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Calix JJ, de Almeida MCS, Potter RF, Wallace MA, Burnham CAD, Dantas G. Outpatient Clonal Propagation and Rapid Regional Establishment of an Emergent Carbapenem-Resistant Acinetobacter baumannnii Lineage Sequence Type 499Pas. J Infect Dis 2023; 227:631-640. [PMID: 36301240 PMCID: PMC10152498 DOI: 10.1093/infdis/jiac427] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2022] [Revised: 09/29/2022] [Accepted: 10/25/2022] [Indexed: 11/13/2022] Open
Abstract
Eliminating carbapenem-resistant Acinetobacter baumannii (CRAb) disease requires comprehensive knowledge of how this noncommensal organism propagates among at-risk hosts. We molecularly characterized an ongoing surge of CRAb cases among patients in a Midwest US healthcare system, which coincided with sustained reductions in hospital-acquired CRAb infections and falloffs of cases associated with distinctly more resistant antibiotypes. Genome sequencing revealed surge isolates belonged to an emergent Pasteur scheme sequence type 499 and comprised multiple contemporaneous clonal clusters. Detailed query of health records revealed no consistent hospital source but instead identified various outpatient healthcare settings linked to cluster cases. We show that CRAb can rapidly establish a regional presence even without gains in breadth of antibiotic resistance and negligible contribution from sustained intrahospital transmission. As CRAb lineages may sidestep control efforts via outpatient epidemiological niches, our approach can be implemented to investigate outpatient CRAb propagation and inform subsequent local surveillance outside hospital settings.
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Affiliation(s)
- Juan J Calix
- Division of Infectious Diseases, Washington University School of Medicine in St. Louis, St. Louis, Missouri, USA
- The Edison Family Center for Genome Sciences and Systems Biology, Washington University School of Medicine in St. Louis, St. Louis, Missouri, USA
| | | | - Robert F Potter
- Department of Pathology and Immunology, Washington University School of Medicine in St. Louis, St. Louis, Missouri, USA
| | - Meghan A Wallace
- Department of Pathology and Immunology, Washington University School of Medicine in St. Louis, St. Louis, Missouri, USA
| | - Carey-Ann D Burnham
- Division of Infectious Diseases, Washington University School of Medicine in St. Louis, St. Louis, Missouri, USA
- Department of Pathology and Immunology, Washington University School of Medicine in St. Louis, St. Louis, Missouri, USA
- Department of Molecular Microbiology, Washington University School of Medicine in St. Louis, St. Louis, Missouri, USA
| | - Gautam Dantas
- The Edison Family Center for Genome Sciences and Systems Biology, Washington University School of Medicine in St. Louis, St. Louis, Missouri, USA
- Department of Pathology and Immunology, Washington University School of Medicine in St. Louis, St. Louis, Missouri, USA
- Department of Molecular Microbiology, Washington University School of Medicine in St. Louis, St. Louis, Missouri, USA
- Department of Biomedical Engineering, Washington University School of Medicine in St. Louis, St. Louis, Missouri, USA
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Polymicrobial community-acquired Acinetobacter baumannii and Burkholderia pseudomallei bacteremia: opportunistic infections with similar risk factors in northern Australia. IDCases 2020; 21:e00833. [PMID: 32509526 PMCID: PMC7264049 DOI: 10.1016/j.idcr.2020.e00833] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Revised: 05/19/2020] [Accepted: 05/19/2020] [Indexed: 11/25/2022] Open
Abstract
We report the case of a 61-year-old man from northern Australia with concurrent community-onset Acinetobacter baumannii complex and Burkholderia pseudomallei bacteremia presenting as severe tropical pneumonia requiring intensive care unit support. The pneumonia was complicated by L3/4 discitis and vertebral osteomyelitis presumed to be due to melioidosis. His risk factors included chronic lung disease and immunosuppression with etanercept. This case of concurrent infection highlights the similar risk factors, presentation and epidemiology of both infections, emphasises the importance of accurate microbiologic identification and reinforces the current Australian empiric antimicrobial treatment recommendations for severe tropical pneumonia.
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