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Barbosa TA, Bentlin MR, Rugolo LMSDS, Lyra JC, Ferreira AM, dos Santos ACML, Teixeira NB, Medeiros Romero LC, Castelo Branco Fortaleza CM, Ribeiro de Souza da Cunha MDL. Molecular Characterization of Gram-Negative Bacilli Isolated from a Neonatal Intensive Care Unit and Phenotypic and Molecular Detection of ESBL and Carbapenemase. Antibiotics (Basel) 2025; 14:342. [PMID: 40298504 PMCID: PMC12024293 DOI: 10.3390/antibiotics14040342] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2024] [Revised: 02/25/2025] [Accepted: 03/17/2025] [Indexed: 04/30/2025] Open
Abstract
INTRODUCTION The increase in the rates of multidrug-resistant bacteria in healthcare environments has been recognized as a global public health problem. In view of the scarcity of data on the neonatal population, this study aimed to provide information on the genotypic and epidemiological characteristics of Gram-negative microorganisms isolated from colonization and infection sites in neonates admitted to a tertiary university center of high complexity. METHODS Enterobacterales and non-fermenting Gram-negative bacilli previously collected in a prospective cohort study were submitted to genotypic identification, detection of extended-spectrum β-lactamases (ESBL), carbapenemases and biofilm production, detection of specific virulence markers in Pseudomonas aeruginosa, and typing by pulsed-field gel electrophoresis. RESULTS The data found here revealed higher rates of infection by Klebsiella spp. and Serratia marcescens that caused bloodstream infection and pneumonia, respectively. In this study, high biofilm production was observed, with 95.0% of Enterobacterales and 100% of non-fermenting Gram-negative bacilli being producers. Most of the P. aeruginosa isolates carried pathogenicity factors such as alginate, hemolytic phospholipase C, exotoxin A, and rhamnolipids. The phenotypic analysis of ESBL revealed that 16 (5.3%) isolates produced these enzymes. Four of these isolates (66.7%) carried the CTX-M-9 gene, three (50%) carried the TEM gene, and one (16.7%) was positive for the SHV and CMY-2 genes. Univariate and multivariate Cox regression analyses were used to identify risk factors for colonization and infection by Gram-negative microorganisms. The results of multivariate analysis revealed that biofilm production by these microorganisms was associated with the persistence of colonization by the same pathogen in the newborn and increased by 75% the daily probability of the newborn developing infection. The production of ESBL also increased the daily probability of infection by 46.8 times. CONCLUSIONS Enterobacterales showed average biofilm production, while the majority of non-fermenting Gram-negative bacilli were strong producers. The present data increase our knowledge of the molecular epidemiology of important Enterobacterales species, with emphasis on ESBL-producing Enterobacter cloacae and Klebsiella pneumoniae with emerging epidemiological potential in the neonatal intensive care unit of a tertiary university hospital. Furthermore, the results highlight the need for the monitoring and implementation of control measures and for restricting the use of broad-spectrum antibiotics.
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Affiliation(s)
- Thaís Alves Barbosa
- Department of Infectious Diseases, Botucatu Medical School, São Paulo State University (UNESP), Botucatu 18618-687, Brazil; (T.A.B.); (C.M.C.B.F.)
- Department of Genetics, Microbiology and Immunology, Institute of Biosciences, São Paulo State University (UNESP), Botucatu 18618-691, Brazil; (A.C.M.L.d.S.); (N.B.T.); (L.C.R.M.)
| | - Maria Regina Bentlin
- Department of Pediatrics, Botucatu Medical School, São Paulo State University (UNESP), Botucatu 18618-687, Brazil; (M.R.B.); (L.M.S.d.S.R.); (J.C.L.)
| | - Lígia Maria Suppo de Souza Rugolo
- Department of Pediatrics, Botucatu Medical School, São Paulo State University (UNESP), Botucatu 18618-687, Brazil; (M.R.B.); (L.M.S.d.S.R.); (J.C.L.)
