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Gharaibeh MH, Abandeh YM, Elnasser ZA, Lafi SQ, Obeidat HM, Khanfar MA. Multi-drug Resistant Acinetobacter baumannii: Phenotypic and Genotypic Resistance Profiles and the Associated Risk Factors in Teaching Hospital in Jordan. J Infect Public Health 2024; 17:543-550. [PMID: 38367568 DOI: 10.1016/j.jiph.2024.01.018] [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: 06/08/2023] [Revised: 01/02/2024] [Accepted: 01/30/2024] [Indexed: 02/19/2024] Open
Abstract
BACKGROUND This study aimed to determine the prevalence of Antimicrobial Resistance Genes (ARGs), with a focus on colistin resistance in clinical A. baumannii, as well as the risk factors associated with A. baumannii infection in Jordanian patients. METHODS In total, 150 A. baumannii isolates were obtained from patients at a teaching hospital. The isolates were tested for antimicrobial susceptibility using disc diffusion and microdilution methods. PCR amplification was used to detect ARGs, and statistical analysis was conducted to evaluate the influence of identified risk factors on the ARGs acquisition. RESULTS More than 90% of A. baumannii isolates were resistant to monobactam, carbapenem, cephalosporins, Fluoroquinolones, penicillin, and β-lactam agents. Moreover, 20.6% of the isolates (n = 31) were colistin-resistant. Several ARGs were also detected in A. baumannii isolates. Univariate analysis indicated that risk factors and the carriage of ARGs were significantly associated P ≤ (0.05) with gender, invasive devices, immunodeficiency, systemic diseases, tumors, and covid-19. Logistic regression analysis indicated seven risk factors, and three protective factors were associated with the ARGs (armA, strA, and strB) P ≤ (0.05). In contrast, tetB and TEM were associated with 2 risk factors each P ≤ (0.05). CONCLUSION Our study indicates a high prevalence of MDR A. baumannii infections in ICU patients, as well as describing the case of colistin-resistant A. baumannii for the first time in Jordan. Additionally, the risk factors associated with ARGs-producing A. baumannii infections among ICU patients suggest a rapid emergence and spread of MDR A. baumannii without adequate surveillance and control measures.
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Affiliation(s)
- Mohammad H Gharaibeh
- Department of Basic Veterinary Medical Science, Faculty of Veterinary Medicine, Jordan University of Science and Technology, P. O. Box 3030, Irbid 22110, Jordan.
| | - Yaman M Abandeh
- Department of Basic Veterinary Medical Science, Faculty of Veterinary Medicine, Jordan University of Science and Technology, P. O. Box 3030, Irbid 22110, Jordan
| | - Ziad A Elnasser
- Department of Pathology and Microbiology, Faculty of Medicine, Jordan University of Science and Technology, P.O. Box 3030, Irbid 22110, Jordan
| | - Shawkat Q Lafi
- Department of Pathology and Public Health, Faculty of Veterinary Medicine, Jordan University of Science and Technology, P. O. Box 3030, Irbid 22110, Jordan
| | - Haneen M Obeidat
- Department of Medical Laboratory Sciences, Faculty of Applied Medical Sciences, Jordan University of Science and Technology, P.O. Box 3030, Irbid 22110, Jordan
| | - Malak A Khanfar
- Department of Biotechnology and Genetic Engineering, Faculty of Science and Arts, Jordan University of Science and Technology, P. O. Box 3030, Irbid 22110, Jordan
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Thomsen J, Abdulrazzaq NM, AlRand H. Epidemiology and antimicrobial resistance trends of Acinetobacter species in the United Arab Emirates: a retrospective analysis of 12 years of national AMR surveillance data. Front Public Health 2024; 11:1245131. [PMID: 38239785 PMCID: PMC10794577 DOI: 10.3389/fpubh.2023.1245131] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2023] [Accepted: 11/22/2023] [Indexed: 01/22/2024] Open
Abstract
