1887

Abstract

. Colonization by carbapenem-resistant (CRAB) causes therapeutic and economic problems for critically ill patients.

. The analysis of CRAB in China was limited to certain regions.

. To investigate the antibiotic susceptibility, molecular characterization and clonal relationship among CRAB isolates from multiple hospitals of eastern China.

. Isolates from 29 tertiary hospitals from September 2015 to September 2018 were recovered. All strains were analysed using antimicrobial susceptibility testing to detect their tolerance. PCR was also used to detect multiple β-lactamase genes. After multilocus sequence typing (MLST) of seven house-keeping genes. eBURST was used to assess clonal complexes and explore evolutionary relationships.

. All isolates showed resistance to carbapenems, while remaining susceptible to colistin and tigecycline. All isolates were detected with gene by PCR, and 80.1 % harboured the gene. The prevalence of bla gene was remarkably increased from 50.7 % in 2015 to 90.5 % in 2018. Other genes such as , , , , , and were also obtained. While , , and were not found in these strains. MLST showed all isolates could be divided into 26 known sequence types (STs) and ten novel STs and 47.2 % isolates belong to ST195 and ST208. eBURST revealed clonal complex 92 as the major clonal complex (98.4 %), which includes 88.5 % (23/26) of known STs and 80 % (8/10) of unknown STs. Phylogenetic analysis also found that almost all CRAB isolates could cluster into one lineage, suggesting an epidemic of this CRAB lineage. This indicated severe nosocomial infections of CRAB in multiple hospitals of eastern China.

. An outbreak of ST195 and ST208 CRAB-resistant clones with gene might be happening in multiple hospitals in eastern China.

Funding
This study was supported by the:
  • Provincial Health Services Authority (Award No.AHWJ2021b096)
    • Principle Award Recipient: yingye
  • Innovative Research Group Project of the National Natural Science Foundation of China (Award No. 81373072)
    • Principle Award Recipient: yingye
  • This is an open-access article distributed under the terms of the Creative Commons Attribution License.
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2023-02-09
2024-05-01
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References

