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Acinetobacter baumannii Antibiotic Resistance Mechanisms. Pathogens 2021; 10:pathogens10030373. [PMID: 33808905 PMCID: PMC8003822 DOI: 10.3390/pathogens10030373] [Citation(s) in RCA: 184] [Impact Index Per Article: 61.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2021] [Revised: 03/16/2021] [Accepted: 03/18/2021] [Indexed: 12/11/2022] Open
Abstract
Acinetobacter baumannii is a Gram-negative ESKAPE microorganism that poses a threat to public health by causing severe and invasive (mostly nosocomial) infections linked with high mortality rates. During the last years, this pathogen displayed multidrug resistance (MDR), mainly due to extensive antibiotic abuse and poor stewardship. MDR isolates are associated with medical history of long hospitalization stays, presence of catheters, and mechanical ventilation, while immunocompromised and severely ill hosts predispose to invasive infections. Next-generation sequencing techniques have revolutionized diagnosis of severe A. baumannii infections, contributing to timely diagnosis and personalized therapeutic regimens according to the identification of the respective resistance genes. The aim of this review is to describe in detail all current knowledge on the genetic background of A. baumannii resistance mechanisms in humans as regards beta-lactams (penicillins, cephalosporins, carbapenems, monobactams, and beta-lactamase inhibitors), aminoglycosides, tetracyclines, fluoroquinolones, macrolides, lincosamides, streptogramin antibiotics, polymyxins, and others (amphenicols, oxazolidinones, rifamycins, fosfomycin, diaminopyrimidines, sulfonamides, glycopeptide, and lipopeptide antibiotics). Mechanisms of antimicrobial resistance refer mainly to regulation of antibiotic transportation through bacterial membranes, alteration of the antibiotic target site, and enzymatic modifications resulting in antibiotic neutralization. Virulence factors that may affect antibiotic susceptibility profiles and confer drug resistance are also being discussed. Reports from cases of A. baumannii coinfection with SARS-CoV-2 during the COVID-19 pandemic in terms of resistance profiles and MDR genes have been investigated.
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Antibiogram, Prevalence of OXA Carbapenemase Encoding Genes, and RAPD-Genotyping of Multidrug-Resistant Acinetobacter baumannii Incriminated in Hidden Community-Acquired Infections. Antibiotics (Basel) 2020; 9:antibiotics9090603. [PMID: 32942596 PMCID: PMC7558960 DOI: 10.3390/antibiotics9090603] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2020] [Revised: 09/10/2020] [Accepted: 09/13/2020] [Indexed: 12/16/2022] Open
Abstract
Acinetobacter spp. has gained fame from their ability to resist difficult conditions and their constant development of antimicrobial resistance. This study aimed to investigate the prevalence, susceptibility testing, OXA carbapenemase-encoding genes, and RAPD-genotyping of multidrug resistant Acinetobacter baumannii incriminated in hidden community-acquired infections in Egypt. The antimicrobial susceptibility testing was assessed phenotypically using Kirby–Bauer disk diffusion method. Also, Modified-Hodge test (MHT) was carried out to detect the carbapenemases production. Multiplex-PCR was used to detect the carbapenemase-encoding genes. Furthermore, the genetic relationship among the isolated strains was investigated using RAPD fingerprinting. The bacteriological examination revealed that, out of 200 Gram-negative non-fermentative isolates, 44 (22%) were identified phenotypically and biochemically as Acinetobacter spp. and 23 (11.5%) were molecularly confirmed as A.baumannii. The retrieved A.baumannii strains were isolated from urine (69%), sputum (22%), and cerebrospinal fluid (csf) (9%). The isolated A. baumannii strains exhibited multidrug resistance and the production rates of carbapenemases were 56.5, 60.9, and 78.3% with meropenem, imipenem, and ertapenem disks, respectively. The blaOXA-24-like genes were the most predominant among the tested strains (65.2%), followed by blaOXA-23 (30.4%) and blaOXA-58 (17.4%), in addition, the examined strains are harbored IMP, VIM, and NDM genes with prevalence of 60.9, 43.5, and 13%, respectively, while KPC and GES genes were not detected. RAPD-PCR revealed that the examined strains are clustered into 11 different genotypes at ≥90% similarity. Briefly, to the best of our knowledge, this study is the first report concerning community-associated A. baumannii infections in Egypt. The high prevalence of hidden multidrug-resistant (MDR) and extensively drug-resistant (XDR) A.baumannii strains associated with non-hospitalized patients raises an alarm for healthcare authorities to set strict standards to control the spread of such pathogens with high rates of morbidity and mortality.