Introduction Acinetobacter spp., in particular A. baumannii, are opportunistic pathogens linked to nosocomial pneumonia (particularly ventilator-associated pneumonia), central-line catheter-associated blood stream infections, meningitis, urinary tract infections, surgical-site infections, and other types of wound infections. A. baumannii is able to acquire or upregulate various resistance determinants, making it frequently multidrug-resistant, and contributing to increased mortality and morbidity. Data on the epidemiology, levels, and trends of antimicrobial resistance of Acinetobacter spp. in clinical settings is scarce in the Gulf Cooperation Council (GCC) and Middle East and North Africa (MENA) regions. Methods A retrospective 12-year analysis of 17,564 non-duplicate diagnostic Acinetobacter spp. isolates from the United Arab Emirates (UAE) was conducted. Data was generated at 317 surveillance sites by routine patient care during 2010-2021, collected by trained personnel and reported by participating surveillance sites to the UAE National AMR Surveillance program. Data analysis was conducted with WHONET. Results Species belonging to the A. calcoaceticus-baumannii complex were mostly reported (86.7%). They were most commonly isolated from urine (32.9%), sputum (29.0%), and soft tissue (25.1%). Resistance trends to antibiotics from different classes during the surveillance period showed a decreasing trend. Specifically, there was a significant decrease in resistance to imipenem, meropenem, and amikacin. Resistance was lowest among Acinetobacter species to both colistin and tigecycline. The percentages of multidrug-resistant (MDR) and possibly extensively drug-resistant (XDR) isolates was reduced by almost half between the beginning of the study in 2010 and its culmination in 2021. Carbapenem-resistant Acinetobacter spp. (CRAB) was associated with a higher mortality (RR: 5.7), a higher admission to ICU (RR 3.3), and an increased length of stay (LOS; 13 excess inpatient days per CRAB case), as compared to Carbapenem-susceptible Acinetobacter spp. Conclusion Carbapenem-resistant Acinetobacter spp. are associated with poorer clinical outcomes, and higher associated costs, as compared to carbapenem-susceptible Acinetobacter spp. A decreasing trend of MDR Acinetobacter spp., as well as resistance to all antibiotic classes under surveillance was observed during 2010 to 2021. Further studies are needed to explore the reasons and underlying factors leading to this remarkable decrease of resistance over time.
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Affiliation(s)
- Jens Thomsen
- Abu Dhabi Public Health Center, Abu Dhabi, United Arab Emirates
- Department of Pathology and Infectious Diseases, Khalifa University, Abu Dhabi, United Arab Emirates
| | | | - Hussain AlRand
- Public Health Sector, Ministry of Health and Prevention, Dubai, United Arab Emirates
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Kipsang F, Munyiva J, Menza N, Musyoki A. Carbapenem-resistant Acinetobacter baumannii infections: Antimicrobial resistance patterns and risk factors for acquisition in a Kenyan intensive care unit. IJID REGIONS 2023; 9:111-116. [PMID: 38020185 PMCID: PMC10652105 DOI: 10.1016/j.ijregi.2023.10.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/28/2023] [Revised: 10/17/2023] [Accepted: 10/20/2023] [Indexed: 12/01/2023]
Abstract
Objectives Multidrug-resistant (MDR) Acinetobacter baumannii (AB), especially carbapenem-resistant (CR) strains, presents a significant challenge in intensive care units (ICUs) but surveillance data in many resource-constrained countries is inadequate. Here, we determined the prevalence of MDRAB and risk factors for infection and mortality in ICU-admitted patients. Methods A cross-sectional study among 132 consecutive patients between July 2019 and July 2020, with infected patients followed for 30 days from sample collection to ICU discharge/death. Blood, urine, and tracheal aspirate samples were processed following the standard bacteriological procedures. Isolate identity and antimicrobial susceptibility were elucidated by VITEK 2 Compact system. Results The prevalence of MDRAB was 22.7% (30/132), mostly from urine samples (12.1%, 16/132), and dominated by CRAB (83.3%) that were colistin-nonresistant and exhibited high multiple antibiotic resistance indices, ranging from 0.64-0.91. Risk factors for infection were occupation (adjusted odds ratio = 4.41, P = 0.016) and interhospital referral status (adjusted odds ratio = 0.14, P = 0.001). ICU mortality was 20% (6/30). Conclusion Our findings underpin the need for strict adherence to and evaluation of infection prevention and control, and continuous surveillance of CRAB in ICU, especially among the risk groups, in the current study setting and beyond.
