1887

Abstract

Purpose. Acinetobacter baumannii is a major cause of multidrug-resistant nosocomial infections. The characteristics of A. baumannii at two hospitals in a city in Central Brazil are described by analysing the phenotypes and molecular profiles of isolates recovered from 87 patients.

Methodology. The isolates were identified and their antimicrobial susceptibility was evaluated using the the Bact/Alert 3D and Vitek2 methods. Patients’ clinical data were obtained from medical files. Genes associated with resistance to carbapenems were analysed by multilocus sequence typing, clinical and bacteriological variables were analysed by descriptive statistics, and logistic models were generated to adjust the associations.

Results. Sixty-four (73.5 %) out of 87 A. baumannii isolates analysed were from patients in intensive care. The mortality rate was 43.7 %. Eighty (91.9 %) isolates were resistant to imipenem and 86 were susceptible to colistin (98.8 %). The blaOXA-23 gene (78.2 %) and its upstream insertion ISAba1 (55.2 %) were predominant, followed by blaOXA-24 (55.2 %) and blaOXA-143 (28.7 %). The blaOXA-23 gene and ISAba1 were independently associated with resistance to imipenem (P<0.05). There were 13 different sequence types (STs) among the 35 isolates. ST1 (nine; 25.7 %), ST162 (eight; 22.8 %) and ST730 (six; 17.1 %) were the most common, and four new STs were identified. The isolates were grouped into five clonal complexes (CC1, CC15, CC79, CC108 and CC162) plus a singleton using eburst.

Conclusion. Respiratory infection, age >60 years and use of noradrenaline were factors associated with fatality. ST730 (CC79) was associated with higher mortality (P<0.05) and ST162 (CC162) was associated with increased survival probability (P<0.05).

Loading

Article metrics loading...

/content/journal/jmm/10.1099/jmm.0.000853
2018-12-05
2020-01-28
Loading full text...

Full text loading...

/deliver/fulltext/jmm/68/1/31.html?itemId=/content/journal/jmm/10.1099/jmm.0.000853&mimeType=html&fmt=ahah