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Al-Khudhairy MK, Al-Shammari MMM. Prevalence of metallo-β-lactamase-producing Pseudomonas aeruginosa isolated from diabetic foot infections in Iraq. New Microbes New Infect 2020; 35:100661. [PMID: 32194966 PMCID: PMC7076140 DOI: 10.1016/j.nmni.2020.100661] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2019] [Revised: 01/14/2020] [Accepted: 02/10/2020] [Indexed: 12/03/2022] Open
Abstract
Metallo-β-lactamase (MBL)-producing Pseudomonas aeruginosa is a major cause of nosocomial infections. However, there is little information in Iraq regarding its prevalence in patients with diabetic foot ulcer. Carbapenems are efficient antibiotics against extended-spectrum β-lactamase–producing P. aeruginosa. However, there are many potential health risks associated with carbapenem-resistant P. aeruginosa. We aimed to determine MBL-producing P. aeruginosa isolated from diabetic foot ulcer infections. A total of 97 P. aeruginosa isolates were isolated from pus and deep tissue swabs of 282 patients admitted to Al-Sader hospital, Najaf City, Iraq, with diabetic foot infections from October 2017 to January 2018. All P. aeruginosa isolates were tested by the Kirby-Bauer disc diffusion method for evaluating 13 antibiotics. Phenotypic carbapenem resistance was confirmed by the combined disc test, double-disc synergy test, modified Hodge test and CHROMagar KPC agar. All phenotypic MBL-producing P. aeruginosa isolates were screened for blaIMP, blaNDM, blaSIM, blaSPM and blaVIM genes by multiplex PCR. Of the 97 P. aeruginosa isolates, combined disc test and modified Hodge test revealed 12 isolates (12.4%) to be MBL producers, and ten (10.3%) displayed MBL production as accessed by CHROMagar KPC agar test. Nine isolates (9.3%) were carbapenemase producers by the imipenem and ceftizoxime double-disc synergy test. Of 12 phenotypic MBL-producing P. aeruginosa, PCR amplification confirmed 4 (33.3%) and 3 (25%) isolates harbouring blaVIM and blaIMP gene respectively, but none carried the blaNDM, blaSIM or blaSPM genes. The steady and rapid increase of MBL production is worrisome and needs to be controlled through extensive studies and more judicious selection of antibiotics, especially carbapenems.
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Affiliation(s)
- M K Al-Khudhairy
- Department of Community Health, College of Health and Medical Techniques, Al-Furat Al-Awsat Technical University, Kufa, Iraq
| | - M M M Al-Shammari
- College of Medicine, Jabir Ibn Hayyan Medical University, Al-Najaf, Iraq
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Esther J, Edwin D, Uma. Prevalence of Carbapenem Resistant Non-Fermenting Gram Negative Bacterial Infection and Identification of Carbapenemase Producing NFGNB Isolates by Simple Phenotypic Tests. J Clin Diagn Res 2017; 11:DC10-DC13. [PMID: 28511381 DOI: 10.7860/jcdr/2017/23996.9526] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2016] [Accepted: 11/21/2016] [Indexed: 11/24/2022]
Abstract
INTRODUCTION Non-Fermenting Gram negative bacilli (NFGNB) are emerging multi-drug resistant pathogens causing nosocomial infections. In recent years, carbapenem resistance in NFGNB has increased due to a variety of drug resistance mechanisms, the most common being production of carbapenemases. AIM To detect carbapenemase and metallo-β-lactamase (MBL) production in NFGNBs by four phenotypic tests and to compare the various phenotypic methods for detection of carbapenemase and MBL production in nosocomial NFGNB isolates. MATERIALS AND METHODS It is a cross sectional study carried out in the department of Microbiology, Chennai Medical College Hospital and Research Center, Irungalur, Trichy between January 2015 and December 2015. Out of the 598 NFGNB isolated from all the 5402 heterogenous clinical samples that were processed, 52 (8.7%) NFGNB showed resistance or intermediate sensitivity to meropenem as tested by disc diffusion assay. All the 52 isolates were subjected to four different phenotypic tests for carbapenemase and MBL detection, which included Modified Hodge Test (MHT), Meropenem-EDTA Disc Synergy (EDS) test, Meropenem-EDTA Combined Disc Test (CDT) and Growth on CHROMagar KPC. RESULTS Among the 52 isolates, 29 (55.77%) were MHT positive and 49 (94.23%) were positive for growth on CHROMEagar KPC which were identified as carbapenemase producers. 44 (84.61%) were EDS positive and 46 (88.46%) were CDT positive which were identified as metallo-β-lactamase producers. CONCLUSION The presence of these resistant bugs strongly suggests the need to prevent their further spread by implementation of strict infection control measures and regular surveillance to check their outcome. Growth on CHROMagar KPC is the test that has picked up more number of carbapenem resistant isolates as carbapenemase and metallo-β-lactamase producers among the four tests. It is also cheap and easy to perform, making it the most reliable test for routine screening of carbapenemase and MBL producers in clinical laboratories.
