Importation of<i>Acinetobacter baumannii</i>Into a Burn Unit: A Recurrent Outbreak of Infection Associated With Widespread Environmental Contamination

Zanetti, Giorgio; Blanc, Dominique; Federli, I.; Raffoul, Wassim; Petignat, Christiane; Maravic, Philippe; Francioli, P.; Berger, Mette M.

doi:10.1086/517956

Cited by 72 publications

(37 citation statements)

References 13 publications

(10 reference statements)

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“…Several Acinetobacter outbreaks in burn units were described previously and were partially associated with extensive environmental contamination (42)(43)(44)(45). A. baumannii survives in the hospital environment for a prolonged period, even on dry surfaces and the hands of health care personnel, and the carriage of MDRAB in human hosts may also be prolonged (10,46,47), which can facilitate transmission and outbreaks of A. baumannii.…”

Section: Discussionmentioning

confidence: 96%

Next-Generation Sequencing and Comparative Analysis of Sequential Outbreaks Caused by Multidrug-Resistant Acinetobacter baumannii at a Large Academic Burn Center

Kanamori

Parobek

Weber

et al. 2016

Antimicrob Agents Chemother

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f Next-generation sequencing (NGS) analysis has emerged as a promising molecular epidemiological method for investigating health care-associated outbreaks. Here, we used NGS to investigate a 3-year outbreak of multidrug-resistant Acinetobacter baumannii (MDRAB) at a large academic burn center. A reference genome from the index case was generated using de novo assembly of PacBio reads. Forty-six MDRAB isolates were analyzed by pulsed-field gel electrophoresis (PFGE) and sequenced using an Illumina platform. After mapping to the index case reference genome, four samples were excluded due to low coverage, leaving 42 samples for further analysis. Multilocus sequence types (MLST) and the presence of acquired resistance genes were also determined from the sequencing data. A transmission network was inferred from genomic and epidemiological data using a Bayesian framework. Based on single-nucleotide variant (SNV) differences, this MDRAB outbreak represented three sequential outbreaks caused by distinct clones. The first and second outbreaks were caused by sequence type 2 (ST2), while the third outbreak was caused by ST79. For the second outbreak, the MLST and PFGE results were discordant. However, NGS-based SNV typing detected a recombination event and consequently enabled a more accurate phylogenetic analysis. The distribution of resistance genes varied among the three outbreaks. The first-and second-outbreak strains possessed a bla OXA-23-like group, while the thirdoutbreak strains harbored a bla OXA-40-like group. NGS-based analysis demonstrated the superior resolution of outbreak transmission networks for MDRAB and provided insight into the mechanisms of strain diversification between sequential outbreaks through recombination.H ealth care-associated infections (HAI) are a substantial cause of morbidity and mortality in acute-care hospitals (1). Acinetobacter baumannii is an important opportunistic pathogen causing HAI (2) and has become one of the most common colonizing pathogens in burn patients (3, 4). A. baumannii may cause serious outbreaks despite the implementation of rigorous infection prevention interventions and control measures, which occur most commonly in intensive care units (5-8). Furthermore, the emergence of multidrug-resistant A. baumannii (MDRAB), especially carbapenem-resistant A. baumannii (CRAB), has become a global concern (5, 9). Patients infected by multidrug-resistant Acinetobacter strains are likely to have higher mortality rates and longer lengths of hospitalization than those infected by susceptible strains (10).Pulsed-field gel electrophoresis (PFGE) has been the gold standard approach for bacterial strain typing in hospital outbreak investigations, but several disadvantages have been described, including that it is a time-consuming, labor-intensive, and technically demanding assay and that is has limited reproducibility among laboratories; also, the interpretation of the relative relatedness of strains using this method may be discordant and subjective (11-13). For these reasons, next...