| | - João César Lyra
- Department of Pediatrics, Botucatu Medical School, São Paulo State University (UNESP), Botucatu 18618-687, Brazil; (M.R.B.); (L.M.S.d.S.R.); (J.C.L.)
| | - Adriano Martison Ferreira
- Clinical Laboratory-Microbiology, Botucatu Medical School, São Paulo State University (UNESP), Botucatu 18618-687, Brazil;
| | - Ana Cláudia Moro Lima dos Santos
- Department of Genetics, Microbiology and Immunology, Institute of Biosciences, São Paulo State University (UNESP), Botucatu 18618-691, Brazil; (A.C.M.L.d.S.); (N.B.T.); (L.C.R.M.)
| | - Nathalia Bibiana Teixeira
- Department of Genetics, Microbiology and Immunology, Institute of Biosciences, São Paulo State University (UNESP), Botucatu 18618-691, Brazil; (A.C.M.L.d.S.); (N.B.T.); (L.C.R.M.)
| | - Letícia Calixto Medeiros Romero
- Department of Genetics, Microbiology and Immunology, Institute of Biosciences, São Paulo State University (UNESP), Botucatu 18618-691, Brazil; (A.C.M.L.d.S.); (N.B.T.); (L.C.R.M.)
| | | | - Maria de Lourdes Ribeiro de Souza da Cunha
- Department of Infectious Diseases, Botucatu Medical School, São Paulo State University (UNESP), Botucatu 18618-687, Brazil; (T.A.B.); (C.M.C.B.F.)
- Department of Genetics, Microbiology and Immunology, Institute of Biosciences, São Paulo State University (UNESP), Botucatu 18618-691, Brazil; (A.C.M.L.d.S.); (N.B.T.); (L.C.R.M.)
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Park JY, Kim JS, Shin SH, Lee JY, Kim EK, Kim HS, Choi JH. Risk Factors of Invasive Carbapenem-Resistant Acinetobacter baumanniiInfection in Neonatal Intensive Care Unit during Outbreak. NEONATAL MEDICINE 2014. [DOI: 10.5385/nm.2014.21.1.38] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Affiliation(s)
- Ji Youn Park
- Department of Pediatrics, Seoul National University College of Medicine, Seoul, Korea
| | - Ji Soo Kim
- Department of Pediatrics, Seoul National University College of Medicine, Seoul, Korea
| | - Seung Han Shin
- Department of Pediatrics, Seoul National University College of Medicine, Seoul, Korea
| | - Ju Young Lee
- Department of Pediatrics, Seoul National University College of Medicine, Seoul, Korea
| | - Ee Kyung Kim
- Department of Pediatrics, Seoul National University College of Medicine, Seoul, Korea
| | - Han Suk Kim
- Department of Pediatrics, Seoul National University College of Medicine, Seoul, Korea
| | - Jung Hwan Choi
- Department of Pediatrics, Seoul National University College of Medicine, Seoul, Korea
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Siqueira VLD, Cardoso RF, Pádua RAFD, Caleffi-Ferracioli KR, Helbel C, Santos ACB, Aoki EE, Nakamura CV. High genetic diversity among Pseudomonas aeruginosa and Acinetobacter spp. isolated in a public hospital in Brazil. BRAZ J PHARM SCI 2013. [DOI: 10.1590/s1984-82502013000100006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
In Brazil and other regions of the world, Pseudomonas aeruginosa and Acinetobacter spp. have emerged as important agents of nosocomial infection and are commonly involved in outbreaks. The main objective of the present study was to evaluate the genetic relationship among P. aeruginosa and Acinetobacter spp. isolated from patients in a public university hospital in northwestern Paraná, Brazil, and report their antimicrobial resistance profile. A total of 75 P. aeruginosa and 94 Acinetobacter spp. isolates were phenotypically identified and tested for antibiotic susceptibility using automated methodology. Polymyxin B was tested by disk diffusion for P. aeruginosa. Metallo-β-lactamase (MBL) was detected using a disk approximation test. Genotyping was performed using enterobacterial repetitive intergenic consensus polymerase chain reaction (ERIC-PCR). Approximately 55% of the P. aeruginosa isolates and 92% of the Acinetobacter spp. isolates were multiresistant, but none were MBL-producers. ERIC-PCR revealed the presence of small clusters of carbapenem-resistant Acinetobacter spp., most likely OXA-type carbapenemase producers. Furthermore, high genetic diversity in P. aeruginosa and Acinetobacter spp. clinical isolates was observed, suggesting that cross-transmission is not very frequent in the studied hospital.