  1. Dijkshoorn L, Nemec A, Seifert H. An increasing threat in hospitals: multidrug-resistant Acinetobacter baumannii. Nat Rev Microbiol 2007; 5:939–951 [View Article] [PubMed]
    [Google Scholar]
  2. Peleg AY, Seifert H, Paterson DL. Acinetobacter baumannii: emergence of a successful pathogen. Clin Microbiol Rev 2008; 21:538–582 [View Article] [PubMed]
    [Google Scholar]
  3. Papp-Wallace KM, Endimiani A, Taracila MA, Bonomo RA. Carbapenems: past, present, and future. Antimicrob Agents Chemother 2011; 55:4943–4960 [View Article] [PubMed]
    [Google Scholar]
  4. Ayobami O, Willrich N, Harder T, Okeke IN, Eckmanns T et al. The incidence and prevalence of hospital-acquired (carbapenem-resistant) Acinetobacter baumannii in Europe, Eastern Mediterranean and Africa: a systematic review and meta-analysis. Emerg Microbes Infect 2019; 8:1747–1759 [View Article] [PubMed]
    [Google Scholar]
  5. Gales AC, Seifert H, Gur D, Castanheira M, Jones RN et al. Antimicrobial susceptibility of Acinetobacter calcoaceticus-Acinetobacter baumannii complex and Stenotrophomonas maltophilia clinical isolates: results from the SENTRY antimicrobial surveillance program (1997-2016). Open Forum Infect Dis 2019; 6:S34–S46 [View Article]
    [Google Scholar]
  6. Tacconelli E, Carrara E, Savoldi A, Harbarth S, Mendelson M et al. Discovery, research, and development of new antibiotics: the WHO priority list of antibiotic-resistant bacteria and tuberculosis. Lancet Infect Dis 2018; 18:318–327 [View Article] [PubMed]
    [Google Scholar]
  7. Kyriakidis I, Vasileiou E, Pana ZD, Tragiannidis A. Acinetobacter baumannii antibiotic resistance mechanisms. Pathogens 2021; 10:373 [View Article]
    [Google Scholar]
  8. Bush K, Jacoby GA, Medeiros AA. A functional classification scheme for beta-lactamases and its correlation with molecular structure. Antimicrob Agents Chemother 1995; 39:1211–1233 [View Article]
    [Google Scholar]
  9. Tooke CL, Hinchliffe P, Bragginton EC, Colenso CK, Hirvonen VHA et al. β-Lactamases and β-Lactamase inhibitors in the 21st century. J Mol Biol 2019; 431:3472–3500 [View Article]
    [Google Scholar]
  10. Potron A, Poirel L, Nordmann P. Emerging broad-spectrum resistance in Pseudomonas aeruginosa and Acinetobacter baumannii: mechanisms and epidemiology. Int J Antimicrob Agents 2015; 45:568–585 [View Article]
    [Google Scholar]
  11. Karah N, Sundsfjord A, Towner K, Samuelsen Ø. Insights into the global molecular epidemiology of carbapenem non-susceptible clones of Acinetobacter baumannii. Drug Resist Updat 2012; 15:237–247 [View Article] [PubMed]
    [Google Scholar]
  12. Ruan Z, Chen Y, Jiang Y, Zhou H, Zhou Z et al. Wide distribution of CC92 carbapenem-resistant and OXA-23-producing Acinetobacter baumannii in multiple provinces of China. Int J Antimicrob Agents 2013; 42:322–328 [View Article] [PubMed]
    [Google Scholar]
  13. Chen Y, Gao J, Zhang H, Ying C. Spread of the blaOXA–23-containing Tn2008 in carbapenem-resistant Acinetobacter baumannii isolates grouped in CC92 from China. Front Microbiol 2017; 8: [View Article]
    [Google Scholar]
  14. Hwang SM, Cho HW, Kim TY, Park JS, Jung J et al. Whole-genome sequencing for investigating a health care-associated outbreak of carbapenem-resistant Acinetobacter baumannii. Diagnostics 2021; 11:201 [View Article]
    [Google Scholar]
  15. Makke G, Bitar I, Salloum T, Panossian B, Alousi S et al. Whole-genome-sequence-based characterization of extensively drug-resistant Acinetobacter baumannii hospital outbreak. mSphere 2020; 5:e00934-19 [View Article]
    [Google Scholar]
  16. Lee MJ, Jang SJ, Li XM, Park G, Kook J-K et al. Comparison of rpoB gene sequencing, 16S rRNA gene sequencing, gyrB multiplex PCR, and the VITEK2 system for identification of Acinetobacter clinical isolates. Diagn Microbiol Infect Dis 2014; 78:29–34 [View Article]
    [Google Scholar]
  17. 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 [View Article] [PubMed]
    [Google Scholar]
