1887

Abstract

Infections associated with represent an increasing threat in healthcare settings. Therefore, we investigated the epidemiological relationship between clinical isolates of obtained from patients in a university hospital in Bandar Abbas in southern Iran.

Sixty-four consecutive non-duplicate clinical isolates collected during 2014–2015 were subjected to susceptibility testing, clonal relationship analysis using PFGE, multilocus variable-number tandem-repeat analysis (MLVA) and multilocus sequence typing (MLST), and examined for the presence of carbapenemases and integrons.

Almost all isolates were extensively drug-resistant (XDR; 98 %) and carried an OXA carbapenemase gene ( -like; 98 %) and class 1 integrons (48 %). PFGE and MLST analysis identified three major genotypes, all belonging to clonal complex 92 (CC92): sequence type 848 (ST848) (=23), ST451 (=16) and ST195 (=8). CC92 has previously been documented in the hospital setting in northern Iran, and ST195 has been reported in Arab States of the Persian Gulf. These data suggest national and global transmission of CC92.

This report demonstrates the occurrence and potential spread of closely related XDR genotypes of CC92 within a university hospital in southern Iran. These genotypes were found in the majority of the investigated isolates, showed high prevalence of and integron class 1, and were associated with stay in the intensive care unit. Very few treatment options remain for healthcare-adapted XDR , and hence effective measures are desperately needed to reduce the spread of these strains and resultant infections in the healthcare setting.

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2017-11-01
2024-03-28
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References

