Molecular Epidemiology of Carbapenem-Resistant Acinetobacter baumannii From Khartoum State, Sudan

Abstract

Carbapenem resistant Acinetobacter baumannii (CRAb) is an important global pathogen contributing to increased morbidity and mortality in hospitalized patients, due to limited alternative treatment options. Nine international clonal (IC) lineages have been identified in many countries worldwide, however, data still lacks from some parts of the world, particularly in Africa. We hereby present the molecular epidemiology of MDR A. baumannii from four hospitals in Khartoum, Sudan, collected from 2017 to 2018. Forty-two isolates were whole-genome sequenced, and subsequent molecular epidemiology was determined by core genome MLST (cgMLST), and their resistomes identified. All isolates had an array of diverse antibiotic resistance mechanisms conferring resistance to multiple classes of antibiotics. We found a predominance (88%) of IC2 (with the intrinsic OXA-66 and acquired OXA-23), and some with NDM-1. IC2 isolates were sub-divided into 4 STs separated by 5 to 431 allelic differences, and with evidence of seven transmission clusters. Isolates belonging to IC1, IC5, and IC9 were also identified. These data illustrate that MDR IC2 A. baumannii are widely distributed in Khartoum hospitals and are in possession of multiple antibiotic resistance determinants.

Rectal Colonization and Nosocomial Transmission of Carbapenem-Resistant Acinetobacter baumannii in an Intensive Care Unit, Southwest Nigeria

“…Six of the outbreak strains identified were isolated within 2 weeks of each other from six different patients within the same ICU unit. These strains belong to the IC2 lineage previously thought to be endemic in Europe and the United States (24) but increasingly reported as causes of nosocomial infections globally (12,(25)(26)(27)(28)(29). Strains in this lineage are highly adapted to the hospital setting, can spread rapidly within hospitals, and are highly resistant to antimicrobials, including carbapenems (12,30).…”

Diversity of International High-Risk Clones of Acinetobacter baumannii Revealed in a Russian Multidisciplinary Medical Center during 2017–2019

“…However, one of the most commonly used concepts for molecular epidemiology investigations is epidemic clonal lineages, or simply ‘international clones’, which represent genetically distinct populations of A. baumannii successfully spreading in different geographic locations [ 37 ]. Eight international clones were defined earlier [ 17 ], and the ninth was introduced recently [ 18 ]. The first three clones (IC1–IC3) are distributed worldwide, with IC1 and IC2 also known as global clones (GC), while the rest were sometimes defined as regional, or even endemic clones [ 13 , 20 , 21 , 22 ].…”

“…A. baumannii evolution during the past five decades was mainly driven by two globally disseminated clones, GC1 and GC2 (also called IC1 and IC2, IC standing for ‘international clone’) [ 16 ]. However, six additional clonal lineages are currently generally accepted [ 17 ], and IC9 is on its way [ 18 ].…”

Extensive acquisition of carbapenem-resistant Acinetobacter baumannii in Intensive Care Unit patients is driven by widespread environmental contamination

“…11,12 WGS has been employed to assess multi-centre CRAB populations, revealing that individual hospitals harbour multiple clusters and that these may be found across multiple hospitals. 13,14 These studies have focused on isolates derived from clinical or patient screening specimens.…”