1887

Abstract

Carbapenem-resistant is a major health problem worldwide, especially in intensive care units (ICUs). This study aimed to detect the prevalence of colonization of the gastrointestinal tract of patients admitted to the ICU in two hospitals in Saudi Arabia. In addition, it aimed to characterize the molecular mechanisms of carbapenem resistance in these isolates. From January to June 2014, 565 rectal swab specimens were screened for strains and carbapenem resistance using CHROMagar and CHROMagar KPC agar plates, respectively. Organism identification and susceptibility were detected using the Vitek 2 system. A total of 47 spp. were detected, and 35 were resistant to carbapenem, making the prevalence of spp. 8.3 % (47/565) and carbapenem resistance (6.2 %, 35/565). The 47 strains showed remarkable clonal diversity as revealed by PFGE. Using PCR, OXA-51, a chromosomal marker for , was detected in 46 strains. OXA-23 β-lactamase was detected in all 35 carbapenem-resistant . No IMP, VIM, SPM, SIM, GIM, KPC or NDM β-lactamases were detected in these isolates. Thus, OXA-23 was the main mechanism of carbapenem resistance in these isolates. To the best of our knowledge, this is the first study to detect the prevalence of colonization in the digestive tract of ICU patients in Saudi Arabia. This study revealed the importance of having well-established protocols for early identification of these multidrug-resistant organisms, optimizing infection-control strategies and having active surveillance studies to reduce morbidity, mortality and cost.

Loading

Article metrics loading...

/content/journal/jmm/10.1099/jmm.0.000033
2015-04-01
2019-10-18
Loading full text...

Full text loading...

/deliver/fulltext/jmm/64/4/400.html?itemId=/content/journal/jmm/10.1099/jmm.0.000033&mimeType=html&fmt=ahah