  1. Wong D, Nielsen TB, Bonomo RA, Pantapalangkoor P, Luna B et al. Clinical and pathophysiological overview of acinetobacter infections: a century of challenges. Clin Microbiol Rev 2017; 30:409–447 [View Article][PubMed]
    [Google Scholar]
  2. Karah N, Dwibedi CK, Sjöström K, Edquist P, Johansson A et al. Novel aminoglycoside resistance transposons and transposon-derived circular forms detected in carbapenem-resistant Acinetobacter baumannii clinical isolates. Antimicrob Agents Chemother 2016; 60:1801–1818 [View Article][PubMed]
    [Google Scholar]
  3. Lemos EV, de La Hoz FP, Einarson TR, McGhan WF, Quevedo E et al. Carbapenem resistance and mortality in patients with Acinetobacter baumannii infection: systematic review and meta-analysis. Clin Microbiol Infect 2014; 20:416–423 [View Article][PubMed]
    [Google Scholar]
  4. Hsu LY, Apisarnthanarak A, Khan E, Suwantarat N, Ghafur A et al. Carbapenem-resistant Acinetobacter baumannii and Enterobacteriaceae in South and Southeast Asia. Clin Microbiol Rev 2017; 30:1–22 [View Article][PubMed]
    [Google Scholar]
  5. WHO 2017; WHO publishes list of bacteria for which new antibiotics are urgently needed. Available from www.who.int/mediacentre/news/releases/2017/bacteria-antibiotics-needed/en/
  6. Huang LY, Chen TL, Lu PL, Tsai CA, Cho WL et al. Dissemination of multidrug-resistant, class 1 integron-carrying Acinetobacter baumannii isolates in Taiwan. Clin Microbiol Infect 2008; 14:1010–1019 [View Article][PubMed]
    [Google Scholar]
  7. 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; 5:8643 [View Article][PubMed]
    [Google Scholar]
  8. Sirichot S, Diraphat P, Utrarachkij F, Tribuddharat C, Siripanichgon K. Dissemination of class I integron in Acinetobacter baumliannii isolated from ventilator-associated pneumonia patients and their environment. Southeast Asian J Trop Med Public Health 2009; 40:1284–1292[PubMed]
    [Google Scholar]
  9. Wang H, Guo P, Sun H, Wang H, Yang Q et al. Molecular epidemiology of clinical isolates of carbapenem-resistant Acinetobacter spp. from Chinese hospitals. Antimicrob Agents Chemother 2007; 51:4022–4028 [View Article][PubMed]
    [Google Scholar]
  10. Scaife W, Young HK, Paton RH, Amyes SG. Transferable imipenem-resistance in Acinetobacter species from a clinical source. J Antimicrob Chemother 1995; 36:585–586 [View Article][PubMed]
    [Google Scholar]
  11. Evans BA, Amyes SG. OXA beta-lactamases. Clinical microbiology reviews 2014; 27:241–263 [Crossref]
    [Google Scholar]
  12. Tomaschek F, Higgins PG, Stefanik D, Wisplinghoff H, Seifert H. Head-to-head comparison of two multi-locus sequence typing (MLST) schemes for characterization of Acinetobacter baumannii outbreak and sporadic isolates. PLoS One 2016; 11:e0153014 [View Article][PubMed]
    [Google Scholar]
  13. Pourcel C, Minandri F, Hauck Y, D'Arezzo S, Imperi F et al. Identification of variable-number tandem-repeat (VNTR) sequences in Acinetobacter baumannii and interlaboratory validation of an optimized multiple-locus VNTR analysis typing scheme. J Clin Microbiol 2011; 49:539–548 [View Article][PubMed]
    [Google Scholar]
  14. Hojabri Z, Pajand O, Bonura C, Aleo A, Giammanco A et al. Molecular epidemiology of Acinetobacter baumannii in Iran: endemic and epidemic spread of multiresistant isolates. J Antimicrob Chemother 2014; 69:2383–2387 [View Article][PubMed]
    [Google Scholar]
  15. 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 [View Article][PubMed]
    [Google Scholar]
  16. Farshadzadeh Z, Hashemi FB, Rahimi S, Pourakbari B, Esmaeili D et al. Wide distribution of carbapenem resistant Acinetobacter baumannii in burns patients in Iran. Front Microbiol 2015; 6:1146 [View Article]
    [Google Scholar]
  17. Higgins PG, Dammhayn C, Hackel M, Seifert H. Global spread of carbapenem-resistant Acinetobacter baumannii . J Antimicrob Chemother 2010; 65:233–238 [View Article][PubMed]
    [Google Scholar]
  18. Woodford N, Turton JF, Livermore DM. Multiresistant Gram-negative bacteria: the role of high-risk clones in the dissemination of antibiotic resistance. FEMS Microbiol Rev 2011; 35:736–755 [View Article][PubMed]
    [Google Scholar]
  19. Mencacci A, Monari C, Leli C, Merlini L, de Carolis E et al. Typing of nosocomial outbreaks of Acinetobacter baumannii by use of matrix-assisted laser desorption ionization-time of flight mass spectrometry. J Clin Microbiol 2013; 51:603–606 [View Article][PubMed]
    [Google Scholar]
  20. CLSI Performance standards for antimicrobial disk susceptibility tests, 9th ed Approved standard M02-A10. Wayne, PA: CLSI; 2012
    [Google Scholar]
