position 379 in blaOXA-78. Of the 33 MDR isolates, 28 (85%) contained blaOXA-23, 2 (6%) blaOXA-24 and 6 (18%) blaPER-1 gene. We did not detect blaOXA-58, blaVIM, blaIMP, blaGES,blaVEB, and blaNDM genes in any of the tested isolates. In three blaPER-1 positive isolates the genetic environment of blaPER-1 consisted of two copies of ISPa12 (tnpiA1) surrounding the blaPER-1 gene on a highly stable plasmid of ca. 140-kb. Multilocus-sequence typing (MLST) analysis of the 33 A. baumannii isolates identified 20 different STs, of which six (ST-607, ST-608, ST-609, ST-610, ST-611, and ST-612) were novel. Emerging STs such as ST15 (identified for the first time in the Middle East), ST78 and ST25 were also detected. The predominant clonal complex was CC2. Pulsed-field gel electrophoresis and MLST defined the MDR isolates as multi-clonal with diverse lineages. Our results lead us to believe that A. baumannii is diverse in clonal origins and/or is undergoing clonal expansion continuously while multiple lineages of MDR A. baumannii circulate in hospital ward simultaneously.
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Affiliation(s)
- Leila Vali
- Department of Medical Laboratory Sciences, Faculty of Allied Health Sciences, Kuwait University Sulaibekhat, Kuwait
| | - Khadija Dashti
- Department of Medical Laboratory Sciences, Faculty of Allied Health Sciences, Kuwait University Sulaibekhat, Kuwait
| | - Andrés F Opazo-Capurro
- Laboratorio de Investigación en Agentes Antibacterianos, Departamento de Microbiología, Facultad de Ciencias Biológicas, Universidad de Concepción Concepción, Chile
| | - Ali A Dashti
- Department of Medical Laboratory Sciences, Faculty of Allied Health Sciences, Kuwait University Sulaibekhat, Kuwait
| | | | - Benjamin A Evans
- Department of Biomedical and Forensic Sciences, Faculty of Science and Technology, Anglia Ruskin University Cambridge, UK
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28
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Bedenić B, Beader N, Godič-Torkar K, Vranić-Ladavac M, Luxner J, Veir Z, Grisold AJ, Zarfel G. Nursing Home as a Reservoir of Carbapenem-ResistantAcinetobacter baumannii. Microb Drug Resist 2015; 21:270-8. [DOI: 10.1089/mdr.2014.0157] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Affiliation(s)
- Branka Bedenić
- Department of Microbiology, School of Medicine, University of Zagreb, Zagreb, Croatia
- Department of Clinical and Molecular Microbiology, Clinical Hospital Center Zagreb, Zagreb, Croatia
| | - Nataša Beader
- Department of Microbiology, School of Medicine, University of Zagreb, Zagreb, Croatia
- Department of Clinical and Molecular Microbiology, Clinical Hospital Center Zagreb, Zagreb, Croatia
| | - Karmen Godič-Torkar
- Department for Sanitary Engineering, Faculty of Health Sciences, University of Ljubljana, Ljubljana, Slovenia
| | - Mirna Vranić-Ladavac
- Department of Microbiology, Public Health Institute of Istria County, Pula, Croatia
| | - Josefa Luxner
- Institute for Hygiene, Microbiology and Environmental Medicine, Medical University of Graz, Graz, Austria
| | - Zoran Veir
- Department of Surgery, Clinical Hospital Center Zagreb, Zagreb, Croatia
| | - Andrea J. Grisold
- Institute for Hygiene, Microbiology and Environmental Medicine, Medical University of Graz, Graz, Austria
| | - Gernot Zarfel
- Institute for Hygiene, Microbiology and Environmental Medicine, Medical University of Graz, Graz, Austria
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29
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Bahador A, Raoofian R, Taheri M, Pourakbari B, Hashemizadeh Z, Hashemi FB. Multidrug Resistance AmongAcinetobacter baumanniiIsolates from Iran: Changes in Antimicrobial Susceptibility Patterns and Genotypic Profile. Microb Drug Resist 2014; 20:632-40. [DOI: 10.1089/mdr.2013.0146] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Affiliation(s)
- Abbas Bahador
- Department of Microbiology, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Reza Raoofian
- Department of Medical Genetics, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Mohammad Taheri
- Diagnostic Laboratory Sciences and Technology Research Center, School of Paramedical Sciences, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Babak Pourakbari
- Pediatrics Infectious Disease Research Center, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Zahra Hashemizadeh
- Department of Microbiology and Virology, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Farhad B. Hashemi
- Department of Microbiology, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
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30
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Rafei R, Kempf M, Eveillard M, Dabboussi F, Hamze M, Joly-Guillou ML. Current molecular methods in epidemiological typing of Acinetobacter baumannii. Future Microbiol 2014; 9:1179-94. [DOI: 10.2217/fmb.14.63] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
ABSTRACT The emergence of Acinetobacter baumannii during recent decades as an important nosocomial pathogen responsible of worldwide, intensively documented, outbreaks has resulted in a need for effective epidemiological typing methods. Throughout the years, many typing methods for A. baumannii epidemiological studies have been proposed from phenotypic to molecular methods. Currently, the use of phenotypic typing methods have declined considerably and been progressively replaced by molecular methods. In this review, we introduce the current molecular methods available for A. baumannii typing. Each method has its own advantages and disadvantages, and the selection of an appropriate genotyping method depends on studied objectives. This review sheds light on questions in different epidemiological settings and most molecular methods used to fit these objectives.
