Nosocomial colonization and infection with multiresistant Acinetobacter baumannii: outbreak delineation using DNA macrorestriction analysis and PCR-fingerprinting

Struelens, Marc; Carlier, Eric; Maes, Nicole; Serruys, Elisabeth Schoutens; Quint, W. G. V.; Belkum, Alex van

doi:10.1016/0195-6701(93)90005-k

Cited by 134 publications

(107 citation statements)

References 31 publications

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“…For example, our data differ from the observations made by Struelens et al (20) in a Belgian hospital. Under circumstances of endemicity, about half of their Acinetobacter isolates were identified as A. baumannii, twice as many as we found.…”

Section: Discussioncontrasting

confidence: 56%

Endemic and Epidemic Acinetobacter Species in a University Hospital: an 8-Year Survey

et al. 2009

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The prevalence of the currently known Acinetobacter species and related trends of antimicrobial resistance in a Dutch university hospital were studied. Between 1999 and 2006, Acinetobacter isolates from clinical samples were collected prospectively. Isolates were analyzed by amplified fragment length polymorphism fingerprinting. For species identification, a profile similarity cutoff level of 50% was used, and for strain identification, a cutoff level of 90% was used. Susceptibility for antimicrobial agents was tested by disk diffusion by following the CLSI guideline.The incidences of Acinetobacter isolates ranged from 1.7 to 3.7 per 10,000 patients per year, without a trend of increase, during the study years. Twenty different species were distinguished. Acinetobacter baumannii (27%) and Acinetobacter genomic species (gen. sp.) 3 (26%) were the most prevalent. Other species seen relatively frequently were Acinetobacter lwoffii (11%), Acinetobacter ursingii (4%), Acinetobacter johnsonii (4%), and Acinetobacter junii (3%). One large cluster of A. baumannii, involving 31 patients, and 16 smaller clusters of various species, involving in total 39 patients, with at most 5 patients in 1 cluster, occurred. Overall, 37% of the A. baumannii isolates were fully susceptible to the tested antibiotics. There was a borderline significant (P ‫؍‬ 0.059) trend of decreasing susceptibility. A. baumannii was the Acinetobacter species causing the largest burden of multiple-antibiotic resistance and transmissions in the hospital.More than 30 named and unnamed species of Acinetobacter have been described (14), some of which are of clinical importance, including A. baumannii, Acinetobacter gen. sp. 3, and Acinetobacter gen. sp. 13TU, while other species, like A. junii, A. johnsonii, A. ursingii, and Acinetobacter schindleri, can also incidentally be associated with infections (8). Much attention has been paid to outbreaks caused by acinetobacters (28), which in most cases are caused by A. baumannii (15,23). Notably, in diagnostic microbiology, isolates identified as A. baumannii may also include the closely related species Acinetobacter gen. sp. 3 or Acinetobacter gen. sp. 13TU. Bacteria belonging to other Acinetobacter species are frequently not further identified as or designated Acinetobacter species, as this would require genotypic methods that are usually not available in clinical diagnostic microbiology. These difficulties in identification explain why, overall, not much is known about the occurrences of the different Acinetobacter species in the hospital.The aim of the present study was to determine the prevalences of the currently known Acinetobacter species and related trends of antimicrobial resistance in our hospital through the years. To this aim, we identified all available Acinetobacter isolates obtained from our hospital in the period between 1999 and 2006 to the species level by amplified fragment length polymorphism (AFLP) analysis, a well-validated method for Acinetobacter species identification (7,8). Furthermore, ...

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Section: Discussioncontrasting

confidence: 56%

Endemic and Epidemic Acinetobacter Species in a University Hospital: an 8-Year Survey

et al. 2009

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“…There are many studies in the literature showing that genomic DNA group 2 (A. baumannii), together with genomic DNA groups 1, 3, and 13TU (known as the Acinetobacter calcoaceticus-A. baumannii complex [Acb complex]), is predominantly involved in infection (2,5,8,9,13,17,20,24,28,36,39). Many of these studies were, however, based on outbreak strains or did not use reliable methods for genomic identification (18,40).…”

Section: Discussionmentioning

confidence: 99%

“…The environmental load in the ICU was significantly higher than in the four surgical wards, although there was no significant difference in the distribution of genomic DNA groups. Risk factors, such as antibiotic therapy, mechanical ventilation, and others, are well described for Acinetobacter carriage and infections among ICU patients (2,8,10,14,17,18,20,24,36,42). The presence of a large number of patients with risk factors and a high volume of clinical activities, together with other factors in the ICU, could have contributed to the heavy load of acinetobacters in the environment.…”

Section: Discussionmentioning

confidence: 99%

“…Species other than A. baumannii appear to be of greater epidemiological significance than was previously appreciated (7). This raises the question of whether identified risk factors of infection and control measures that are promulgated and practiced in areas where the infection is not endemic are wholly applicable to our region (8,9,24,36,42). We report here the molecular epidemiology of isolates obtained from clinical specimens and compare it with that in the environment both inside and outside the hospital.…”

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confidence: 99%

“…Outbreaks of Acinetobacter infections, often caused by multiresistant strains, have been widely reported, commonly in intensive care units (ICUs) in North America and Europe. Epidemiological features and risk factors of these outbreaks have also been well described (2,5,8,10,14,16,17,18,20,24,36,43). In contrast, there is a paucity of information in regions of Acinetobacter endemicity, such as Hong Kong (28,34,35).…”

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Epidemiology and Infection Control Implications of Acinetobacter spp. in Hong Kong

et al. 2001

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In a previous study, we showed that Acinetobacter genomic DNA group 3 was the most common species among blood culture isolates and was commonly found on superficial carriage sites of the healthy and the sick, which are different findings from those reported in Europe and North America. We used amplified ribosomal DNA restriction analysis and pulsed-field gel electrophoresis to study further the molecular epidemiology of acinetobacters in our region. Over a study period of 6 weeks with 136 consecutive routine clinical isolates (1.33% of all specimens), genomic DNA groups 2 (Acinetobacter baumannii), 3, and 13TU were obtained from 59 of 69 positive patients. There is a significant difference in the specimen sources of the three genomic DNA groups, with group 13TU being significantly associated with the respiratory tract (chi-square exact test, P ‫؍‬ 0.0064). Settle plates showed a significantly heavier environmental load from the intensive care unit (ICU) than from the four surgical wards examined (22 of 70 versus 76 of 120 plates with <5 colonies; chi-square test, P < 0.0001). Genomic group 3 accounted for 6 of 12 clusters of possibly related strains among patients, between patients and the ICU environment, and in the ICU environment. Genomic groups 2 and 3 accounted for 21% of the 132 genomically identified isolates recovered from 21 of 41 local vegetables, 53 of 74 fish and meat samples, and 22 of 60 soil samples. Group 13TU was present only in patients' immediate surroundings. The role played by the environment and by human carriage should be evaluated in order to devise a cost-effective infection control program pertinent to our situation of acinetobacter endemicity.

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AcinetobacterandMoraxella

Riley¹

2010

Topley &Amp; Wilson's Microbiology and Microbial Infections

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Nosocomial colonization and infection with multiresistant Acinetobacter baumannii: outbreak delineation using DNA macrorestriction analysis and PCR-fingerprinting

Cited by 134 publications

References 31 publications

Endemic and Epidemic Acinetobacter Species in a University Hospital: an 8-Year Survey

Endemic and Epidemic Acinetobacter Species in a University Hospital: an 8-Year Survey

Epidemiology and Infection Control Implications of Acinetobacter spp. in Hong Kong

AcinetobacterandMoraxella

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