  21. Magiorakos AP, Srinivasan A, Carey RB, Carmeli Y, Falagas ME et al. Multidrug-resistant, extensively drug-resistant and pandrug-resistant bacteria: an international expert proposal for interim standard definitions for acquired resistance. Clin Microbiol Infect 2012; 18:268–281 [View Article][PubMed]
    [Google Scholar]
  22. Dillon B, Thomas L, Mohmand G, Zelynski A, Iredell J. Multiplex PCR for screening of integrons in bacterial lysates. J Microbiol Methods 2005; 62:221–232 [View Article][PubMed]
    [Google Scholar]
  23. 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]
  24. Weniger T, Krawczyk J, Supply P, Niemann S, Harmsen D. MIRU-VNTRplus: a web tool for polyphasic genotyping of Mycobacterium tuberculosis complex bacteria. Nucleic Acids Res 2010; 38:W326–W331 [View Article][PubMed]
    [Google Scholar]
  25. Allix-Béguec C, Harmsen D, Weniger T, Supply P, Niemann S. Evaluation and strategy for use of MIRU-VNTRplus, a multifunctional database for online analysis of genotyping data and phylogenetic identification of Mycobacterium tuberculosis complex isolates. J Clin Microbiol 2008; 46:2692–2699 [View Article][PubMed]
    [Google Scholar]
  26. Seifert H, Dolzani L, Bressan R, van der Reijden T, van Strijen B et al. Standardization and interlaboratory reproducibility assessment of pulsed-field gel electrophoresis-generated fingerprints of Acinetobacter baumannii . J Clin Microbiol 2005; 43:4328–4335 [View Article][PubMed]
    [Google Scholar]
  27. Bartual SG, Seifert H, Hippler C, Luzon MA, Wisplinghoff H et al. Development of a multilocus sequence typing scheme for characterization of clinical isolates of Acinetobacter baumannii . J Clin Microbiol 2005; 43:4382–4390 [View Article][PubMed]
    [Google Scholar]
  28. Farshadzadeh Z, Hashemi FB, Rahimi S, Pourakbari B, Esmaeili D et al. Wide distribution of carbapenem resistant Acinetobacter baumannii in burns patients in Iran. Front Microbiol 2015; 6:1146 [View Article][PubMed]
    [Google Scholar]
  29. Turton JF, Gabriel SN, Valderrey C, Kaufmann ME, Pitt TL. Use of sequence-based typing and multiplex PCR to identify clonal lineages of outbreak strains of Acinetobacter baumannii . Clin Microbiol Infect 2007; 13:807–815 [View Article][PubMed]
    [Google Scholar]
  30. Najar Peerayeh S, Karmostaji A. Molecular identification of resistance determinants, integrons and genetic relatedness of extensively drug resistant Acinetobacter baumannii isolated From hospitals in Tehran, Iran. Jundishapur J Microbiol 2015; 8:e27021 [View Article]
    [Google Scholar]
  31. Turton JF, Kaufmann ME, Gill MJ, Pike R, Scott PT et al. Comparison of Acinetobacter baumannii isolates from the United Kingdom and the United States that were associated with repatriated casualties of the Iraq conflict. J Clin Microbiol 2006; 44:2630–2634 [View Article][PubMed]
    [Google Scholar]
  32. Wisplinghoff H, Hippler C, Bartual SG, Haefs C, Stefanik D et al. Molecular epidemiology of clinical Acinetobacter baumannii and Acinetobacter genomic species 13TU isolates using a multilocus sequencing typing scheme. Clin Microbiol Infect 2008; 14:708–715 [View Article][PubMed]
    [Google Scholar]
  33. 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][PubMed]
    [Google Scholar]
  34. Azimi L, Talebi M, Khodaei F, Najafi M, Lari AR. Comparison of multiple-locus variable-number tandem-repeat analysis with pulsed-field gel electrophoresis typing of carbapenemases producing Acinetobacter baumannii isolated from burn patients. Burns 2016; 42:441–445 [View Article][PubMed]
    [Google Scholar]
  35. Najar Peerayeh S, Karmostaji A. Molecular identification of resistance determinants, integrons and genetic relatedness of extensively drug resistant Acinetobacter baumannii isolated from hospitals in Tehran, Iran. Jundishapur J Microbiol 2015; 8:e27021 [View Article][PubMed]
    [Google Scholar]
  36. Schultz MB, Pham Thanh D, Tran do Hoan N, Wick RR, Ingle DJ et al. Repeated local emergence of carbapenem-resistant Acinetobacter baumannii in a single hospital ward. Microb Genom 2016; 2:e000050 [View Article][PubMed]
    [Google Scholar]
  37. Hauck Y, Soler C, Jault P, Mérens A, Gérome P et al. Diversity of Acinetobacter baumannii in four French military hospitals, as assessed by multiple locus variable number of tandem repeats analysis. PLoS One 2012; 7:e44597 [View Article][PubMed]
    [Google Scholar]
  38. Johnson JK, Robinson GL, Zhao L, Harris AD, Stine OC et al. Comparison of molecular typing methods for the analyses of Acinetobacter baumannii from ICU patients. Diagn Microbiol Infect Dis 2016; 86:345–350 [View Article][PubMed]
    [Google Scholar]
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