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Beig M, Parvizi E, Navidifar T, Bostanghadiri N, Mofid M, Golab N, Sholeh M. Geographical mapping and temporal trends of Acinetobacter baumannii carbapenem resistance: A comprehensive meta-analysis. PLoS One 2024; 19:e0311124. [PMID: 39680587 PMCID: PMC11649148 DOI: 10.1371/journal.pone.0311124] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2024] [Accepted: 09/04/2024] [Indexed: 12/18/2024] Open
Abstract
BACKGROUND Carbapenem-resistant Acinetobacter baumannii (CRAB) is of critical concern in healthcare settings, leading to limited treatment options. In this study, we conducted a comprehensive meta-analysis to assess the prevalence of CRAB by examining temporal, geographic, and bias-related variations. METHODS We systematically searched prominent databases, including Scopus, PubMed, Web of Science, and EMBASE. Quality assessment was performed using the JBI checklist. Subgroup analyses were performed based on the COVID-19 timeframes, years, countries, continents, and bias levels, antimicrobial susceptivity test method and guidelines. RESULTS Our comprehensive meta-analysis, which included 795 studies across 80 countries from 1995 to 2023, revealed a surge in carbapenem resistance among A. baumannii, imipenem (76.1%), meropenem (73.5%), doripenem (73.0%), ertapenem (83.7%), and carbapenems (74.3%). Temporally, 2020-2023 witnessed significant peaks, particularly in carbapenems (81.0%) and meropenem (80.7%), as confirmed by meta-regression, indicating a steady upward trend. CONCLUSION This meta-analysis revealed an alarmingly high resistance rate to CRAB as a global challenge, emphasizing the urgent need for tailored interventions. Transparency, standardized methodologies, and collaboration are crucial for the accurate assessment and maintenance of carbapenem efficacy.
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Affiliation(s)
- Masoumeh Beig
- Department of Bacteriology, Pasteur Institute of Iran, Tehran, Iran
| | - Elnaz Parvizi
- Department of Microbiology, Science and Research Branch, Islamic Azad University, Fars, Iran
| | - Tahereh Navidifar
- Shoushtar Faculty of Medical Sciences, Department of Basic Sciences, Shoushtar, Iran
| | - Narjes Bostanghadiri
- Department of Microbiology, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Maryam Mofid
- School of Medicine, Hamadan University of Medical Science, Hamadan, Iran
| | - Narges Golab
- Department of Microbiology, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Mohammad Sholeh
- Department of Bacteriology, Pasteur Institute of Iran, Tehran, Iran
- Student Research Committee, Pasteur Institute of Iran, Tehran, Iran
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Papadopoulou M, Deliolanis I, Polemis M, Vatopoulos A, Psichogiou M, Giakkoupi P. Characteristics of the Genetic Spread of Carbapenem-Resistant Acinetobacter baumannii in a Tertiary Greek Hospital. Genes (Basel) 2024; 15:458. [PMID: 38674392 PMCID: PMC11050095 DOI: 10.3390/genes15040458] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2024] [Revised: 03/30/2024] [Accepted: 04/03/2024] [Indexed: 04/28/2024] Open
Abstract
Acinetobacter baumannii (Ab) has increasingly been identified as a cause of hospital-acquired infections and epidemics. The rise of carbapenem-resistant Acinetobacter baumannii (CRAB) poses significant challenges in treatment. Nosocomial outbreaks linked to CRAΒ A. baumannii strains have been reported worldwide, including in Greece. This study aimed to analyze the molecular epidemiology trends of multidrug-resistant A. baumannii isolates in a tertiary hospital in Athens, Greece. A total of 43 clinical isolates of extensively drug-resistant (XDRAB), pan-drug-resistant (PDRAB), and CRAB were collected from patients suffering from blood infection, hospitalized between 2016 and 2020 at the internal medicine clinics and the ICU. A.baumannii isolates underwent testing for Ambler class B and D carbapenemases and the detection of ISAba1, and were typed, initially, using pulsed-field gel electrophoresis, and, subsequently, using sequence-based typing and multiplex PCR to determine European Clone lineages. The blaOXA-23 gene accompanied by ISAba1 was prevalent in nearly all A. baumannii isolates, except for one carrying blaOXA-58. The intrinsic blaOXA-51-like gene was found in all isolates. No Ambler class B carbapenemases (VIM, NDM) were detected. Isolates were grouped into four PF-clusters and no one-cluster spread was documented, consistent with the absence of outbreak. The study indicated that XDR/PDR-CRAB isolates predominantly produce OXA-23 carbapenemase and belong to European Clone II. Further research is needed to understand the distribution of resistant bacteria and develop effective prevention and control strategies.
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Affiliation(s)
- Martha Papadopoulou
- Laboratory for the Surveillance of Infectious Diseases-LSID, Department of Public Health Policy, University of West Attica, 11521 Athens, Greece; (A.V.); (P.G.)
| | - Ioannis Deliolanis
- Department of Microbiology, Laiko General Hospital, 11527 Athens, Greece;
| | - Michalis Polemis
- Hellenic National Public Health Organization, 15123 Athens, Greece;
| | - Alkiviadis Vatopoulos
- Laboratory for the Surveillance of Infectious Diseases-LSID, Department of Public Health Policy, University of West Attica, 11521 Athens, Greece; (A.V.); (P.G.)
| | - Mina Psichogiou
- 1st Department of Internal Medicine, Laiko General Hospital, National and Kapodistrian University of Athens, 11527 Athens, Greece;
| | - Panagiota Giakkoupi
- Laboratory for the Surveillance of Infectious Diseases-LSID, Department of Public Health Policy, University of West Attica, 11521 Athens, Greece; (A.V.); (P.G.)
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Azaiez S, Haenni M, Cheikh AB, Chalbi MS, Messaoudi A, Tilouch L, Bahri S, Drapeau A, Saras E, Mtibâa M, Zouaoui R, Said H, Madec JY, Lupo A, Mansour W. Healthcare Equipment and Personnel Reservoirs of Carbapenem-Resistant Acinetobacter baumannii Epidemic Clones in Intensive Care Units in a Tunisian Hospital. Microorganisms 2023; 11:2637. [PMID: 38004649 PMCID: PMC10672855 DOI: 10.3390/microorganisms11112637] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2023] [Revised: 10/18/2023] [Accepted: 10/19/2023] [Indexed: 11/26/2023] Open
Abstract
Carbapenem-resistant Acinetobacter baumannii (CRAB) strains can cause severe and difficult-to-treat infections in patients with compromised general health. CRAB strains disseminate rapidly in nosocomial settings by patient-to-patient contact, through medical devices and inanimate reservoirs. The occurrence of CRAB in patients residing in the intensive care units (ICUs) of the Sahloul University hospital in Sousse, Tunisia is high. The objective of the current study was to determine whether the surfaces of items present in five ICU wards and the medical personnel there operating could serve as reservoirs for CRAB strains. Furthermore, CRAB isolates from patients residing in the ICUs during the sampling campaign were analyzed for genome comparison with isolates from the ICUs environment. Overall, 206 items were screened for CRAB presence and 27 (14%) were contaminated with a CRAB isolate. The items were located in several areas of three ICUs. Eight of the 54 (15%) screened people working in the wards were colonized by CRAB on the hands. Patients residing in the ICUs were infected with CRAB strains sharing extensive genomic similarity with strains recovered in the nosocomial environment. The strains belonged to three sub-clades of the internationally disseminated clone (ST2). A clone emerging in the Mediterranean basin (ST85) was detected as well. The strains were OXA-23 or NDM-1 producers and were also pan-aminoglycoside resistant due to the presence of the armA gene. Hygiene measures are urgent to be implemented in the Sahloul hospital to avoid further spread of difficult-to-treat CRAB strains and preserve health of patients and personnel operating in the ICU wards.
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Affiliation(s)
- Sana Azaiez
- Laboratoire de Recherche Biophysique Métabolique et Pharmacologie Appliquée, LR12ES02, Faculté de Médecine Ibn Al Jazzar Sousse, Université de Sousse, Sousse 4002, Tunisia; (S.A.); (A.M.); (S.B.); (M.M.); (R.Z.)
| | - Marisa Haenni
- Unité Antibiorésistance et Virulence Bactériennes, ANSES—Université de Lyon, 69007 Lyon, France; (M.H.); (A.D.); (E.S.); (J.-Y.M.)
| | - Asma Ben Cheikh
- Departement of Prevention and Security of Care, Sahloul University Hospital of Sousse, Sousse 4054, Tunisia; (A.B.C.); (M.S.C.); (H.S.)
- Faculté de Médecine Ibn Al Jazzar Sousse, Université de Sousse, Sousse 4002, Tunisia
| | - Mohamed Sahbi Chalbi
- Departement of Prevention and Security of Care, Sahloul University Hospital of Sousse, Sousse 4054, Tunisia; (A.B.C.); (M.S.C.); (H.S.)
- Faculté de Médecine Ibn Al Jazzar Sousse, Université de Sousse, Sousse 4002, Tunisia
| | - Aziza Messaoudi
- Laboratoire de Recherche Biophysique Métabolique et Pharmacologie Appliquée, LR12ES02, Faculté de Médecine Ibn Al Jazzar Sousse, Université de Sousse, Sousse 4002, Tunisia; (S.A.); (A.M.); (S.B.); (M.M.); (R.Z.)
| | - Lamia Tilouch
- Laboratoire de Microbiologie Sahloul, University Hospital of Sousse, Sousse 4054, Tunisia;
- Faculté de Pharmacie, Université de Monastir, Monastir 5019, Tunisia
| | - Sana Bahri
- Laboratoire de Recherche Biophysique Métabolique et Pharmacologie Appliquée, LR12ES02, Faculté de Médecine Ibn Al Jazzar Sousse, Université de Sousse, Sousse 4002, Tunisia; (S.A.); (A.M.); (S.B.); (M.M.); (R.Z.)
| | - Antoine Drapeau
- Unité Antibiorésistance et Virulence Bactériennes, ANSES—Université de Lyon, 69007 Lyon, France; (M.H.); (A.D.); (E.S.); (J.-Y.M.)
| | - Estelle Saras
- Unité Antibiorésistance et Virulence Bactériennes, ANSES—Université de Lyon, 69007 Lyon, France; (M.H.); (A.D.); (E.S.); (J.-Y.M.)
| | - Mariem Mtibâa
- Laboratoire de Recherche Biophysique Métabolique et Pharmacologie Appliquée, LR12ES02, Faculté de Médecine Ibn Al Jazzar Sousse, Université de Sousse, Sousse 4002, Tunisia; (S.A.); (A.M.); (S.B.); (M.M.); (R.Z.)
| | - Rania Zouaoui
- Laboratoire de Recherche Biophysique Métabolique et Pharmacologie Appliquée, LR12ES02, Faculté de Médecine Ibn Al Jazzar Sousse, Université de Sousse, Sousse 4002, Tunisia; (S.A.); (A.M.); (S.B.); (M.M.); (R.Z.)
| | - Houyem Said
- Departement of Prevention and Security of Care, Sahloul University Hospital of Sousse, Sousse 4054, Tunisia; (A.B.C.); (M.S.C.); (H.S.)
- Faculté de Médecine Ibn Al Jazzar Sousse, Université de Sousse, Sousse 4002, Tunisia
| | - Jean-Yves Madec
- Unité Antibiorésistance et Virulence Bactériennes, ANSES—Université de Lyon, 69007 Lyon, France; (M.H.); (A.D.); (E.S.); (J.-Y.M.)
| | - Agnese Lupo
- Unité Antibiorésistance et Virulence Bactériennes, ANSES—Université de Lyon, 69007 Lyon, France; (M.H.); (A.D.); (E.S.); (J.-Y.M.)
| | - Wejdene Mansour
- Laboratoire de Recherche Biophysique Métabolique et Pharmacologie Appliquée, LR12ES02, Faculté de Médecine Ibn Al Jazzar Sousse, Université de Sousse, Sousse 4002, Tunisia; (S.A.); (A.M.); (S.B.); (M.M.); (R.Z.)
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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: 16] [Impact Index Per Article: 8.0] [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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Kumkar SN, Kamble EE, Chavan NS, Dhotre DP, Pardesi KR. Diversity of resistant determinants, virulence factors, and mobile genetic elements in Acinetobacter baumannii from India: A comprehensive in silico genome analysis. Front Cell Infect Microbiol 2022; 12:997897. [PMID: 36519127 PMCID: PMC9742364 DOI: 10.3389/fcimb.2022.997897] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2022] [Accepted: 11/07/2022] [Indexed: 11/29/2022] Open
Abstract
Introduction The frequency of infections associated with multidrug resistant A. baumannii has risen substantially in India. The use of next-generation sequencing (NGS) techniques combined with comparative genomics has great potential for tracking, monitoring, and ultimately controlling the spread of this troublesome pathogen. Here, we investigated the whole genome sequences of 47 A. baumannii from India. Methods In brief, A. baumannii genomes were analyzed for the presence of antibiotic resistance genes (ARGs), virulence factors genes (VFGs), and mobile genetic elements (MGEs) using various in silico tools. The AbaR-type resistance islands (AbaRIs) were detected by examining the genetic environment of the chromosomal comM gene. Multilocus sequence types were determined using the Pasteur scheme. The eBURST and whole genome SNPs-based phylogenetic analysis were performed to analyze genetic diversity between A. baumannii genomes. Results and discussion A larger number of A. baumannii isolates belonging to the ST2 genotype was observed. The SNPs-based phylogenetic analysis showed a diversity between compared genomes. The predicted resistome showed the presence of intrinsic and acquired ARGs. The presence of plasmids, insertion sequences, and resistance islands carrying putative ARGs conferring resistance to antibiotics, quaternary ammonium compounds, and heavy metals was predicted in 43 (91%) genomes. The presence of putative VFGs related to adherence, biofilm formation and iron uptake was observed in the study. Overall, the comprehensive genome analysis in this study provides an essential insight into the resistome, virulome and mobilome of A. baumannii isolates from India.
