Increased blaOXA-23-like prevalence in Acinetobacter baumannii at a tertiary care center in Lebanon (2007-2013)

Introduction: The spread of Acinetobacter baumannii, resistant to most of the available antimicrobial agents, is a serious health problem. The high rate of carbapenem resistance among Acinetobacter baumannii isolates is considered as a threat to public health. In this study, we aimed to determine the antibiotic resistance and related genes in carbapenem-resistant Acinetobacter baumannii isolates. Methodology: Ninety six isolates of A. baumannii were included. Antimicrobial susceptibility was performed by Phoenix Automated System and disk diffusion method. Carbapenem resistane was characterized by scrneeing of resistance genes such as blaTEM, blaSHV, blaCTX-M1-2, blaPER, blaVEB, blaKPC, blaGES, blaNDM, blaVIM, blaIMP and blaOXA23-24-51-58 using multiplex polymerase chain reaction. Results: Resistance for the levofloxacin, gentamicin, amikacin, and tigecycline were determined as 96.9%, 93.7%, 72.9% and 45.8% respectively. Colistin was the only susceptible antibiotic against all clinical isolates. All isolates were defined as multidrug resistance and of these, 31.2% were extensively drug-resistant (sensitive only to colistin). BlaOXA-51 and blaOXA-23 genes were detected in 100% strains while blaTEM was found in only 2% strains. There was no amplification for the blaSHV, blaCTX-M1-2, blaPER, blaVEB, blaKPC, blaGES blaNDM, blaVIM, blaIMP and blaOXA24-58 genes. Conclusions: The high frequency of blaOXA-23 and low frequency of blaTEM gene was observed that indicate prevalence of a variety of A. baumannii strains. The rates of resistance genes vary from region to region. Studies are required for the prevention and control of A. baumannii infection and to formulate the strategies of antibiotic usage.

Section: Discussionmentioning

confidence: 99%

β-lactamase genes in carbapenem resistance Acinetobacter baumannii isolates from a Turkish university hospital

Çoşkun

Çalışkan

Cicek

et al. 2019

“…Prior to the discovery of bla OXA-23, the OXA enzymes were thought to be a small group of enzymes encoded by plasmids that affected only penicillins; the migration of these genes via transposons caused them to become the dominant mechanism of antibiotic resistance [4]. The frequency of bla OXA-23 in A. baumannii strains has been reported to range from 32% to 100% in Turkey [21,31,32] and from 28% to 96% worldwide [33][34][35][36].…”

Section: Discussionmentioning

confidence: 99%

High prevalence of TEM, VIM, and OXA-2 beta-lactamases and clonal diversity among Acinetobacter baumannii isolates in Turkey

Aşgın

Otlu

Çakmaklıoğulları

et al. 2019

Introduction: Acinetobacter baumannii is an opportunistic pathogen that causes nosocomial infections with high mortality. Treatment options are limited owing to its resistance to numerous antibiotics. Here, we sought to determine the antibiotic susceptibilities of A. baumannii isolates, investigate clonal relationship among the strains, and determine the frequency of beta-lactamase resistance genes. Methodology: The identification and antibiotic susceptibilities of 69 A. baumannii strains were determined using a BD-Phoenix automated system. The presence of blaOXA-2, blaOXA-10, blaOXA-23, blaOXA-24/40, blaOXA-51, blaOXA-58, blaTEM, blaSHV, blaIMP, blaVIM, and blaGIM genes were investigated using polymerase chain reaction (PCR), and clonal relatioships among the isolates were determined using pulsed-field gel electrophoresis (PFGE). Results: All strains were resistant to ampicillin–sulbactam, gentamicin, cefepime, ciprofloxacin, and ceftriaxone. While 65 of the 69 strains (94.2%) were resistant to piperacillin-tazobactam, amikacin, imipenem, and meropenem, all strains were susceptible to tigecycline and colistin. The frequencies of blaOXA-51, blaOXA-23, blaTEM, blaOXA-2, blaVIM, and blaSHV were 100%, 94.2%, 53.6%, 21.7%, 14.5%, and 2.9%, respectively. Based on PFGE results, 56 of the 69 strains were clonally related, and the clustering rate was 81.2%. No common outbreak isolate was detected. Conclusions: The most prevalent OXA genes were blaOXA-51, blaOXA-23, and blaOXA-2. Furthermore, blaTEM, blaSHV, and blaVIM, which are common in Enterobacterales and Pseudomonas spp, were detected, suggesting horizontal gene transfer had occurred between bacteria. No single clone outbreak was detected by PFGE. However, multiclonal spread and the high clustering rate suggest cross-contamination. Therefore, in future, more effective infection control measures must be implemented.

“…Interestingly, strains isolated in both periods revealed only 22% of genomic relatedness. This suggests on one hand the rapidly changing diversity of this species, and on the other hand the significance of horizontal gene transfer between different clusters over the six years interval [39]. In view of its importance at the national level as a major medical center receiving patients from all over the country, the AUBMC results could be considered as representative of the country.…”

Section: Epidemiology Of Carbapenem Resistant Acinetobacter Species Imentioning

confidence: 99%

“…Similarly, non baumannii strains of Acinetobacter were detected by Hajjar et al but were not explored further [7]. A study conducted at the American University of Beirut Medical center (AUBMC), a major tertiary care center located in Beirut, revealed an increase of OXA-23 positive A. baumannii strains between two outbreaks, the first one described in 2007/2008 and the second one in 2013 [39]. Interestingly, strains isolated in both periods revealed only 22% of genomic relatedness.…”

Section: Epidemiology Of Carbapenem Resistant Acinetobacter Species Imentioning

confidence: 99%

“…These latter should be practiced even if in a given hospital, the prevalence of a MDROs is still low. An example of a successful containment of an A. baumannii outbreak in Lebanon is at the AUBMC [39]. In this case, onadmission and weekly screening of all respiratory, ICU and high risk patients was performed.…”

Section: Acinetobacter Spread In Lebanon What Needs To Be Done?mentioning

confidence: 99%

See 1 more Smart Citation

Acinetobacter spp in a Third World Country with Socio-economic and Immigrants Challenges

Dandachi¹,

Azar²,

Hamouch³

et al. 2019

Self Cite

Introduction: In the last decade, Acinetobacter species have taken a major public health concern. This is mainly due the increased resistance to a wide range of antibiotics causing treatment challenges. In view of the constant population mobilization and the economic crisis that Lebanon is currently facing, it becomes a necessity to re-evaluate the real threat of Acinetobacter spp and its implication in the one health. Methodology: This review was conducted through the analysis of 45 research papers and reports pertaining to Acinetobacter spp performed in Lebanon. More than 82% of the papers consulted were published in international journals and more than 70 percent of them had received impact factor. Results: An in depth description of the involvement of this organism in human infection and its role as potential pathogen or simple colonizer was performed. In addition, the different aspects of resistance, mostly to carbapenems and colistin was studied and summarized. While in animals and environment, susceptible strains were mostly isolated, OXA-23/OXA-24 were predominant in humans. Recently, NDM-1 producing Acinetobacter spp was detected in a Syrian refugee which then was reported in Lebanese patients. The bacterial identification procedures are non-systematic and not always reliable in the Lebanese studies presenting sometimes discrepancies an inconsistency. Conclusion: Acinetobacter is commonly isolated Lebanon. In view of the spread of resistance among these isolated and their dissemination, Infection control measures attempting to control the spread of this genus in and outside hospitals are lacking and thus require more attention and stewardship activities.