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Affiliation(s)
- Fred Kipsang
- Department of Biomedical Sciences, Kabarak University, P.O. Private Bag 20157, Nakuru, Kenya
| | - Jeniffer Munyiva
- Department of Laboratory Medicine, Kenyatta National Hospital, P.O. Box 20723-00202, Nairobi, Kenya
| | - Nelson Menza
- Department of Medical Laboratory Sciences, Kenyatta University, P.O. BOX 43844-00100, Nairobi, Kenya
| | - Abednego Musyoki
- Department of Medical Laboratory Sciences, Kenyatta University, P.O. BOX 43844-00100, Nairobi, Kenya
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Itani R, Khojah HMJ, Karout S, Rahme D, Hammoud L, Awad R, Abu-Farha R, Mukattash TL, Raychouni H, El-Lakany A. Acinetobacter baumannii: assessing susceptibility patterns, management practices, and mortality predictors in a tertiary teaching hospital in Lebanon. Antimicrob Resist Infect Control 2023; 12:136. [PMID: 38031181 PMCID: PMC10685635 DOI: 10.1186/s13756-023-01343-8] [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: 06/28/2023] [Accepted: 11/22/2023] [Indexed: 12/01/2023] Open
Abstract
BACKGROUND Acinetobacter baumannii is a major nosocomial pathogen capable of causing life-threatening infections. This bacterium is highly resistant to antibiotics and associated with high mortality rates. Therefore, this study aimed to evaluate A. baumannii's susceptibility patterns to antimicrobials, assess the appropriateness of the initiated antimicrobial therapy, determine the mortality rate, and identify predictors associated with mortality. METHODS A retrospective observational study was conducted among patients infected with A. baumannii at a university hospital in Lebanon through the revision of medical records. Kaplan-Meier survival analysis and log-rank tests were used to analyze time-to-mortality. Binary logistic regression was performed to identify predictors of mortality. RESULTS The records of 188 patients were screened, and 111 patients with A. baumannii infection were enrolled. Almost all isolates were resistant to carbapenem, and 43% of the isolates were extensively-drug resistant. Almost half of the patients received initial inappropriate antimicrobial therapy (n = 50, 45.1%). The 30-day mortality rate associated with A. baumannii infection was 71.2% (79/111). The time to mortality in patients who received inappropriate antimicrobial therapy (5.70 ± 1.07 days) was significantly shorter than in those who received appropriate antimicrobial therapy (12.43 ± 1.01 days, P < 0.01). Binary logistic regression revealed that inappropriate antimicrobial therapy (adjusted odds ratio [AOR] = 16.22, 95% CI 2.68-9.97, P = 0.002), mechanical ventilation (AOR = 14.72, 95% CI 3.27-6.61, P < 0.001), and thrombocytopenia (AOR = 8.82, 95% CI 1.12-9.75, P = 0.003) were more likely associated with mortality. CONCLUSIONS A. baumannii exhibits an alarming mortality rate among infected patients. Thrombocytopenia, mechanical ventilation, and inappropriate antibiotic administration are associated with mortality in patients infected with A. baumannii. The prompt initiation of appropriate antimicrobial therapy, infection control measures, and effective stewardship program are crucial to reduce the incidence of A. baumannii and improve the treatment outcomes.