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Affiliation(s)
- Shital N. Kumkar
- Department of Microbiology, Savitribai Phule Pune University, Pune, Maharashtra State, India
| | - Ekta E. Kamble
- Department of Microbiology, Savitribai Phule Pune University, Pune, Maharashtra State, India
| | - Nikeeta S. Chavan
- National Centre for Cell Science, Savitribai Phule Pune University Pune, Maharashtra State, India
| | - Dhiraj P. Dhotre
- National Centre for Cell Science, Savitribai Phule Pune University Pune, Maharashtra State, India,*Correspondence: Dhiraj P. Dhotre, ; Karishma R. Pardesi,
| | - Karishma R. Pardesi
- Department of Microbiology, Savitribai Phule Pune University, Pune, Maharashtra State, India,*Correspondence: Dhiraj P. Dhotre, ; Karishma R. Pardesi,
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Petropoulou D, Siopi M, Vourli S, Pournaras S. Activity of Sulbactam-Durlobactam and Comparators Against a National Collection of Carbapenem-Resistant Acinetobacter baumannii Isolates From Greece. Front Cell Infect Microbiol 2022; 11:814530. [PMID: 35127562 PMCID: PMC8812809 DOI: 10.3389/fcimb.2021.814530] [Citation(s) in RCA: 30] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2021] [Accepted: 12/28/2021] [Indexed: 02/01/2023] Open
Abstract
Background Acinetobacter baumannii is a leading cause of healthcare-associated infections worldwide, due to both its persistence in the hospital setting and ability to acquire high levels of antibiotic resistance. Carbapenem-resistant A. baumannii isolates (CRAB) limit the activity of current antimicrobial regimens and new alternatives or adjuncts to traditional antibiotics are urgently needed. Durlobactam is a novel broad-spectrum inhibitor of serine-type β-lactamases that restores sulbactam (SUL) activity against A. baumannii. The sulbactam-durlobactam (SD) combination has recently completed Phase 3 testing in the global ATTACK trial. Objectives The aim of this study is to evaluate the in vitro activity of SD versus comparators against a representative nationwide collection of CRAB isolates. Methods One hundred ninety CRAB isolates were collected from clinical samples of patients hospitalized in 11 hospitals throughout Greece during 2015. In vitro activities of SD and comparators (SUL alone, amikacin, minocycline, imipenem, meropenem, colistin, SD and imipenem combined with SD) were determined by broth microdilution. Results Durlobactam restored sulbactam activity against the majority of the strains tested, with SD exhibiting the lowest MIC90 (8 μg/ml) relative to the other single comparators tested; 87.9% of the isolates had SD MICs ≤4/4 µg/ml. The most active comparator was colistin (MIC90 = 16 μg/ml). The addition of imipenem further lowered the MIC90 of SD by one two-fold dilution. Conclusions This study demonstrated the potential utility of SD for the treatment of infections caused by A. baumannii. If its clinical efficacy is confirmed, SD may be an important therapeutic option for CRAB infections.
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Kumar S, Anwer R, Azzi A. Virulence Potential and Treatment Options of Multidrug-Resistant (MDR) Acinetobacter baumannii. Microorganisms 2021; 9:microorganisms9102104. [PMID: 34683425 PMCID: PMC8541637 DOI: 10.3390/microorganisms9102104] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2021] [Revised: 09/18/2021] [Accepted: 09/21/2021] [Indexed: 12/12/2022] Open
Abstract
Acinetobacter baumannii is an opportunistic pathogen which is undoubtedly known for a high rate of morbidity and mortality in hospital-acquired infections. A. baumannii causes life-threatening infections, including; ventilator-associated pneumonia (VAP), meningitis, bacteremia, and wound and urinary tract infections (UTI). In 2017, the World Health Organization listed A. baumannii as a priority-1 pathogen. The prevalence of A. baumannii infections and outbreaks emphasizes the direct need for the use of effective therapeutic agents for treating such infections. Available antimicrobials, such as; carbapenems, tigecycline, and colistins have insufficient effectiveness due to the appearance of multidrug-resistant strains, accentuating the need for alternative and novel therapeutic remedies. To understand and overcome this menace, the knowledge of recent discoveries on the virulence factors of A. baumannii is needed. Herein, we summarized the role of various virulence factors, including; outer membrane proteins, efflux pumps, biofilm, penicillin-binding proteins, and siderophores/iron acquisition systems. We reviewed the recent scientific literature on different A. baumannii virulence factors and the effective antimicrobial agents for the treatment and management of bacterial infections.
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Affiliation(s)
- Sunil Kumar
- Department of Biotechnology, Maharishi Markandeshwar (Deemed to Be University), Mullana, Ambala 133207, India;
| | - Razique Anwer
- Department of Pathology, College of Medicine, Imam Mohammad Ibn Saud Islamic University (IMSIU), Riyadh 13317-4233, Saudi Arabia;
| | - Arezki Azzi
- Department of Biochemistry, College of Medicine, Imam Mohammad Ibn Saud Islamic University (IMSIU), Riyadh 13317-4233, Saudi Arabia
- Correspondence:
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Kostyanev T, Xavier BB, García-Castillo M, Lammens C, Bravo-Ferrer Acosta J, Rodríguez-Baño J, Cantón R, Glupczynski Y, Goossens H. Phenotypic and molecular characterizations of carbapenem-resistant Acinetobacter baumannii isolates collected within the EURECA study. Int J Antimicrob Agents 2021; 57:106345. [PMID: 33887390 DOI: 10.1016/j.ijantimicag.2021.106345] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2020] [Revised: 04/08/2021] [Accepted: 04/10/2021] [Indexed: 12/15/2022]
Abstract
Multi-drug-resistant Acinetobacter baumannii isolates are key pathogens that contribute to the global burden of antimicrobial resistance. This study aimed to investigate the phenotypic and molecular characteristics of carbapenem-resistant A. baumannii (CRAB) isolates from the EURECA clinical trial. In total, 228 CRAB clinical strains were recovered from 29 sites in 10 European countries participating in the EURECA study between May 2016 and November 2018. All strains were reconfirmed centrally for identification and antimicrobial susceptibility testing, and were then subjected to DNA isolation and whole-genome sequencing (WGS), with analysis performed using BacPipe v.1.2.6. K and O typing was performed using KAPTIVE. Overall, 226 (99.1%) strains were confirmed as CRAB isolates. The minimum inhibitory concentration (MIC90) results of imipenem and meropenem were >16 mg/L. WGS showed that the isolates mainly harboured blaOXA-23 (n=153, 67.7%) or blaOXA-72 (n=70, 30.1%). Four blaOXA-72 isolates from Serbia co-harboured blaNDM-1. An IS5 transposase family element, ISAba31, was found upstream of the blaOXA-72 gene harboured on a small (~10-kb) pSE41030-EUR plasmid. The majority of isolates (n=178, 79.1%) belonged to international clone II. Strains belonging to the same sequence type but isolated in different countries or within the same country could be delineated in different clusters by core-genome multi-locus sequence typing (MLST). Whole-genome/core-genome MLST showed high diversity among the isolates, and the most common sequence type was ST2 (n=153, 67.7%). The EURECA A. baumannii strain collection represents a unique, diverse repository of carbapenem-resistant isolates that adds to the existing knowledge of A. baumannii epidemiology and resistance genes harboured by these strains.
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Affiliation(s)
- T Kostyanev
- Laboratory of Medical Microbiology, Vaccine and Infectious Disease Institute, University of Antwerp, Antwerp, Belgium.
| | - B B Xavier
- Laboratory of Medical Microbiology, Vaccine and Infectious Disease Institute, University of Antwerp, Antwerp, Belgium
| | - M García-Castillo
- Servicio de Microbiología, Hospital Universitario Ramón y Cajal and Instituto Ramón y Cajal de Investigación Sanitaria, Madrid, Spain; Red Española de Investigación en Patología Infecciosa, Madrid, Spain
| | - C Lammens
- Laboratory of Medical Microbiology, Vaccine and Infectious Disease Institute, University of Antwerp, Antwerp, Belgium
| | - J Bravo-Ferrer Acosta
- Unidad de Gestión Clínica de Enfermedades Infecciosas, Microbiología y Medicina Preventiva, Hospital Universitario Virgen Macarena - IBiS and Departamento de Medicina, Universidad de Sevilla, Seville, Spain
| | - J Rodríguez-Baño
- Unidad de Gestión Clínica de Enfermedades Infecciosas, Microbiología y Medicina Preventiva, Hospital Universitario Virgen Macarena - IBiS and Departamento de Medicina, Universidad de Sevilla, Seville, Spain
| | - R Cantón
- Servicio de Microbiología, Hospital Universitario Ramón y Cajal and Instituto Ramón y Cajal de Investigación Sanitaria, Madrid, Spain; Red Española de Investigación en Patología Infecciosa, Madrid, Spain
| | - Y Glupczynski
- Laboratory of Medical Microbiology, Vaccine and Infectious Disease Institute, University of Antwerp, Antwerp, Belgium
| | - H Goossens
- Laboratory of Medical Microbiology, Vaccine and Infectious Disease Institute, University of Antwerp, Antwerp, Belgium
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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: 203] [Impact Index Per Article: 40.6] [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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10
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Palmieri M, D’Andrea MM, Pelegrin AC, Perrot N, Mirande C, Blanc B, Legakis N, Goossens H, Rossolini GM, van Belkum A. Abundance of Colistin-Resistant, OXA-23- and ArmA-Producing Acinetobacter baumannii Belonging to International Clone 2 in Greece. Front Microbiol 2020; 11:668. [PMID: 32425900 PMCID: PMC7212473 DOI: 10.3389/fmicb.2020.00668] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2019] [Accepted: 03/24/2020] [Indexed: 12/14/2022] Open
Abstract
Carbapenem resistant Acinetobacter baumannii (CRAB) represents one of the most challenging pathogens in clinical settings. Colistin is routinely used for treatment of infections by this pathogen, but increasing colistin resistance has been reported. We obtained 122 CRAB isolates from nine Greek hospitals between 2015 and 2017, and those colistin resistant (ColR; N = 40, 32.8%) were whole genome sequenced, also by including two colistin susceptible (ColS) isolates for comparison. All ColR isolates were characterized by a previously described mutation, PmrBA226V, which was associated with low-level colistin resistance. Some isolates were characterized by additional mutations in PmrB (E140V or L178F) or PmrA (K172I or D10N), first described here, and higher colistin minimum inhibitory concentrations (MICs), up to 64 mg/L. Mass spectrometry analysis of lipid A showed the presence of a phosphoethanolamine (pEtN) moiety on lipid A, likely resulting from the PmrA/B-induced pmrC overexpression. Interestingly, also the two ColS isolates had the same lipid A modification, suggesting that not all lipid A modifications lead to colistin resistance or that other factors could contribute to the resistance phenotype. Most of the isolates (N = 37, 92.5%) belonged to the globally distributed international clone (IC) 2 and comprised four different sequence types (STs) as defined by using the Oxford scheme (ST 425, 208, 451, and 436). Three isolates belonged to IC1 and ST1567. All the genomes harbored an intrinsic bla OXA-51 group carbapenemase gene, where bla OXA-66 and bla OXA-69 were associated with IC2 and IC1, respectively. Carbapenem resistance was due to the most commonly reported acquired carbapenemase gene bla OXA-23, with ISAba1 located upstream of the gene and likely increasing its expression. The armA gene, associated with high-level resistance to aminoglycosides, was detected in 87.5% of isolates. Collectively, these results revealed a convergent evolution of different clonal lineages toward the same colistin resistance mechanism, thus limiting the effective therapeutic options for the treatment of CRAB infections.
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Affiliation(s)
- Mattia Palmieri
- bioMérieux, Data Analytics Unit, La Balme-les-Grottes, France
| | - Marco Maria D’Andrea
- Department of Medical Biotechnologies, University of Siena, Siena, Italy
- Department of Biology, University of Rome Tor Vergata, Rome, Italy
| | | | - Nadine Perrot
- bioMérieux, R&D Microbiology, La Balme-les-Grottes, France
| | | | | | | | - Herman Goossens
- Laboratory of Medical Microbiology, Vaccine and Infectious Disease Institute, University of Antwerp, Antwerp, Belgium
| | - Gian Maria Rossolini
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
- Clinical Microbiology and Virology Unit, Florence Careggi University Hospital, Florence, Italy
| | - Alex van Belkum
- bioMérieux, Data Analytics Unit, La Balme-les-Grottes, France
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11
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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: 12] [Impact Index Per Article: 2.0] [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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12
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Kimura Y, Harada K, Shimizu T, Sato T, Kajino A, Usui M, Tamura Y, Tsuyuki Y, Miyamoto T, Ohki A, Watarai M. Species distribution, virulence factors, and antimicrobial resistance of Acinetobacter spp. isolates from dogs and cats: a preliminary study. Microbiol Immunol 2018; 62:462-466. [PMID: 29752821 DOI: 10.1111/1348-0421.12601] [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: 12/04/2017] [Revised: 04/30/2018] [Accepted: 05/11/2018] [Indexed: 11/29/2022]
Abstract
We investigated the prevalence of virulence factors and antimicrobial resistance among 67 Acinetobacter spp. isolates, consisting of 21 Acinetobacter baumannii and 46 non-baumannii Acinetobacter from companion animals. The PCR analysis showed that the most prevalent virulence gene was afa/draBC (29.9%), followed by papC (22.4%) and cvaC (20.9%). Antimicrobial susceptibility testing revealed that resistance to gentamicin (14.9%) and ciprofloxacin (11.9%) was relatively prevalent. Five gentamicin- and/or ciprofloxacin-resistant A. baumannii strains were assigned to ST25, ST149, ST164, ST203, and ST1198. All ciprofloxacin-resistant isolates harbored point mutations in gyrA and/or parC. This is the first preliminary monitoring of animal-origin Acinetobacter spp. in Japan.
