Characterization of multidrug-resistant Acinetobacter ssp. strains isolated from medical intensive care units in Cali - Colombia.
Main Article Content
Introduction:
The extensive use of antibiotics has led to the emergence of multi-resistant strains in some species of the genus Acinetobacter.
Objective:
To investigate the molecular characteristics of multidrug-resistant of Acinetobacter ssp. strains isolated from 52 patients collected between March 2009 and July 2010 in medical intensive care units in Cali - Colombia.
Methods:
The susceptibility to various classes of antibiotics was determined by disc diffusion method, and the determination of the genomic species was carried out using amplified ribosomal DNA restriction analysis (ARDRA) and by sequencing of the 16s rDNA gene. Also, the genes of beta-lactamases as well as, integrases IntI1 and IntI2 were analyzed by PCR method.
Results:
The phenotypic identification showed that the isolates belong mainly to A. calcoaceticus- A. baumannii complex. All of them were multi-resistant to almost the whole antibiotics except to tigecycline and sulperazon, and they were grouped into five (I to V) different antibiotypes, being the antibiotype I the most common (50.0%). The percent of beta-lactamases detected was: blaTEM (17.3%), blaCTX-M (9.6%), blaVIM (21.2%), blaIMP (7.7%), blaOXA-58 (21.2%), and blaOXA-51 (21.2%). The phylogenetic tree analysis showed that the isolates were clustering to A. baumannii (74.1%), A. nosocomialis (11.1%) and A. calcoaceticus (7.4 %). Besides, the integron class 1 and class 2 were detected in 23.1% and 17.3% respectively.
Conclusion:
The isolates were identified to species A. baumanii mainly, and they were multiresistant. The resistance to beta-lactams may be by for presence of beta-lactamases in the majority of the isolates.
- Acinetobacter infections
- multiple drug resistance
- 16S ribosomal RNA
- healthcare associated infections
Peleg AY, Seifert H, Paterson DL. Acinetobacter baumannii: Emergence of a Successful Pathogen. Clin Microbiol Rev. 2008; 21:538-82. DOI: https://doi.org/10.1128/CMR.00058-07
Maragakis LL, Perl TM. Acinetobacter baumannii: Epidemiology, Antimicrobial Resistance and Treatment Options. Clin Infec Dis. 2008; 46:1254-63. DOI: https://doi.org/10.1086/529198
Scott P, Deye A, Srinivasan C, Murray K, Moran E, Hulten J. et al. An outbreak of multidrug-resistant Acinetobacter baumannii-calcoaceticus complex infection in the US military health care system associated with military operations in Iraq. Clin Infect Dis. 2007; 44:1577-84. DOI: https://doi.org/10.1086/518170
Sunenshine R, Wright L, Maragakis AD, Harris X, Song J, Hebden SE. et al. Multidrug-resistant Acinetobacter infection mortality rate and length of hospitalization. Emerg Infect Dis. 2007; 13:97-103. DOI: https://doi.org/10.3201/eid1301.060716
Perez F, Hujer AM, Hujer KM, Decker BK, Rather PN, Bonomo RA. Global challenge of multidrug-resistant Acinetobacter baumannii. Antimicrob Agents Chemother. 2007; 51: 3471-84. DOI: https://doi.org/10.1128/AAC.01464-06
Ledeboer N, Hodinka R. Molecular Detection of resistance determinants. J Clin Microbiol. 2011; 49 Supl 9: S20-S24. DOI: https://doi.org/10.1128/JCM.00771-11
Saavedra SY, Nuñez JC, Pulido IY, González EB, Valenzuela EM, Reguero MT, et al. Characterization of carbapenem resistant Acinetobacter calcoaceticus-A. baumannii complex isolates in a third level hospital in Bogotá, Colombia. Int J Antimicrob Agents. 2008; 31 supl 4: 389-91. DOI: https://doi.org/10.1016/j.ijantimicag.2007.12.008