References

  1. Abdalhamid B., Hassan H., Itbaileh A., Shorman M.. ( 2014;). Characterization of carbapenem-resistant Acinetobacter baumannii clinical isolates in a tertiary care hospital in Saudi Arabia. . New Microbiol 37:, 65–73.[PubMed]
    [Google Scholar]
  2. Al-Agamy M. H., Khalaf N. G., Tawfick M. M., Shibl A. M., El Kholy A.. ( 2014;). Molecular characterization of carbapenem-insensitive Acinetobacter baumannii in Egypt. . Int J Infect Dis 22:, 49–54. [CrossRef][PubMed]
    [Google Scholar]
  3. Al-Sweih N. A., Al-Hubail M., Rotimi V. O.. ( 2012;). Three distinct clones of carbapenem-resistant Acinetobacter baumannii with high diversity of carbapenemases isolated from patients in two hospitals in Kuwait. . J Infect Public Health 5:, 102–108. [CrossRef][PubMed]
    [Google Scholar]
  4. Alsultan A. A., Aboulmagd E., Evans B. A., Amyes S. G.. ( 2014;). Clonal diversity of Acinetobacter baumannii from diabetic patients in Saudi Arabian hospitals. . J Med Microbiol 63:, 1460–1466. [CrossRef][PubMed]
    [Google Scholar]
  5. Bannerman T. L., Hancock G. A., Tenover F. C., Miller J. M.. ( 1995;). Pulsed-field gel electrophoresis as a replacement for bacteriophage typing of Staphylococcus aureus. . J Clin Microbiol 33:, 551–555.[PubMed]
    [Google Scholar]
  6. Chihara S., Okuzumi K., Yamamoto Y., Oikawa S., Hishinuma A.. ( 2011;). First case of New Delhi metallo-α-lactamase 1-producing Escherichia coli infection in Japan. . Clin Infect Dis 52:, 153–154. [CrossRef][PubMed]
    [Google Scholar]
  7. Corbella X., Pujol M., Ayats J., Sendra M., Ardanuy C., Domínguez M. A., Liñares J., Ariza J., Gudiol F.. ( 1996;). Relevance of digestive tract colonization in the epidemiology of nosocomial infections due to multiresistant Acinetobacter baumannii. . Clin Infect Dis 23:, 329–334. [CrossRef][PubMed]
    [Google Scholar]
  8. Dalla-Costa L. M., Coelho J. M., Souza H. A., Castro M. E., Stier C. J., Bragagnolo K. L., Rea-Neto A., Penteado-Filho S. R., Livermore D. M., Woodford N.. ( 2003;). Outbreak of carbapenem-resistant Acinetobacter baumannii producing the OXA-23 enzyme in Curitiba, Brazil. . J Clin Microbiol 41:, 3403–3406. [CrossRef][PubMed]
    [Google Scholar]
  9. Dijkshoorn L., van Aken E., Shunburne L., van der Reijden T. J., Bernards A. T., Nemec A., Towner K. J.. ( 2005;). Prevalence of Acinetobacter baumannii and other Acinetobacter spp. in faecal samples from non-hospitalised individuals. . Clin Microbiol Infect 11:, 329–332. [CrossRef][PubMed]
    [Google Scholar]
  10. Doi Y., Onuoha E. O., Adams-Haduch J. M., Pakstis D. L., McGaha T. L., Werner C. A., Parker B. N., Brooks M. M., Shutt K. A. et al. ( 2011;). Screening for Acinetobacter baumannii colonization by use of sponges. . J Clin Microbiol 49:, 154–158. [CrossRef][PubMed]
    [Google Scholar]
  11. El-Saed A., Balkhy H. H., Al-Dorzi H. M., Khan R., Rishu A. H., Arabi Y. M.. ( 2013;). Acinetobacter is the most common pathogen associated with late-onset and recurrent ventilator-associated pneumonia in an adult intensive care unit in Saudi Arabia. . Int J Infect Dis 17:, e696–e701. [CrossRef][PubMed]
    [Google Scholar]
  12. Feizabadi M. M., Fathollahzadeh B., Taherikalani M., Rasoolinejad M., Sadeghifard N., Aligholi M., Soroush S., Mohammadi-Yegane S.. ( 2008;). Antimicrobial susceptibility patterns and distribution of blaOXA genes among Acinetobacter spp. isolated from patients at Tehran hospitals. . Jpn J Infect Dis 61:, 274–278.[PubMed]
    [Google Scholar]
  13. Girlich D., Poirel L., Nordmann P.. ( 2013;). Comparison of the SUPERCARBA, CHROMagar KPC, and Brilliance CRE screening media for detection of Enterobacteriaceae with reduced susceptibility to carbapenems. . Diagn Microbiol Infect Dis 75:, 214–217. [CrossRef][PubMed]
    [Google Scholar]
  14. Gordon N. C., Wareham D. W.. ( 2009;). Evaluation of CHROMagar Acinetobacter for detection of enteric carriage of multidrug-resistant Acinetobacter baumannii in samples from critically ill patients. . J Clin Microbiol 47:, 2249–2251. [CrossRef][PubMed]
    [Google Scholar]
  15. Gröbner S., Linke D., Schütz W., Fladerer C., Madlung J., Autenrieth I. B., Witte W., Pfeifer Y.. ( 2009;). Emergence of carbapenem-non-susceptible extended-spectrum β-lactamase-producing Klebsiella pneumoniae isolates at the university hospital of Tübingen, Germany. . J Med Microbiol 58:, 912–922. [CrossRef][PubMed]
    [Google Scholar]
  16. Gur D., Korten V., Unal S., Deshpande L. M., Castanheira M.. ( 2008;). Increasing carbapenem resistance due to the clonal dissemination of oxacillinase (OXA-23 and OXA-58)-producing Acinetobacter baumannii: report from the Turkish SENTRY Program sites. . J Med Microbiol 57:, 1529–1532. [CrossRef][PubMed]
    [Google Scholar]
  17. Huang J., Chen E. Z., Qu H. P., Mao E. Q., Zhu Z. G., Ni Y. X., Han L. Z., Tang Y. Q.. ( 2013;). Sources of multidrug-resistant Acinetobacter baumannii and its role in respiratory tract colonization and nosocomial pneumonia in intensive care unit patients. . Chin Med J (Engl) 126:, 1826–1831.[PubMed]
    [Google Scholar]
  18. Jeon B. C., Jeong S. H., Bae I. K., Kwon S. B., Lee K., Young D., Lee J. H., Song J. S., Lee S. H.. ( 2005;). Investigation of a nosocomial outbreak of imipenem-resistant Acinetobacter baumannii producing the OXA-23 β-lactamase in Korea. . J Clin Microbiol 43:, 2241–2245. [CrossRef][PubMed]
