Community-acquired in name only: A cluster of carbapenem-resistant Acinetobacter baumannii in a burn intensive care unit and beyond

2020 ◽  
Vol 41 (5) ◽  
pp. 531-538 ◽  
Author(s):  
Erica S. Shenoy ◽  
Virginia M. Pierce ◽  
Mohamad R. A. Sater ◽  
Febriana K. Pangestu ◽  
Ian C. Herriott ◽  
...  
Keyword(s):  
Acinetobacter Baumannii ◽  
Tertiary Care ◽  
Index Patient ◽  
Environmental Sampling ◽  
Snp Analysis ◽  
Environmental Isolates ◽  
Carbapenem Resistant ◽  
Single Cluster ◽  
Clinical Cases

AbstractObjective:To describe an investigation into 5 clinical cases of carbapenem-resistant Acinetobacter baumannii (CRAB).Design:Epidemiological investigation supplemented by whole-genome sequencing (WGS) of clinical and environmental isolates.Setting:A tertiary-care academic health center in Boston, Massachusetts.Patients or participants:Individuals identified with CRAB clinical infections.Methods:A detailed review of patient demographic and clinical data was conducted. Clinical isolates underwent phenotypic antimicrobial susceptibility testing and WGS. Infection control practices were evaluated, and CRAB isolates obtained through environmental sampling were assessed by WGS. Genomic relatedness was measured by single-nucleotide polymorphism (SNP) analysis.Results:Four clinical cases spanning 4 months were linked to a single index case; isolates differed by 1–7 SNPs and belonged to a single cluster. The index patient and 3 case patients were admitted to the same room prior to their development of CRAB infection, and 2 case patients were admitted to the same room within 48 hours of admission. A fourth case patient was admitted to a different unit. Environmental sampling identified highly contaminated areas, and WGS of 5 environmental isolates revealed that they were highly related to the clinical cluster.Conclusions:We report a cluster of highly resistant Acinetobacter baumannii that occurred in a burn ICU over 5 months and then spread to a separate ICU. Two case patients developed infections classified as community acquired under standard epidemiological definitions, but WGS revealed clonality, highlighting the risk of burn patients for early-onset nosocomial infections. An extensive investigation identified the role of environmental reservoirs.

Environmental contamination by carbapenem-resistant Acinetobacter baumannii: The effects of room type and cleaning methods

2019 ◽  
pp. 1-6 ◽  
Author(s):  
Anat Or Lerner ◽  
Jalal Abu-Hanna ◽  
Yehuda Carmeli ◽  
Vered Schechner
Keyword(s):  
Hydrogen Peroxide ◽  
Acinetobacter Baumannii ◽  
Environmental Contamination ◽  
Tertiary Care ◽  
Care Hospital ◽  
Single Patient ◽  
Carbapenem Resistant ◽  
Cleaning Methods ◽  
Almost All

Abstract Objective: We evaluated environmental contamination by carbapenem-resistant Acinetobacter baumannii (CRAB), the effectiveness of cleaning practices, the performance of aerosolized hydrogen-peroxide (aHP) technology, and the correlation between measures of cleaning and environmental contamination. Design: Serial testing of environmental contamination during a 7-month period. Setting: Single-patient rooms in intensive care units (ICUs) and multipatient step-up and regular rooms in internal medicine wards in a tertiary-care hospital with endemic CRAB. Methods: CRAB environmental contamination was determined semiquantitatively using sponge sampling. Results: In step-up rooms, 91% of patient units (56% of objects) were contaminated, and half of them were heavily contaminated. In regular rooms, only 21% of patient units (3% of objects) were contaminated. In ICUs, 76% of single-patient rooms (24% of objects) were contaminated. Cleaning did not reduce the number of contaminated objects or patient units in step-up rooms. After refresher training, cleaning reduced the proportion of contaminated objects by 2-fold (P = .001), but almost all patient units remained contaminated. Using aerosolized hydrogen peroxide (aHP) disinfection after discharge of a known CRAB-carrier decreased room contamination by 78%, similar to the reduction achieved by manual hypochloride cleaning. Measuring cleaning efficacy using fluorescent gel did not correlate with recovery of CRAB by sponge cultures. Conclusions: In step-up rooms, the high number of objects contaminated combined with poor efficacy of cleaning resulted in failure to eliminate CRAB in patient units. Fluorescent gel is a poor detector of CRAB contamination. The role of aHP is still unclear. However, its use in multipatient rooms is limited because it can only be used in unoccupied rooms.

scholarly journals The Role of Uniform Meropenem Usage in Acinetobacter baumannii Clone Replacement

