Trend of extensively drug-resistant<i>Acinetobacter baumannii</i>and the remaining therapeutic options: a multicenter study in Tehran, Iran over a 3-year period

Jasemi, Seyedesomaye; Douraghi, Masoumeh; Adibhesami, Habibeh; Zeraati, Hojjat; Rahbar, Mohammad; Boroumand, MA; Aliramezani, Amir; Ghourchian, Sedighe; Mohammadzadeh, Mona

doi:10.1111/lam.12669

Cited by 17 publications

(12 citation statements)

References 41 publications

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“…In the present study, we observed a significant MDR (21.9%) and XDR (18.8%) frequency. The XDR rate in this study was lower than the usual reported rates of clinical A. baumannii isolates, as it reached more than 90% in one report from Tehran (7). However, the MDR rate in this study was higher than reported rates of clinical isolates.…”

Section: Discussioncontrasting

confidence: 85%

“…We screened surfaces and equipment of five hospitals and observed a high frequency (53.1%) of CRAB isolates which were simultaneously resistant to some tested antimicrobial agents. Previously, the high distribution of XDR A. baumannii in clinical isolates was reported in hospitals of Tehran, central Iran (7,17). Based on the present results, tigecycline exhibited promising in vitro activity against A. baumannii isolates.…”

Section: Discussionmentioning

confidence: 94%

“…Growing prevalence of carbapenem-resistant and multidrug resistant A. baumannii is a major risk in care facilities. This resistance is often associated with acquisition of class D eral pieces of evidence around the world have shown dissemination of OTC-harboring A. baumannii strains within and between hospitals (6,7).…”

Section: Introductionmentioning

confidence: 99%

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Genetic Diversity of OXA Producing Carbapenem-Resistant Acinetobacter baumannii from Environment of Tertiary Hospitals in Central Iran

Rostami

Mehrban

Ghourchian

et al. 2020

Arch Clin Infect Dis

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Background:The hospital environment usually involves in cross-colonization and/or outbreaks of carbapenem-resistant Acinetobacter baumannii (CRAB). This study aims to identify genetic diversity of environmental Acinetobacter baumannii (A. baumannii) isolates based on OXA-type carbapenems. Objectives: It was intended to identify the environmental source of A. baumannii strains to control future infections and ongoing outbreaks. Methods: Swab samples were collected from equipment, fluids and surfaces of intensive care units of five hospitals (H1 to H5). The susceptibility of the isolates was defined through disk diffusion method. blaOXA-51, blaOXA-58, blaOXA-23, and blaOXA-24 genes were detected by multiplex polymerase chain reaction (PCR) . Genetic diversity was investigated using ERIC-PCR. Mean values were compared using an Independent samples t-test. Results:The mean number of Gram-negative bacilli colony per sample was significantly higher in moist surfaces (1.9 ± 2.37) than in dry surfaces and medical equipment (P < 0.05). Among 32 A. baumannii isolates, 17 (53.1%) were classified as CRAB, 13 (40.6%) as multidrug resistant (MDR) and six (18.8%) as extremely drug resistant (XDR) phenotypes. The isolates showed the most susceptibility to tigecycline (81.3%) and doxycycline (81.3%). Totally, 10 isolates (31.3%) carried blaOXA-23 and one isolate carried blaOXA-58, but none contained blaOXA-24. Typing of the strains provided seven single types (ST) and nine clusters (A-I). Two isolates in cluster B (different surfaces of H4) and two in cluster I (from ventilators of H3 and H1) were designated as common type (CT). In H4 and H1, different isolates belonging to different clusters were recovered from bed sheet and baby sink bath, respectively. Conclusions: Clonally-related blaOXA-23 positive CRABs occurred in the environment, especially on moist surfaces of hospitals. The distribution of the same clones in different hospitals may point to expansion of a specific clone which increases the risk of crosscolonization of vulnerable patients.

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Section: Discussioncontrasting

confidence: 85%

Section: Discussionmentioning

confidence: 94%

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Genetic Diversity of OXA Producing Carbapenem-Resistant Acinetobacter baumannii from Environment of Tertiary Hospitals in Central Iran

Rostami

Mehrban

Ghourchian

et al. 2020

Arch Clin Infect Dis

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“…In 2015, we reported the resistance profiles of 401 clinical A. baumannii isolates recovered from 5 hospitals in Iran between 2011 and 2013, with 90% of the isolates being found to be extensively drug resistant (XDR) (20). Later, all the isolates were further examined using allele-specific PCRs (21), and 57 (14%) and 86 (22%) isolates were found to belong to GC1 and GC2, respectively (22).…”

mentioning

confidence: 99%

Accumulation of Antibiotic Resistance Genes in Carbapenem-Resistant Acinetobacter baumannii Isolates Belonging to Lineage 2, Global Clone 1, from Outbreaks in 2012–2013 at a Tehran Burns Hospital