References

  1. Siegel JD, Rhinehart E, Jackson M, Chiarello L.the Healthcare Infection Control Practices Advisory Advisory Committee Management of multidrug-resistant in healthcare settings, 2006. www.cdc.gov/infectioncontrol/guidelines/mdro/ (Last update February 15, 2017)
  2. Busani S, Serafini G, Mantovani E, Venturelli C, Giannella M et al. Mortality in patients with septic shock by multidrug resistant bacteria. J Intensive Care Med 2017;088506661668816 [CrossRef][PubMed]
    [Google Scholar]
  3. Wałaszek M, Kosiarska A, Gniadek A, Kołpa M, Wolak Z et al. The risk factors for hospital-acquired pneumonia in the Intensive Care Unit. Przegl Epidemiol 2016;70:15–20[PubMed]
    [Google Scholar]
  4. Bou G, Martínez-Beltrán J. Cloning, nucleotide sequencing, and analysis of the gene encoding an AmpC beta-lactamase in Acinetobacter baumannii. Antimicrob Agents Chemother 2000;44:428–432 [CrossRef][PubMed]
    [Google Scholar]
  5. Poirel L, Nordmann P. Carbapenem resistance in Acinetobacter baumannii: mechanisms and epidemiology. Clin Microbiol Infect 2006;12:826–836 [CrossRef][PubMed]
    [Google Scholar]
  6. Lob SH, Hoban DJ, Sahm DF, Badal RE. Regional differences and trends in antimicrobial susceptibility of Acinetobacter baumannii. Int J Antimicrob Agents 2016;47:317–323 [CrossRef][PubMed]
    [Google Scholar]
  7. European Centre for Disease Prevention and Control Surveillance of antimicrobial resistance in Europe 2016. Annual Report of the European Antimicrobial Resistance Surveillance Network (EARS-Net) Stockholm: ECDC; 2017
    [Google Scholar]
  8. Gales AC, Castanheira M, Jones RN, Sader HS. Antimicrobial resistance among Gram-negative bacilli isolated from Latin America: results from SENTRY Antimicrobial Surveillance Program (Latin America, 2008-2010). Diagn Microbiol Infect Dis 2012;73:354–360 [CrossRef][PubMed]
    [Google Scholar]
  9. Higgins PG, Lehmann M, Seifert H. Inclusion of OXA-143 primers in a multiplex polymerase chain reaction (PCR) for genes encoding prevalent OXA carbapenemases in Acinetobacter spp. Int J Antimicrob Agents 2010;35:305 [CrossRef][PubMed]
    [Google Scholar]
  10. Higgins PG, Pérez-Llarena FJ, Zander E, Fernández A, Bou G et al. OXA-235, a novel class D β-lactamase involved in resistance to carbapenems in Acinetobacter baumannii. Antimicrob Agents Chemother 2013;57:2121–2126 [CrossRef][PubMed]
    [Google Scholar]
  11. Turton JF, Ward ME, Woodford N, Kaufmann ME, Pike R et al. The role of ISAba1 in expression of OXA carbapenemase genes in Acinetobacter baumannii. FEMS Microbiol Lett 2006;258:72–77 [CrossRef][PubMed]
    [Google Scholar]
  12. Viana GF, Zago MC, Moreira RR, Zarpellon MN, Menegucci TC et al. ISAba1/blaOXA-23: A serious obstacle to controlling the spread and treatment of Acinetobacter baumannii strains. Am J Infect Control 2016;44:593–595 [CrossRef][PubMed]
    [Google Scholar]
  13. Figueiredo S, Poirel L, Croize J, Recule C, Nordmann P. In vivo selection of reduced susceptibility to carbapenems in Acinetobacter baumannii related to ISAba1-mediated overexpression of the natural bla(OXA-66) oxacillinase gene. Antimicrob Agents Chemother 2009;53:2657–2659 [CrossRef][PubMed]
    [Google Scholar]
  14. Rodríguez CH, Balderrama Yarhui N, Nastro M, Nuñez Quezada T, Castro Cañarte G et al. Molecular epidemiology of carbapenem-resistant Acinetobacter baumannii in South America. J Med Microbiol 2016;65:1088–1091 [CrossRef][PubMed]
    [Google Scholar]