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Affiliation(s)
- Rania Itani
- Pharmacy Practice Department, Faculty of Pharmacy, Beirut Arab University, Riad El Solh, 1107 2809, P.O. Box: 11-5020, Beirut, Lebanon
| | - Hani M J Khojah
- Department of Pharmacy Practice, College of Pharmacy, Taibah University, P.O. Box: 30051, 41477, Madinah, Kingdom of Saudi Arabia
| | - Samar Karout
- Pharmacy Practice Department, Faculty of Pharmacy, Beirut Arab University, Riad El Solh, 1107 2809, P.O. Box: 11-5020, Beirut, Lebanon.
| | - Deema Rahme
- Pharmacy Practice Department, Faculty of Pharmacy, Beirut Arab University, Riad El Solh, 1107 2809, P.O. Box: 11-5020, Beirut, Lebanon
- INSPECT-LB (Institut National de Santé Publique, d'Épidémiologie Clinique et de Toxicologie-Liban), Beirut, Lebanon
| | - Lara Hammoud
- Pharmacy Department, Hammoud Hospital University Medical Center, Sidon, Lebanon
| | - Reem Awad
- Pharmacy Practice Department, Faculty of Pharmacy, Beirut Arab University, Riad El Solh, 1107 2809, P.O. Box: 11-5020, Beirut, Lebanon
| | - Rana Abu-Farha
- Department of Clinical Pharmacy and Therapeutics, Faculty of Pharmacy, Applied Science Private University, P.O. Box: 11931, Amman, Jordan
| | - Tareq L Mukattash
- Department of Clinical Pharmacy, Faculty of Pharmacy, Jordan University of Science and Technology, P.O. Box: 3030, Irbid, 22110, Jordan
| | - Hamza Raychouni
- Intensive Care Unit, Central Military Hospital, Military Healthcare, Lebanese Army, Beirut, Lebanon
- Intensive Care Unit, American University of Beirut Medical Center, Beirut, Lebanon
| | - Abdalla El-Lakany
- Department of Pharmaceutical Sciences, Faculty of Pharmacy, Beirut Arab University, Riad El Solh, 1107 2809, P.O. Box: 11-5020, Beirut, Lebanon
- Department of Pharmacognosy, Faculty of Pharmacy, Alexandria University, Alexandria, Egypt
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Shahbazi S, Shivaee A, Nasiri M, Mirshekar M, Sabzi S, Sariani OK. Zinc oxide nanoparticles impact the expression of the genes involved in toxin-antitoxin systems in multidrug-resistant Acinetobacter baumannii. J Basic Microbiol 2023; 63:1007-1015. [PMID: 36086811 DOI: 10.1002/jobm.202200382] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2022] [Revised: 08/20/2022] [Accepted: 08/25/2022] [Indexed: 11/09/2022]
Abstract
The aim of this study was to investigate the effect of zinc oxide nanoparticles (ZnO-NPs) on the expression of genes involved in toxin-antitoxin (TA) systems in multidrug-resistant (MDR) Acinetobacter baumannii. Seventy clinical isolates of A. baumannii were collected from variuos clinical samples. Antimicrobial susceptibility test was determined by disk diffusion. Type II TA system-related genes including GNAT, XRE-like, hipA, hipB, hicA, hicB were screened using polymerase chain reaction (PCR). ZnO-NPs prepared and characterized by field emission scanning electron microscopy and X-ray diffraction. MIC of ZnO-NPs of A. baumannii isolates was performed using the microdilution method. The expression of type II TA systems-related genes were assessed with and without exposure to ZnO-NPs using real-time PCR. The highest rate of resistance and sensitivity was observed against cefepime (77.14%), and ampicillin/sulbactam (42.85%), respectively. All A. baumannii isolates were considered as MDR. In this study, three TA loci were identified for A. baumannii including GNAT/XRE-like, HicA/HicB, and HipA/HipB and their prevalence was 100%, 42%, and 27.1%, respectively. There was no significant relationship between the prevalence of these systems and the origin of A. baumannii. Our data showed significant correlations between the presence of HicA/HicB system and resistance to ceftazidime, meropenem, imipenem, and cefepime (p < 0.05), and the presence of HipA/HipB system and resistance to ceftazidime, meropenem, imipenem, and cefepime (p < 0.05). In presence of ZnO-NPs, the expression of all studied genes decreased. GNAT and hicB showed the highest and lowest expression changes by 2.4 folds (p < 0.001) and 1.3 folds (p < 0.05), respectively. This study demonstrates the promising potential of nanoparticles to impact the expression of the genes involved in TA Systems. So, the application of ZnO-NPs may be helpful to design target-based strategies towards MDRs pathogens for empowered clinical applications by microbiologists and nanotechnologists.