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Hosoglu S, Hascuhadar M, Yasar E, Uslu S, Aldudak B. Control of an Acinetobacter [corrected] baumannii outbreak in a neonatal ICU without suspension of service: a devastating outbreak in Diyarbakir, Turkey. Infection 2012; 40:11-8. [PMID: 21881956 DOI: 10.1007/s15010-011-0180-y] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2011] [Accepted: 08/09/2011] [Indexed: 11/28/2022]
Abstract
BACKGROUND A nosocomial outbreak of Acinetobacter baumannii bloodstream infections (Ab-BSI) was identified in Diyarbakir Children's Hospital's (Diyarbakir, Turkey) 60-bed Neonatal Intensive Care Unit (NICU) in 2006 and 2007. METHODS The investigation and control of the outbreak were based on case-control and epidemiological studies as well as multifaceted interventions. Sixty-four neonates (case patients) with Ab-BSI and 128 neonates (control patients) free of Ab-BSI, who had been hospitalized at the unit during the outbreak period, were included in the study. Case and control patients were compared for possible predisposing factors (e.g., gender, length of NICU stay, antibiotic use, intubation, etc.). An intervention program (cohorting, education, reinforcing hand hygiene, antibiotic restriction, improving processes of patient care, environmental cleaning, and barrier isolation) was implemented to control the outbreak. Surveillance cultures were collected from all possible sources, and the epidemiological investigation was supplemented by a pulsed field gel electrophoresis (PFGE) study. RESULTS Fifty-three neonates (82.8%) died in the case group and 51 (39.8%) in the control group (P < 0.001). The duration of stay at the NICU [odds ratio (OR) 1.15; 95% confidence interval (CI) 1.07-1.23; P < 0.001] and re-intubation (OR 38.62; CI 12.66-117.87; P < 0.001) were found to be significant risk factors for Ab-BSI. Surveillance cultures showed a heavy contamination in the NICU, and the outbreak ended after a series multifaceted interventions. All A. baumannii isolates, both from the cases and environmental samples, had an identical PFGE fingerprint pattern. CONCLUSION The control of Ab-BSI requires a multifaceted intervention program and complex efforts and implementations, especially if the ICU does not implement any suspension of care provision.
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Affiliation(s)
- S Hosoglu
- Department of Infectious Diseases, Dicle University Hospital, 21285 Diyarbakir, Turkey.
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Pancholi P, Healy M, Bittner T, Webb R, Wu F, Aiello A, Larson E, Latta PD. Molecular characterization of hand flora and environmental isolates in a community setting. J Clin Microbiol 2005; 43:5202-7. [PMID: 16207984 PMCID: PMC1248454 DOI: 10.1128/jcm.43.10.5202-5207.2005] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2005] [Revised: 06/16/2005] [Accepted: 07/07/2005] [Indexed: 11/20/2022] Open
Abstract
We analyzed 69 bacterial isolates, comprising seven species of gram-negative bacterial rods and three species of coagulase-negative staphylococci, recovered from both the hands of caretakers and their environment in households sampled in upper Manhattan. Repetitive sequence-based PCR and dendrogram analysis were used to determine strain similarity. Greater than 25% of individual species of Acinetobacter, Enterobacter, and coagulase-negative staphylococci recovered from the hands and immediate environment within each household shared the same genotype. This study is the first to demonstrate the frequency of bacteria shared within community households. These strains may serve as potential reservoirs for either community- or hospital-acquired infections.