Giamarellou H, Antoniadou A, Kanellakopoulou K. Acinetobacter baumannii: a universal threat to public health? Int J Antimicrob. Agents. 2008; 32:106-19. DOI: https://doi.org/10.1016/j.ijantimicag.2008.02.013
Villegas MV, Kattan J, Correa A, Lolans K, Guzman AM, Woodford N, et al. Dissemination of Acinetobacter baumannii Clones with OXA-23 Carbapenemase in Colombian Hospitals. Ant Agents Chem. 2007; 51:2001-4. DOI: https://doi.org/10.1128/AAC.00226-07
Touati M, Diene SM, Racherache A, Dekhil M, Djahoudi A, Rolain JM. Emergence of blaOXA-23 and blaOXA-58 carbapenemase-encoding genes in multidrug-resistant Acinetobacter baumannii isolates from University Hospital of Annaba, Algeria. Int J Antimicrob Agents. 2012; 40: 89-91. DOI: https://doi.org/10.1016/j.ijantimicag.2012.03.017
Mugnier P, Poirel L, Nordmann P. Functional analysis of insertion sequence ISAba1, responsible for genomic plasticity of Acinetobacter baumannii. J Bacteriol. 2009; 191:2414-18. DOI: https://doi.org/10.1128/JB.01258-08
Aubert D, Naas T, Héritier C, Poirel L, Nordmann P. Functional characterization of IS1999, an IS4 family element involved in mobilization and expression of beta-lactam resistance genes. J Bacteriol. 2006; 188; Supl 18:6506-14. DOI: https://doi.org/10.1128/JB.00375-06
Mazel D. Integrons: agents of bacterial evolution. Nat Rev Microbiol. 2006; 4: 608-20. DOI: https://doi.org/10.1038/nrmicro1462
Ramírez MS, Stietz MS, Vilacoba E, Jeric P, Limansky AS, Catalano M, et al. Increasing frequency of class 1 and 2 integrons in multidrug-resistant clones of Acinetobacter baumannii reveals the need for continuous molecular surveillance. Int J Antimicrob Agents. 2011; 37:175-77. DOI: https://doi.org/10.1016/j.ijantimicag.2010.10.006
Ramirez MS, Pineiro S, Centron D. Novel insights about class 2 integrons from experimental and genomic epidemiology. Antimicrob Agents Chemother. 2010; 54:699-706. DOI: https://doi.org/10.1128/AAC.01392-08
Clinical and Laboratory Standards Institute. Performance Standards for Antimicrobial Susceptibility Testing: Twenty-third Informational Supplement; 2013. M100-S23. CLSI, Wayne, PA, USA.
Manchanda V, Sanchaita S, Singh NP. Multidrug Resistant Acinetobacter. J Glob Infect Dis. 2010; 2 Supl 3: 291-304. DOI: https://doi.org/10.4103/0974-777X.68538
Vaneechoutte M, L Dijishoorn, I Tjernberg, A Elaichouni, P de Vos, G Claeys, G. Verschraegen. Identification of Acinetobacter genomic species by amplified ribosomal DNA restriction analysis. J Clin Microbiol. 1995; 33:11-15. DOI: https://doi.org/10.1128/jcm.33.1.11-15.1995
Dijkshoorn L, B Van Harsselaar, I Tjernberg, P J Bouvet, M Vaneechoutte. Evaluation of amplified ribosomal DNA restriction analysis for identification of Acinetobacter genomic species. Syst Appl Microbiol. 1998; 21:33-39. DOI: https://doi.org/10.1016/S0723-2020(98)80006-4
Kimura MA. Simple method for estimating evolutionary rates of base substitutions through comparative studies of nucleotide sequences. J Mol Evol. 1980;16:111-20. DOI: https://doi.org/10.1007/BF01731581
Tamura K, Peterson D, Peterson N, Stecher G, Nei M, Kumar S MEGA5: Molecular evolutionary genetics analysis using maximum likelihood, evolutionary distance, and maximum parsimony methods. Mol Biol Evol. 2011; 28: 2731-39. DOI: https://doi.org/10.1093/molbev/msr121
Vaneechoutte M, Dijkshoorn L, Tjernberg I, ElaichouniA, de Vos P, Claeys G, Verschraegen, G. Identification of Acinetobacter genomic species by amplified ribosomal DNA restriction analysis. J Clin Microbiol. 1995; 33 Supl 1:11-15. DOI: https://doi.org/10.1128/jcm.33.1.11-15.1995