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Affiliation(s)
- Shahla Shahbazi
- Department of Molecular Biology, Pasteur Institute of Iran, Tehran, Iran
| | - Ali Shivaee
- Department of Microbiology, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Marzieh Nasiri
- Department of Genetics, College of Sciences, Kazerun Branch, Islamic Azad University, Kazerun, Iran
| | - Maryam Mirshekar
- Department of Microbiology, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Samira Sabzi
- Department of Molecular Biology, Pasteur Institute of Iran, Tehran, Iran
- Department of Bacteriology, Pasteur Institute of Iran, Tehran, Iran
| | - Omid K Sariani
- Department of Genetics, College of Sciences, Kazerun Branch, Islamic Azad University, Kazerun, Iran
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Saleh NM, Saad SI, El-Sayed M, El-Sayyad GS, Abo Safe FA. Contribution of different mechanisms to aminoglycoside resistance in clinical isolates of Acinetobacter baumannii. Microb Pathog 2023; 182:106255. [PMID: 37481006 DOI: 10.1016/j.micpath.2023.106255] [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: 05/08/2023] [Revised: 06/23/2023] [Accepted: 07/13/2023] [Indexed: 07/24/2023]
Abstract
The antibiotics overuse for infection treatment was the sparkle in the spreading of multi-drug resistance Acinetobacter baumannii in hospitals. In our study, we evaluated the contribution of the aminoglycoside resistance mechanisms of A. baumannii to the resistance surge in some selected Egyptian hospitals with a checkerboard assay application to retrieve the aminoglycoside activity. The resistance profile analysis of collected 200 A. baumannii isolates revealed a multidrug-resistant pattern with limited susceptibilities to aminoglycosides. Analysis of the prevalence of aminoglycoside-modifying enzyme (AMEs) genes revealed the presence of the six AMEs genes either singly or in combination in selected isolates and aph (3)-VIa gene was the predominant one. At the same time, four efflux pump genes of AdeABC and AdeKJL family showed significant (P < 0.001) up-regulation levels. Moreover, the implementation of combination strategy showed fourteen synergistic activities against two high-level aminoglycoside-resistance (HLAR) A. baumannii isolates. The findings highlighted the alarming levels of aminoglycoside resistance in A. baumannii isolates, which proved that a common enzymatic modification mechanism acts synergistically with decreased antibiotic accumulation in acquiring aminoglycoside resistance. Additionally, the study provides useful information for the promising synergistic combination therapy that reduces the therapeutic dose of aminoglycosides used and subsequently increases their clinical application.
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Affiliation(s)
- Neveen M Saleh
- Microbiology Department, Egyptian Drug Authority (EDA) (former National Organization for Drug Control and Research, NODCAR), 14281, Giza, Egypt.
| | - Sarah I Saad
- Botany Department, Faculty of Women for Arts, Science and Education, Ain Shams University, Cairo, Egypt
| | - Mohamed El-Sayed
- Microbiology Department, Egyptian Drug Authority (EDA) (former National Organization for Biological Control and Research, NODCAR), Giza, Egypt
| | - Gharieb S El-Sayyad
- Microbiology and Immunology Department, Faculty of Pharmacy, Ahram Canadian University (ACU), 6th of October city, Giza, Egypt; Department of Microbiology and Immunology, Faculty of Pharmacy, Galala University, New Galala city, Suez, Egypt; Drug Microbiology Lab, Drug Radiation Research Department, National Center for Radiation Research and Technology (NCRRT), Egyptian Atomic Energy Authority (EAEA), Cairo, Egypt.