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Affiliation(s)
- Preeti Pancholi
- Clinical Microbiology Laboratory, Department of Pathology, New York, NY, USA.
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Wu TL, Ma L, Chang JC, Su LH, Chu C, Leu HS, Siu LK. Variable resistance patterns of integron-associated multidrug-resistant Acinetobacter baumannii isolates in a surgical intensive care unit. Microb Drug Resist 2005; 10:292-9. [PMID: 15650373 DOI: 10.1089/mdr.2004.10.292] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Between 1998 and 2000, we characterized 91 nosocomial isolates of Acinetobacter baumannii by antibiotyping and genotyping. A total of 25 ribotypes were obtained among these 91 isolates. When the isolates from surgical intensive care units (ICUs) and other wards were compared, multiresistant A. baumannii isolates with the same ribotype 25 (R-25) were significantly more prevalent in nosocomial infections among the surgical patients. Further subtyping of the strains by pulsed-field gel electrophoresis confirmed that strains of the same ribotype in surgical ICUs and a few isolates from other wards were identical or clonally related. Different antibiotic resistance profiles were observed among these R-25 isolates. All R-25 isolates contained intI1 integrase, and two clusters of integron cassettes were found. These clusters of cassettes were encoded by an open reading frame (ORF) of -5'CS-aac(3)Ia-aadA1a-unknown or f-3'CS or 5'CS-aacA4-aadA1-catB8-3'CS, indicating the involvement of different resistant genes. Two isolates contained bla (IMP-1), which was acquired from a conjugatively transferable plasmid and did not involve integron-associated resistance. In conclusion, an epidemic of nosocomial infections associated with A. baumannii strains that have different resistance profiles was identified. Resistance profiles can change by a combination of plasmid- and integron-associated acquisition, especially in a unit with high antibiotic selective pressures. Infectious control personnel should be alert to the change in resistance profiles during routine monitoring.
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Affiliation(s)
- Tsu-Lan Wu
- Department of Clinical Pathology, Chang Gung University, Taoyuan
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Wu TL, Su LH, Leu HS, Chiu CH, Chiu YP, Chia JH, Kuo AJ, Sun CF. Molecular epidemiology of nosocomial infection associated with multi-resistant Acinetobacter baumannii by infrequent-restriction-site PCR. J Hosp Infect 2002; 51:27-32. [PMID: 12009817 DOI: 10.1053/jhin.2002.1206] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Acinetobacter baumannii was considered endemic in a university-affiliated tertiary hospital. A significant increase was noted in the proportion of nosocomial infections associated with this micro-organism from 1996 to 1999, although no apparent clusters could be found. Between July 1998 and February 2000, 58 nosocomial isolates of A. baumannii were collected and characterized by antibiotyping and a genotyping method, infrequent-restriction-site PCR (IRS-PCR). High resistance to the 14 antimicrobial agents examined was observed among the isolates. Of the 13 antibiograms detected, eight were multi-resistant to gentamicin and almost all of the traditional and extended-spectrum beta-lactams. These multi-resistant strains consisted of 41 isolates (71%), distributed amongst different wards and intensive care units (ICUs). By IRS-PCR, 23 types were obtained, with one major type found among 28 (48%) isolates. All of these 28 isolates were collected from surgical ICUs. It appears that a single strain of multi-resistant A. baumannii was responsible for the prevalence of nosocomial infection amongst surgical patients, clearly differentiating this outbreak from the previous endemic situation. An efficient molecular typing method played a vital role in making this discrimination.
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Affiliation(s)
- T-L Wu
- Department of Clinical Pathology, Lin-Kou Medical Centre, Chang Gung Memorial Hospital, No. 5 Fu-Hsing Street, Kweishan, Taoyuan 333, Taiwan.
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