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Affiliation(s)
- Rayane Rafei
- L'UNAM Université, Université d'Angers, Groupe d'Etude des Interactions Hôte-Pathogène, UPRES EA3142, Institut de Biologie en Santé – IRIS, CHU, 4, rue Larrey, 49933 Angers cedex, France
- Laboratoire de Microbiologie Santé et Environnement (LMSE), Centre AZM pour la recherche en Biotechnologie et ses applications, Université Libanaise, Tripoli, Liban
| | - Marie Kempf
- L'UNAM Université, Université d'Angers, Groupe d'Etude des Interactions Hôte-Pathogène, UPRES EA3142, Institut de Biologie en Santé – IRIS, CHU, 4, rue Larrey, 49933 Angers cedex, France
- Laboratoire de Bactériologie, Institut de Biologie en Santé - PBH, CHU, 4 rue Larrey, 49933 Angers cedex, France
| | - Matthieu Eveillard
- L'UNAM Université, Université d'Angers, Groupe d'Etude des Interactions Hôte-Pathogène, UPRES EA3142, Institut de Biologie en Santé – IRIS, CHU, 4, rue Larrey, 49933 Angers cedex, France
- Laboratoire de Bactériologie, Institut de Biologie en Santé - PBH, CHU, 4 rue Larrey, 49933 Angers cedex, France
| | - Fouad Dabboussi
- Laboratoire de Microbiologie Santé et Environnement (LMSE), Centre AZM pour la recherche en Biotechnologie et ses applications, Université Libanaise, Tripoli, Liban
| | - Monzer Hamze
- Laboratoire de Microbiologie Santé et Environnement (LMSE), Centre AZM pour la recherche en Biotechnologie et ses applications, Université Libanaise, Tripoli, Liban
| | - Marie-Laure Joly-Guillou
- L'UNAM Université, Université d'Angers, Groupe d'Etude des Interactions Hôte-Pathogène, UPRES EA3142, Institut de Biologie en Santé – IRIS, CHU, 4, rue Larrey, 49933 Angers cedex, France
- Laboratoire de Bactériologie, Institut de Biologie en Santé - PBH, CHU, 4 rue Larrey, 49933 Angers cedex, France
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Gentile V, Frangipani E, Bonchi C, Minandri F, Runci F, Visca P. Iron and Acinetobacter baumannii Biofilm Formation. Pathogens 2014; 3:704-19. [PMID: 25438019 PMCID: PMC4243436 DOI: 10.3390/pathogens3030704] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2014] [Revised: 08/09/2014] [Accepted: 08/12/2014] [Indexed: 01/19/2023] Open
Abstract
Acinetobacter baumannii is an emerging nosocomial pathogen, responsible for infection outbreaks worldwide. The pathogenicity of this bacterium is mainly due to its multidrug-resistance and ability to form biofilm on abiotic surfaces, which facilitate long-term persistence in the hospital setting. Given the crucial role of iron in A. baumannii nutrition and pathogenicity, iron metabolism has been considered as a possible target for chelation-based antibacterial chemotherapy. In this study, we investigated the effect of iron restriction on A. baumannii growth and biofilm formation using different iron chelators and culture conditions. We report substantial inter-strain variability and growth medium-dependence for biofilm formation by A. baumannii isolates from veterinary and clinical sources. Neither planktonic nor biofilm growth of A. baumannii was affected by exogenous chelators. Biofilm formation was either stimulated by iron or not responsive to iron in the majority of isolates tested, indicating that iron starvation is not sensed as an overall biofilm-inducing stimulus by A. baumannii. The impressive iron withholding capacity of this bacterium should be taken into account for future development of chelation-based antimicrobial and anti-biofilm therapies.