| | - Feriala A Abo Safe
- Botany Department, Faculty of Women for Arts, Science and Education, Ain Shams University, Cairo, Egypt
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Zhang S, Mi P, Wang J, Li P, Luo K, Liu S, Al-Shamiri MM, Lei J, Lai S, Han B, Chen Y, Han L, Han S. The optimized carbapenem inactivation method for objective and accurate detection of carbapenemase-producing Acinetobacter baumannii. Front Microbiol 2023; 14:1185450. [PMID: 37520356 PMCID: PMC10372451 DOI: 10.3389/fmicb.2023.1185450] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Accepted: 06/27/2023] [Indexed: 08/01/2023] Open
Abstract
The modified carbapenem inactivation method (mCIM) recommended by the Clinical and Laboratory Standards Institute is not applicable for detecting carbapenemases in Acinetobacter baumannii. Four currently reported phenotypic detection methods, namely, the modified Hodge test, the mCIM, the adjusted mCIM, and the simplified carbapenem inactivation method (sCIM), did not perform well in our 90 clinical A. baumannii isolates. Thus, the minimal inhibitory concentrations (MICs) of carbapenems and the existence and expression of carbapenemase-encoding genes were detected to explain the results. According to the E-test, which was more accurate than the VITEK 2 system, 80.0 and 41.1% were resistant to imipenem (IPM) and meropenem (MEM), respectively, and 14.4 and 53.3% exhibited intermediate resistance, respectively. Five β-lactamase genes were found, of which blaOXA-51-like, blaTEM, and blaOXA-23-like were detected more frequently in 85 non-susceptible strains. The expression of blaOXA-23-like was positively correlated with the MIC values of IPM and MEM. Therefore, an improved approach based on the mCIM, designated the optimized CIM (oCIM), was developed in this study to detect carbapenemases more accurately and reproducibly. The condition was improved by evaluating the factors of A. baumannii inoculum, incubation broth volume, and MEM disk incubation time. Obvious high sensitivity (92.94%) and specificity (100.00%) were obtained using the oCIM, which was cost-effective and reproducible in routine laboratory work.
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Affiliation(s)
- Sirui Zhang
- Department of Microbiology and Immunology, School of Basic Medical Sciences, Xi’an Jiaotong University Health Science Center, Xi’an, China
| | - Peng Mi
- Department of Microbiology and Immunology, School of Basic Medical Sciences, Xi’an Jiaotong University Health Science Center, Xi’an, China
- Department of Laboratory Medicine, Shaanxi Provincial People’s Hospital, Xi’an, China
| | - Jingdan Wang
- School of Public Health, Xi’an Jiaotong University Health Science Center, Xi’an, China
| | - Pu Li
- School of Public Health, Xi’an Jiaotong University Health Science Center, Xi’an, China
| | - Kai Luo
- Department of Microbiology and Immunology, School of Basic Medical Sciences, Xi’an Jiaotong University Health Science Center, Xi’an, China
| | - Shuyan Liu
- Department of Microbiology and Immunology, School of Basic Medical Sciences, Xi’an Jiaotong University Health Science Center, Xi’an, China
| | - Mona Mohamed Al-Shamiri
- Department of Microbiology and Immunology, School of Basic Medical Sciences, Xi’an Jiaotong University Health Science Center, Xi’an, China
| | - Jin’e Lei
- Department of Laboratory Medicine, The First Affiliated Hospital of Xi’an Jiaotong University, Xi’an, China
| | - Simin Lai
- Department of Microbiology and Immunology, School of Basic Medical Sciences, Xi’an Jiaotong University Health Science Center, Xi’an, China
| | - Bei Han
- School of Public Health, Xi’an Jiaotong University Health Science Center, Xi’an, China
| | - Yanjiong Chen
- Department of Microbiology and Immunology, School of Basic Medical Sciences, Xi’an Jiaotong University Health Science Center, Xi’an, China
| | - Lei Han
- Department of Microbiology and Immunology, School of Basic Medical Sciences, Xi’an Jiaotong University Health Science Center, Xi’an, China
| | - Shaoshan Han
- Department of Hepatobiliary Surgery, The First Affiliated Hospital of Xi’an Jiaotong University, Xi'an, China
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Ameer NAA, Dhahi MAR. Alterations in gene expression of recA and umuDC in antibiotic-resistant Acinetobacter baumannii. J Med Life 2023; 16:531-539. [PMID: 37305826 PMCID: PMC10251391 DOI: 10.25122/jml-2022-0358] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2022] [Accepted: 03/01/2023] [Indexed: 06/13/2023] Open
Abstract