Sundsfjord A, Simonsen GS, Haldorsen BC, Haaheim SO, Hjelmevoll SO, Littauer P, Dahl KH. Genetic methods for detection of antimicrobial resistance. APMIS. 2004; 112: 815-37. DOI: https://doi.org/10.1111/j.1600-0463.2004.apm11211-1208.x
Queenan AM, Bush K. Carbapenemases: the versatile beta-lactamases. Clin Microbiol Rev. 2007; 20: 440-58. DOI: https://doi.org/10.1128/CMR.00001-07
Walsh TR, Toleman MA, Hryniewicz W, Bennett PM, Jones RN. Evolution of an integron carrying blaVIM-2 in Eastern Europe: report from the SENTRY Antimicrobial Surveillance Program. J Antimicrob Chemother. 2003; 52:116-9. DOI: https://doi.org/10.1093/jac/dkg299
Cantón R, Oliver A, Coque TM, Varela M del C, Pérez-Díaz JC, Baquero F. Epidemiology of Extended-Spectrum beta-Lactamase-Producing Enterobacter Isolates in a Spanish Hospital during a 12-Year Period. J Clin Microbiol. 2002; 40 Supl 4:1237-43. DOI: https://doi.org/10.1128/JCM.40.4.1237-1243.2002
Chuang YC, Chang SC, Wang WK. High and Increasing Oxa-51 DNA load predict mortality in Acinetobacter baumannii Bacteremia: Implication for Pathogenesis and Evaluation of Therapy. PLoS ONE. 2010; 5 Supl 11: e14133. DOI: https://doi.org/10.1371/journal.pone.0014133
Turton JF, Woodford N, Glover J, Yarde S, Kaufmann ME, Pitt TL. Identification of Acinetobacter baumannii by Detection of the blaOXA-51-like Carbapenemase Gene Intrinsic to This Species. J Clin Microbiol. 2006; 44 Supl 8:2974-76. DOI: https://doi.org/10.1128/JCM.01021-06
Koeleman JG, Stoof J, Van Der Bijl MW, Vandenbroucke Grauls CM, Savelkoul PH. Identification of epidemic strains of Acinetobacter baumannii by integrase gene PCR. J Clin Microbiol. 2001; 39:8-13. DOI: https://doi.org/10.1128/JCM.39.1.8-13.2001
Gu B, Tong M, Zhao W, Liu G, Ning M, Pan S, Zhao W. Prevalence and Characterization of Class I Integrons among Pseudomonas aeruginosa and Acinetobacter baumannii Isolates from Patients in Nanjing, China. J Clin Microbiol. 2007; 45 Supl 1:241-43. DOI: https://doi.org/10.1128/JCM.01318-06
Falagas ME, Kolets PK, Bliziotis IA. The diversity of definitions of multidrug-resistant and pandrug-resistant (PDR) Acinetobacter baumannii and Pseudomonas aeruginosa. J Med Microbiol. 2006; 55:1619 -29. DOI: https://doi.org/10.1099/jmm.0.46747-0
La Scola B, Bui LTM, Baranton G, Khamis A, Raoult D. Partial rpoB gene sequencing for identification of Leptospira species. FEMS Microbiol Letters. 2007; 263 Supl 2:142-47. DOI: https://doi.org/10.1111/j.1574-6968.2006.00377.x
Higgins PG, Dammhayn C, Hackel M, Seifert H. Global spread of carbapenem-resistant Acinetobacter baumannii. J Antimicrob Chemother. 2010; 65: 233-8. DOI: https://doi.org/10.1093/jac/dkp428
Montero JC, Ortiz E, Fernandez T, Cayuela A, Marque J, García A, et al. Acinetobacter baumannii ventilator-associated pneumonia: epidemiological and clinical findings. Intensive Care Med. 2005; 31:649-55. DOI: https://doi.org/10.1007/s00134-005-2598-0
Garnacho J, Ortiz C, Fernández E, Aldabo T, Cayuela A, et al. Acinetobacter baumanni ventilator- associated pneumonia: Epidemiological and clinical findings. Intensive Care Med. 2005; 31:649-55. DOI: https://doi.org/10.1007/s00134-005-2598-0
Cortes JA, Leal AL, Montañez AM, Buitrago G, Castillo JS, Guzman L. Frequency of microorganisms isolated in patients with bacteremia in intensive care units in Colombia and their resistance profiles. Braz j infect dis. 2013; 17 Supl 3:346-52 DOI: https://doi.org/10.1016/j.bjid.2012.10.022
Pinzón JO, Mantilla JR, Valenzuela EM, Fernández F, Álvarez CA, Osorio E. Molecular characterization of Acinetobacter baumannii isolations from a burns unit in a third level attention hospital in Bogotá. Infectio. 2006; 10:71-8.
