Molecular Characterization of Carbapenem Resistant Acinetobacter baumannii in Cancer Patients

Hamid, Rasha M. Abdel; Hassan, Safaa Shawky; El-Mahallawy, Hadir A.; Saber, Mohamed

doi:10.20546/ijcmas.2016.511.075

Cited by 3 publications

(6 citation statements)

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“…These observations were in parallel with previous studies, which reported MDR bla NDM-1-positive Acinetobacter as a late-onset pathogen 4,45. In agreement with our finding, previous Egyptian studies by Amr and Abdel Razek and Hamid et al concluded that prolonged ICU stay and mechanical ventilation days with prior use of antibiotics were the recognized factors increasing the risk of VAP in >70% of patients due to multidrug and imipenem-resistant Acinetobacter infection 27,47…”

Section: Discussionsupporting

confidence: 93%

“…The overall mortality of VAP patients was found to be high (30/64; 46.8%); of these, 27/42 (64.3%) patients were infected with bla NDM-1-positive Acinetobacter isolates, and only 3 patients (13.6%) were infected with bla NDM-1-negative isolates with a statistically significant difference ( P =0.0001). Similar high mortality rates in VAP patients were previously recorded with Acinetobacter infections 4,47. Available data in the literature suggested that mortality related to Acinetobacter VAP varies from 26% to 68% 47.…”

Section: Discussionsupporting

confidence: 77%

“…Similar high mortality rates in VAP patients were previously recorded with Acinetobacter infections 4,47. Available data in the literature suggested that mortality related to Acinetobacter VAP varies from 26% to 68% 47. This high mortality, despite appropriate therapy, can be explained by low colistin pulmonary penetration 51…”

Section: Discussionsupporting

confidence: 59%

“…In this study, there was a significant relationship between prior use of carbapenem treatment (76.1% vs 40.9%; P =0.0052) and the acquisition of infections caused by bla NDM-1-positive Acinetobacter isolates. Prior use of antibiotics is a recognized factor increasing the risk of VAP due to MDR Acinetobacter infection 47. Moreover, Nhu et al and Aneta et al suggested that there is a risk that prior carbapenem exposure predisposes patients to subsequent colonization and infection with resistant pathogens 48,49.…”

Section: Discussionmentioning

confidence: 99%

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New Delhi metallo-β-lactamase-producing Acinetobacter isolates among late-onset VAP patients: multidrug-resistant pathogen and poor outcome

Elbrolosy

Labeeb

Hassan

2019

IDR

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Background Acinetobacter spp. are increasingly important microbes involved in late-onset ventilator-associated pneumonia (VAP). Purpose The aims of this study were to determine the prevalence of New Delhi metallo-β-lactamase (MβL) ( bla NDM-1)-producing Acinetobacter spp. among late-onset VAP patients in different intensive care units (ICUs) of Menoufia and Kasr Al Ainy University Hospitals, to investigate the possible risk factors contributing to the acquisition of bla NDM-1-producing Acinetobacter infection, and to correlate between antimicrobial resistance pattern and therapeutic efficacy as well as clinical outcomes of these patients. Materials and methods Sixty-four Acinetobacter isolates were collected from mechanically ventilated patients with suspected late-onset VAP and subjected to antimicrobial susceptibility testing. The modified Hodge test (MHT) and combined disk tests (CDT) were applied for bla NDM-1 MβL detection. Acinetobacter isolates with phenotypically confirmed MβLs production were subjected to a PCR assay to verify the presence of bla NDM-1 gene. The most obvious risk factors for acquisition of carbapenem resistance in VAP patients and treatment outcomes were also analyzed. Results Out of 64 Acinetobacter isolates, 42 (65.6%) proved to be bla NDM-1 positive. The sensitivity and specificity of MHT were 52.38% and 41.67%, while for CDT they were 92.86% and 83.33%, respectively. Acinetobacter isolates showed high susceptibility to colistin (85.7%). The clinical response was better among VAP patients who received combined carbapenem plus colistin therapy than those who received colistin alone. Relapse of infection was detected in 12.5% (8/64) of VAP cases. The reported mortality reached 46.8% (30/64) of which 27 (64.3%) were infected with bla NDM-1-positive isolates. Prolonged duration of mechanical ventilation, longer hospital and ICU stays, and prior exposure to antibiotic therapy were by far the most important factors predisposing to carbapenem resistance among VAP patients. Conclusion A worldwide spread of Acinetobacter spp. expressing carbapenemases represents a significant threat to the medical community. The current study addressed the high prevalence of bla NDM-1-producing Acinetobacter isolates among late-onset VAP patients.