  18. Clinical and Laboratory Standards Institute (CLSI) Performance Standards for Antimicrobial Susceptibility Testing Wayne, PA: 2021
    [Google Scholar]
  19. Ku YH, Yu WL. Cefoperazone/sulbactam: new composites against multiresistant gram negative bacteria?. Infect Genet Evol 2021; 88:104707 [View Article]
    [Google Scholar]
  20. Jones RN, Barry AL, Packer RR, Gregory WW, Thornsberry C. In vitro antimicrobial spectrum, occurrence of synergy, and recommendations for dilution susceptibility testing concentrations of the cefoperazone-sulbactam combination. J Clin Microbiol 1987; 25:1725–1729 [View Article]
    [Google Scholar]
  21. Yang Q, Xu Y, Jia P, Zhu Y, Zhang J et al. In vitro activity of sulbactam/durlobactam against clinical isolates of Acinetobacter baumannii collected in China. J Antimicrob Chemother 2020; 75:1833–1839 [View Article]
    [Google Scholar]
  22. Sader HS, Castanheira M, Farrell DJ, Flamm RK, Mendes RE et al. Tigecycline antimicrobial activity tested against clinical bacteria from Latin American medical centres: results from SENTRY Antimicrobial Surveillance Program (2011-2014). Int J Antimicrob Agents 2016; 48:144–150 [View Article] [PubMed]
    [Google Scholar]
  23. Liu J-W, Ko W-C, Huang C-H, Liao C-H, Lu C-T et al. Agreement assessment of tigecycline susceptibilities determined by the disk diffusion and broth microdilution methods among commonly encountered resistant bacterial isolates: results from the Tigecycline In Vitro Surveillance in Taiwan (TIST) study, 2008 to 2010. Antimicrob Agents Chemother 2012; 56:1414–1417 [View Article]
    [Google Scholar]
  24. Poirel L, Walsh TR, Cuvillier V, Nordmann P. Multiplex PCR for detection of acquired carbapenemase genes. Diagn Microbiol Infect Dis 2011; 70:119–123 [View Article]
    [Google Scholar]
  25. Woodford N, Ellington MJ, Coelho JM, Turton JF, Ward ME et al. Multiplex PCR for genes encoding prevalent OXA carbapenemases in Acinetobacter spp. Int J Antimicrob Agents 2006; 27:351–353 [View Article] [PubMed]
    [Google Scholar]
  26. Chu YW, Afzal-Shah M, Houang ET, Palepou MI, Lyon DJ et al. IMP-4, a novel metallo-beta-lactamase from nosocomial Acinetobacter spp. collected in Hong Kong between 1994 and 1998. Antimicrob Agents Chemother 2001; 45:710–714 [View Article]
    [Google Scholar]
  27. Lee K, Yum JH, Yong D, Lee HM, Kim HD et al. Novel acquired metallo-beta-lactamase gene, bla(SIM-1), in a class 1 integron from Acinetobacter baumannii clinical isolates from Korea. Antimicrob Agents Chemother 2005; 49:4485–4491 [View Article]
    [Google Scholar]
  28. Rezaee MA, Pajand O, Nahaei MR, Mahdian R, Aghazadeh M et al. Prevalence of Ambler class A β-lactamases and ampC expression in cephalosporin-resistant isolates of Acinetobacter baumannii. Diagn Microbiol Infect Dis 2013; 76:330–334 [View Article]
    [Google Scholar]
  29. Bonnin RA, Nordmann P, Poirel L. Screening and deciphering antibiotic resistance in Acinetobacter baumannii: a state of the art. Expert Rev Anti Infect Ther 2013; 11:571–583 [View Article]
    [Google Scholar]
  30. Gaiarsa S, Batisti Biffignandi G, Esposito EP, Castelli M, Jolley KA et al. Comparative analysis of the two Acinetobacter baumannii Multilocus Sequence Typing (MLST) schemes. Front Microbiol 2019; 10:930 [View Article]
    [Google Scholar]
  31. Feil EJ, Li BC, Aanensen DM, Hanage WP, Spratt BG. eBURST: inferring patterns of evolutionary descent among clusters of related bacterial genotypes from multilocus sequence typing data. J Bacteriol 2004; 186:1518–1530 [View Article] [PubMed]
    [Google Scholar]
  32. Katoh K, Standley DM. MAFFT multiple sequence alignment software version 7: improvements in performance and usability. Mol Biol Evol 2013; 30:772–780 [View Article]
    [Google Scholar]
  33. Nguyen L-T, Schmidt HA, von Haeseler A, Minh BQ. IQ-TREE: a fast and effective stochastic algorithm for estimating maximum-likelihood phylogenies. Mol Biol Evol 2015; 32:268–274 [View Article]
    [Google Scholar]