Antibiotics ◽  
2021 ◽  
Vol 10 (2) ◽  
pp. 127
Author(s):  
Bence Balázs ◽  
Zoltán Tóth ◽  
Fruzsina Nagy ◽  
Renátó Kovács ◽  
Hajnalka Tóth ◽  
...  
Keyword(s):  
Acinetobacter Baumannii ◽  
Care Center ◽  
Tertiary Care ◽  
Antibiotic Consumption ◽  
Resistance Level ◽  
Carbapenem Resistant ◽  
Significant Difference ◽  
Time Kill ◽  
Sequence Types

The dominant carbapenem resistant Acinetobacter baumannii harboring blaOXA-23-like carbapenemase was replaced by blaOXA-40-like carriers in a Hungarian tertiary-care center with high meropenem but relatively low imipenem use. We hypothesized that alterations in antibiotic consumption may have contributed to this switch. Our workgroup previous study examined the relation between resistance spiral and the antibiotic consumption, and the results suggest that the antibiotic usage provoked the increasing resistance in case of A. baumannii. We aimed at measuring the activity of imipenem and meropenem to compare the selection pressure exerted by the different carbapenems in time-kill assays. Strain replacement was confirmed by whole genome sequencing, core-genome multilocus sequence typing (cgMLST), and resistome analysis. Based on results of the time-kill assays, we found a significant difference between two different sequence-types (STs) in case of meropenem, but not in case of imipenem susceptibility. The newly emerged ST636 and ST492 had increased resistance level against meropenem compared to the previously dominant ST2 and ST49. On the other hand, the imipenem and colistin resistance profiles were similar. These results suggest, that the uniform meropenem usage may have contributed to A. baumannii strain replacement in our setting.

scholarly journals Whole-Genome Sequencing for Investigating a Health Care-Associated Outbreak of Carbapenem-Resistant Acinetobacter baumannii

Diagnostics ◽  
2021 ◽  
Vol 11 (2) ◽  
pp. 201
Author(s):  
Sang Mee Hwang ◽  
Hee Won Cho ◽  
Tae Yeul Kim ◽  
Jeong Su Park ◽  
Jongtak Jung ◽  
...  
Keyword(s):  
Whole Genome Sequencing ◽  
Acinetobacter Baumannii ◽  
Genome Sequencing ◽  
Snp Analysis ◽  
Whole Genome ◽  
Phylogenetic Tree Analysis ◽  
Web Based ◽  
Hospital Outbreak ◽  
Carbapenem Resistant ◽  
Bioinformatics Tools

Carbapenem-resistant Acinetobacter baumannii (CRAB) outbreaks in hospital settings challenge the treatment of patients and infection control. Understanding the relatedness of clinical isolates is important in distinguishing outbreak isolates from sporadic cases. This study investigated 11 CRAB isolates from a hospital outbreak by whole-genome sequencing (WGS), utilizing various bioinformatics tools for outbreak analysis. The results of multilocus sequence typing (MLST), single nucleotide polymorphism (SNP) analysis, and phylogenetic tree analysis by WGS through web-based tools were compared, and repetitive element polymerase chain reaction (rep-PCR) typing was performed. Through the WGS of 11 A. baumannii isolates, three clonal lineages were identified from the outbreak. The coexistence of blaOXA-23, blaOXA-66, blaADC-25, and armA with additional aminoglycoside-inactivating enzymes, predicted to confer multidrug resistance, was identified in all isolates. The MLST Oxford scheme identified three types (ST191, ST369, and ST451), and, through whole-genome MLST and whole-genome SNP analyses, different clones were found to exist within the MLST types. wgSNP showed the highest discriminatory power with the lowest similarities among the isolates. Using the various bioinformatics tools for WGS, CRAB outbreak analysis was applicable and identified three discrete clusters differentiating the separate epidemiologic relationships among the isolates.

Role of tigecycline in the control of a carbapenem-resistant Acinetobacter baumannii outbreak in an intensive care unit

2009 ◽  
Vol 72 (3) ◽  
pp. 234-242 ◽  
Author(s):  
W. Jamal ◽  
M. Salama ◽  
N. Dehrab ◽  
G. Al Hashem ◽  
M. Shahin ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Acinetobacter Baumannii ◽  
Carbapenem Resistant

Molecular detection of blaOXA-23gene and blaOXA-51 gene in carbapenem resistant strains of Acinetobacterbaumannii in patients with ventilator associated pneumonia at tertiary care hospital