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Affiliation(s)
- Valentina Gentile
- Department of Sciences, Roma Tre University, Viale Marconi 446, 00146 Rome, Italy.
| | - Emanuela Frangipani
- Department of Sciences, Roma Tre University, Viale Marconi 446, 00146 Rome, Italy.
| | - Carlo Bonchi
- Department of Sciences, Roma Tre University, Viale Marconi 446, 00146 Rome, Italy.
| | - Fabrizia Minandri
- Department of Sciences, Roma Tre University, Viale Marconi 446, 00146 Rome, Italy.
| | - Federica Runci
- Department of Sciences, Roma Tre University, Viale Marconi 446, 00146 Rome, Italy.
| | - Paolo Visca
- Department of Sciences, Roma Tre University, Viale Marconi 446, 00146 Rome, Italy.
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Epidemic diffusion of OXA-23-producing Acinetobacter baumannii isolates in Italy: results of the first cross-sectional countrywide survey. J Clin Microbiol 2014; 52:3004-10. [PMID: 24920776 DOI: 10.1128/jcm.00291-14] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Carbapenem-resistant Acinetobacter baumannii (CRAb) is emerging worldwide as a public health problem in various settings. The aim of this study was to investigate the prevalence of CRAb isolates in Italy and to characterize their resistance mechanisms and genetic relatedness. A countrywide cross-sectional survey was carried out at 25 centers in mid-2011. CRAb isolates were reported from all participating centers, with overall proportions of 45.7% and 22.2% among consecutive nonreplicate clinical isolates of A. baumannii from inpatients (n = 508) and outpatients (n = 63), respectively. Most of them were resistant to multiple antibiotics, whereas all remained susceptible to colistin, with MIC50 and MIC90 values of ≤ 0.5 mg/liter. The genes coding for carbapenemase production were identified by PCR and sequencing. OXA-23 enzymes (found in all centers) were by far the most common carbapenemases (81.7%), followed by OXA-58 oxacillinases (4.5%), which were found in 7 of the 25 centers. In 6 cases, CRAb isolates carried both bla(OXA-23-like) and bla(OXA-58-like) genes. A repetitive extragenic palindromic (REP)-PCR technique, multiplex PCRs for group identification, and multilocus sequence typing (MLST) were used to determine the genetic relationships among representative isolates (n = 55). Two different clonal lineages were identified, including a dominant clone of sequence type 2 (ST2) related to the international clone II (sequence group 1 [SG1], SG4, and SG5) and a clone of ST78 (SG6) previously described in Italy. Overall, our results demonstrate that OXA-23 enzymes have become the most prevalent carbapenemases and are now endemic in Italy. In addition, molecular typing profiles showed the presence of international and national clonal lineages in Italy.
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Distribution and molecular profiling of class 1 integrons in MDR Acinetobacter baumannii isolates and whole genome-based analysis of antibiotic resistance mechanisms in a representative strain. Microbiol Res 2014; 169:811-6. [PMID: 24809232 DOI: 10.1016/j.micres.2014.04.002] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2014] [Revised: 03/31/2014] [Accepted: 04/05/2014] [Indexed: 11/23/2022]
Abstract
The class 1 integron is an important driver of the nosocomial dissemination of multidrug-resistant (MDR) bacteria, such as Acinetobacters. In this study, we characterized the gene cassette arrays of class 1 integrons in Acinetobacter baumannii, where the detailed structure of these integrons for 38 clinical strains was analyzed. The results showed that there are three types of gene cassette arrays that are carried by different class 1 integrons, among them the aac(6')-IId-catB8-aadA1 array was the most prevalent. For detailed analysis of the integron structure, whole genome sequencing was carried out on strain AB16, and it was found that a single integron on its chromosome has a partial Tn21 transposon in its 5' flanking region and two complete copies of the insertion element IS26 in both the 5' and 3' flanking regions, indicating that the integron could be acquired by horizontal gene transfer. Furthermore, there is one resistance island AbaR22, one bla gene containing a transposon, four intrinsic resistant genes and one efflux pump that together confer six types of antibiotic resistance.