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Section: Discussionmentioning

confidence: 96%

Next-Generation Sequencing and Comparative Analysis of Sequential Outbreaks Caused by Multidrug-Resistant Acinetobacter baumannii at a Large Academic Burn Center

Kanamori

Parobek

Weber

et al. 2016

Antimicrob Agents Chemother

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“…Carbapenems are considered the first-line drugs for treatment of A. baumannii infections in Iran; however, resistance to these drugs is increasing owing to the overexpression of efflux pumps and to the ability of the bacterium to produce different carbapenemases, in particular class D carbapenemases [1,2,5,6]. A. baumannii is increasingly causing infections in burn units worldwide including Iran [7][8][9]. In addition, A. baumannii strains resistant to different classes of antibiotics including carbapenems have reportedly been isolated from burn patients in Iran [8,9].…”

Section: Introductionmentioning

confidence: 99%

Acinetobacter baumannii clonal lineages I and II harboring different carbapenem-hydrolyzing-β-lactamase genes are widespread among hospitalized burn patients in Tehran

Mahdian

Sadeghifard

Pakzad

et al. 2015

Journal of Infection and Public Health

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The aim of this study was to analyze antimicrobial resistance patterns and their encoding genes and genotypic diversity of Acinetobacter baumannii isolated from burn patients in Tehran, Iran. The presence of extended-spectrum beta-lactamase- and blaOXA-encoding genes among 37 multidrug resistant (MDR) A. baumannii strains isolated from patients hospitalized in a teaching hospital in Tehran was evaluated. Susceptibility to 7 antibiotics was tested by disk agar diffusion and to polymyxin B and colistin was tested by E-test, according to CLSI guidelines. All isolates were then analyzed by PCR for the presence of blaIMP, blaVIM, blaSIMblaOXA-23, blaOXA-24, and blaOXA-58-like carbapenemase genes, and blaOXA-51-like, blaTEM, blaSHV, blaPER, blaVEB, and blaGIM genes. Genotyping of A. baumannii strains was performed by repetitive sequence-based (REP)-PCR and cluster analysis of REP-PCR profiles. A. baumannii isolates were assigned to international clones by multiplex PCR sequence group analysis. Twenty-five A. baumannii isolates were classified as MDR, and 12 were classified as extensively drug resistant. All isolates were susceptible to colistin and polymyxin B. Eighty-one percent of the isolates was resistant to imipenem or meropenem and harbored at least one or both of the blaOXA-23-like or blaOXA-24-like carbapenemase genes. Co-existence of different resistance genes was found among carbapenem-resistant isolates. Multiplex PCR sequence group analysis most commonly assigned A. baumannii isolates to international clones I (18/37; 48.6%) and II (18/37; 48.6%). An alarming increase in resistance to carbapenems and the spread of blaOXA-23-like and/or blaOXA-24-like carbapenemase genes was observed among A. baumannii strains belonging to clonal lineages I and II, isolated from burn patients in Tehran.

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“…Closed-suctioning system minimizes environmental contamination and was thus preferred as suggested previously [16]. Some studies have reported complete sealing of units for control the outbreaks [15,16].…”

Section: Discussionmentioning

confidence: 99%

Successful control of outbreak caused by clonally related extensively-resistant Acinetobacter baumannii in an intensive care unit

Sultan¹

2017

Journal of Microbiology and Infectious Diseases

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Importation ofAcinetobacter baumanniiInto a Burn Unit: A Recurrent Outbreak of Infection Associated With Widespread Environmental Contamination

Cited by 72 publications

References 13 publications

Next-Generation Sequencing and Comparative Analysis of Sequential Outbreaks Caused by Multidrug-Resistant Acinetobacter baumannii at a Large Academic Burn Center

Next-Generation Sequencing and Comparative Analysis of Sequential Outbreaks Caused by Multidrug-Resistant Acinetobacter baumannii at a Large Academic Burn Center

Acinetobacter baumannii clonal lineages I and II harboring different carbapenem-hydrolyzing-β-lactamase genes are widespread among hospitalized burn patients in Tehran

Successful control of outbreak caused by clonally related extensively-resistant Acinetobacter baumannii in an intensive care unit

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