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Affiliation(s)
- Yui Kimura
- The United Graduate School of Veterinary Science, Yamaguchi University, 1677-1 Yoshida, Yamaguchi 753-8515, Japan
- Miyamoto Animal Hospital, 2265-8 Kurokawa, Yamaguchi 753-0851, Japan
| | - Kazuki Harada
- The United Graduate School of Veterinary Science, Yamaguchi University, 1677-1 Yoshida, Yamaguchi 753-8515, Japan
- Department of Veterinary Internal Medicine, Tottori University, Minami 4-101, Koyama, Tottori 680-8553, Japan
| | - Takae Shimizu
- The United Graduate School of Veterinary Science, Yamaguchi University, 1677-1 Yoshida, Yamaguchi 753-8515, Japan
- Department of Veterinary Internal Medicine, Tottori University, Minami 4-101, Koyama, Tottori 680-8553, Japan
| | - Tomomi Sato
- Laboratory of Food Microbiology and Food Safety, Rakuno Gakuen University, 582 Midori, Bunkyodai, Ebetsu, Hokkaido 069-8501, Japan
| | - Akari Kajino
- Laboratory of Food Microbiology and Food Safety, Rakuno Gakuen University, 582 Midori, Bunkyodai, Ebetsu, Hokkaido 069-8501, Japan
| | - Masaru Usui
- Laboratory of Food Microbiology and Food Safety, Rakuno Gakuen University, 582 Midori, Bunkyodai, Ebetsu, Hokkaido 069-8501, Japan
| | - Yutaka Tamura
- Laboratory of Food Microbiology and Food Safety, Rakuno Gakuen University, 582 Midori, Bunkyodai, Ebetsu, Hokkaido 069-8501, Japan
| | - Yuzo Tsuyuki
- Sanritsu Zelkova Veterinary Laboratory, 2-5-8 Kuji, Takatsu, Kawasaki, Kanagawa 213-0032, Japan
| | - Tadashi Miyamoto
- Miyamoto Animal Hospital, 2265-8 Kurokawa, Yamaguchi 753-0851, Japan
| | - Asami Ohki
- Fujifilm Monoris Co., Ltd., 1-49-18 Nishikoigakubo, Kokubunji, Tokyo 185-0013, Japan
| | - Masahisa Watarai
- The United Graduate School of Veterinary Science, Yamaguchi University, 1677-1 Yoshida, Yamaguchi 753-8515, Japan
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13
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Analysis of global prevalence of antibiotic resistance in Acinetobacter baumannii infections disclosed a faster increase in OECD countries. Emerg Microbes Infect 2018. [PMID: 29535298 PMCID: PMC5849731 DOI: 10.1038/s41426-018-0038-9] [Citation(s) in RCA: 95] [Impact Index Per Article: 13.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Acinetobacter baumannii is one of the most challenging nosocomial pathogens due to the emergence and widespread of antibiotic resistance. We aimed to provide the first analysis of global prevalence of antibiotic resistance in A. baumannii infections, by synthesizing data and knowledge through a systematic review. We searched studies reporting antibiotic resistance in A. baumannii infections using the Medline, Embase, Web of Science, and Cochrane databases from January 2000 to December 2016. Studies were eligible if they investigated and reported antibiotic resistance in A. baumannii infections with inpatients or outpatients in hospital. Our investigation showed a high prevalence of resistance to the common prescribed antibiotics in A. baumannii infections in both OECD (Organization for Economic Co-operation and Development) and non-OECD countries. Strikingly, though OECD countries have substantially lower pooled prevalence of resistance compared to non-OECD countries based on the data during 2006-2016, a further investigation in a time scale disclosed a faster increase in OECD countries during the past 11 years, and currently both of them have a comparable prevalence of resistance (2011-2016). Tigecycline and colistin are still active but their resistances are expected to become common if the preventative measures are not taken. Antibiotic resistance in A. baumannii infection developed fast and is a crisis for both OECD and non-OECD countries. A "post-antibiotic era" for A. baumannii infection is expected in the next 10-20 years without immediate actions from pharmaceutical companies and governments.
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14
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Nowak J, Zander E, Stefanik D, Higgins PG, Roca I, Vila J, McConnell MJ, Cisneros JM, Seifert H, MagicBullet Working Group WP4. High incidence of pandrug-resistant Acinetobacter baumannii isolates collected from patients with ventilator-associated pneumonia in Greece, Italy and Spain as part of the MagicBullet clinical trial. J Antimicrob Chemother 2017; 72:3277-3282. [PMID: 28961773 PMCID: PMC5890771 DOI: 10.1093/jac/dkx322] [Citation(s) in RCA: 143] [Impact Index Per Article: 17.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2017] [Revised: 08/01/2017] [Accepted: 08/01/2017] [Indexed: 01/05/2023] Open
Abstract
OBJECTIVES To investigate the molecular epidemiology, antimicrobial susceptibility and carbapenem resistance determinants of Acinetobacter baumannii isolates from respiratory tract samples of patients diagnosed with ventilator-associated pneumonia (VAP) who were enrolled in the MagicBullet clinical trial. METHODS A. baumannii isolates were prospectively cultured from respiratory tract samples from 65 patients from 15 hospitals in Greece, Italy and Spain. Susceptibility testing was performed by broth microdilution. Carbapenem resistance determinants were identified by PCR and sequencing. Molecular epidemiology was investigated using rep-PCR (DiversiLab) and international clones (IC) were identified using our in-house database. RESULTS Of 65 isolates, all but two isolates (97%) were resistant to imipenem and these were always associated with an acquired carbapenemase, OXA-23 (80%), OXA-40 (4.6%), OXA-58 (1.5%) or OXA-23/58 (1.5%). Resistance to colistin was 47.7%. Twenty-two isolates were XDR, and 20 isolates were pandrug-resistant (PDR). The majority of isolates clustered with IC2 (n = 54) with one major subtype comprising isolates from 12 hospitals in the three countries, which included 19 XDR and 16 PDR isolates. CONCLUSIONS Carbapenem resistance rates were very high in A. baumannii recovered from patients with VAP. Almost half of the isolates were colistin resistant, and 42 (64.6%) isolates were XDR or PDR. Rep-PCR confirmed IC2 is the predominant clonal lineage in Europe and suggests the presence of an epidemic XDR/PDR A. baumannii clone that has spread in Greece, Italy and Spain. These data highlight the difficulty in empirical treatment of patients with A. baumannii VAP in centres with a high prevalence of carbapenem-resistant A. baumannii.
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Affiliation(s)
- J Nowak
- Institute for Medical Microbiology, Immunology and Hygiene, University of Cologne, Goldenfelsstraße 19-21, 50935 Cologne, Germany
| | - E Zander
- Institute for Medical Microbiology, Immunology and Hygiene, University of Cologne, Goldenfelsstraße 19-21, 50935 Cologne, Germany
| | - D Stefanik
- Institute for Medical Microbiology, Immunology and Hygiene, University of Cologne, Goldenfelsstraße 19-21, 50935 Cologne, Germany
| | - P G Higgins
- Institute for Medical Microbiology, Immunology and Hygiene, University of Cologne, Goldenfelsstraße 19-21, 50935 Cologne, Germany
- German Centre for Infection Research (DZIF), partner site Bonn-Cologne, Germany
| | - I Roca
- Department of Clinical Microbiology and ISGlobal, Barcelona Ctr. Int. Health Res. CRESIB, Hospital Clínic, Universitat de Barcelona, Barcelona, Spain
| | - J Vila
- Department of Clinical Microbiology and ISGlobal, Barcelona Ctr. Int. Health Res. CRESIB, Hospital Clínic, Universitat de Barcelona, Barcelona, Spain
| | - M J McConnell
- Clinical Unit of Infectious Diseases, Microbiology, and Preventive Medicine Infectious Diseases Research Group, Institute of Biomedicine of Seville (IBiS), University of Seville/CSIC/University Hospital Virgen del Rocío, Seville, Spain
| | - J M Cisneros
- Clinical Unit of Infectious Diseases, Microbiology, and Preventive Medicine Infectious Diseases Research Group, Institute of Biomedicine of Seville (IBiS), University of Seville/CSIC/University Hospital Virgen del Rocío, Seville, Spain
| | - H Seifert
- Institute for Medical Microbiology, Immunology and Hygiene, University of Cologne, Goldenfelsstraße 19-21, 50935 Cologne, Germany
- German Centre for Infection Research (DZIF), partner site Bonn-Cologne, Germany
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15
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Mathlouthi N, Ben Lamine Y, Somai R, Bouhalila-Besbes S, Bakour S, Rolain JM, Chouchani C. Incidence of OXA-23 and OXA-58 Carbapenemases Coexpressed in Clinical Isolates of Acinetobacter baumannii in Tunisia. Microb Drug Resist 2017; 24:136-141. [PMID: 28691891 DOI: 10.1089/mdr.2016.0306] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
Acinetobacter baumannii is an important opportunistic and multidrug-resistant pathogen responsible for nosocomial infections in health facilities. The aim of this study was to characterize the molecular mechanisms of carbapenem resistance in A. baumannii isolates isolated from Mohamed Kassab Orthopedic Institute in Tunis, Tunisia. Twenty-five imipenem-resistant A. baumannii clinical isolates collected between 2013 and 2016 were identified using API 20NE and were confirmed by matrix-assisted laser desorption/ionization time-of-flight mass spectrometry (MALDI-TOF/MS). Carbapenemase activity was detected using microbiological tests and PCR. The epidemiological relatedness of the isolates was studied using multilocus sequence typing (MLST). The isolates were resistant to all antibiotics tested with increased minimum inhibitory concentration values (>32 mg/L). The microbiological tests showed that the 25 A. baumannii were positive for modified Hodge test and for the Carba NP test; however, β-lactamase activity was not inhibited by EDTA. All the isolates harbored the naturally occurring blaOXA-51-like gene and the blaOXA-23-like carbapenemase gene. Among these isolates, one isolate coexpressed the blaOXA-58 gene. MLST revealed several sequence types (STs) with the predominance of ST2 imipenem-resistant A. baumannii (14/25; 56%). In this study we report the prevalence of ST2 imipenem resistance and for the first time the coexpression of blaOXA-23 and blaOXA-58 in clinical isolates of A. baumannii in a Tunisian hospital.
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Affiliation(s)
- Najla Mathlouthi
- 1 Unité de Recherche sur les Maladies Infectieuses et Tropicales Emergentes (URMITE), UM 63, CNRS 7278, IRD 198, INSERM 1095, IHU Méditerranée Infection, Faculté de Médecine et de Pharmacie, Aix-Marseille-Université , Marseille, France .,2 Laboratoire des Microorganismes et Biomolécules Actives, Faculté des Sciences de Tunis, Campus Universitaire, Université Tunis El-Manar , Tunis, Tunisie.,3 Laboratoire de Recherche Sciences et Technologies de l'Environnement, Institut Supérieur des Sciences et Technologies de l'Environnement de Borj-Cedria, Université de Carthage , Technopôle de Borj-Cedria, Hammam-Lif, Tunisie
| | - Yomna Ben Lamine
- 4 Laboratoire de Biologie Clinique, Unité de Microbiologie, Institut Mohamed Kassab d'orthopédie Tunis , Tunis, Tunisie
| | - Rania Somai
- 2 Laboratoire des Microorganismes et Biomolécules Actives, Faculté des Sciences de Tunis, Campus Universitaire, Université Tunis El-Manar , Tunis, Tunisie
| | - Sophia Bouhalila-Besbes
- 4 Laboratoire de Biologie Clinique, Unité de Microbiologie, Institut Mohamed Kassab d'orthopédie Tunis , Tunis, Tunisie
| | - Sofiane Bakour
- 1 Unité de Recherche sur les Maladies Infectieuses et Tropicales Emergentes (URMITE), UM 63, CNRS 7278, IRD 198, INSERM 1095, IHU Méditerranée Infection, Faculté de Médecine et de Pharmacie, Aix-Marseille-Université , Marseille, France
| | - Jean-Marc Rolain
- 1 Unité de Recherche sur les Maladies Infectieuses et Tropicales Emergentes (URMITE), UM 63, CNRS 7278, IRD 198, INSERM 1095, IHU Méditerranée Infection, Faculté de Médecine et de Pharmacie, Aix-Marseille-Université , Marseille, France
| | - Chedly Chouchani
- 2 Laboratoire des Microorganismes et Biomolécules Actives, Faculté des Sciences de Tunis, Campus Universitaire, Université Tunis El-Manar , Tunis, Tunisie.,3 Laboratoire de Recherche Sciences et Technologies de l'Environnement, Institut Supérieur des Sciences et Technologies de l'Environnement de Borj-Cedria, Université de Carthage , Technopôle de Borj-Cedria, Hammam-Lif, Tunisie
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16
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Karampatakis T, Antachopoulos C, Tsakris A, Roilides E. Molecular epidemiology of carbapenem-resistant Acinetobacter baumannii in Greece: an extended review (2000–2015). Future Microbiol 2017; 12:801-815. [DOI: 10.2217/fmb-2016-0200] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Carbapenem-resistant Acinetobacter baumannii (CRAB) is endemic in Greece. CRAB initially emerged in 2000 and since then, carbapenemases still have a crucial role in CRAB appearance, except for a few cases resulting from efflux pump or outer-membrane protein mechanisms. OXA-type carbapenemases present the highest prevalence worldwide and bla OXA-23-like and bla OXA-58-like are the most important genes found; VIM-yielding CRAB have also been detected, while a single CRAB isolate producing NDM has quite recently emerged in Greece. The predominant OXA-23 producers are associated with multilocus sequence typing Pasteur scheme sequence type 2 clonal strains of the international clone II. The emergence of colistin-resistant CRAB has complicated the treatment of such infections and the interpretation of susceptibility data. Infection control measures and adjusted antimicrobial treatment strategies could confine CRAB spread. The aim of this review is to go through the molecular epidemiology of CRAB, in an endemic area and highlight its potential future evolution.