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Ji S, Chen Y, Ruan Z, Fu Y, Ji J, Fu Y, Wang H, Yu Y. Prevalence of carbapenem-hydrolyzing class D β-lactamase genes in Acinetobacter spp. isolates in China. Eur J Clin Microbiol Infect Dis 2013; 33:989-97. [PMID: 24374815 DOI: 10.1007/s10096-013-2037-z] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2013] [Accepted: 12/12/2013] [Indexed: 10/25/2022]
Abstract
In order to assess the prevalence of carbapenem-hydrolyzing class D β-lactamase genes in Acinetobacter spp. isolates in China, we conducted a polymerase chain reaction (PCR)-based surveillance of OXA-type β-lactamase gene clusters for a total of 2,880 Acinetobacter spp. isolates collected from 23 Chinese provinces. All isolates were tested for susceptibility to 12 antimicrobial agents and showed high rates of resistance to all these agents except minocycline. We also found that the vast majority of carbapenem-resistant Acinetobacter spp. were OXA-23-like-producing isolates, predominantly Acinetobacter baumannii isolates. Besides, bla OXA-58-like and bla OXA-24-like genes were detected in 32 and 11 isolates, respectively, involving many provinces throughout China. Furthermore, these two carbapenem-resistance determinants were located on transferable plasmids in most cases, indicating an emerging threat for both OXA-58-like- and OXA-24-like-producing Acinetobacter spp. isolates in China. Interestingly, a novel homologue of the bla OXA-143 gene was identified in a susceptible Acinetobacter pittii isolate. Overall, these observations suggest that the bla OXA-23-harboring A. baumannii isolates are the most frequent carbapenem-resistant Acinetobacter spp. in China, and the bla OXA-24-like and bla OXA-58-like genes have emerged as potential threats of hospital outbreaks of multidrug-resistant Acinetobacter spp.
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Affiliation(s)
- S Ji
- Department of Infectious Diseases, Sir Run Run Shaw Hospital, College of Medicine, Zhejiang University, Hangzhou, Zhejiang, China
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35
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Gurung M, Rho JS, Lee YC, Kim HS, Moon SY, Yu BH, Lee JH, Jang CW, Chung SY, Cho IH, Jee HS, Choi SW, Heo JY, Lee JC. Emergence and spread of carbapenem-resistant Acinetobacter baumannii sequence type 191 in a Korean hospital. INFECTION GENETICS AND EVOLUTION 2013; 19:219-22. [DOI: 10.1016/j.meegid.2013.07.016] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/13/2013] [Revised: 07/11/2013] [Accepted: 07/15/2013] [Indexed: 11/24/2022]
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36
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Bahador A, Taheri M, Pourakbari B, Hashemizadeh Z, Rostami H, Mansoori N, Raoofian R. Emergence of Rifampicin, Tigecycline, and Colistin-ResistantAcinetobacter baumanniiin Iran; Spreading of MDR Strains of Novel International Clone Variants. Microb Drug Resist 2013; 19:397-406. [DOI: 10.1089/mdr.2012.0233] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023] Open
Affiliation(s)
- Abbas Bahador
- Department of Microbiology, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Mohammad Taheri
- Diagnostic Laboratory Sciences and Technology Research Center, Faculty of Paramedical School, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Babak Pourakbari
- Pediatrics Infectious Disease Research Center, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Zahra Hashemizadeh
- Department of Microbiology and Virology, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Hossein Rostami
- Department of Microbiology, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Noormohamad Mansoori
- Department of Microbiology, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Reza Raoofian
- Department of Medical Genetics, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
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37
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Alsultan AA, Evans BA, Elsayed EA, Al-Thawadi SI, Al-Taher AY, Amyes SGB, Al-Dughaym AM, Hamouda A. High frequency of carbapenem-resistant Acinetobacter baumannii in patients with diabetes mellitus in Saudi Arabia. J Med Microbiol 2013; 62:885-888. [DOI: 10.1099/jmm.0.057216-0] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Carbapenem-resistant Acinetobacter baumannii is becoming increasingly prevalent in patients with diabetes mellitus in the Middle East. We examined the relationship of these bacteria and their resistance mechanisms to the diabetic disease status of patients in Saudi Arabia. Susceptibilities of 271 isolates to carbapenems, tigecycline and colistin were determined, followed by detection of carbapenemase genes. A bla
VIM gene was detected in ~95 % of isolates; bla
OXA-23 and bla
OXA-40 genes were also prevalent. Diabetic patients were significantly more likely to carry carbapenem-resistant isolates. Carbapenem-resistant A. baumannii is a serious problem in diabetic patients, and molecular detection of resistance mechanisms in these isolates is required.