    [Google Scholar]
  19. Jung J. Y., Park M. S., Kim S. E., Park B. H., Son J. Y., Kim E. Y., Lim J. E., Lee S. K., Lee S. H. et al. ( 2010;). Risk factors for multi-drug resistant Acinetobacter baumannii bacteremia in patients with colonization in the intensive care unit. . BMC Infect Dis 10:, 228. [CrossRef][PubMed]
    [Google Scholar]
  20. Khan F. Y., Abukhattab M., Baager K.. ( 2012;). Nosocomial postneurosurgical Acinetobacter baumannii meningitis: a retrospective study of six cases admitted to Hamad General Hospital, Qatar. . J Hosp Infect 80:, 176–179. [CrossRef][PubMed]
    [Google Scholar]
  21. Lopez-Otsoa F., Gallego L., Towner K. J., Tysall L., Woodford N., Livermore D. M.. ( 2002;). Endemic carbapenem resistance associated with OXA-40 carbapenemase among Acinetobacter baumannii isolates from a hospital in northern Spain. . J Clin Microbiol 40:, 4741–4743. [CrossRef][PubMed]
    [Google Scholar]
  22. Mansour W., Poirel L., Bettaieb D., Bouallegue O., Boujaafar N., Nordmann P.. ( 2008;). Dissemination of OXA-23-producing and carbapenem-resistant Acinetobacter baumannii in a University Hospital in Tunisia. . Microb Drug Resist 14:, 289–292. [CrossRef][PubMed]
    [Google Scholar]
  23. Maragakis L. L., Perl T. M.. ( 2008;). Acinetobacter baumannii: epidemiology, antimicrobial resistance, and treatment options. . Clin Infect Dis 46:, 1254–1263. [CrossRef][PubMed]
    [Google Scholar]
  24. Mendes R. E., Kiyota K. A., Monteiro J., Castanheira M., Andrade S. S., Gales A. C., Pignatari A. C., Tufik S.. ( 2007;). Rapid detection and identification of metallo-β-lactamase-encoding genes by multiplex real-time PCR assay and melt curve analysis. . J Clin Microbiol 45:, 544–547. [CrossRef][PubMed]
    [Google Scholar]
  25. Mohajeri P., Farahani A., Feizabadi M. M., Ketabi H., Abiri R., Najafi F.. ( 2013;). Antimicrobial susceptibility profiling and genomic diversity of Acinetobacter baumannii isolates: A study in western Iran. . Iran J Microbiol 5:, 195–202.[PubMed]
    [Google Scholar]
  26. Mugnier P., Poirel L., Pitout M., Nordmann P.. ( 2008;). Carbapenem-resistant and OXA-23-producing Acinetobacter baumannii isolates in the United Arab Emirates. . Clin Microbiol Infect 14:, 879–882. [CrossRef][PubMed]
    [Google Scholar]
  27. Mugnier P. D., Bindayna K. M., Poirel L., Nordmann P.. ( 2009;). Diversity of plasmid-mediated carbapenem-hydrolysing oxacillinases among carbapenem-resistant Acinetobacter baumannii isolates from Kingdom of Bahrain. . J Antimicrob Chemother 63:, 1071–1073. [CrossRef][PubMed]
    [Google Scholar]
  28. Peleg A. Y., Seifert H., Paterson D. L.. ( 2008;). Acinetobacter baumannii: emergence of a successful pathogen. . Clin Microbiol Rev 21:, 538–582. [CrossRef][PubMed]
    [Google Scholar]
  29. Poirel L., Nordmann P.. ( 2006;). Carbapenem resistance in Acinetobacter baumannii: mechanisms and epidemiology. . Clin Microbiol Infect 12:, 826–836. [CrossRef][PubMed]
    [Google Scholar]
  30. Principe L., Piazza A., Giani T., Bracco S., Caltagirone M. S., Arena F., Nucleo E., Tammaro F., Rossolini G. M. et al. ( 2014;). Epidemic diffusion of OXA-23-producing Acinetobacter baumannii isolates in Italy: results of the first cross-sectional countrywide survey. . J Clin Microbiol 52:, 3004–3010. [CrossRef][PubMed]
    [Google Scholar]
  31. Segal H., Garny S., Elisha B. G.. ( 2005;). Is ISABA-1 customized for Acinetobacter?. FEMS Microbiol Lett 243:, 425–429. [CrossRef][PubMed]
    [Google Scholar]
  32. Tian G. B., Adams-Haduch J. M., Bogdanovich T., Pasculle A. W., Quinn J. P., Wang H. N., Doi Y.. ( 2011;). Identification of diverse OXA-40 group carbapenemases, including a novel variant, OXA-160, from Acinetobacter baumannii in Pennsylvania. . Antimicrob Agents Chemother 55:, 429–432. [CrossRef][PubMed]
    [Google Scholar]
  33. Turton J. F., Ward M. E., Woodford N., Kaufmann M. E., Pike R., Livermore D. M., Pitt T. L.. ( 2006;). The role of ISAba1 in expression of OXA carbapenemase genes in Acinetobacter baumannii. . FEMS Microbiol Lett 258:, 72–77. [CrossRef][PubMed]
    [Google Scholar]
  34. Vrioni G., Daniil I., Voulgari E., Ranellou K., Koumaki V., Ghirardi S., Kimouli M., Zambardi G., Tsakris A.. ( 2012;). Comparative evaluation of a prototype chromogenic medium (ChromID CARBA) for detecting carbapenemase-producing Enterobacteriaceae in surveillance rectal swabs. . J Clin Microbiol 50:, 1841–1846. [CrossRef][PubMed]
    [Google Scholar]
  35. Woodford N., Ellington M. J., Coelho J. M., Turton J. F., Ward M. E., Brown S., Amyes S. G., Livermore D. M.. ( 2006;). Multiplex PCR for genes encoding prevalent OXA carbapenemases in Acinetobacter spp. . Int J Antimicrob Agents 27:, 351–353. [CrossRef][PubMed]
    [Google Scholar]
http://instance.metastore.ingenta.com/content/journal/jmm/10.1099/jmm.0.000033
Loading
/content/journal/jmm/10.1099/jmm.0.000033
Loading

Data & Media loading...

This is a required field
Please enter a valid email address
Approval was a Success
Invalid data
An Error Occurred
Approval was partially successful, following selected items could not be processed due to error