  34. Letunic I, Bork P. Interactive tree of life (iTOL) v3: an online tool for the display and annotation of phylogenetic and other trees. Nucleic Acids Res 2016; 44:W242–5 [View Article]
    [Google Scholar]
  35. Zhen X, Lundborg CS, Sun X, Hu X, Dong H. The clinical and economic impact of antibiotic resistance in China: a systematic review and meta-analysis. Antibiotics 2019; 8:115 [View Article]
    [Google Scholar]
  36. Zhen X, Chen Y, Hu X, Dong P, Gu S et al. The difference in medical costs between carbapenem-resistant Acinetobacter baumannii and non-resistant groups: a case study from a hospital in Zhejiang province, China. Eur J Clin Microbiol Infect Dis 2017; 36:1989–1994 [View Article]
    [Google Scholar]
  37. Zhen X, Stålsby Lundborg C, Sun X, Gu S, Dong H. Clinical and economic burden of carbapenem-resistant infection or colonization caused by Klebsiella pneumoniae, Pseudomonas aeruginosa, Acinetobacter baumannii: a multicenter study in China. Antibiotics 2020; 9:514 [View Article]
    [Google Scholar]
  38. Opazo-Capurro A, San Martín I, Quezada-Aguiluz M, Morales-León F, Domínguez-Yévenes M et al. Evolutionary dynamics of carbapenem-resistant Acinetobacter baumannii circulating in Chilean hospitals. Infect Genet Evol 2019; 73:93–97 [View Article]
    [Google Scholar]
  39. Vázquez-López R, Solano-Gálvez SG, Juárez Vignon-Whaley JJ, Abello Vaamonde JA, Padró Alonzo LA et al. Acinetobacter baumannii resistance: a real challenge for clinicians. Antibiotics 2020; 9:205 [View Article]
    [Google Scholar]
  40. Luna CM, Aruj PK. Nosocomial Acinetobacter pneumonia. Respirology 2007; 12:787–791 [View Article]
    [Google Scholar]
  41. Almasaudi SB. Acinetobacter spp. as nosocomial pathogens: epidemiology and resistance features. Saudi J Biol Sci 2018; 25:586–596 [View Article]
    [Google Scholar]
  42. Mavroidi A, Likousi S, Palla E, Katsiari M, Roussou Z et al. Molecular identification of tigecycline- and colistin-resistant carbapenemase-producing Acinetobacter baumannii from a Greek hospital from 2011 to 2013. J Med Microbiol 2015; 64:993–997 [View Article]
    [Google Scholar]
  43. Zowawi HM, Sartor AL, Sidjabat HE, Balkhy HH, Walsh TR et al. Molecular epidemiology of carbapenem-resistant Acinetobacter baumannii isolates in the Gulf Cooperation Council States: dominance of OXA-23-type producers. J Clin Microbiol 2015; 53:896–903 [View Article]
    [Google Scholar]
  44. Bou G, Oliver A, Martínez-Beltrán J. OXA-24, a novel class D beta-lactamase with carbapenemase activity in an Acinetobacter baumannii clinical strain. Antimicrob Agents Chemother 2000; 44:1556–1561 [View Article]
    [Google Scholar]
  45. Di Popolo A, Giannouli M, Triassi M, Brisse S, Zarrilli R. Molecular epidemiological investigation of multidrug-resistant Acinetobacter baumannii strains in four Mediterranean countries with a multilocus sequence typing scheme. Clin Microbiol Infect 2011; 17:197–201 [View Article]
    [Google Scholar]
  46. Bonnin RA, Nordmann P, Poirel L. Screening and deciphering antibiotic resistance in Acinetobacter baumannii: a state of the art. Expert Rev Anti Infect Ther 2013; 11:571–583 [View Article]
    [Google Scholar]
  47. Krizova L, Poirel L, Nordmann P, Nemec A. TEM-1 β-lactamase as a source of resistance to sulbactam in clinical strains of Acinetobacter baumannii. J Antimicrob Chemother 2013; 68:2786–2791 [View Article]
    [Google Scholar]
  48. Hamidian M, Nigro SJ. Emergence, molecular mechanisms and global spread of carbapenem-resistant Acinetobacter baumannii. Microb Genom 2019; 5:e00 [View Article]
    [Google Scholar]
  49. Ruan Z, Chen Y, Jiang Y, Zhou H, Zhou Z et al. Wide distribution of CC92 carbapenem-resistant and OXA-23-producing Acinetobacter baumannii in multiple provinces of China. Int J Antimicrob Agents 2013; 42:322–328 [View Article] [PubMed]
    [Google Scholar]
  50. Zarrilli R, Bagattini M, Migliaccio A, Esposito EP, Triassi M. Molecular epidemiology of carbapenem-resistant Acinetobacter baumannii in Italy. Ann Ig 2021; 33:401–409 [View Article]
    [Google Scholar]
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