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Affiliation(s)
- A. A. Alsultan
- College of Medicine, King Faisal University, Alahsa 31982, PO Box 400, Kingdom of Saudi Arabia
| | - B. A. Evans
- Department of Life Sciences, Faculty of Science and Technology, Anglia Ruskin University, East Road, Cambridge CB1 1PT, UK
| | - E. A. Elsayed
- College of Medicine, King Faisal University, Alahsa 31982, PO Box 400, Kingdom of Saudi Arabia
| | - S. I. Al-Thawadi
- King Faisal Specialist Hospital & Research Centre, PO Box 3354, Riyadh 11211, Saudi Arabia
| | - A. Y. Al-Taher
- College of Medicine, King Faisal University, Alahsa 31982, PO Box 400, Kingdom of Saudi Arabia
| | - S. G. B. Amyes
- Medical Microbiology, University of Edinburgh, The Chancellor’s Building, 49 Little France Crescent, Edinburgh EH16 4SB, UK
| | - A. M. Al-Dughaym
- College of Medicine, King Faisal University, Alahsa 31982, PO Box 400, Kingdom of Saudi Arabia
| | - A. Hamouda
- Taibah University, Department of Clinical Biochemistry, Universities Road, Almadinah Almunawarah, PO Box 344, Saudi Arabia
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38
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Migliavacca R, Espinal P, Principe L, Drago M, Fugazza G, Roca I, Nucleo E, Bracco S, Vila J, Pagani L, Luzzaro F. Characterization of resistance mechanisms and genetic relatedness of carbapenem-resistant Acinetobacter baumannii isolated from blood, Italy. Diagn Microbiol Infect Dis 2012; 75:180-6. [PMID: 23265293 DOI: 10.1016/j.diagmicrobio.2012.11.002] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2012] [Revised: 10/11/2012] [Accepted: 11/05/2012] [Indexed: 10/27/2022]
Abstract
The aim of this study was to characterize the resistance mechanisms and genetic relatedness of 21 carbapenem-resistant Acinetobacter baumannii blood isolates collected in Italy during a 1-year multicenter prospective surveillance study. Genes coding for carbapenemase production were identified by polymerase chain reaction (PCR) and sequencing. Pulsed-field gel electrophoresis (PFGE), multiplex PCRs for group identification, and multilocus sequence typing (MLST) were used to determine genetic relationships. Carbapenem resistance was consistently related to the production of oxacillinases, mostly the plasmid-mediated OXA-58 enzyme. Strains producing the OXA-23 enzyme (chromosomally mediated) were also detected. Seven PFGE clones were identified, some of which being related to international (ICL- I and ICL-II) or national clonal lineages. Multiplex PCRs identified 4 different groups (group 2 being dominant), further distinguishable in 6 sequence types by MLST. The heterogeneity of profiles highlights the diffusion of international and national clonal lineages in Italy. Continuous surveillance is needed for monitoring the spread of these worrisome strains equipped with multiple drug resistance mechanisms.
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Affiliation(s)
- Roberta Migliavacca
- Department of Clinical Surgical Diagnostic and Pediatric Sciences, Section of Microbiology, University of Pavia, Pavia, Italy
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Dissemination of a carbapenem-resistant Acinetobacter baumannii strain belonging to international clone II/sequence type 2 and harboring a novel AbaR4-like resistance island in Latvia. Antimicrob Agents Chemother 2012; 57:1069-72. [PMID: 23229482 DOI: 10.1128/aac.01783-12] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
An outbreak of hospital-acquired Acinetobacter baumannii infections, caused by a bla(OXA-23)-positive carbapenem-resistant strain belonging to international clone II/ST2, was detected in Latvia. The strain was partially equipped with the armA gene and the intI1-aacA4-catB8-aadA1-qacEΔ1 class 1 integron. In addition, the strain carried AbaR25, a novel AbaR4-like resistance island of ~46,500 bp containing structures similar to the previously described AbaR22 and Tn6167 islands. AbaR25 was characterized by the occurrence of a second copy of Tn6022a interrupted by Tn2006 carrying the bla(OXA-23) gene.
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40
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Antimicrobial resistance patterns and their encoding genes among Acinetobacter baumannii strains isolated from burned patients. Burns 2012; 38:1198-203. [DOI: 10.1016/j.burns.2012.04.008] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2012] [Revised: 03/09/2012] [Accepted: 04/15/2012] [Indexed: 11/20/2022]
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41
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Karah N, Sundsfjord A, Towner K, Samuelsen Ø. Insights into the global molecular epidemiology of carbapenem non-susceptible clones of Acinetobacter baumannii. Drug Resist Updat 2012; 15:237-47. [PMID: 22841809 DOI: 10.1016/j.drup.2012.06.001] [Citation(s) in RCA: 192] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2012] [Accepted: 06/29/2012] [Indexed: 12/17/2022]
Abstract
The global emergence of multidrug resistance (MDR) among Gram-negative bacteria has dramatically limited the therapeutic options. During the last two decades, Acinetobacter baumannii has become a pathogen of increased clinical importance due to its remarkable ability to cause outbreaks of infections and to acquire resistance to almost all currently used antibiotics, including the carbapenems. This review considers the literature on A. baumannii and data from multilocus sequence typing studies to explore the global population structure of A. baumannii and detect the occurrence of clonality, with the focus on the presence of specific resistance mechanisms such as the OXA-carbapenemases. The worldwide dissemination of MDR and carbapenem non-susceptible A. baumannii is associated with diverse genetic backgrounds, but predominated by a number of extensively distributed clones, such as CC92(B)/CC2(P) and CC109(B)/CC1(P), which have frequently been supplemented by acquired OXA-type carbapenemase genes.