  15. Carvalho KR, Carvalho-Assef AP, Peirano G, Santos LC, Pereira MJ et al. Dissemination of multidrug-resistant Acinetobacter baumannii genotypes carrying bla(OXA-23) collected from hospitals in Rio de Janeiro, Brazil. Int J Antimicrob Agents 2009;34:25–28 [CrossRef][PubMed]
    [Google Scholar]
  16. Chagas TP, Carvalho KR, de Oliveira Santos IC, Carvalho-Assef AP, 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;79:468–472 [CrossRef][PubMed]
    [Google Scholar]
  17. Janssen P, Maquelin K, Coopman R, Tjernberg I, Bouvet P et al. Discrimination of Acinetobacter genomic species by AFLP fingerprinting. Int J Syst Bacteriol 1997;47:1179–1187 [CrossRef][PubMed]
    [Google Scholar]
  18. Diancourt L, Passet V, Nemec A, Dijkshoorn L, Brisse S. The population structure of Acinetobacter baumannii: expanding multiresistant clones from an ancestral susceptible genetic pool. PLoS One 2010;5:e10034 [CrossRef][PubMed]
    [Google Scholar]
  19. Vasconcelos AT, Barth AL, Zavascki AP, Gales AC, Levin AS et al. The changing epidemiology of Acinetobacter spp. producing OXA carbapenemases causing bloodstream infections in Brazil: a BrasNet report. Diagn Microbiol Infect Dis 2015;83:382–385 [CrossRef][PubMed]
    [Google Scholar]
  20. Cardoso JP, Cayô R, Girardello R, Gales AC. Diversity of mechanisms conferring resistance to β-lactams among OXA-23-producing Acinetobacter baumannii clones. Diagn Microbiol Infect Dis 2016;85:90–97 [CrossRef][PubMed]
    [Google Scholar]
  21. Clinical & Laboratory Standards Institute Performance Standards for Antimicrobial Susceptibility Testing, 27th informational supplement M100. Wayne, PA: Clinical and Laboratory Standards Institute; 2017; pp.46–48
    [Google Scholar]
  22. Sambrook J, Fritsch EF, Maniatis T. Molecular Cloning: A Laboratory Manual, 2nd ed. NY: Cold Spring Harbor Laboratory Press, Cold Spring Harbor,NY; 1989
    [Google Scholar]
  23. Turton JF, Woodford N, Glover J, Yarde S, Kaufmann ME et al. Identification of Acinetobacter baumannii by detection of the blaOXA-51-like carbapenemase gene intrinsic to this species. J Clin Microbiol 2006;44:2974–2976 [CrossRef][PubMed]
    [Google Scholar]
  24. Hou C, Yang F. Drug-resistant gene of blaOXA-23, blaOXA-24, blaOXA-51 and blaOXA-58 in Acinetobacter baumannii. Int J Clin Exp Med 2015;15:13859–13863
    [Google Scholar]
  25. Segal H, Garny S, Elisha BG. Is IS(ABA-1) customized for Acinetobacter?. FEMS Microbiol Lett 2005;243:425–429 [CrossRef][PubMed]
    [Google Scholar]
  26. Principe L, Piazza A, Giani T, Bracco S, Caltagirone MS et al. Epidemic diffusion of OXA-23-producing Acinetobacter baumannii isolates in Italy: results of the first cross-sectional countrywide survey. J Clin Microbiol 2014;52:3004–3010 [CrossRef][PubMed]
    [Google Scholar]
  27. Obeidat N, Jawdat F, Al-Bakri AG, Shehabi AA. Major biologic characteristics of Acinetobacter baumannii isolates from hospital environmental and patients' respiratory tract sources. Am J Infect Control 2014;42:401–404 [CrossRef][PubMed]
    [Google Scholar]
  28. Alcántar-Curiel MD, García-Torres LF, González-Chávez MI, Morfín-Otero R, Gayosso-Vázquez C et al. Molecular mechanisms associated with nosocomial carbapenem-resistant Acinetobacter baumannii in Mexico. Arch Med Res 2014;45:553–560 [CrossRef][PubMed]
    [Google Scholar]
  29. Mugnier PD, Poirel L, Naas T, Nordmann P. Worldwide dissemination of the blaOXA-23 carbapenemase gene of Acinetobacter baumannii. Emerg Infect Dis 2010;16:35–40 [CrossRef][PubMed]
    [Google Scholar]