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Affiliation(s)
- Theodoros Karampatakis
- Infectious Diseases Unit, 3rd Department of Pediatrics, Medical Faculty, School of Health Sciences, Aristotle University, Hippokration General Hospital, Thessaloniki, Greece
| | - Charalampos Antachopoulos
- Infectious Diseases Unit, 3rd Department of Pediatrics, Medical Faculty, School of Health Sciences, Aristotle University, Hippokration General Hospital, Thessaloniki, Greece
| | - Athanassios Tsakris
- Microbiology Department, National & Kapodistrian University School of Medicine, Athens, Greece
| | - Emmanuel Roilides
- Infectious Diseases Unit, 3rd Department of Pediatrics, Medical Faculty, School of Health Sciences, Aristotle University, Hippokration General Hospital, Thessaloniki, Greece
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17
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Pournaras S, Dafopoulou K, Del Franco M, Zarkotou O, Dimitroulia E, Protonotariou E, Poulou A, Zarrilli R, Tsakris A, Skoura L, Themeli-Digalaki K, Perivolioti E, Tsiplakou S, Karavassilis V, Panopoulou M, Orfanidou M, Hadjichristodoulou C, Levidiotou S, Gikas A. Predominance of international clone 2 OXA-23-producing- Acinetobacter baumannii clinical isolates in Greece, 2015: results of a nationwide study. Int J Antimicrob Agents 2017; 49:749-753. [DOI: 10.1016/j.ijantimicag.2017.01.028] [Citation(s) in RCA: 43] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2016] [Revised: 01/16/2017] [Accepted: 01/28/2017] [Indexed: 10/19/2022]
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18
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Geladari A, Karampatakis T, Antachopoulos C, Iosifidis E, Tsiatsiou O, Politi L, Karyoti A, Papanikolaou V, Tsakris A, Roilides E. Epidemiological surveillance of multidrug-resistant gram-negative bacteria in a solid organ transplantation department. Transpl Infect Dis 2017; 19. [DOI: 10.1111/tid.12686] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2016] [Revised: 10/17/2016] [Accepted: 12/04/2016] [Indexed: 12/16/2022]
Affiliation(s)
- Anastasia Geladari
- Solid Organ Transplantation Department; Medical Faculty; Aristotle University School of Health Sciences; Hippokration General Hospital; Thessaloniki Greece
| | | | - Charalampos Antachopoulos
- Third Department of Pediatrics; Medical Faculty; Aristotle University School of Health Sciences; Hippokration General Hospital; Thessaloniki Greece
- Infection Control Committee; Hippokration General Hospital; Thessaloniki Greece
| | - Elias Iosifidis
- Third Department of Pediatrics; Medical Faculty; Aristotle University School of Health Sciences; Hippokration General Hospital; Thessaloniki Greece
- Infection Control Committee; Hippokration General Hospital; Thessaloniki Greece
| | - Olga Tsiatsiou
- Third Department of Pediatrics; Medical Faculty; Aristotle University School of Health Sciences; Hippokration General Hospital; Thessaloniki Greece
- Infection Control Committee; Hippokration General Hospital; Thessaloniki Greece
| | - Lida Politi
- Microbiology Department; National and Kapodistrian University School of Medicine; Athens Greece
| | - Aggeliki Karyoti
- Microbiology Department; Hippokration General Hospital; Thessaloniki Greece
| | - Vasilios Papanikolaou
- Solid Organ Transplantation Department; Medical Faculty; Aristotle University School of Health Sciences; Hippokration General Hospital; Thessaloniki Greece
| | - Athanassios Tsakris
- Microbiology Department; National and Kapodistrian University School of Medicine; Athens Greece
| | - Emmanuel Roilides
- Third Department of Pediatrics; Medical Faculty; Aristotle University School of Health Sciences; Hippokration General Hospital; Thessaloniki Greece
- Infection Control Committee; Hippokration General Hospital; Thessaloniki Greece
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Lee CR, Lee JH, Park M, Park KS, Bae IK, Kim YB, Cha CJ, Jeong BC, Lee SH. Biology of Acinetobacter baumannii: Pathogenesis, Antibiotic Resistance Mechanisms, and Prospective Treatment Options. Front Cell Infect Microbiol 2017; 7:55. [PMID: 28348979 PMCID: PMC5346588 DOI: 10.3389/fcimb.2017.00055] [Citation(s) in RCA: 578] [Impact Index Per Article: 72.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2016] [Accepted: 02/13/2017] [Indexed: 12/27/2022] Open
Abstract
Acinetobacter baumannii is undoubtedly one of the most successful pathogens responsible for hospital-acquired nosocomial infections in the modern healthcare system. Due to the prevalence of infections and outbreaks caused by multi-drug resistant A. baumannii, few antibiotics are effective for treating infections caused by this pathogen. To overcome this problem, knowledge of the pathogenesis and antibiotic resistance mechanisms of A. baumannii is important. In this review, we summarize current studies on the virulence factors that contribute to A. baumannii pathogenesis, including porins, capsular polysaccharides, lipopolysaccharides, phospholipases, outer membrane vesicles, metal acquisition systems, and protein secretion systems. Mechanisms of antibiotic resistance of this organism, including acquirement of β-lactamases, up-regulation of multidrug efflux pumps, modification of aminoglycosides, permeability defects, and alteration of target sites, are also discussed. Lastly, novel prospective treatment options for infections caused by multi-drug resistant A. baumannii are summarized.
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Affiliation(s)
- Chang-Ro Lee
- National Leading Research Laboratory of Drug Resistance Proteomics, Department of Biological Sciences, Myongji University Yongin, South Korea
| | - Jung Hun Lee
- National Leading Research Laboratory of Drug Resistance Proteomics, Department of Biological Sciences, Myongji University Yongin, South Korea
| | - Moonhee Park
- National Leading Research Laboratory of Drug Resistance Proteomics, Department of Biological Sciences, Myongji UniversityYongin, South Korea; DNA Analysis Division, Seoul Institute, National Forensic ServiceSeoul, South Korea
| | - Kwang Seung Park
- National Leading Research Laboratory of Drug Resistance Proteomics, Department of Biological Sciences, Myongji University Yongin, South Korea
| | - Il Kwon Bae
- Department of Dental Hygiene, College of Health and Welfare, Silla University Busan, South Korea
| | - Young Bae Kim
- Biotechnology Program, North Shore Community College Danvers, MA, USA
| | - Chang-Jun Cha
- Department of Systems Biotechnology, College of Biotechnology and Natural Resources, Chung-Ang University Anseong, South Korea
| | - Byeong Chul Jeong
- National Leading Research Laboratory of Drug Resistance Proteomics, Department of Biological Sciences, Myongji University Yongin, South Korea
| | - Sang Hee Lee
- National Leading Research Laboratory of Drug Resistance Proteomics, Department of Biological Sciences, Myongji University Yongin, South Korea
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Granov D, Ljubovic AD, Zec SL, Granov N, Hukic M. The Impact of Antibiotic Consumption on Development of Acinetobacter Baumannii Resistance. Mater Sociomed 2017; 28:449-453. [PMID: 28144198 PMCID: PMC5239659 DOI: 10.5455/msm.2016.28.449-453] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Abstract
Aim: The aim of this study was to examine the impact of antibiotic consumption on development of antimicrobial resistance in Acinetobacter baumannii. Material and Methods: The study was conducted in University Clinical Center of Sarajevo. In our retrospective study Acinetobacter baumannii isolated in period from July 1st 2009 to December 31st 2012. Isolates were detected from different clinical samples including urine, wound swab, blood, bronchial aspirate and other samples which were collected from patients situated on various hospital wards. Clinical isolates belonged to one per patient in a given period of time. Results: Antimicrobial resistance was interpreted according to CLSI breakpoints. Consumption of antibiotics was analyzed according to recommendations of the ESAC-Net and current Acinetobacter baumannii classification. Pearson’s correlation showed a positive correlation between gentamicin consumption and emerging of resistance (p = 0.023). Conclusion: Increase in the antimicrobial use was followed with an increase in resistance of Acinetobacter baumannii isolates. Monitoring of antibiotic resistance and consumption is of a great importance in order to reduce the emergence and spread of antimicrobial resistant organisms in the health care settings.
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Affiliation(s)
- Djana Granov
- Clinical Microbiology, University Clinical Center Sarajevo, Bosnia and Herzegovina
| | | | - Svjetlana Loga Zec
- Department of Pharmacology, Clinical Pharmacology and Toxicology, Faculty of Medicine University of Sarajevo, Bosnia and Herzegovina
| | - Nermir Granov
- Clinic for Cardio Surgery, University Clinical Center Sarajevo, Bosnia and Herzegovina
| | - Mirsada Hukic
- Institute for Biomedical Diagnostics and Research-Nalaz, Sarajevo, Bosnia and Herzegovina and International Burch University, Sarajevo, Bosnia and Herzegovina
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Altun Ş, Koçak Tufan Z, Altun B, Önde U, Kınıklı S, Demiröz AP. Growing OXA-23 type strains among carbapenem-resistant Acinetobacter baumannii and tigecycline as an alternate combination therapy. Turk J Med Sci 2016; 46:1894-1899. [PMID: 28081345 DOI: 10.3906/sag-1508-20] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2015] [Accepted: 03/26/2016] [Indexed: 11/03/2022] Open
Abstract
BACKGROUND/AIM The increasing prevalence and global spread of difficult-to-treat carbapenem-resistant Acinetobacter baumannii has become a serious problem. The aim of this study is to investigate the resistance patterns and tigecycline sensitivity of carbapenem-resistant A. baumannii strains. MATERIALS AND METHODS Acinetobacter strains that were carbapenem-resistant and collected mainly from intensive care units were included into this study. The antibiotic sensitivity/resistance of the strains to other antibiotics and tigecycline were noted. Presence of blaOXA-23, blaOXA-48, blaOXA-58, and NDM-1 was investigated by PCR. RESULTS In total, 44 carbapenem-resistant A. baumannii strains were detected. In addition, 57% (25/44) showed resistance to netilmicin and 2% (1/43) to tigecycline. All of the strains were susceptible to colistin. blaOXA-58 was found only in one (2%) strain while blaOXA-23 was found in 14 (32%) strains. All strains were negative for blaOXA-48 and NDM-1. CONCLUSION blaOXA-23 was the main resistance pattern in carbapenem-resistant A. baumannii strains. blaOXA-58 was present only in one strain and no blaOXA-48 was found. Tigecycline susceptibility is high and it can be a treatment option for a possible combination therapy of carbapenem-resistant A. baumannii, especially for those for whom colistin is contraindicated because of its toxicity.
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Affiliation(s)
- Şerife Altun
- Department of Infectious Diseases and Clinical Microbiology, Polatlı Duatepe State Hospital, Ankara, Turkey
| | - Zeliha Koçak Tufan
- Department of Infectious Diseases & Clinical Microbiology, Ankara Atatürk Training and Research Hospital, Yıldırım Beyazıt University, Ankara, Turkey
| | - Belgin Altun
- Center for Stem Cell Research and Development, Hacettepe University, Ankara, Turkey
| | - Ufuk Önde
- Department of Microbiology, Ankara Training and Research Hospital, Ankara, Turkey
| | - Sami Kınıklı
- Department of Infectious Diseases and Clinical Microbiology, Ankara Training and Research Hospital, Ankara, Turkey
| | - Ali Pekcan Demiröz
- Department of Infectious Diseases and Clinical Microbiology, Ankara Training and Research Hospital, Ankara, Turkey
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In Vitro Bactericidal Activity of Trimethoprim-Sulfamethoxazole Alone and in Combination with Colistin against Carbapenem-Resistant Acinetobacter baumannii Clinical Isolates. Antimicrob Agents Chemother 2016; 60:6903-6906. [PMID: 27550356 DOI: 10.1128/aac.01082-16] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2016] [Accepted: 08/17/2016] [Indexed: 01/09/2023] Open
Abstract
Trimethoprim-sulfamethoxazole alone and combined with colistin was tested in vitro against six carbapenem-resistant Acinetobacter baumannii (CRAB) clinical strains. After 24 h, at achievable serum concentrations, trimethoprim-sulfamethoxazole effectively killed all strains, while colistin killed only one strain. Trimethoprim-sulfamethoxazole plus colistin rapidly killed all strains after 6 h and for up to 24 h. Trimethoprim-sulfamethoxazole, one of the few remaining antimicrobials that still has a degree of activity, particularly combined with colistin, might represent an effective therapy for severe CRAB infections.