Douraghi

Kenyon

Aris

et al. 2020

mSphere

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The worldwide distribution of carbapenem-resistant Acinetobacter baumannii (CRAB) has become a global concern, particularly in countries where antibiotic prescription is not tightly regulated. However, knowledge of the genomic aspects of CRAB from many parts of the world is still limited. Here, 50 carbapenem-resistant A. baumannii isolates recovered at a single hospital in Tehran, Iran, during several outbreaks in 2012 and 2013 were found to be resistant to multiple antibiotics. They were examined using PCR mapping and multilocus sequence typing (MLST). All Iranian strains belonged to sequence type 328 in the Institut Pasteur MLST scheme (ST328IP), a single-locus variant of ST81IP, and all Iranian strains contained two carbapenem resistance genes, oxa23 and oxa24. The oxa23 gene is in the transposon Tn2006 in AbaR4, which interrupts the chromosomal comM gene. Phylogenetic analysis using whole-genome sequence (WGS) data for 9 isolates showed that they belonged to the same clade, designated the ST81/ST328 clade, within lineage 2 of global clone 1 (GC1). However, there were two groups that included either KL13 or KL18 at the K locus (KL) for capsular polysaccharide synthesis and either a tet39 or an aadB resistance gene, respectively. The genetic context of the resistance genes was determined, and the oxa24 (OXA-72 variant) and tet39 (tetracycline resistance) genes were each in a pdif module in different plasmids. The aadB gene cassette (which encodes gentamicin, kanamycin, and tobramycin resistance) was harbored by pRAY*, and the aphA6 gene (which encodes amikacin resistance) and sul2 gene (which encodes sulfamethoxazole resistance) were each harbored by a different plasmid. The sequences obtained here will underpin future studies of GC1 CRAB strains from the Middle East region. IMPORTANCE Carbapenem-resistant Acinetobacter baumannii strains are among the most critical antibiotic-resistant bacteria causing hospital-acquired infections and treatment failures. The global spread of two clones has been responsible for the bulk of the resistance, in particular, carbapenem resistance. However, there is a substantial gap in our knowledge of which clones and which specific lineages within each clone are circulating in many parts of the world, including Africa and the Middle East region. This is the first genomic analysis of carbapenem-resistant A. baumannii strains from Iran. All the isolates, from a single hospital, belonged to lineage 2 of global clone 1 (GC1) but fell into two groups distinguished by genes in the locus for capsule biosynthesis. The analysis suggests a potential origin of multiply antibiotic-resistant lineage 2 in the Middle East region and highlights the ongoing evolution of carbapenem-resistant GC1 A. baumannii strains. It will enhance future studies on the local and global GC1 population structure.

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“…In addition, a more recent study carried out on 105 A. baumannii isolates showed that all were multidrug resistant and 71.4% were XDR (23). A multi-hospital study performed in Iran over a three-year period from 2011 to 2013 has also shown that 91.3% of A. baumannii isolates were XDR (24).…”

Section: Discussionmentioning

confidence: 99%

Plasmid-Mediated Class 1 and 2 Integron Carriage in Drug-Resistant Nosocomial Isolates of Acinetobacter baumannii

Eftekhar

Altayar

Khidaei

2018

Arch Clin Infect Dis

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Background: Acinetobacter baumannii is an opportunistic multidrug-resistant pathogen associated with nosocomial infections in critically ill patients. Antibiotic resistance genes are often encoded by class 1 and 2 integrons and located on plasmids that can facilitate their horizontal transfer among bacteria. Objectives: The aim of this research was to study the correlation between plasmid carriage and presence of class 1 and 2 integrons in nosocomial isolates of A. baumannii. Methods: Fifty isolates collected between October 2014 and March 2015 from Imam Hussein hospital in Tehran were examined. Bacterial identification was carried out by biochemical identification as well as detection of the blaOXA-51 gene among the isolates. Susceptibility to 18 antibiotics was determined by disc diffusion method. Class 1 and 2 integrons were detected in total DNA extracts as well as in isolated plasmids using specific primers and PCR. Results: All isolates were extremely drug-resistant (XDR). Integron carriage was observed in 32 isolates (64%). Seventeen isolates (34%) carried plasmids with molecular sizes of > 20 kbp. Among them, six (35.4%) carried class 1, three (17.6%) harbored class 2, four (23.5%) had both integron classes, and four isolates (23.5%) carried no integrons. Of the plasmid negative isolates, 14 (42.4%) had no integron, 10 (30.3%) carried integron 2, five (15.2%) harbored integron 1 and interestingly, four (12.1%) carried both integron classes. Conclusions: No correlation was found between antibiotic resistance profiles and integron carriage. Class 1 integron was significantly associated with plasmid carriage showing its role in the dissemination of drug resistance in A. baumannii. No association was observed between class 2 integrons and plasmid carriage suggesting their chromosomal location.

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Trend of extensively drug-resistantAcinetobacter baumanniiand the remaining therapeutic options: a multicenter study in Tehran, Iran over a 3-year period

Cited by 17 publications

References 41 publications

Genetic Diversity of OXA Producing Carbapenem-Resistant Acinetobacter baumannii from Environment of Tertiary Hospitals in Central Iran

Genetic Diversity of OXA Producing Carbapenem-Resistant Acinetobacter baumannii from Environment of Tertiary Hospitals in Central Iran

Accumulation of Antibiotic Resistance Genes in Carbapenem-Resistant Acinetobacter baumannii Isolates Belonging to Lineage 2, Global Clone 1, from Outbreaks in 2012–2013 at a Tehran Burns Hospital

Plasmid-Mediated Class 1 and 2 Integron Carriage in Drug-Resistant Nosocomial Isolates of Acinetobacter baumannii

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