  30. Ahmed SS, Alp E, Ulu-Kilic A, Dinc G, Aktas Z et al. Spread of carbapenem-resistant international clones of Acinetobacter baumannii in Turkey and Azerbaijan: a collaborative study. Eur J Clin Microbiol Infect Dis 2016;35:1463–1468 [CrossRef][PubMed]
    [Google Scholar]
  31. Dalla-Costa LM, Coelho JM, Souza HA, Castro ME, Stier CJ et al. Outbreak of carbapenem-resistant Acinetobacter baumannii producing the OXA-23 enzyme in Curitiba, Brazil. J Clin Microbiol 2003;41:3403–3406 [CrossRef][PubMed]
    [Google Scholar]
  32. Camargo CH, Tiba MR, Saes MR, Vasconcellos FM, Santos LF et al. Population structure analysis of carbapenem-resistant Acinetobacter baumannii clinical isolates from Brazil reveals predominance of clonal complexes 1, 15, and 79. Antimicrob Agents Chemother 2016;60:2545–2547 [CrossRef][PubMed]
    [Google Scholar]
  33. Ladavac R, Bedenić B, Vranić-Ladavac M, Barišić N, Karčić N et al. Emergence of different Acinetobacter baumannii clones in a Croatian hospital and correlation with antibiotic susceptibility. J Glob Antimicrob Resist 2017;10:213–218 [CrossRef][PubMed]
    [Google Scholar]
  34. Zarrilli R, Casillo R, di Popolo A, Tripodi MF, Bagattini M et al. Molecular epidemiology of a clonal outbreak of multidrug-resistant Acinetobacter baumannii in a university hospital in Italy. Clin Microbiol Infect 2007;13:481–489 [CrossRef][PubMed]
    [Google Scholar]
  35. Antonio CS, Neves PR, Medeiros M, Mamizuka EM, Elmor de Araújo MR et al. High prevalence of carbapenem-resistant Acinetobacter baumannii carrying the blaOXA-143 gene in Brazilian hospitals. Antimicrob Agents Chemother 2011;55:1322–1323 [CrossRef][PubMed]
    [Google Scholar]
  36. de Sá Cavalcanti FL, Almeida AC, Vilela MA, de Morais Junior MA, de Morais MM et al. Emergence of extensively drug-resistant OXA-72-producing Acinetobacter baumannii in Recife, Brazil: risk of clonal dissemination?. Diagn Microbiol Infect Dis 2013;77:250–251 [CrossRef][PubMed]
    [Google Scholar]
  37. Pagano M, Rocha L, Sampaio JL, Martins AF, Barth AL. Emergence of OXA-72-producing Acinetobacter baumannii belonging to high-risk clones (CC15 and CC79) in different Brazilian States. Infect Control Hosp Epidemiol 2017;38:252–254 [CrossRef][PubMed]
    [Google Scholar]
  38. Zander E, Bonnin RA, Seifert H, Higgins PG. Characterization of blaOXA-143 variants in Acinetobacter baumannii and Acinetobacter pittii. Antimicrob Agents Chemother 2014;58:2704–2708 [CrossRef][PubMed]
    [Google Scholar]
  39. Malathi K, Anbarasu A, Ramaiah S. Exploring the resistance mechanism of imipenem in carbapenem hydrolysing class D beta-lactamases OXA-143 and its variant OXA-231 (D224A) expressing Acinetobacter baumannii: An in-silico approach. Comput Biol Chem 2017;67:1–8 [CrossRef][PubMed]
    [Google Scholar]
  40. Neves FC, Clemente WT, Lincopan N, Paião ID, Neves PR et al. Clinical and microbiological characteristics of OXA-23- and OXA-143-producing Acinetobacter baumannii in ICU patients at a teaching hospital, Brazil. Braz J Infect Dis 2016;20:556–563 [CrossRef][PubMed]
    [Google Scholar]
  41. Mostachio AK, Levin AS, Rizek C, Rossi F, Zerbini J et al. High prevalence of OXA-143 and alteration of outer membrane proteins in carbapenem-resistant Acinetobacter spp. isolates in Brazil. Int J Antimicrob Agents 2012;39:396–401 [CrossRef][PubMed]
    [Google Scholar]
  42. Werneck JS, Picão RC, Girardello R, Cayô R, Marguti V et al. Low prevalence of blaOXA-143 in private hospitals in Brazil. Antimicrob Agents Chemother 2011;55:4494–4495 [CrossRef][PubMed]
    [Google Scholar]
  43. 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 [CrossRef][PubMed]