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Use of Comparative Genomics To Characterize the Diversity of Acinetobacter baumannii Surveillance Isolates in a Health Care Institution. Antimicrob Agents Chemother 2016; 60:5933-41. [PMID: 27458211 DOI: 10.1128/aac.00477-16] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2016] [Accepted: 07/05/2016] [Indexed: 01/19/2023] Open
Abstract
Despite the increasing prevalence of the nosocomial pathogen Acinetobacter baumannii, little is known about which genomic components contribute to clinical presentation of this important pathogen. Most whole-genome comparisons of A. baumannii have focused on specific genomic regions associated with phenotypes in a limited number of genomes. In this work, we describe the results of a whole-genome comparative analysis of 254 surveillance isolates of Acinetobacter species, 203 of which were A. baumannii, isolated from perianal swabs and sputum samples collected as part of an infection control active surveillance program at the University of Maryland Medical Center. The collection of surveillance isolates includes both carbapenem-susceptible and -resistant isolates. Based on the whole-genome phylogeny, the A. baumannii isolates collected belong to two major phylogenomic lineages. Results from multilocus sequence typing indicated that one of the major phylogenetic groups of A. baumannii was comprised solely of strains from the international clonal lineage 2. The genomic content of the A. baumannii isolates was examined using large-scale BLAST score ratio analysis to identify genes that are associated with carbapenem-susceptible and -resistant isolates, as well as genes potentially associated with the source of isolation. This analysis revealed a number of genes that were exclusive or at greater frequency in each of these classifications. This study is the most comprehensive genomic comparison of Acinetobacter isolates from a surveillance study to date and provides important information that will contribute to our understanding of the success of A. baumannii as a human pathogen.
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Al Atrouni A, Hamze M, Jisr T, Lemarié C, Eveillard M, Joly-Guillou ML, Kempf M. Wide spread of OXA-23-producing carbapenem-resistant Acinetobacter baumannii belonging to clonal complex II in different hospitals in Lebanon. Int J Infect Dis 2016; 52:29-36. [PMID: 27663910 DOI: 10.1016/j.ijid.2016.09.017] [Citation(s) in RCA: 52] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2016] [Revised: 09/14/2016] [Accepted: 09/15/2016] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVES To investigate the molecular epidemiology of Acinetobacter baumannii strains isolated from different hospitals in Lebanon. METHODS A total of 119 non-duplicate Acinetobacter strains were identified using matrix-assisted laser desorption/ionization time-of-flight mass spectrometry (MALDI-TOF MS) and partial rpoB gene sequencing. Antibiotic susceptibility testing was performed by disc diffusion method and all identified carbapenem-resistant isolates were investigated by PCR assays for the presence of the carbapenemase-encoding genes. Multilocus sequence typing (MLST) and pulsed-field gel electrophoresis (PFGE) were used for molecular typing. RESULTS Of the 119 A. baumannii isolates, 76.5% were resistant to carbapenems. The most common carbapenemase was the OXA-23-type, found in 82 isolates. The study of population structure using MLST revealed the presence of 30 sequence types (STs) including 18 new ones, with ST2 being the most commonly detected, accounting for 61% of the isolates typed. PFGE performed on all strains of ST2 identified a major cluster of 53 isolates, in addition to three other minor clusters and ten unique profiles. CONCLUSIONS This study highlights the wide dissemination of highly related OXA-23-producing carbapenem-resistant A. baumannii belonging to the international clone II in Lebanon. Thus, appropriate infection control measures are recommended in order to control the geographical spread of this clone in this country.
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Affiliation(s)
- Ahmad Al Atrouni
- Laboratoire Microbiologie Santé et Environnement (LMSE), Ecole Doctorale des Sciences et de Technologie et Faculté de Santé Publique, Université Libanaise, Tripoli, Lebanon; ATOMycA, InsermAtip-Avenir Team, CRCNA, Inserm U892, 6299 CNRS, University of Angers, Angers, France
| | - Monzer Hamze
- Laboratoire Microbiologie Santé et Environnement (LMSE), Ecole Doctorale des Sciences et de Technologie et Faculté de Santé Publique, Université Libanaise, Tripoli, Lebanon
| | - Tamima Jisr
- Department of Clinical Laboratory, Makassed General Hospital, Beirut, Lebanon
| | - Carole Lemarié
- Laboratoire de Bactériologie, Institut de Biologie en Santé - Centre Hospitalier Universitaire Angers, 4 rue Larrey, 49933 Angers cedex, France
| | - Matthieu Eveillard
- ATOMycA, InsermAtip-Avenir Team, CRCNA, Inserm U892, 6299 CNRS, University of Angers, Angers, France; Laboratoire de Bactériologie, Institut de Biologie en Santé - Centre Hospitalier Universitaire Angers, 4 rue Larrey, 49933 Angers cedex, France
| | - Marie-Laure Joly-Guillou
- ATOMycA, InsermAtip-Avenir Team, CRCNA, Inserm U892, 6299 CNRS, University of Angers, Angers, France; Laboratoire de Bactériologie, Institut de Biologie en Santé - Centre Hospitalier Universitaire Angers, 4 rue Larrey, 49933 Angers cedex, France
| | - Marie Kempf
- ATOMycA, InsermAtip-Avenir Team, CRCNA, Inserm U892, 6299 CNRS, University of Angers, Angers, France; Laboratoire de Bactériologie, Institut de Biologie en Santé - Centre Hospitalier Universitaire Angers, 4 rue Larrey, 49933 Angers cedex, France.
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Maraki S, Mantadakis E, Mavromanolaki VE, Kofteridis DP, Samonis G. A 5-year Surveillance Study on Antimicrobial Resistance of Acinetobacter baumannii Clinical Isolates from a Tertiary Greek Hospital. Infect Chemother 2016; 48:190-198. [PMID: 27659437 PMCID: PMC5048000 DOI: 10.3947/ic.2016.48.3.190] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2016] [Accepted: 06/17/2016] [Indexed: 11/24/2022] Open
Abstract
Background Acinetobacter baumannii has emerged as a major cause of nosocomial outbreaks. It is particularly associated with nosocomial pneumonia and bloodstream infections in immunocompromised and debilitated patients with serious underlying pathologies. Over the last two decades, a remarkable rise in the rates of multidrug resistance to most antimicrobial agents that are active against A. baumannii has been noted worldwide. We evaluated the rates of antimicrobial resistance and changes in resistance over a 5-year period (2010–2014) in A. baumannii strains isolated from hospitalized patients in a tertiary Greek hospital. Materials and Methods Identification of A. baumannii was performed by standard biochemical methods and the Vitek 2 automated system, which was also used for susceptibility testing against 18 antibiotics: ampicillin/sulbactam, ticarcillin, ticarcillin/clavulanic acid, piperacillin, piperacillin/tazobactam, cefotaxime, ceftazidime, cefepime, imipenem, meropenem, gentamicin, amikacin, tobramycin, ciprofloxacin, tetracycline, tigecycline, trimethoprim/sulfamethoxazole, and colistin. Interpretation of susceptibility results was based on the Clinical and Laboratory Standards Institute criteria, except for tigecycline, for which the Food and Drug Administration breakpoints were applied. Multidrug resistance was defined as resistance to ≥3 classes of antimicrobial agents. Results Overall 914 clinical isolates of A. baumannii were recovered from the intensive care unit (ICU) (n = 493), and medical (n = 252) and surgical (n = 169) wards. Only 4.9% of these isolates were fully susceptible to the antimicrobials tested, while 92.89% of them were multidrug resistant (MDR), i.e., resistant to ≥3 classes of antibiotics. ICU isolates were the most resistant followed by isolates from surgical and medical wards. The most effective antimicrobial agents were, in descending order: colistin, amikacin, trimethoprim/sulfamethoxazole, tigecycline, and tobramycin. Nevertheless, with the exception of colistin, no antibiotic was associated with a susceptibility rate >40% for the entire study period. The most common phenotype showed resistance against ampicillin/sulbactam, cephalosporins, carbapenems, aminoglycosides, ciprofloxacin, and tigecycline. An extremely concerning increase in colistin-resistant isolates (7.9%) was noted in 2014, the most recent study year. Conclusion The vast majority of A. baumannii clinical isolates in our hospital are MDR. The remaining therapeutic options for critically ill patients who suffer from MDR A. baumannii infections are severely limited, with A. baumannii beginning to develop resistance even against colistin. Scrupulous application of infection control practices should be implemented in every hospital unit. Lastly, given the lack of available therapeutic options for MDR A. baumannii infections, well-controlled clinical trials of combinations of existing antibiotics are clearly needed.
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Affiliation(s)
- Sofia Maraki
- Department of Clinical Microbiology, University Hospital of Heraklion, Crete, Greece.
| | - Elpis Mantadakis
- Department of Pediatrics, Democritus University of Thrace Faculty of Medicine and University General District Hospital of Evros, Alexandroupolis, Thrace, Greece
| | | | - Diamantis P Kofteridis
- Department of Internal Medicine, Infectious Diseases Unit, University of Crete Medical School, Heraklion, Crete, Greece
| | - George Samonis
- Department of Internal Medicine, Infectious Diseases Unit, University of Crete Medical School, Heraklion, Crete, Greece
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Aly MM, Abu Alsoud NM, Elrobh MS, Al Johani SM, Balkhy HH. High prevalence of the PER-1 gene among carbapenem-resistant Acinetobacter baumannii in Riyadh, Saudi Arabia. Eur J Clin Microbiol Infect Dis 2016; 35:1759-1766. [PMID: 27527351 DOI: 10.1007/s10096-016-2723-8] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2016] [Accepted: 06/30/2016] [Indexed: 11/29/2022]
Abstract
The prevalence of carbapenem-resistant Acinetobacter baumannii in Saudi Arabia and their resistance genetic mechanisms are yet to be identified. We studied the prevalence and genetic diversity of extended-spectrum beta-lactamase genes, particularly the PER-1 gene, among carbapenem-resistant A. baumannii strains from patients at a tertiary care hospital in Riyadh, Saudi Arabia between 2006 and 2014. Fresh subcultured samples were tested for antimicrobial susceptibility minimum inhibitory concentration (MIC). Total genomic DNA was extracted from each isolate and further used for polymerase chain reaction (PCR) genotyping, sequence-based typing (SBT) of PER-1 and OXA-51-like gene, and multilocus sequence typing (MLST) of positive isolates. Randomly selected clinical isolates (n = 100) were subjected to MLST. A total of 503 isolates were characterized as multidrug-resistant (MDR) using the MIC. Isolates were further PCR tested for bla -TEM and bla -PER-1 resistance genes (n = 503). The genotyping results showed that 68/503 (14 %) isolates were positive to bla TEM. The genotyping results of PER-1-like genes showed that 384/503 (76.3 %) were positive among MDR Acinetobacter isolates. Based on SBT, the majority of these isolates were clustered into three main groups including isolates harboring PER-1: AB11 (bla -PER-1), isolate AB16 (bla -PER-1), and, finally, the plasmid pAB154 (bla -PER-7). Remarkably, many isolates were concealing the PER-1 gene and harboring the TEM resistance genes as well. MLST results for selected isolates (n = 100) identified four main sequence types (STs: 2, 19, 20, and 25) and four novel isolates (ST 486-489). We report 76.3 % prevalence of the PER-1 resistance gene among Acinetobacter clinical isolates from Riyadh, Saudi Arabia. Further work is needed to explore the clinical risks and patient outcome with such resistance related to healthcare-associated infections and investigate the genetic and molecular mechanisms that confer the MDR phenotype.
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Affiliation(s)
- M M Aly
- National Guard Health Affairs, King Abdullah International Medical Research Center (KAIMRC), P.O. Box 22490, Riyadh, 11426, Saudi Arabia. .,Department of Pathology, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia.
| | - N M Abu Alsoud
- National Guard Health Affairs, King Abdullah International Medical Research Center (KAIMRC), P.O. Box 22490, Riyadh, 11426, Saudi Arabia
| | - M S Elrobh
- Biochemistry Department, College of Science, King Saud University, Riyadh, Saudi Arabia.,Biochemistry Department, Faculty of Science, Ain Shams University, Cairo, Egypt
| | - S M Al Johani
- Department of Pathology, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
| | - H H Balkhy
- National Guard Health Affairs, King Abdullah International Medical Research Center (KAIMRC), P.O. Box 22490, Riyadh, 11426, Saudi Arabia.,Department of Infection Prevention and Control, King Abdulaziz Medical City, Riyadh, Saudi Arabia.,Department of Pediatrics, King Abdulaziz Medical City, Riyadh, Saudi Arabia
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Pfeifer Y, Trifonova A, Pietsch M, Brunner M, Todorova I, Gergova I, Wilharm G, Werner G, Savov E. Clonal Transmission of Gram-Negative Bacteria with Carbapenemases NDM-1, VIM-1, and OXA-23/72 in a Bulgarian Hospital. Microb Drug Resist 2016; 23:301-307. [PMID: 27459019 DOI: 10.1089/mdr.2016.0059] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
We characterized 72 isolates with reduced susceptibility to carbapenems (50 Acinetobacter spp., 13 Proteus mirabilis, five Escherichia coli, one Morganella morganii, one Enterobacter cloacae, one Providencia rettgeri, and one Pseudomonas aeruginosa) from a hospital in Sofia, Bulgaria. Different β-lactamase genes were identified by polymerase chain reaction and sequencing. Bacterial strain typing was performed by enzymatic macrorestriction and pulsed-field gel electrophoresis (PFGE) typing as well as multilocus sequence typing for selected isolates. The majority of Acinetobacter baumannii (46/50) and one Acinetobacter pittii isolate harbored carbapenemase genes blaOXA-23 or blaOXA-72; two A. baumannii contained both genes. PFGE typing of all A. baumannii showed the presence of nine different clones belonging to eight sequence types ST350, ST208, ST436, ST437, ST449, ST231, ST502, and ST579. Molecular characterization of the remaining isolates confirmed the presence of one NDM-1-producing E. coli-ST101 clone (five isolates) and one P. mirabilis clone (13 isolates) with VIM-1 and CMY-99. Furthermore, NDM-1 was identified in P. rettgeri and M. morganii and VIM-2 in the P. aeruginosa isolate. The permanent introduction of OXA-23/72 carbapenemase-producing A. baumannii clones into the hospital and the repeated occurrence of one VIM-1-producing P. mirabilis and one NDM-1-producing E. coli-ST101 clone over a period of more than 1 year is of concern and requires intensified investigations.