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Affiliation(s)
- Jane Esther
- Postgraduate, Department of Microbiology, Chennai Medical College and Research Centre, Dr. MGR Medical University, Trichy, Tamilnadu, India
| | - Diego Edwin
- Assistant Professor, Department of Microbiology, Chennai Medical College and Research Centre, Dr. MGR Medical University, Trichy, Tamilnadu, India
| | - Uma
- Professor and Head, Department of Microbiology, Chennai Medical College and Research Centre, Dr. MGR Medical University, Trichy, Tamilnadu, India
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Ning NZ, Liu X, Bao CM, Chen SM, Cui EB, Zhang JL, Huang J, Chen FH, Li T, Qu F, Wang H. Molecular epidemiology of bla OXA-23 -producing carbapenem-resistant Acinetobacter baumannii in a single institution over a 65-month period in north China. BMC Infect Dis 2017; 17:14. [PMID: 28056839 PMCID: PMC5217423 DOI: 10.1186/s12879-016-2110-1] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2016] [Accepted: 12/10/2016] [Indexed: 01/29/2023] Open
Abstract
BACKGROUND Carbapenem-resistant Acinetobacter baumannii poses a significant threat to hospitalized patients, as few therapeutic options remain. Thus, we investigated the molecular epidemiology and mechanism of resistance of carbapenem-resistant A.baumannii isolates in Beijing, China. METHODS Carbapenem-resistant A.baumannii isolates (n = 101) obtained between June 2009 and November 2014 were used. Multilocus sequence typing (MLST) and PCR assays for class C and D β-lactamase were performed on all isolates. S1 nuclease pulsed-field gel electrophoresis (PFGE) and Southern blot hybridization were performed to identify the resistance gene location. RESULTS All 101 A.baumannii isolates were highly resistant to frequently used antimicrobials, and were considered multidrug resistant. A total of 12 sequence types (STs) were identified, including 10 reported STs and 2 novel STs. Eighty-seven isolates were classified to clonal complex 92 (CC92), among which ST191 and ST195 were the most common STs. The bla OXA-23 gene was positive in most (n = 95) of the A.baumannii isolates. Using S1-nuclease digestion PFGE and Southern blot hybridization, 3 patterns of plasmids carrying bla OXA-23 were confirmed. ST191 and ST195 (both harboring bla OXA-23 ) caused outbreaks during the study period, and this is the first report of outbreaks caused by ST191 and ST195 in north China. CONCLUSION bla OXA-23 -producing A.baumannii ST191 and ST 195 isolates can disseminate in a hospital and are potential nosocomial outbreak strains. Surveillance of imipenem-resistant A.baumannii and antimicrobial stewardship should be strengthened.
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Affiliation(s)
- Nian-Zhi Ning
- State Key Laboratory of Pathogen and Biosecurity, Beijing Institute of Microbiology and Epidemiology, No.20 Dongda Street, Fengtai District, 100071, Beijing, China
| | - Xiong Liu
- State Key Laboratory of Pathogen and Biosecurity, Beijing Institute of Microbiology and Epidemiology, No.20 Dongda Street, Fengtai District, 100071, Beijing, China
| | - Chun-Mei Bao
- The Center of Clinical Diagnosis Laboratory, Beijing 302 Hospital, Beijing, 100039, China
| | - Su-Ming Chen
- The Center of Clinical Diagnosis Laboratory, Beijing 302 Hospital, Beijing, 100039, China
| | - En-Bo Cui
- The Center of Clinical Diagnosis Laboratory, Beijing 302 Hospital, Beijing, 100039, China
| | - Ju-Ling Zhang
- The Center of Clinical Diagnosis Laboratory, Beijing 302 Hospital, Beijing, 100039, China
| | - Jie Huang
- State Key Laboratory of Pathogen and Biosecurity, Beijing Institute of Microbiology and Epidemiology, No.20 Dongda Street, Fengtai District, 100071, Beijing, China
| | - Fang-Hong Chen
- State Key Laboratory of Pathogen and Biosecurity, Beijing Institute of Microbiology and Epidemiology, No.20 Dongda Street, Fengtai District, 100071, Beijing, China
| | - Tao Li
- State Key Laboratory of Pathogen and Biosecurity, Beijing Institute of Microbiology and Epidemiology, No.20 Dongda Street, Fengtai District, 100071, Beijing, China.
| | - Fen Qu
- The Center of Clinical Diagnosis Laboratory, Beijing 302 Hospital, Beijing, 100039, China.
| | - Hui Wang
- State Key Laboratory of Pathogen and Biosecurity, Beijing Institute of Microbiology and Epidemiology, No.20 Dongda Street, Fengtai District, 100071, Beijing, China.
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