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Affiliation(s)
- Nabil Karah
- Reference Centre for Detection of Antimicrobial Resistance, Department of Microbiology and Infection Control, University Hospital of North Norway, Tromsø, Norway
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42
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Mammina C, Palma DM, Bonura C, Aleo A, Fasciana T, Sodano C, Saporito MA, Verde MS, Calà C, Cracchiolo AN, Tetamo R. Epidemiology and clonality of carbapenem-resistant Acinetobacter baumannii from an intensive care unit in Palermo, Italy. BMC Res Notes 2012; 5:365. [PMID: 22818424 PMCID: PMC3410802 DOI: 10.1186/1756-0500-5-365] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2012] [Accepted: 07/20/2012] [Indexed: 01/18/2023] Open
Abstract
Background Multidrug-resistant Acinetobacter baumannii, initially considered as having a poor clinical relevance, is frequently isolated from infection cases in intensive care units. We describe the epidemiology of carbapenem resistant A. baumannii (CRAB) in a general ICU in Palermo, Italy, from October 2010 to March 2011. Findings 58 of 61 isolates exhibited MICs for meropenem or imipenem ≥16 mg/L. Forty-nine carried blaOXA-23 and two blaOXA-58 genes. Five subtype clusters were detected by rep-PCR. Clusters D and E included 10 isolates that tested negative for the carbapenem resistance genes. MLST attributed all isolates, but two, with sequence type (ST)2, whereas the two remaining isolates with ST78. The respiratory tract was the most common site of infection (26 out of 36 cases. 72.2%). A high infection related mortality rate was observed (18 out of 35 patients, 51.4%). Nineteen patients tested positive for other multidrug resistant organisms in addition to CRAB. In eight cases isolates belonging to distinct subtype clusters and/or with distinct carbapenemase profiles were identified. Conclusions Carbapenem resistance was prominently driven by the dissemination of CRAB isolates belonging to ST2, carrying the carbapenemase gene blaOXA-23. The colonization/infection of some patients by multiple strains is suggestive of an endemic circulation of CRAB.
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Affiliation(s)
- Caterina Mammina
- Department of Sciences for Health Promotion G, D'Alessandro, Section of Hygiene, University of Palermo, Palermo, Italy.
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43
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Peymani A, Higgins PG, Nahaei MR, Farajnia S, Seifert H. Characterisation and clonal dissemination of OXA-23-producing Acinetobacter baumannii in Tabriz, northwest Iran. Int J Antimicrob Agents 2012; 39:526-8. [DOI: 10.1016/j.ijantimicag.2012.02.014] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2011] [Revised: 02/06/2012] [Accepted: 02/22/2012] [Indexed: 10/28/2022]
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44
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Decker BK, Perez F, Hujer AM, Hujer KM, Hall GS, Jacobs MR, Gebreyes WA, Zoll ST, Massire C, Eshoo MW, Ecker DJ, Rather PN, Bonomo RA. Longitudinal analysis of the temporal evolution of Acinetobacter baumannii strains in Ohio, USA, by using rapid automated typing methods. PLoS One 2012; 7:e33443. [PMID: 22511922 PMCID: PMC3325217 DOI: 10.1371/journal.pone.0033443] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2011] [Accepted: 02/09/2012] [Indexed: 01/29/2023] Open
Abstract
Genotyping methods are essential to understand the transmission dynamics of Acinetobacter baumannii. We examined the representative genotypes of A. baumannii at different time periods in select locations in Ohio, using two rapid automated typing methods: PCR coupled with electrospray ionization mass spectrometry (PCR/ESI-MS), a form of multi-locus sequence typing (MLST), and repetitive-sequence-based-PCR (rep-PCR). Our analysis included 122 isolates from 4 referral hospital systems, in 2 urban areas of Ohio. These isolates were associated with outbreaks at 3 different time periods (1996, 2000 and 2005–2007). Type assignments of PCR/ESI-MS and rep-PCR were compared to each other and to worldwide (WW) clone types. The discriminatory power of each method was determined using the Simpson's index of diversity (DI). We observed that PCR/ESI-MS sequence type (ST) 14, corresponding to WW clone 3, predominated in 1996, whereas ST 12 and 14 co-existed in the intermediate period (2000) and ST 10 and 12, belonging to WW clone 2, predominated more recently in 2007. The shift from WW clone 3 to WW clone 2 was accompanied by an increase in carbapenem resistance. The DI was approximately 0.74 for PCR/ESI-MS, 0.88 for rep-PCR and 0.90 for the combination of both typing methods. We conclude that combining rapid automated typing methods such as PCR/ESI-MS and rep-PCR serves to optimally characterize the regional molecular epidemiology of A. baumannii. Our data also sheds light on the changing sequence types in an 11 year period in Northeast Ohio.