Martínez P, Mattar S. Imipenem-resistant Acinetobacter baumannii carrying the IsaBA1-BlaOXA-23, 51 and IsaB1-BlaaDC-7 genes in Monteria, Colombia. Braz J Microbiol. 2012; 43(4):1274-80. DOI: https://doi.org/10.1590/S1517-83822012000400006
Organización Panamericana de Salud. Informe anual de la Red de Monitoreo de Vigilancia de la Resistencia a los Antibióticos. OPS/HDM/CD/A/541/09 2009. Washington, D.C. Organización Panamericana de la Salud; 2011.
Curcio D. Multidrug-resistant gram-negative bacterial infections: Are you ready for the challenge? Curr Clin Pharmacol. 2014; 9: 27-38. DOI: https://doi.org/10.2174/15748847113089990062
Boo TW, Walsh F, Crowley B. Molecular characterization of carbapenem-resistant Acinetobacter species in an Irish university hospital: predominance of Acinetobacter genomic species. J Med Microbiol. 2009; 58 Supl 2: 209-16. DOI: https://doi.org/10.1099/jmm.0.004911-0
Gales AC, Castanheira M, Jones RN, Sader HS. Antimicrobial resistance among Gram-negative bacilli isolated from Latin America: results from SENTRY Antimicrobial Surveillance Program (Latin America, 2008-2010). Diagn Microbiol Infect Dis. 2012; 73:354-60. DOI: https://doi.org/10.1016/j.diagmicrobio.2012.04.007
Dijkshoorn L, Nemec A, Seifert H. An increasing threat in hospitals: multidrug-resistant Acinetobacter baumannii. Nat Rev Microbiol. 2007; 5:939-951. DOI: https://doi.org/10.1038/nrmicro1789
Karageorgopoulos DE, Kelesidis T, Kelesidis I, Falagas ME. Tigecycline for the treatment of multidrug-resistant (including carbapenem-resistant) Acinetobacter infections: a review of the scientific evidence. J Antimicrob Chemother. 2008; 62 Supl 1: 45-55. DOI: https://doi.org/10.1093/jac/dkn165
Poirel L, Nordmann P. Genetic structures at the origin of acquisition and expression of the carbapenem-hydrolyzing oxacillinase gene blaOXA-58 in Acinetobacter baumannii. Antimicrob. Agents Chemother. 2006; 50: 1442-48. DOI: https://doi.org/10.1128/AAC.50.4.1442-1448.2006
Hrenovica J, Durnb G, Goic-Barisicc I, Kovacicd A. Occurrence of an Environmental Acinetobacter baumannii Strain Similar to a Clinical Isolate in Paleosol from Croatia. Appl Environ Microbiol. 2014; 80:2860-66. DOI: https://doi.org/10.1128/AEM.00312-14
Poirel L, Nordmann P, Carbapenem resistance in Acinetobacter baumannii: mechanisms and epidemiology. Clin Microbiol Infect. 2006; 12:826- 36.. DOI: https://doi.org/10.1111/j.1469-0691.2006.01456.x
Downloads
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
The copy rights of the articles published in Colombia Médica belong to the Universidad del Valle. The contents of the articles that appear in the Journal are exclusively the responsibility of the authors and do not necessarily reflect the opinions of the Editorial Committee of the Journal. It is allowed to reproduce the material published in Colombia Médica without prior authorization for non-commercial use