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Affiliation(s)
- Yvonne Pfeifer
- 1 Robert Koch Institute , FG13 Nosocomial Pathogens and Antibiotic Resistance, Wernigerode, Germany
| | | | - Michael Pietsch
- 1 Robert Koch Institute , FG13 Nosocomial Pathogens and Antibiotic Resistance, Wernigerode, Germany
| | - Magdalena Brunner
- 1 Robert Koch Institute , FG13 Nosocomial Pathogens and Antibiotic Resistance, Wernigerode, Germany
| | | | | | - Gottfried Wilharm
- 3 Robert Koch Institute , P2 Acinetobacter baumannii, Wernigerode, Germany
| | - Guido Werner
- 1 Robert Koch Institute , FG13 Nosocomial Pathogens and Antibiotic Resistance, Wernigerode, Germany
| | - Encho Savov
- 2 Military Medical Academy , Sofia, Bulgaria
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Abstract
The OXA β-lactamases were among the earliest β-lactamases detected; however, these molecular class D β-lactamases were originally relatively rare and always plasmid mediated. They had a substrate profile limited to the penicillins, but some became able to confer resistance to cephalosporins. From the 1980s onwards, isolates of Acinetobacter baumannii that were resistant to the carbapenems emerged, manifested by plasmid-encoded β-lactamases (OXA-23, OXA-40, and OXA-58) categorized as OXA enzymes because of their sequence similarity to earlier OXA β-lactamases. It was soon found that every A. baumannii strain possessed a chromosomally encoded OXA β-lactamase (OXA-51-like), some of which could confer resistance to carbapenems when the genetic environment around the gene promoted its expression. Similarly, Acinetobacter species closely related to A. baumannii also possessed their own chromosomally encoded OXA β-lactamases; some could be transferred to A. baumannii, and they formed the basis of transferable carbapenem resistance in this species. In some cases, the carbapenem-resistant OXA β-lactamases (OXA-48) have migrated into the Enterobacteriaceae and are becoming a significant cause of carbapenem resistance. The emergence of OXA enzymes that can confer resistance to carbapenems, particularly in A. baumannii, has transformed these β-lactamases from a minor hindrance into a major problem set to demote the clinical efficacy of the carbapenems.
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Rieber H, Frontzek A, Pfeifer Y. Molecular Investigation of Carbapenem-Resistant Acinetobacter spp. from Hospitals in North Rhine-Westphalia, Germany. Microb Drug Resist 2016; 23:25-31. [PMID: 27093111 DOI: 10.1089/mdr.2016.0035] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
Emergence of carbapenem-resistant Acinetobacter spp., especially Acinetobacter baumannii, in hospitals has been increasingly detected worldwide. In the present study, we analyzed carbapenem-resistant isolates (70 A. baumannii and one Acinetobacter pittii) collected in a period of 4 years (February 2008 to January 2012) in one diagnostic laboratory in Germany. All isolates were carbapenemase positive with OXA-23 as by far the most common enzyme (n = 66, 93%). Carbapenemases OXA-24-like and OXA-58 were not present in the isolates, but genes blaGIM-1 and ISAba1+blaOXA-80/82 were found to be the cause of carbapenem resistance in one and four isolates, respectively. Polymerase chain reaction typing revealed that the majority of A. baumannii isolates could be assigned to the very successful international clone 2. ApaI-macrorestriction and pulsed-field gel electrophoresis (PFGE) indicated clonal transmission of resistant strains (eight different PFGE types) within several hospitals. By multilocus sequence typing, the isolates were to be assigned to ST195 (n = 44), ST236 (n = 12), ST208 (n = 4), ST437 (n = 3), ST231 (n = 3), ST448 (n = 2), ST556 (n = 1), and ST945 (n = 1). The wide spread of carbapenem-resistant clones of A. baumannii is facilitated by international travelling and needs continuous surveillance in hospitals and diagnostic laboratories.
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Affiliation(s)
- Heime Rieber
- 1 Division of Microbiology , Medizinisches Versorgungszentrum Dr. Stein, Mönchengladbach, Germany
| | - Andre Frontzek
- 1 Division of Microbiology , Medizinisches Versorgungszentrum Dr. Stein, Mönchengladbach, Germany
| | - Yvonne Pfeifer
- 2 Robert Koch Institute , Nosocomial Pathogens and Antibiotic Resistance, Wernigerode, Germany
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El-Shazly S, Dashti A, Vali L, Bolaris M, Ibrahim AS. Molecular epidemiology and characterization of multiple drug-resistant (MDR) clinical isolates of Acinetobacter baumannii. Int J Infect Dis 2015; 41:42-9. [PMID: 26518066 DOI: 10.1016/j.ijid.2015.10.016] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2015] [Revised: 10/05/2015] [Accepted: 10/22/2015] [Indexed: 01/17/2023] Open
Abstract
OBJECTIVES The aim of this study was to identify the genetic relatedness of multiple drug-resistant (MDR) Acinetobacter baumannii clinical isolates recovered from a hospital in Los Angeles. METHODS Twenty-one MDR A. baumannii isolates were collected and their antibiotic susceptibilities determined according to Clinical and Laboratory Standards Institute guidelines. Genes coding for antibiotic resistance were identified by PCR, and their identities were confirmed by DNA sequencing. Clonal relationships were studied by pulsed-field gel electrophoresis (PFGE) and multilocus sequence typing (MLST). RESULTS MDR consistently correlated with the presence of oxacillinases, mostly in the form of the plasmid-mediated OXA-23 enzyme, which was detected in 12 (57.1%) isolates. GES-type carbapenemases were found in 20 (95.2%) strains, AAC in all 21 (100%) strains, and PER in seven (33.3%) strains, and ISAba1 was detected in 16 (76.2%) isolates. The association between ISAba1 and resistance genes confirms insertion elements as a source of β-lactamase production. Of the 21 clinical isolates, five were found to be related to sequence type 1 (ST1) and 16 to ST2, as analyzed by MLST. PFGE demonstrated that the majority of clinical isolates were highly related (>85%). CONCLUSIONS This study supports a more complete understanding of genotyping of antibiotic resistance for better assessment of MDR strain transmission.
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Affiliation(s)
- Sherief El-Shazly
- Department of Medical Laboratory Sciences, Faculty of Allied Health Sciences, Health Sciences Center, Kuwait University, Kuwait; Division of Adult Infectious Diseases, Los Angeles Biomedical Research Institute at Harbor-University of California Los Angeles (UCLA) Medical Center, 1124 West Carson St., St. John's Cardiovascular Research Center, Torrance, CA 90502, USA
| | - Ali Dashti
- Department of Medical Laboratory Sciences, Faculty of Allied Health Sciences, Health Sciences Center, Kuwait University, Kuwait
| | - Leila Vali
- Department of Medical Laboratory Sciences, Faculty of Allied Health Sciences, Health Sciences Center, Kuwait University, Kuwait
| | - Michael Bolaris
- Division of Pediatric Infectious Diseases, Los Angeles Biomedical Research Institute at Harbor-University of California Los Angeles (UCLA) Medical Center, Torrance, California, USA
| | - Ashraf S Ibrahim
- Division of Adult Infectious Diseases, Los Angeles Biomedical Research Institute at Harbor-University of California Los Angeles (UCLA) Medical Center, 1124 West Carson St., St. John's Cardiovascular Research Center, Torrance, CA 90502, USA; David Geffen School of Medicine at UCLA, Los Angeles, California, USA.
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Sahl JW, Del Franco M, Pournaras S, Colman RE, Karah N, Dijkshoorn L, Zarrilli R. Phylogenetic and genomic diversity in isolates from the globally distributed Acinetobacter baumannii ST25 lineage. Sci Rep 2015; 5:15188. [PMID: 26462752 PMCID: PMC4604477 DOI: 10.1038/srep15188] [Citation(s) in RCA: 55] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2015] [Accepted: 09/22/2015] [Indexed: 02/06/2023] Open
Abstract
Acinetobacter baumannii is a globally distributed nosocomial pathogen that has gained interest due to its resistance to most currently used antimicrobials. Whole genome sequencing (WGS) and phylogenetics has begun to reveal the global genetic diversity of this pathogen. The evolution of A. baumannii has largely been defined by recombination, punctuated by the emergence and proliferation of defined clonal lineages. In this study we sequenced seven genomes from the sequence type (ST)25 lineage and compared them to 12 ST25 genomes deposited in public databases. A recombination analysis identified multiple genomic regions that are homoplasious in the ST25 phylogeny, indicating active or historical recombination. Genes associated with antimicrobial resistance were differentially distributed between ST25 genomes, which matched our laboratory-based antimicrobial susceptibility typing. Differences were also observed in biofilm formation between ST25 isolates, which were demonstrated to produce significantly more extensive biofilm than an isolate from the ST1 clonal lineage. These results demonstrate that within A. baumannii, even a fairly recently derived monophyletic lineage can still exhibit significant genotypic and phenotypic diversity. These results have implications for associating outbreaks with sequence typing as well as understanding mechanisms behind the global propagation of successful A. baumannii lineages.
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Affiliation(s)
- Jason W. Sahl
- Translational Genomics Research Institute, Flagstaff, AZ, USA
- Center for Microbial Genetics and Genomics, Northern Arizona University, Flagstaff, AZ, USA
| | | | - Spyros Pournaras
- Department of Microbiology, Medical School, University of Athens, Athens, Greece
| | | | - Nabil Karah
- Department of Molecular Biology, Umeå University, Umeå, Sweden
| | - Lenie Dijkshoorn
- Department of Infectious Diseases, Leiden University Medical Centre, Leiden, The Netherlands
| | - Raffaele Zarrilli
- Department of Public Health, University of Naples “Federico II”, Naples, Italy
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Sun Y, Li M, Chen L, Chen H, Yu X, Ye J, Zhang Y, Ma C, Zhou T. Prevalence and molecular characterization of carbapenemase-producing gram-negative bacteria from a university hospital in China. Infect Dis (Lond) 2015; 48:138-46. [DOI: 10.3109/23744235.2015.1094822] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Affiliation(s)
- Yao Sun
- From the Department of Clinical Laboratory, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou and
| | - Meimei Li
- From the Department of Clinical Laboratory, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou and
| | - Lijiang Chen
- From the Department of Clinical Laboratory, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou and
| | - Huale Chen
- From the Department of Clinical Laboratory, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou and
| | - Xiao Yu
- From the School of Laboratory Medicine and Life Science, Wenzhou Medical University, Wenzhou, Zhejiang Province, China
| | - Jianzhong Ye
- From the Department of Clinical Laboratory, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou and
| | - Yapei Zhang
- From the Department of Clinical Laboratory, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou and
| | - Chuanling Ma
- From the Department of Clinical Laboratory, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou and
| | - Tieli Zhou
- From the Department of Clinical Laboratory, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou and
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Kaliterna V, Kaliterna M, Hrenović J, Barišić Z, Tonkić M, Goic-Barisic I. Acinetobacter baumanniiin Southern Croatia: clonal lineages, biofilm formation, and resistance patterns. Infect Dis (Lond) 2015; 47:902-7. [DOI: 10.3109/23744235.2015.1078906] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Bakour S, Alsharapy SA, Touati A, Rolain JM. Characterization of Acinetobacter baumannii clinical isolates carrying bla(OXA-23) carbapenemase and 16S rRNA methylase armA genes in Yemen. Microb Drug Resist 2015; 20:604-9. [PMID: 24901296 DOI: 10.1089/mdr.2014.0018] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
PURPOSE The aim of this study was to investigate the molecular support of resistance to carbapenems, aminoglycosides, and fluoroquinolones in Acinetobacter baumannii clinical isolates collected from Yemen hospital. METHODS Three A. baumannii were isolated in February 2013 from three patients hospitalized at Al-Thawra University Hospital in Sana'a, Yemen. Antibiotic susceptibility testing was performed using the disk diffusion and E-test methods. Carbapenemase production was carried out by the modified Hodge test (MHT) and imipenem-ethylenediaminetetraacetic acid (EDTA) methods. Carbapenem, aminoglycoside, and fluoroquinolone resistance determinants were studied by polymerase chain reaction and sequencing. The epidemiological relatedness of the three strains was studied using multilocus sequence typing (MLST). RESULTS The isolates were resistant to almost all antibiotics tested with very high imipenem, amikacin, and ciprofloxacin minimum inhibitory concentrations (>32, >256, and >32 mg/L, respectively). The microbiological tests showed that the three A. baumannii were MHT positive, besides, the activity of β-lactamases was not inhibited by EDTA. All the three isolates contained the naturally occurring bla(OXA-51)-like gene and the bla(OXA-23)-like carbapenemase-encoding gene. The 16S rRNA methylase armA gene was detected in the three isolates. In addition, screening for genes encoding the aminoglycoside-modifying enzymes (AMEs) demonstrated that one isolate contained the acetyltransferase gene aac(6')-Ib. Fluoroquinolone resistance was associated with a single mutation Ser83Leu in the quinolone resistance determining region of the gyrA gene in all isolates. The MLST showed that the sequence type (ST) obtained corresponds to ST2 for the three strains. CONCLUSIONS Here we report the first identification of multidrug-resistant A. baumannii isolates harboring the bla(OXA-23)-like gene, AMEs [aac(6')-Ib], and the 16S rRNA methylase (armA) in the Yemen hospital.