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Affiliation(s)
- Brooke K. Decker
- Department of Medicine, Case Western Reserve University School of Medicine, Cleveland, Ohio, United States of America
| | - Federico Perez
- Department of Medicine, Case Western Reserve University School of Medicine, Cleveland, Ohio, United States of America
- Research Service, Louis Stokes Cleveland Department of Veterans Affairs Medical Center, Cleveland, Ohio, United States of America
| | - Andrea M. Hujer
- Department of Medicine, Case Western Reserve University School of Medicine, Cleveland, Ohio, United States of America
- Research Service, Louis Stokes Cleveland Department of Veterans Affairs Medical Center, Cleveland, Ohio, United States of America
| | - Kristine M. Hujer
- Department of Medicine, Case Western Reserve University School of Medicine, Cleveland, Ohio, United States of America
- Research Service, Louis Stokes Cleveland Department of Veterans Affairs Medical Center, Cleveland, Ohio, United States of America
| | - Geraldine S. Hall
- Cleveland Clinic Pathology and Laboratory Medicine Institute, Cleveland, Ohio, United States of America
| | - Michael R. Jacobs
- Department of Pathology, Case Western Reserve University School of Medicine, Cleveland, Ohio, United States of America
| | - Wondwossen A. Gebreyes
- College of Veterinary Medicine, Ohio State University, Columbus, Ohio, United States of America
| | - Scott T. Zoll
- Ibis Biosciences Inc., Abbott Molecular, Inc., Carlsbad, California, United States of America
| | - Christian Massire
- Ibis Biosciences Inc., Abbott Molecular, Inc., Carlsbad, California, United States of America
| | - Mark W. Eshoo
- Ibis Biosciences Inc., Abbott Molecular, Inc., Carlsbad, California, United States of America
| | - David J. Ecker
- Ibis Biosciences Inc., Abbott Molecular, Inc., Carlsbad, California, United States of America
| | - Philip N. Rather
- Research Service, Veterans Affairs Medical Center, Decatur, Georgia, United States of America
- Department of Microbiology & Immunology, Emory University School of Medicine, Atlanta, Georgia, United States of America
| | - Robert A. Bonomo
- Department of Medicine, Case Western Reserve University School of Medicine, Cleveland, Ohio, United States of America
- Research Service, Louis Stokes Cleveland Department of Veterans Affairs Medical Center, Cleveland, Ohio, United States of America
- Department of Molecular Biology and Microbiology, Case Western Reserve University School of Medicine, Cleveland, Ohio, United States of America
- Department of Pharmacology, Case Western Reserve University School of Medicine, Cleveland, Ohio, United States of America
- * E-mail:
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45
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Mezzatesta M, D'Andrea M, Migliavacca R, Giani T, Gona F, Nucleo E, Fugazza G, Pagani L, Rossolini G, Stefani S. Epidemiological characterization and distribution of carbapenem-resistant Acinetobacter baumannii clinical isolates in Italy. Clin Microbiol Infect 2012; 18:160-6. [DOI: 10.1111/j.1469-0691.2011.03527.x] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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46
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Brigante G, Migliavacca R, Bramati S, Motta E, Nucleo E, Manenti M, Migliorino G, Pagani L, Luzzaro F, Viganò FE. Emergence and spread of a multidrug-resistant Acinetobacter baumannii clone producing both the carbapenemase OXA-23 and the 16S rRNA methylase ArmA. J Med Microbiol 2012; 61:653-661. [PMID: 22282459 DOI: 10.1099/jmm.0.040980-0] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Acinetobacter baumannii is a Gram-negative organism reported worldwide as a cause of health-care-associated infections, particularly in intensive care units (ICUs). The aim of this study is to describe the emergence and spread of carbapenem-resistant A. baumannii (CRAB) isolates in hospitalized patients. From March to November 2009, multidrug-resistant CRAB isolates were obtained from 21 patients hospitalized in different wards (mostly ICUs). Antimicrobial susceptibility was determined by using the Etest method. Carbapenem and aminoglycoside resistance determinants were studied by PCR and sequencing. Genetic relatedness was investigated by pulsed-field gel electrophoresis and multiplex PCR identification of sequence groups. Clinical records of patients were examined retrospectively. CRAB isolates were consistently resistant to multiple drugs including fluoroquinolones and aminoglycosides, whereas they retained a susceptibility to colistin. Molecular analysis revealed that 19 of the 21 CRAB isolates belonged to a single clone producing both the carbapenemase OXA-23 and the 16S rRNA methylase ArmA. Based on clinical data, the patients included in the study were classified as infected (n=13) or colonized (n=8). Colistin alone or in combination with ampicillin-sulbactam was administered to 11 of the 13 infected patients. A complete or partial response was obtained in eight cases, whereas a failure to respond was observed in one patient and a relapse was observed in two patients. An A. baumannii clone producing both OXA-23 and ArmA has been identified as an emerging and rapidly spreading pathogen. To our knowledge, this is the first report of the ArmA enzyme in A. baumannii in Italy and is the first report of hospital dissemination of A. baumannii carrying both bla(OXA-23) and armA genes.