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Section: Discussionsupporting

confidence: 93%

Section: Discussionsupporting

confidence: 77%

Section: Discussionsupporting

confidence: 59%

Section: Discussionmentioning

confidence: 99%

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New Delhi metallo-β-lactamase-producing Acinetobacter isolates among late-onset VAP patients: multidrug-resistant pathogen and poor outcome

Elbrolosy

Labeeb

Hassan

2019

IDR

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“…In the Middle East, the rate in the last two decades was 45% in Tunisia (Ben Othman et al 2007), 65% in Saudi Arabia (Al-Agamy et al 2014), 19.14% in Kuwait (Al-Sweih et al 2012, and 47.9% in Algeria (Bakour et al 2013). In Cairo, Egypt, one study conducted between 2011 and 2012 (Fouad et al 2013) showed imipenem and meropenem resistance rates of 74% and 100%, respectively among A. baumannii clinical isolates, while a second study between (Abdel Hamid et al 2016 found that 95.1% of the tested isolates were resistant to carbapenems. Moreover, a more recent study carried out in Mansoura, Egypt reported extensive drug resistance among 100% of the A. baumannii isolates obtained from patients suffering from nosocomial infections.…”

Section: Discussionmentioning

confidence: 99%

Role of plasmid carrying blaNDM in mediating antibiotic resistance among Acinetobacter baumannii clinical isolates from Egypt

2020

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We investigated antibiotic resistance levels among bla NDM -positive (n = 9) and -negative (n = 65) A. baumannii clinical isolates collected in 2010 and 2015 from Alexandria Main University Hospital, Egypt using disc diffusion and minimum inhibitory concentration (MIC) determination. Plasmids from bla NDM -positive isolates were transformed into a carbapenem-susceptible A. baumannii (CS-AB) isolate to assess the role of plasmid transfer in mediating carbapenem resistance. Imipenem, meropenem, and ertapenem MIC90 values against bla NDM -positive isolates were 128, > 256, and 256 µg/mL, respectively. Plasmid isolation and polymerase chain reaction revealed that bla NDM was plasmid mediated. The plasmids were electroporated into the cells of a CS-AB isolate at an efficiency of 1.3 × 10 -8 to 2.6 × 10 -7 , transforming them to bla NDM -positive carbapenemresistant cells with an imipenem MIC increase of 256-fold. In addition to carbapenem resistance, the bla NDM -positive isolates also exhibited higher levels of cephalosporins, tetracycline, aminoglycosides, fluoroquinolones, and colistin resistance than the bla NDM -negative isolates. Acquisition of bla NDM -carrying plasmids dramatically increased imipenem resistance among A. baumannii isolates. Intriguingly, bla NDM -positive isolates also showed a high degree of resistance to antibiotics of different classes. The potential co-existence of different resistance determinants on A. baumannii plasmids and their possible transfer owing to the natural competence of the pathogen are especially alarming. More effective infection control and antibiotic stewardship programs are needed to curb the spread and treat such infections in both hospital and community settings.