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Affiliation(s)
- Sofiane Bakour
- 1 Laboratoire d'Ecologie Microbienne, FSNV, Université A/MIRA de Béjaia , Béjaia, Algérie
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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: 2.4] [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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Ou HY, Kuang SN, He X, Molgora BM, Ewing PJ, Deng Z, Osby M, Chen W, Xu HH. Complete genome sequence of hypervirulent and outbreak-associated Acinetobacter baumannii strain LAC-4: epidemiology, resistance genetic determinants and potential virulence factors. Sci Rep 2015; 5:8643. [PMID: 25728466 PMCID: PMC4345345 DOI: 10.1038/srep08643] [Citation(s) in RCA: 84] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2014] [Accepted: 01/29/2015] [Indexed: 12/22/2022] Open
Abstract
Acinetobacter baumannii is an important human pathogen due to its multi-drug resistance. In this study, the genome of an ST10 outbreak A. baumannii isolate LAC-4 was completely sequenced to better understand its epidemiology, antibiotic resistance genetic determinants and potential virulence factors. Compared with 20 other complete genomes of A. baumannii, LAC-4 genome harbors at least 12 copies of five distinct insertion sequences. It contains 12 and 14 copies of two novel IS elements, ISAba25 and ISAba26, respectively. Additionally, three novel composite transposons were identified: Tn6250, Tn6251 and Tn6252, two of which contain resistance genes. The antibiotic resistance genetic determinants on the LAC-4 genome correlate well with observed antimicrobial susceptibility patterns. Moreover, twelve genomic islands (GI) were identified in LAC-4 genome. Among them, the 33.4-kb GI12 contains a large number of genes which constitute the K (capsule) locus. LAC-4 harbors several unique putative virulence factor loci. Furthermore, LAC-4 and all 19 other outbreak isolates were found to harbor a heme oxygenase gene (hemO)-containing gene cluster. The sequencing of the first complete genome of an ST10 A. baumannii clinical strain should accelerate our understanding of the epidemiology, mechanisms of resistance and virulence of A. baumannii.
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Affiliation(s)
- Hong-Yu Ou
- State Key Laboratory of Microbial Metabolism and School of Life Sciences &Biotechnology, Shanghai Jiaotong University, Shanghai, China
| | - Shan N Kuang
- Department of Biological Sciences, California State University Los Angeles, Los Angeles, California, USA
| | - Xinyi He
- State Key Laboratory of Microbial Metabolism and School of Life Sciences &Biotechnology, Shanghai Jiaotong University, Shanghai, China
| | - Brenda M Molgora
- Department of Biological Sciences, California State University Los Angeles, Los Angeles, California, USA
| | - Peter J Ewing
- Department of Biological Sciences, California State University Los Angeles, Los Angeles, California, USA
| | - Zixin Deng
- State Key Laboratory of Microbial Metabolism and School of Life Sciences &Biotechnology, Shanghai Jiaotong University, Shanghai, China
| | - Melanie Osby
- Department of Pathology, LAC+USC Medical Center, Los Angeles, California, USA
| | - Wangxue Chen
- Human Health Therapeutics, National Research Council Canada, 100 Sussex Drive, Ottawa, Ontario K1A 0R6, Canada
| | - H Howard Xu
- Department of Biological Sciences, California State University Los Angeles, Los Angeles, California, USA
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Karah N, Samuelsen Ø, Zarrilli R, Sahl JW, Wai SN, Uhlin BE. CRISPR-cas subtype I-Fb in Acinetobacter baumannii: evolution and utilization for strain subtyping. PLoS One 2015; 10:e0118205. [PMID: 25706932 PMCID: PMC4338279 DOI: 10.1371/journal.pone.0118205] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2014] [Accepted: 01/09/2015] [Indexed: 12/13/2022] Open
Abstract
Clustered regularly interspaced short palindromic repeats (CRISPR) are polymorphic elements found in the genome of some or all strains of particular bacterial species, providing them with a system of acquired immunity against invading bacteriophages and plasmids. Two CRISPR-Cas systems have been identified in Acinetobacter baumannii, an opportunistic pathogen with a remarkable capacity for clonal dissemination. In this study, we investigated the mode of evolution and diversity of spacers of the CRISPR-cas subtype I-Fb locus in a global collection of 76 isolates of A. baumannii obtained from 14 countries and 4 continents. The locus has basically evolved from a common ancestor following two main lineages and several pathways of vertical descent. However, this vertical passage has been interrupted by occasional events of horizontal transfer of the whole locus between distinct isolates. The isolates were assigned into 40 CRISPR-based sequence types (CST). CST1 and CST23-24 comprised 18 and 9 isolates, representing two main sub-clones of international clones CC1 and CC25, respectively. Epidemiological data showed that some of the CST1 isolates were acquired or imported from Iraq, where it has probably been endemic for more than one decade and occasionally been able to spread to USA, Canada, and Europe. CST23-24 has shown a remarkable ability to cause national outbreaks of infections in Sweden, Argentina, UAE, and USA. The three isolates of CST19 were independently imported from Thailand to Sweden and Norway, raising a concern about the prevalence of CST19 in Thailand. Our study highlights the dynamic nature of the CRISPR-cas subtype I-Fb locus in A. baumannii, and demonstrates the possibility of using a CRISPR-based approach for subtyping a significant part of the global population of A. baumannii.
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Affiliation(s)
- Nabil Karah
- The Laboratory for Molecular Infection Medicine Sweden (MIMS), Department of Molecular Biology, Umeå University, Umeå, Sweden
- Umeå Centre for Microbial Research, Umeå University, Umeå, Sweden
- * E-mail:
| | - Ørjan Samuelsen
- Norwegian National Advisory Unit on Detection of Antimicrobial Resistance, Department of Microbiology and Infection Control, University Hospital of North Norway, Tromsø, Norway
| | - Raffaele Zarrilli
- Department of Public Health, University of Naples “Federico II”, Naples, Italy
- CEINGE Biotecnologie Avanzate, Naples, Italy
| | - Jason W. Sahl
- Department of Pathogen Genomics, Translational Genomics Research Institute, Flagstaff, Arizona, United States of America
| | - Sun Nyunt Wai
- The Laboratory for Molecular Infection Medicine Sweden (MIMS), Department of Molecular Biology, Umeå University, Umeå, Sweden
- Umeå Centre for Microbial Research, Umeå University, Umeå, Sweden
| | - Bernt Eric Uhlin
- The Laboratory for Molecular Infection Medicine Sweden (MIMS), Department of Molecular Biology, Umeå University, Umeå, Sweden
- Umeå Centre for Microbial Research, Umeå University, Umeå, Sweden
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Tsiatsiou O, Iosifidis Ε, Katragkou A, Dimou V, Sarafidis K, Karampatakis T, Antachopoulos C, Orfanou A, Tsakris A, Drossou-Agakidou V, Roilides E. Successful management of an outbreak due to carbapenem-resistant Acinetobacter baumannii in a neonatal intensive care unit. Eur J Pediatr 2015; 174:65-74. [PMID: 24985124 DOI: 10.1007/s00431-014-2365-8] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2014] [Revised: 06/01/2014] [Accepted: 06/16/2014] [Indexed: 10/25/2022]
Abstract
UNLABELLED The investigation and successful management of a monoclonal Acinetobacter baumannii outbreak in a neonatal intensive care unit are described. Upon the first clustered carbapenem-resistant A. baumannii (CRAB) infections, a bundle of actions were taken, including enhanced infection control, active surveillance (weekly stool samples), case-control study, staff education, daily audits and discontinuation of new admissions. Between September and December 2011, eight neonates developed 10 CRAB infections (five blood, four respiratory and one eye). A total of 216 active surveillance cultures were obtained from 96 neonates (43 % had ≥2 samples). During weeks 12, 16 and 17, active surveillance detected 3, 1 and 2 new CRAB acquisitions, respectively. Prevalence of infections/colonizations decreased, and no event occurred after 20th week. A colonized neonate developed CRAB sepsis and died. All CRAB isolates harboured bla OXA-58 and the intrinsic chromosomal bla OXA-51 carbapenemase genes. CONCLUSION Active surveillance and enhanced infection control measures effectively contained spread of CRAB clone in the neonatal intensive care unit.
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Affiliation(s)
- Olga Tsiatsiou
- Infectious Diseases Unit, 3rd Department of Pediatrics, Aristotle University School of Medicine, Hippokration General Hospital, Konstantinoupoleos 49, 546 42, Thessaloniki, Greece,
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Jeannot K, Diancourt L, Vaux S, Thouverez M, Ribeiro A, Coignard B, Courvalin P, Brisse S. Molecular epidemiology of carbapenem non-susceptible Acinetobacter baumannii in France. PLoS One 2014; 9:e115452. [PMID: 25517732 PMCID: PMC4269441 DOI: 10.1371/journal.pone.0115452] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2014] [Accepted: 11/24/2014] [Indexed: 01/27/2023] Open
Abstract
Carbapenem-resistant Acinetobacter baumannii have emerged globally. The objective of this study was to investigate the epidemiology, clonal diversity and resistance mechanisms of imipenem non-susceptible A. baumannii isolates in France. Between December 2010 and August 2011, 132 notifications were collected, including 37 outbreaks corresponding to 242 cases (2 to 55 per cluster). Multilocus sequence typing, pulsed-field gel electrophoresis (PFGE) and characterisation of carbapenemase-encoding genes were performed on 110 non-repetitive isolates. Gene blaOXA-23 was the most frequently detected (82%), followed by blaOXA-24 (11%) and blaOXA-58 (7%). Eleven sequence types (ST) were distinguished, among which sequence types ST1, ST2 (64%), ST20, ST25, ST85 and ST107. Isolates from epidemiological clusters had the same ST and resistance genes, indicating probable transmission within centres. In contrast, PFGE types of isolates differed among centres, arguing against transmission among centers. This study provides the first epidemiological snapshot of the population of A. baumannii with reduced susceptibility to carbapenems from France, and further underlines the predominance of international clones.
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Affiliation(s)
- Katy Jeannot
- Institut Pasteur, Centre National de Référence de la Résistance aux Antibiotiques, Unité des Agents Antibactériens, Paris, France
| | - Laure Diancourt
- Institut Pasteur, Genotyping of Pathogens and Public Health, Paris, France
| | - Sophie Vaux
- French Institute for Public Health Surveillance (InVS), Saint-Maurice, France
| | - Michelle Thouverez
- Laboratoire d'Epidémiologie et d'Hygiène Hospitalière, CHRU Jean Minjoz, Besançon, France
| | - Amandina Ribeiro
- Institut Pasteur, Centre National de Référence de la Résistance aux Antibiotiques, Unité des Agents Antibactériens, Paris, France
| | - Bruno Coignard
- French Institute for Public Health Surveillance (InVS), Saint-Maurice, France
| | - Patrice Courvalin
- Institut Pasteur, Centre National de Référence de la Résistance aux Antibiotiques, Unité des Agents Antibactériens, Paris, France
| | - Sylvain Brisse
- Institut Pasteur, Genotyping of Pathogens and Public Health, Paris, France
- Institut Pasteur, Microbial Evolutionary Genomics, Paris, France
- CNRS, UMR3525, Paris, France
- * E-mail:
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Lin MF, Lan CY. Antimicrobial resistance in Acinetobacter baumannii: From bench to bedside. World J Clin Cases 2014; 2:787-814. [PMID: 25516853 PMCID: PMC4266826 DOI: 10.12998/wjcc.v2.i12.787] [Citation(s) in RCA: 241] [Impact Index Per Article: 21.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2014] [Revised: 08/25/2014] [Accepted: 10/27/2014] [Indexed: 02/05/2023] Open
Abstract
Acinetobacter baumannii (A. baumannii) is undoubtedly one of the most successful pathogens in the modern healthcare system. With invasive procedures, antibiotic use and immunocompromised hosts increasing in recent years, A. baumannii has become endemic in hospitals due to its versatile genetic machinery, which allows it to quickly evolve resistance factors, and to its remarkable ability to tolerate harsh environments. Infections and outbreaks caused by multidrug-resistant A. baumannii (MDRAB) are prevalent and have been reported worldwide over the past twenty or more years. To address this problem effectively, knowledge of species identification, typing methods, clinical manifestations, risk factors, and virulence factors is essential. The global epidemiology of MDRAB is monitored by persistent surveillance programs. Because few effective antibiotics are available, clinicians often face serious challenges when treating patients with MDRAB. Therefore, a deep understanding of the resistance mechanisms used by MDRAB can shed light on two possible strategies to combat the dissemination of antimicrobial resistance: stringent infection control and antibiotic treatments, of which colistin-based combination therapy is the mainstream strategy. However, due to the current unsatisfying therapeutic outcomes, there is a great need to develop and evaluate the efficacy of new antibiotics and to understand the role of other potential alternatives, such as antimicrobial peptides, in the treatment of MDRAB infections.
