Acinetobacter baumannii complex, national laboratory-based surveillance in South Africa, 2017 to 2019

Abstract

Objective We aimed to provide an analysis of A. baumannii complex (ABC) isolated from blood cultures in South Africa. Materials and methods ABC surveillance was conducted from 1 April 2017 to 30 September 2019 at 19 hospital sites from blood cultures of any age and sex. Organism identification was performed using the MALDI-TOF MS and antimicrobial susceptibility testing (AST), MicroScan Walkaway System. We confirmed colistin resistance with Sensititre, FRCOL panel, and selected for whole-genome sequencing. Results During the study period, we identified 4822 cases of ABC, of which 2152 cases were from 19 enhanced surveillance sites were reported during the enhanced surveillance period (1 August 2018 to 30 September 2019). Males accounted for 54% (2611/4822). Of the cases with known age, 41% (1968/4822) were infants (< 1-year-old). Seventy-eight percent (1688/2152) of cases had a known hospital outcome, of which 36% (602/1688) died. HIV status was known for 69% (1168/1688) of cases, and 14% (238/1688) were positive. Eighty-two percent (1389/1688) received antimicrobial treatment in admission. Three percent (35/1389) of cases received single colistin. Four percent (75/2033) were resistant to colistin. At least 75% of the isolates (1530/2033) can be classified as extensively drug-resistant (XDR), with resistance to most antibiotics except for colistin. The majority, 83% (20/24), of the colistin-resistant isolates were of the sequence type (ST) 1. Resistance genes, both plasmid- and chromosomal- mediated were not observed. Although all isolates had, nine efflux pump genes related to antimicrobial resistance. Conclusion Our surveillance data contributed to a better understanding of the natural course of A. baumannii disease, the patient characteristics among infants, and the level of resistance. At least two-thirds of the isolates were extensively drug-resistant, and four percent of isolates were resistant to colistin.

Non-fermenter Gram-negative bacilli at a tertiary hospital, South Africa

“…These findings are similar to the findings in the South African surveillance data of A. baumannii complex bacteraemia in 2017 until 2019 where the majority of the patients were paediatrics. 30 …”

“…These findings are similar to the findings in the South African surveillance data of A. baumannii complex bacteraemia in 2017 until 2019 where the majority of the patients were paediatrics. 30 Pseudomonas species were generally more susceptible to the antimicrobials tested than were Acinetobacter species. The susceptibility to the two commonly used antipseudomonal agents, piperacillin-tazobactam and ceftazidime was 83% and 86%, respectively.…”

Multidrug-Resistant Bacterial Infections Among Very Low Birthweight Infants With Late-Onset Sepsis in Johannesburg, South Africa

“…Several studies have identified risk factors associated with extensively drug-resistant Acinetobacter baumannii infections (XDRABIs) in neonatal units. A. baumannii is a difficult pathogen to eradicate once present in a hospital setting given its ability to form strong biofilms [ 27 ]. Perovic et al reported >4800 cases of A. baumannii from 2017 to 2019, with the majority (60%) of cases from Gauteng province and 41% occurring in infants [ 28 ].…”