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Characterization of Carbapenem-resistant Acinetobacter baumannii Isolated from Intensive Care Unit, Egypt

El-Masry

Masry²

2018

Egyptian Journal of Medical Microbiology

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Background: Carbapenem resistant Acinetobacter baumannii has emerged worldwide in the hospitals especially in Intensive care units (ICU). Objectives: to detect carbapenems resistance and characterization of some carbapenem resistant genes among acinetobacter baumannii isolated from patients in ICU unit in Giza Chest Hospital, Egypt. Methodology: This study was designed to detect the prevalence of carbapenem resistance among A. baumannii species isolated from patients having nosocomial infections in Egypt. Antimicrobial susceptibility pattern was done. Identification and susceptibility testing was confirmed by VITEK® 2 Compact system. Isolates were further tested by the modified Hodge test (MHT) to detect carbapenem resistance. PCR was used to detect some carbapenem resistant genes. Results: A. baumanniii represent 22(16.1%) of total isolates causing nosocomial infection in ICU. A. baumanniii were resistant to sulfamethoxazole-trimethoprim, amoxicillin/ clavulanicacid, ciprofloxacin, piperacillin/tazobactamandceftazidime 100%, 90.9%, 90.9, 90.9%, 81.8% and 81.8% respectively. Imipenem resistance was 14/22(63.6%). Colistin showed the highest activity against A. baumannii isolates; the resistance rate was 4.5%. Total number of carbapenem-resistant gram-negative isolates was (38.9%). Regarding A. baumanniii 14 out of 22(63.6%) were carbapenem resistant as detected by the antibiotic susceptibility test. According to this antibiogram result, 14 A. baumanniii isolates screened for carbapenemase production by MHT, carbapenemase activity was detected among 10(71.4%) of carbapenem-resistant A. baumanniii isolates. Molecular detection of carbapenem resistant genes showed that Bla OXA-23 was the common detected gene 6/14 (42.8%). Bla OXA-58 was detected among 1/14(7.1%) of isolates. Conclusion: A. baumannii with multidrug resistance become a problem especially in immunocompromised patient. Resistance among A. baumannii caused by several mechanisms. OXA-23-like carbapenemase-producing strains have been among the most detected patterns.

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Molecular Characterization of Carbapenem Resistant Acinetobacter baumannii in Cancer Patients

Cited by 3 publications

References 5 publications

<p>New Delhi metallo-β-lactamase-producing <em>Acinetobacter</em> isolates among late-onset VAP patients: multidrug-resistant pathogen and poor outcome</p>

<p>New Delhi metallo-β-lactamase-producing <em>Acinetobacter</em> isolates among late-onset VAP patients: multidrug-resistant pathogen and poor outcome</p>

Role of plasmid carrying blaNDM in mediating antibiotic resistance among Acinetobacter baumannii clinical isolates from Egypt

Characterization of Carbapenem-resistant Acinetobacter baumannii Isolated from Intensive Care Unit, Egypt

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Molecular Characterization of Carbapenem Resistant Acinetobacter baumannii in Cancer Patients

Cited by 3 publications

References 5 publications

<p>New Delhi metallo-&beta;-lactamase-producing <em>Acinetobacter</em> isolates among late-onset VAP patients: multidrug-resistant pathogen and poor outcome</p>

<p>New Delhi metallo-&beta;-lactamase-producing <em>Acinetobacter</em> isolates among late-onset VAP patients: multidrug-resistant pathogen and poor outcome</p>

Role of plasmid carrying blaNDM in mediating antibiotic resistance among Acinetobacter baumannii clinical isolates from Egypt

Characterization of Carbapenem-resistant Acinetobacter baumannii Isolated from Intensive Care Unit, Egypt

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Resources

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<p>New Delhi metallo-β-lactamase-producing <em>Acinetobacter</em> isolates among late-onset VAP patients: multidrug-resistant pathogen and poor outcome</p>

<p>New Delhi metallo-β-lactamase-producing <em>Acinetobacter</em> isolates among late-onset VAP patients: multidrug-resistant pathogen and poor outcome</p>