Acinetobacter baumannii is a critical pathogen with an efficient SOS (Save Our Ship) system that plays a significant role in antibiotic resistance. This prospective descriptive study aimed to investigate the association between expression levels of recA and umuDC genes, which are critical in SOS pathways, and antibiotic resistance in A. baumannii. We analyzed 78 clinical isolates and 31 ecological isolates using the Vitek-2 system for bacterial identification and antibiotic susceptibility testing and confirmed molecular identification of A. baumannii by conventional PCR of blaOXA-51 and blaOXA-23. Quantitative real-time polymerase chain reaction was used to determine gene expression levels of recA and umuDC. The results showed that in 25 clinical strains, 14/25 strains showed upregulation of recA, 7/25 strains exhibited upregulation of both umuDC and recA, and 1/25 strains showed upregulation of umuDC. Of these, 16/25 clinical strains were extensively resistant to antibiotics, except for colistin, and showed upregulation of recA and/or umuDC gene expression levels. In 6 ecological strains, recA showed upregulation in 3/6 strains, while both recA and umuDC were upregulated in 1/6 strain. In conclusion, high expression levels of recA and/or umuDC genes in A. baumannii complex and A. baumannii strains may contribute to increasing resistance to a wide range of antibiotics and may result in the initiation of an extensively drug-resistant (XDR) phenotype.
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Agyepong N, Fordjour F, Owusu-Ofori A. Multidrug-resistant Acinetobacter baumannii in healthcare settings in Africa. FRONTIERS IN TROPICAL DISEASES 2023. [DOI: 10.3389/fitd.2023.1110125] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/04/2023] Open
Abstract
The emergence of multidrug-resistant Acinetobacter baumannii is a major concern to healthcare providers and facilities in many parts of the world. This bacterial pathogen is commonly implicated in hospital-acquired infections, particularly in critically ill patients admitted to the intensive care unit (ICU). The extensive use of antibiotics, particularly in ICUs, and the lack of proper infection control interventions in many hospitals have led to an increased emergence of multidrug-resistant A. baumannii. Infections due to multidrug-resistant A. baumannii are associated with prolonged hospital stays and high morbidity and mortality, particularly among hospitalized ICU patients. The lack of antibiotic stewardship programmes in many healthcare facilities has exacerbated the burden of A. baumannii infections in many parts of Africa. This review discusses the prevalence and antibiotic-resistance pattern of the multidrug-resistant A. baumannii, and the possible ways to address or minimise its emergence in healthcare settings in Africa.
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Occurrence of Multidrug-Resistant Strains of Acinetobacter spp.: An Emerging Threat for Nosocomial-Borne Infection in Najran Region, KSA. Trop Med Infect Dis 2023; 8:tropicalmed8020108. [PMID: 36828524 PMCID: PMC9963463 DOI: 10.3390/tropicalmed8020108] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2022] [Revised: 02/04/2023] [Accepted: 02/07/2023] [Indexed: 02/12/2023] Open
Abstract
Multidrug-resistant strains are frequent causes of nosocomial infections. The majority of nosocomial infections, particularly in critical care units (ICU), have been linked to A. baumannii, which has major clinical significance. The current paper attempts to identify the potential risk and prognosis factors for acquiring an infection due to A. baumannii compared to that of other nosocomial bacteria. In our study, we employed antibiotics generally prescribed for the initial course of treatment such as colistin, meropenem, amikacin, trimethoprime-sulfamethoxazole, levofloxacin, gentamicin, ciprofloxacin, and piperacillin-tazobactam. We found that the isolated A. baumannii were resistant at a high rate to meropenem, piperacillin-tazobactam, amikacin, levofloxacin, and ciprofloxacin, while they were partially susceptible to trimethoprim-sulfamethoxazole. Our study revealed that A. baumannii was most susceptible to gentamicin and colistin at 85.8% and 92.9%, respectively, whereas the combination of colistin and trimethoprim/sulfamethoxazole was 100% active. The patients were the primary source of infection with A. baumannii, followed by inanimate objects present in the ICU and hospital premises, and then the hospital staff who were taking care of the ICU patients. Gentamicin and colistin were the most sensitive antibiotics; of the 13 tested in total, the rate of drug resistance was above 50%. The very high rate of antibiotic resistance is alarming.