    [Google Scholar]
  44. Vranić-Ladavac M, Bedenić B, Minandri F, Ištok M, Bošnjak Z et al. Carbapenem resistance and acquired class D beta-lactamases in Acinetobacter baumannii from Croatia 2009-2010. Eur J Clin Microbiol Infect Dis 2014;33:471–478 [CrossRef][PubMed]
    [Google Scholar]
  45. Wallace L, Daugherty SC, Nagaraj S, Johnson JK, Harris AD et al. Use of Comparative Genomics To Characterize the Diversity of Acinetobacter baumannii Surveillance Isolates in a Health Care Institution. Antimicrob Agents Chemother 2016;60:5933–5941 [CrossRef][PubMed]
    [Google Scholar]
  46. Wu W, He Y, Lu J, Lu Y, Wu J et al. Transition of blaOXA-58-like to blaOXA-23-like in Acinetobacter baumannii clinical isolates in southern China: an 8-year study. PLoS One 2015;10:e0137174 [CrossRef][PubMed]
    [Google Scholar]
  47. Fernández Cuenca F, Sánchez MC, Caballero-Moyano FJ, Vila J, Martínez-Martínez L et al. Prevalence and analysis of microbiological factors associated with phenotypic heterogeneous resistance to carbapenems in Acinetobacter baumannii. Int J Antimicrob Agents 2012;39:472–477 [CrossRef][PubMed]
    [Google Scholar]
  48. Ikonomidis A, Neou E, Gogou V, Vrioni G, Tsakris A et al. Heteroresistance to meropenem in carbapenem-susceptible Acinetobacter baumannii. J Clin Microbiol 2009;47:4055–4059 [CrossRef][PubMed]
    [Google Scholar]
  49. Ribeiro PC, Monteiro AS, Marques SG, Monteiro SG, Monteiro-Neto V et al. Phenotypic and molecular detection of the blaKPC gene in clinical isolates from inpatients at hospitals in São Luis, MA, Brazil. BMC Infect Dis 2016;16:737 [CrossRef][PubMed]
    [Google Scholar]
  50. Robledo IE, Aquino EE, Vázquez GJ. Detection of the KPC gene in Escherichia coli, Klebsiella pneumoniae, Pseudomonas aeruginosa, and Acinetobacter baumannii during a PCR-based nosocomial surveillance study in Puerto Rico. Antimicrob Agents Chemother 2011;55:2968–2970 [CrossRef][PubMed]
    [Google Scholar]
  51. Leungtongkam U, Thummeepak R, Wongprachan S, Thongsuk P, Kitti T et al. Dissemination of blaOXA-23, blaOXA-24, blaOXA-58, and blaNDM-1 Genes of Acinetobacter baumannii Isolates from Four Tertiary Hospitals in Thailand. Microb Drug Resist 2018;24:55–62 [CrossRef][PubMed]
    [Google Scholar]
  52. Ou HY, Kuang SN, He X, Molgora BM, Ewing PJ et al. Complete genome sequence of hypervirulent and outbreak-associated Acinetobacter baumannii strain LAC-4: epidemiology, resistance genetic determinants and potential virulence factors. Sci Rep 2015;5:8646
    [Google Scholar]
  53. Harris G, Kuo Lee R, Lam CK, Kanzaki G, Patel GB et al. A mouse model of Acinetobacter baumannii-associated pneumonia using a clinically isolated hypervirulent strain. Antimicrob Agents Chemother 2013;57:3601–3613 [CrossRef][PubMed]
    [Google Scholar]
  54. Garnacho-Montero J, Gutiérrez-Pizarraya A, Díaz-Martín A, Cisneros-Herreros JM, Cano ME et al. Acinetobacter baumannii in critically ill patients: molecular epidemiology, clinical features and predictors of mortality. Enferm Infecc Microbiol Clin 2016;34:551–558 [CrossRef][PubMed]
    [Google Scholar]
  55. Lee Y, Bae IK, Kim J, Jeong SH, Lee K. Dissemination of ceftazidime-resistant Acinetobacter baumannii clonal complex 92 in Korea. J Appl Microbiol 2012;112:1207–1211 [CrossRef][PubMed]
    [Google Scholar]
http://instance.metastore.ingenta.com/content/journal/jmm/10.1099/jmm.0.000853
Loading
/content/journal/jmm/10.1099/jmm.0.000853
Loading

Data & Media loading...

Supplements

Supplementary File 1

PDF
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