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Affiliation(s)
| | | | - Simone Bramati
- Laboratory of Microbiology, San Gerardo Hospital, Monza, Italy
| | - Eleonora Motta
- Division of Infectious Diseases, San Gerardo Hospital, Monza, Italy
| | | | - Monica Manenti
- Laboratory of Microbiology, San Gerardo Hospital, Monza, Italy
| | | | - Laura Pagani
- Department of Microbiology, University of Pavia, Pavia, Italy
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47
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Post V, Hamidian M, Hall RM. Antibiotic-resistant Acinetobacter baumannii variants belonging to global clone 1. J Antimicrob Chemother 2012; 67:1039-40. [PMID: 22279182 DOI: 10.1093/jac/dkr586] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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48
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Evidence of diversity among epidemiologically related carbapenemase-producing Acinetobacter baumannii strains belonging to international clonal lineage II. J Clin Microbiol 2012; 50:590-7. [PMID: 22205821 DOI: 10.1128/jcm.05555-11] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Carbapenem-resistant Acinetobacter baumannii strains belonging to international clonal lineage II (ICL-II) have become predominant in intensive care units (ICUs) throughout Italy. Between 2005 and 2009, the carbapenem-hydrolyzing class D β-lactamase (CHDL) bla(OXA-23) gene became more prevalent than bla(OXA-58) among epidemic ICL-II strains showing extensive genetic similarity. These findings posed the question of whether CHDL gene replacement occurred in the homogeneous ICL-II population or a new OXA-23 clone(s) emerged and spread in ICUs. In this study, the changes in the ICL-II A. baumannii population and CHDL gene carriage were investigated in 30 genetically related isolates collected during the bla(OXA-58)-to-bla(OXA-23) transition period. Pulsotyping, randomly amplified polymorphic DNA (RAPD) analysis, and multilocus sequence typing (MLST) results were combined with multilocus variable-number tandem-repeat (VNTR) analysis (MLVA-8), siderotyping, and plasmid profiling to improve genotype-based discrimination between isolates. Pulsotyping, RAPD analysis, and MLST clustered isolates into a single type. MLVA-8 identified 19 types that clustered into three complexes. All OXA-23-producing isolates formed a single complex, while OXA-58 producers were split into two complexes. Southern blot analysis of the physical localization and genetic context of the CHDL genes showed that bla(OXA-58) was invariably located on plasmids, while bla(OXA-23) was present within Tn2006 on the chromosome or both the chromosome and plasmids. These data indicate that the apparently homogeneous population of CHDL-producing ICL-II strains was composed of several independent strains and that, between 2005 and 2009, distinct OXA-23 producers displaced the preexisting OXA-58 producers. Thus, MLVA-8 appears to be a suitable tool not only for investigating A. baumannii population structure but also for high-resolution epidemiological typing.
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49
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Mammina C, Bonura C, Aleo A, Calà C, Caputo G, Cataldo M, Benedetto AD, Distefano S, Fasciana T, Labisi M, Sodano C, Palma D, Giammanco A. Characterization of Acinetobacter baumannii from intensive care units and home care patients in Palermo, Italy. Clin Microbiol Infect 2011; 17:E12-5. [DOI: 10.1111/j.1469-0691.2011.03654.x] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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50
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Abstract
Innate resistance and remarkable ability to acquire additional resistance determinants underline the clinical importance of Acinetobacter. Over 210 β-lactamases belonging to 16 families have been identified in the genus, mostly in clinical isolates of A. baumannii. In this review, we update the current taxonomy of the genus Acinetobacter and summarize the β-lactamases detected in Acinetobacter spp. with an emphasis on Acinetobacter-derived cephalosporinases (ADCs) and carbapenem-hydrolysing class D β-lactamases (CHDLs). We also discuss the roles of integrons and insertion sequence (IS) elements in the expression and dissemination of such resistance determinants.
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Affiliation(s)
- Wei-Hua Zhao
- Department of Microbiology and Immunology, Showa University School of Medicine, Tokyo, Japan.
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