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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: 2.3] [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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Chagas TPG, Carvalho KR, de Oliveira Santos IC, Carvalho-Assef APD, Asensi MD. Characterization of carbapenem-resistant Acinetobacter baumannii in Brazil (2008-2011): countrywide spread of OXA-23-producing clones (CC15 and CC79). Diagn Microbiol Infect Dis 2014; 79:468-72. [PMID: 24880823 DOI: 10.1016/j.diagmicrobio.2014.03.006] [Citation(s) in RCA: 65] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2013] [Revised: 03/01/2014] [Accepted: 03/09/2014] [Indexed: 02/06/2023]
Abstract
The study investigated the genetic relationship of carbapenem-resistant Acinetobacter baumannii clinical isolated from inpatients during 2008-2011 from 11 Brazilian states. Antimicrobial susceptibility profile was determined by disc diffusion method and Etest. Polymerase chain reaction was applied for carbapenemase genes, and ISAba1. Isolates were subjected to pulsed field gel electrophoresis (PFGE) and multilocus sequence typing (MLST) for molecular typing. Most of the isolates showed high resistance rates to antibiotics tested. The blaOXA-51-like gene was found in all isolates, and 146 (94.2%) isolates were positive for blaOXA-23-like. In the most OXA-23-producing isolates, the blaOXA-23-like gene was accompanied by ISAba1. A total of 146 OXA-23-producing isolates were clustered into 28 genotypes by PFGE. Molecular analysis by MLST identified 13 sequence types (STs). The most prevalent PFGE profiles were designated as ST15 (CC15), ST1 (CC1), and ST79 (CC79). This study showed the widespread of clonal complexes of A. baumannii harboring the blaOXA-23-like gene in different Brazilian states.
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Affiliation(s)
- Thiago Pavoni Gomes Chagas
- Laboratório de Pesquisa em Infecção Hospitalar (LAPIH), Instituto Oswaldo Cruz/FIOCRUZ, Av. Brasil 4365, Manguinhos, Rio de Janeiro, Brazil
| | - Karyne Rangel Carvalho
- Laboratório de Pesquisa em Infecção Hospitalar (LAPIH), Instituto Oswaldo Cruz/FIOCRUZ, Av. Brasil 4365, Manguinhos, Rio de Janeiro, Brazil
| | - Ivson Cassiano de Oliveira Santos
- Laboratório de Pesquisa em Infecção Hospitalar (LAPIH), Instituto Oswaldo Cruz/FIOCRUZ, Av. Brasil 4365, Manguinhos, Rio de Janeiro, Brazil
| | | | - Marise Dutra Asensi
- Laboratório de Pesquisa em Infecção Hospitalar (LAPIH), Instituto Oswaldo Cruz/FIOCRUZ, Av. Brasil 4365, Manguinhos, Rio de Janeiro, Brazil.
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Single-locus-sequence-based typing of blaOXA-51-like genes for rapid assignment of Acinetobacter baumannii clinical isolates to international clonal lineages. J Clin Microbiol 2014; 52:1653-7. [PMID: 24622099 DOI: 10.1128/jcm.03565-13] [Citation(s) in RCA: 55] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
Single-locus blaOXA-51-like sequence-based typing (SBT) was evaluated for its ability to determine correctly sequence types (STs) in Acinetobacter baumannii clinical isolates, in comparison with the Pasteur's multilocus sequence typing (MLST) reference method and 3-locus sequence typing (3-LST). The comparative study was performed in 585 multidrug-resistant (MDR) A. baumannii clinical isolates recovered from 21 hospitals located throughout Greece, Italy, Lebanon, and Turkey. The isolates belonged to nine clonal complexes (CCs) that correspond to 12 distinct sequence types (STs) and to one singleton ST. These clonal lineages predominate worldwide among nosocomial MDR A. baumannii strains. The most common clone was CC2 (ST2 and ST45; n=278 isolates) followed by CC1 (ST1 and ST20; n=155), CC25 (n=65), ST78 (n=62), CC15 (ST15 and ST84; n=9), CC10 (n=4), CC3 (n=4), CC6 (n=3), CC54 (n=3), and CC83 (n=2). Using the blaOXA-51-like SBT method, all 585 isolates of the study were typed and assigned correctly to the nine CCs and the singleton ST78. The 3-LST method was not able to classify isolates belonging to CC6, CC10, CC54, and CC83, which are not yet characterized in its database. The low-cost and convenient blaOXA-51-like SBT method, compared with 3-LST and MLST, discriminated all epidemic and sporadic lineages of our collection and could be effectively applied to type rapidly A. baumannii strains.
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Fu Y, Jiang J, Zhou H, Jiang Y, Fu Y, Yu Y, Zhou J. Characterization of a novel plasmid type and various genetic contexts of bla OXA-58 in Acinetobacter spp. from multiple cities in China. PLoS One 2014; 9:e84680. [PMID: 24400107 PMCID: PMC3882262 DOI: 10.1371/journal.pone.0084680] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2013] [Accepted: 11/18/2013] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND/OBJECTIVE Several studies have described the epidemiological distribution of blaOXA-58-harboring Acinetobacter baumannii in China. However, there is limited data concerning the replicon types of blaOXA-58-carrying plasmids and the genetic context surrounding blaOXA-58 in Acinetobacter spp. in China. METHODOLOGY/PRINCIPAL FINDINGS Twelve non-duplicated blaOXA-58-harboring Acinetobacter spp. isolates were collected from six hospitals in five different cities between 2005 and 2010. The molecular epidemiology of the isolates was carried out using PFGE and multilocus sequence typing. Carbapenemase-encoding genes and plasmid replicase genes were identified by PCR. The genetic location of blaOXA-58 was analyzed using S1-nuclease method. Plasmid conjugation and electrotransformation were performed to evaluate the transferability of blaOXA-58-harboring plasmids. The genetic structure surrounding blaOXA-58 was determined by cloning experiments. The twelve isolates included two Acinetobacter pittii isolates (belong to one pulsotype), three Acinetobacter nosocomialis isolates (belong to two pulsotypes) and seven Acinetobacter baumannii isolates (belong to two pulsotypes/sequence types). A. baumannii ST91 was found to be a potential multidrug resistant risk clone carrying both blaOXA-58 and blaOXA-23. blaOXA-58 located on plasmids varied from ca. 52 kb to ca. 143 kb. All plasmids can be electrotransformed to A. baumannii recipient, but were untypeable by the current replicon typing scheme. A novel plasmid replicase named repAci10 was identified in blaOXA-58-harboring plasmids of two A. pittii isolates, three A. nosocomialis isolates and two A. baumannii isolates. Four kinds of genetic contexts of blaOXA-58 were identified. The transformants of plasmids with structure of IS6 family insertion sequence (ISOur1, IS1008 or IS15)-ΔISAba3-like element-blaOXA-58 displayed carbapenem nonsusceptible, while others with structure of intact ISAba3-like element-blaOXA-58 were carbapenem susceptible. CONCLUSION The study revealed the unique features of blaOXA-58-carrying plasmids in Acinetobacter spp. in China, which were different from that of Acinetobacter spp. found in European countries. The diversity of the genetic contexts of blaOXA-58 contributed to various antibiotics resistance profiles.
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Affiliation(s)
- Yiqi Fu
- Department of Respiratory Diseases, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China
| | - Jingjin Jiang
- Department of VIP, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China
| | - Hua Zhou
- Department of Respiratory Diseases, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China
| | - Yan Jiang
- Department of Infectious Diseases, Sir Run Run Shaw Hospital, College of Medicine, Zhejiang University, Hangzhou, China
| | - Ying Fu
- Department of Infectious Diseases, Sir Run Run Shaw Hospital, College of Medicine, Zhejiang University, Hangzhou, China
| | - Yunsong Yu
- Department of Infectious Diseases, Sir Run Run Shaw Hospital, College of Medicine, Zhejiang University, Hangzhou, China
- * E-mail: (JZ); (YY)
| | - Jianying Zhou
- Department of Respiratory Diseases, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China
- * E-mail: (JZ); (YY)
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Gogou V, Meletis G, Tsitouras D. Control of a Multi-Drug-Resistant Acinetobacter baumannii Outbreak after Orthopedics Department Relocation. Microorganisms 2013; 1:158-161. [PMID: 27694769 PMCID: PMC5029489 DOI: 10.3390/microorganisms1010158] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2013] [Revised: 11/13/2013] [Accepted: 11/22/2013] [Indexed: 11/16/2022] Open
Abstract
Acinetobacter baumannii clinical isolates have the ability to survive in the hospital niche for prolonged time periods and to develop resistance against multiple antimicrobial agents. Therefore, A. baumannii has emerged as an important cause of nosocomial outbreaks worldwide, especially in critical-care environments such as intensive care units. In the present communication, we report a multi-drug-resistant A. baumannii outbreak that occurred in an orthopedics department in Greece after the admission of a patient previously hospitalized in the intensive care unit of a Greek tertiary care hospital. Despite the implementation of infection control measures, 29 patients were infected, significantly raising their hospitalization periods and treatment costs. Interestingly, the outbreak was put under control after the department’s previously programmed relocation.
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Affiliation(s)
- Vasiliki Gogou
- Department of Clinical Microbiology, Veroia General Hospital, Veroia 59100, Greece.
| | - Georgios Meletis
- Department of Clinical Microbiology, Veroia General Hospital, Veroia 59100, Greece.
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The Guest Who Would Not Leave*. Crit Care Med 2013; 41:2823-4. [DOI: 10.1097/ccm.0b013e31829cb097] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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48
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Globally expanding carbapenemase finally appears in Spain: nosocomial outbreak of acinetobacter baumannii producing plasmid-encoded OXA-23 in Barcelona, Spain. Antimicrob Agents Chemother 2013; 57:5155-7. [PMID: 23877694 DOI: 10.1128/aac.01486-13] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Resistance of Acinetobacter baumannii clinical isolates to carbapenems is on the rise worldwide mainly in association with the production of OXA-23. Until recently, however, OXA-23 was absent in Spain. In this work, we report the molecular characterization of a hospital outbreak of OXA-23-producing A. baumannii in Barcelona caused by a multidrug-resistant (MDR) clone belonging to international clone IC-II/sequence type ST85 between October 2010 and May 2011. blaOXA-23 was carried in a plasmid of 90 kb and located within the composite transposon Tn2006.
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Patel G, Bonomo RA. "Stormy waters ahead": global emergence of carbapenemases. Front Microbiol 2013; 4:48. [PMID: 23504089 PMCID: PMC3596785 DOI: 10.3389/fmicb.2013.00048] [Citation(s) in RCA: 310] [Impact Index Per Article: 25.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2012] [Accepted: 02/20/2013] [Indexed: 01/08/2023] Open
Abstract
Carbapenems, once considered the last line of defense against of serious infections with Enterobacteriaceae, are threatened with extinction. The increasing isolation of carbapenem-resistant Gram-negative pathogens is forcing practitioners to rely on uncertain alternatives. As little as 5 years ago, reports of carbapenem resistance in Enterobacteriaceae, common causes of both community and healthcare-associated infections, were sporadic and primarily limited to case reports, tertiary care centers, intensive care units, and outbreak settings. Carbapenem resistance mediated by β-lactamases, or carbapenemases, has become widespread and with the paucity of reliable antimicrobials available or in development, international focus has shifted to early detection and infection control. However, as reports of Klebsiella pneumoniae carbapenemases, New Delhi metallo-β-lactamase-1, and more recently OXA-48 (oxacillinase-48) become more common and with the conveniences of travel, the assumption that infections with highly resistant Gram-negative pathogens are limited to the infirmed and the heavily antibiotic and healthcare exposed are quickly being dispelled. Herein, we provide a status report describing the increasing challenges clinicians are facing and forecast the “stormy waters” ahead.
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Affiliation(s)
- Gopi Patel
- Department of Medicine, Mount Sinai School of Medicine New York, NY, USA
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OXA-235, a novel class D β-lactamase involved in resistance to carbapenems in Acinetobacter baumannii. Antimicrob Agents Chemother 2013; 57:2121-6. [PMID: 23439638 DOI: 10.1128/aac.02413-12] [Citation(s) in RCA: 167] [Impact Index Per Article: 13.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
We investigated the mechanism of carbapenem resistance in 10 Acinetobacter baumannii strains isolated from the United States and Mexico between 2005 and 2009. The detection of known metallo-β-lactamase or carbapenem-hydrolyzing oxacillinase (OXA) genes by PCR was negative. The presence of plasmid-encoded carbapenem resistance genes was investigated by transformation of A. baumannii ATCC 17978. Shotgun cloning experiments and sequencing were performed, followed by the expression of a novel β-lactamase in A. baumannii. Three novel OXA enzymes were identified, OXA-235 in 8 isolates and the amino acid variants OXA-236 (Glu173-Val) and OXA-237 (Asp208-Gly) in 1 isolate each. The deduced amino acid sequences shared 85% identity with OXA-134, 54% to 57% identities with the acquired OXA-23, OXA-24, OXA-58, and OXA-143, and 56% identity with the intrinsic OXA-51 and, thus, represent a novel subclass of OXA. The expression of OXA-235 in A. baumannii led to reduced carbapenem susceptibility, while cephalosporin MICs were unaffected. Genetic analysis revealed that blaOXA-235, blaOXA-236, and blaOXA-237 were bracketed between two ISAba1 insertion sequences. In addition, the presence of these acquired β-lactamase genes might result from a transposition-mediated mechanism. This highlights the propensity of A. baumannii to acquire multiple carbapenem resistance determinants.
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