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Naderi G, Talebi M, Gheybizadeh R, Seifi A, Ghourchian S, Rahbar M, Abdollahi A, Naseri A, Eslami P, Douraghi M. Mobile genetic elements carrying aminoglycoside resistance genes in Acinetobacter baumannii isolates belonging to global clone 2. Front Microbiol 2023; 14:1172861. [PMID: 37213517 PMCID: PMC10196456 DOI: 10.3389/fmicb.2023.1172861] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2023] [Accepted: 04/12/2023] [Indexed: 05/23/2023] Open
Abstract
Aminoglycosides are used to treat infections caused by carbapenem-resistant Acinetobacter baumannii (CRAB) strains. However, resistance to aminoglycosides has increased remarkably in the last few years. Here, we aimed to determine the mobile genetic elements (MGEs) associated with resistance to aminoglycosides in the global clone 2 (GC2) A. baumannii. Among the 315 A. baumannii isolates, 97 isolates were identified as GC2, and 52 of GC2 isolates (53.6%) were resistant to all the aminoglycosides tested. The AbGRI3s carrying armA were detected in 88 GC2 isolates (90.7%), and of them, 17 isolates (19.3%) carried a new variant of AbGRI3 (AbGRI3ABI221). aphA6 was located in TnaphA6 of 30 isolates out of 55 aphA6-harboring isolates, and 20 isolates were found to harbor TnaphA6 on a RepAci6 plasmid. Tn6020 carrying aphA1b was detected in 51 isolates (52.5%), which was located within AbGRI2 resistance islands. The pRAY* carrying the aadB gene was detected in 43 isolates (44.3%), and no isolate was found to contain a class 1 integron harboring this gene. The GC2 A. baumannii isolates contained at least one MGE carrying the aminoglycoside resistance gene, located mostly either in the chromosome within AbGRIs or on the plasmids. Thus, it is likely that these MGEs play a role in the dissemination of aminoglycoside resistance genes in GC2 isolates from Iran.
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Affiliation(s)
- Ghazal Naderi
- Division of Microbiology, Department of Pathobiology, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Malihe Talebi
- Department of Microbiology, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
- Malihe Talebi
| | - Roghayeh Gheybizadeh
- Division of Microbiology, Department of Pathobiology, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Arash Seifi
- Department of Infectious Diseases, Faculty of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Sedigheh Ghourchian
- Division of Microbiology, Department of Pathobiology, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Mohammad Rahbar
- Department of Microbiology, Iranian Reference Health Laboratory Research Center, Ministry of Health and Medical Education, Tehran, Iran
| | - Alireza Abdollahi
- Department of Pathology, Imam Hospital Complex, Tehran University of Medical SciencesTehran, Iran
| | - Abdolhossein Naseri
- Department of Laboratory Sciences, School of Paramedical Sciences, Iran University of Medical Sciences, Tehran, Iran
| | - Parisa Eslami
- Department of Microbiology, Milad Hospital, Tehran, Iran
| | - Masoumeh Douraghi
- Division of Microbiology, Department of Pathobiology, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
- *Correspondence: Masoumeh Douraghi
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