Co-infection of ST2IP carbapenem-resistant Acinetobacter baumannii with SARS-CoV-2 in the patients admitted to a Tehran tertiary referral hospital

Abstract

Background Carbapenem-resistant Acinetobacter baumannii (CRAB) is among the most concerning cause of healthcare-associated infections (HAI) due to its high level of antibiotic resistance and high mortality. In the era of the COVID-19 pandemic, the key priority of infection control committees is to contain the dissemination of antibiotic resistant Gram-negative bacteria. Here, we aimed to timely recognize the emergence of CRAB in COVID-19 cases admitted to the wards of a tertiary referral hospital and to identify the genetic relatedness of the isolates. Methods From 30 March to 30 May 2020, a total of 242 clinical samples from COVID-19 cases were screened for CRAB isolates using standard microbiologic and antibiotic susceptibility tests. The PCRs targeting oxa23, oxa24, oxa58, blaTEM and blaNDM-1 genes were performed. Two multiplex PCRs for identifying the global clones (GC) of A. baumannii were also performed. The sequence type of CRABs was determined using Institut Pasteur (IP) multilocus sequence typing (MLST) scheme. Results Eighteen CRAB isolates were recovered from COVID-19 patients with the mean age of 63.94 ± 13.8 years. All but 4 COVID-19 patients co-infected with CRAB were suffering from an underlying disease. Death was recorded as the outcome in ICUs for 9 (50%) COVID-19 patients co-infected with CRAB. The CRAB isolates belong to GC2 and ST2IP and carried the oxa23 carbapenem resistance gene. Conclusion This study demonstrated the co-infection of CRAB isolates and SARS-CoV-2 in the patients admitted to different ICUs at a referral hospital in Tehran. The CRAB isolates were found to belong to ST2IP, share the oxa23 gene and to have caused several outbreaks in the wards admitting COVID-19 patients.

Virulence potential of multidrug-resistant Acinetobacter baumannii isolates from COVID-19 patients on mechanical ventilation: The first report from Serbia

“…Further, data from ICUs indicate an additional increase in prevalence of superinfections of COVID-19 patients with carbapenem-resistant A. baumannii ( Zhang et al, 2020 ). As in previous studies, analyzed carbapenem-resistant A. baumannii isolates recovered from COVID-19 patients belonged to IC2 and harbored acquired bla OXA-23 gene alone or in combination with bla OXA-24 ( Abdollahi et al, 2021 ; Gottesman et al, 2021 ). For the first time, bla OXA-58 gene, as well as IS Aba1 upstream from bla OXA-23 , were detected in A. baumannii isolated from COVID-19 patients.…”

A Comparative Study of <em>Acinetobacter</em> Infections in COVID and Non-COVID Patients

“…All patients above 60 years of age with COVID and Acinetobacter infection, had succumbed. In a study conducted by Abdollahi, et al [19], the mean age of patients was 63.94 ± 13.8 years in COVID patients infected with Carbapenem-Resistant A. Baumannii (CRAB). The mean age was 62.1 years old (ranging from 22 to 98 years) in the Hua Zhou, et al [20] study, 41.2 years in the A. Balkhair [21] study group and in our study the mean age was 52 ± 15.7 years in non-COVID patients affected with Acinetobacter infections.…”

Some issues of safety of antimicrobial therapy in COVID-19 patients

“…показано, что A. baumannii оказалась наиболее устойчивой бактерией, резистентной ко всем антибиоти кам, кроме колистина и тигециклина [52]. A. baumannii является грамотрицательным патогеном, который вы зывает различные нозокомиальные инфекции, включая пневмонию, связанную с ИВЛ, инфекции кровотока, свя занные с центральным катетером, и катетерассоцииро ванные инфекции мочевыводящих путей [53]. Вспышки инфекций, вызванных A. baumannii, как правило, возни кают в ОРИТ у пациентов в критическом состоянии [53].…”

“…A. baumannii является грамотрицательным патогеном, который вы зывает различные нозокомиальные инфекции, включая пневмонию, связанную с ИВЛ, инфекции кровотока, свя занные с центральным катетером, и катетерассоцииро ванные инфекции мочевыводящих путей [53]. Вспышки инфекций, вызванных A. baumannii, как правило, возни кают в ОРИТ у пациентов в критическом состоянии [53]. Карбапенемы считаются АМП первой линии для лече ния инфекций, вызванных антибиотикорезистентными грамотрицательными бактериями [53].…”