Spatio-Temporal Distribution of Acinetobacter baumannii in Germany—A Comprehensive Systematic Review of Studies on Resistance Development in Humans (2000–2018)

Abstract

Acinetobacter (A.) baumannii has gained global notoriety as a significant nosocomial pathogen because it is frequently associated with multi-drug resistance and hospital-based outbreaks. There is a substantial difference in the incidence of A. baumannii infections between different countries and within Germany. However, its continuous spread within Germany is a matter of concern. A systematic literature search and analysis of the literature published between 2000 and 2018 on A. baumannii in humans was performed. Forty-four studies out of 216 articles met the criteria for inclusion, and were selected and reviewed. The number of published articles is increasing over time gradually. Case reports and outbreak investigations are representing the main body of publications. North Rhine-Westphalia, Hesse and Baden-Wuerttemberg were states with frequent reports. Hospitals in Cologne and Frankfurt were often mentioned as specialized institutions. Multiresistant strains carrying diverse resistance genes were isolated in 13 of the 16 German states. The oxacillinase blaOXA-23-like, intrinsic blaOXA-51-like, blaOXA-58 variant, blaNDM-1, blaGES-11, blaCTX-M and blaTEM are the most predominant resistance traits found in German A. baumannii isolates. Five clonal lineages IC-2, IC-7, IC-1, IC-4 and IC-6 and six sequence types ST22, ST53, ST195, ST218, ST944/ST78 and ST348/ST2 have been reported. Due to multidrug resistance, colistin, tigecycline, aminoglycosides, fosfomycin, ceftazidime/avibactam and ceftolozan/tazobactam were often reported to be the only effective antibiotics left to treat quadruple multi-resistant Gram-negative (4MRGN) A. baumannii. Dissemination and infection rates of A. baumannii are on the rise nationwide. Hence, several aspects of resistance development and pathogenesis are not fully understood yet. Increased awareness, extensive study of mechanisms of resistance and development of alternative strategies for treatment are required. One-Health genomic surveillance is needed to understand the dynamics of spread, to identify the main reservoirs and routes of transmission and to develop targeted intervention strategies.

WGS based analysis of acquired antimicrobial resistance in human and non-human Acinetobacter baumannii isolates from a German perspective

“…The oxacillinase bla OXA-23 was identified for the first time in A. baumannii strains isolated from the United Kingdom in 1993. Later, it has been found and linked to the dissemination of carbapenem-resistant in A. baumannii worldwide [40] and is one of the most dominant resistance genes described in A. baumannii in Germany last decade [5]. The ADC beta-lactamases are cephalosporinase with extended-spectrum resistance to cephalosporins.…”

“…It is considered one of the critical pathogens that need developing new antibiotics [3,4]. In Germany, A. baumannii is a ubiquitous pathogen, and several communities and hospital-based outbreaks were reported in 13 out of 16 federal states [5]. Among other sources, the pathogen was also isolated from companion animals [6] and found in dried milk samples [7].…”

Analysis of blaCHDL Genes and Insertion Sequences Related to Carbapenem Resistance in Acinetobacter baumannii Clinical Strains Isolated in Warsaw, Poland

“…So far, genetic typing of Polish strains of A. baumannii has not been carried out using the Oxford scheme. Among the A. baumannii strains isolated in Europe, the following above-mentioned sequence types have been described: ST195 in Croatia, ST208 in Bulgaria and Greece, ST348 in Germany and ST425 in Greece [ 31 , 32 , 33 , 34 , 35 ]. Carbapenem-resistant A. baumannii ST195 and ST208 are widespread in the world, and are dominant mainly in the Far East, e.g., in China [ 36 , 37 , 38 , 39 , 40 ].…”

Molecular Characterization of German Acinetobacter baumannii Isolates and Multilocus Sequence Typing (MLST) Analysis Based on WGS Reveals Novel STs

“…Acinetobacter baumannii is a serious and emerging pathogen, causing nosocomial infections in humans and animals in Germany [2,5,7,8]. Accurate identification and differentiation of Acinetobacter at the species level is challenging.…”

“…Multi-drug resistant (MDR) A. baumannii strains are the cause of both hospital-and community-acquired infections worldwide [1]. In Germany, several outbreaks have occurred among hospitalized patients [2] and in veterinary clinics [3][4][5], and a recent study identified A. baumannii in dried milk [6,7]. The impact of A. baumannii in veterinary medicine and food chains is not well understood [8].…”