Investigation of an XDR- Acinetobacter Baumannii ST2 Outbreak in an Intensive Care Unit of a Lebanese Tertiary Care Hospital

Abstract

Aim: We sought to investigate the genetic epidemiological relatedness of carbapenem-resistant Acinetobacter baumannii (CRAB) strains of a suspected outbreak in a Lebanese tertiary care hospital to implement necessary infection prevention and control measures. Methods: Twenty-eight nonduplicate CRAB isolates detected among hospitalized patients between January 2016 and July 2017 were studied by real-time polymerase chain reaction (PCR), pulsed-field gel electrophoresis and multilocus sequence typing analyses. Results: Twenty-seven isolates harbored blaOXA-23. of which one also carried blaNDM-1. The isolates distributed temporally in two presumably episodes were stratified by pulsed-field gel electrophoresis into many clusters. Although several clones have become endemic in the hospital, we have rapidly implemented appropriate infection prevention and control measures, achieving full eradication from August 2017 to November 2019. Conclusion: We have successfully investigated and controlled a polyclonal outbreak of OXA-23 producing ST2 CRAB.

Prevalence and Molecular Mechanisms of Carbapenem Resistance among Gram-Negative Bacilli in Three Hospitals of Northern Lebanon

“…Carbapenem resistance in Pseudomonas aeruginosa is mostly related to non-enzymatic mechanisms, especially those involving mutations in the OprD, the porin responsible for carbapenem uptake, but VIM-2, IMP-1, IMP-2 and IMP-15 carbapenemases have also been described [ 8 ]. The prevalence of OXA-23 of Acinetobacter baumannii is considerably high in Lebanon [ 9 ]. For instance, 91.3% of carbapenem-resistant isolates collected in a study conducted by Dahdouh et al harbored OXA-23 [ 10 ].…”

Antimicrobial Resistance in the Protracted Syrian Conflict: Halting a War in the War

“…The discovery of antibiotics was one of the greatest medical achievements in the 20th century, which has significantly enhanced our capacity to control life-threatening infectious diseases. However, poor practices over decades and the lack of appropriate antimicrobial stewardship programs, including the unregulated or over the counter use of antimicrobials, have contributed to the occurrence and spread of antimicrobial resistance (AMR) [1][2][3][4]. The WHO has highlighted AMR as a global health threat causing around 700,000 deaths per year.…”

Phenotypic and Genotypic Typing of Carbapenem-Resistant Acinetobacter baumannii Isolates from Lebanon. (c2021)

“…Our results revealed the prevalence of the ST2 clone. ST2 was recently linked in Lebanon to an outbreak in a tertiary care hospital, representing 92.9% of the A. baumannii nonduplicate CRAB isolates (Osman et al, 2020). It is noteworthy that between 60-90% of A. baumannii isolates recovered from Lebanon over recent years were identified to be of ST2 sequence type, and which was in harmony with our results and confirming the prevalence of this clone (Jamal et al, 2018).…”

“…It is noteworthy that between 60-90% of A. baumannii isolates recovered from Lebanon over recent years were identified to be of ST2 sequence type, and which was in harmony with our results and confirming the prevalence of this clone (Jamal et al, 2018). ST2, linked to the international clonal lineage IC II (Fitzpatrick et al, 2016), was associated with outbreaks in health settings in Greece (Pournaras et al, 2017), Italy (Agodi et al, 2014), Thailand (Molter et al, 2016), andin Lebanon (Al Atrouni et al, 2016;Osman et al, 2020). Out of 194 CRAB isolates recovered in Greece, 77.8% were ST2 and IC II lineage (Pournaras et al, 2017), while it was 76.5% in Lebanon (Al Atrouni et al, 2016).…”

“…Outbreaks linked to international clonal lineage ST2 were commonly reported in Lebanon with high resistance profiles due to the increase in carbapenem treatment (Ballouz et al, 2017), with 60-90% of A. baumannii isolates collected in Lebanon over recent years belonging to the ST2 clone (Jamal et al, 2018;Osman et al, 2020). On the other hand, Rafei et al (2015), studied A. baumannii's prevalence in animals and environmental sources.…”