2021 ◽  
Vol 71 (11) ◽  
pp. 2576-2581
Author(s):  
Saima Ishtiaq ◽  
Sidrah Saleem ◽  
Abdul Waheed ◽  
Arslan Ahmed Alvi
Keyword(s):  
Acinetobacter Baumannii ◽  
Tertiary Care ◽  
Carbapenem Resistance ◽  
Conventional Polymerase Chain Reaction ◽  
Diffusion Method ◽  
Military Hospital ◽  
Care Hospital ◽  
Acinetobacter Baumanii ◽  
Cross Sectional ◽  
Carbapenem Resistant

Objective: To evaluate carbapenem resistance and to detect blaOXA-23 and blaOXA-51 genes in carbapenem-resistant acinetobacter baumanii isolates recovered from patients having pneumonia secondry to ventilation. Methods: The cross-sectional study was conducted from July 2017 to June 2018 at the Department of Microbiology, University of Health Sciences, Lahore, Pakistan, and comprised endotracheal aspirates / tracheobroncheal lavage samples from patients irrespective of age and gender who developed pneumonia after being on the ventilator for 48 hrs at the Combined Military Hospital, and Jinnah Hospital, Lahore.  The samples were inoculated on MacConkey and blood agar and aerobically incubated at a temperature of 370C for 18-24 hours. The isolated organisms were further assessed by standard morphological, cultural and biochemical profile. Antibiotic susceptibility was done by Kirby-Bauer disc diffusion method. Carbapenem-resistant acinetobacter baumannii were checked for carbapenemase production using Modified Hodge Test. Conventional polymerase chain reaction and agarose gel electrophoreses were performed to detect blaOXA-23 and blaOXA-51 genes. Data was analysed using SPSS 17. Results: Out of 157 samples, 92(58.6%) yielded growth of bacteria, and, among them, 39(42.4%) were identified as acinetobacter baumannii. All (100%) acinetobacter baumannii cases showed resistance to carbapenem, were producing carbapenemase enzyme, and were positive for blaOXA-51 gene. The blaOXA-23 gene was amplified in 38(97.4%) isolates. Conclusion: BlaOXA-23 gene appeared to be the major cause of carbapenem resistance. Continuous...

scholarly journals Outbreak of NDM-1-producing Acinetobacter baumannii in France, January to May 2013

2013 ◽  
Vol 18 (31) ◽  
Author(s):  
J W Decousser ◽  
C Jansen ◽  
P Nordmann ◽  
A Emirian ◽  
R A Bonnin ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Acinetobacter Baumannii ◽  
Index Patient ◽  
Imported Case ◽  
Carbapenem Resistant ◽  
Carbapenemase Gene

We report the first outbreak of carbapenem-resistant NDM-1-producing Acinetobacter baumannii in Europe, in a French intensive-care unit in January to May 2013. The index patient was transferred from Algeria and led to the infection/colonisation of five additional patients. Concurrently, another imported case from Algeria was identified. The seven isolates were genetically indistinguishable, belonging to ST85. The blaNDM-1 carbapenemase gene was part of the chromosomally located composite transposon Tn125. This report underscores the growing concern about the spread of NDM-1-producing A. baumannii in Europe.

scholarly journals Molecular Characterization of Invasive Carbapenem-Resistant Acinetobacter baumannii from a Tertiary Care Hospital in South India

2016 ◽  
Vol 5 (3) ◽  
pp. 379-387 ◽  
Author(s):  
Saranya Vijayakumar ◽  
Radha Gopi ◽  
Priya Gunasekaran ◽  
Manjurekar Bharathy ◽  
Kamini Walia ◽  
...  
Keyword(s):  
Acinetobacter Baumannii ◽  
Molecular Characterization ◽  
South India ◽  
Tertiary Care Hospital ◽  
Tertiary Care ◽  
Care Hospital ◽  
Carbapenem Resistant

scholarly journals Emergence and spread of carbapenem-resistant Acinetobacter baumannii in a tertiary care hospital in Turkey

2008 ◽  
Vol 282 (2) ◽  
pp. 214-218 ◽  
Author(s):  
Meliha Meric ◽  
Murat Kasap ◽  
Gulcin Gacar ◽  
Fatma Budak ◽  
Devrim Dundar ◽  
...  
Keyword(s):  
Acinetobacter Baumannii ◽  
Tertiary Care Hospital ◽  
Tertiary Care ◽  
Care Hospital ◽  
Carbapenem Resistant

scholarly journals Molecular mechanisms of antibiotic co-resistance among carbapenem resistant Acinetobacter baumannii

2019 ◽  
Vol 13 (10) ◽  
pp. 899-905 ◽  
Author(s):  
Mohsin Khurshid ◽  
Muhammad Hidayat Rasool ◽  
Muhammad Hussnain Siddique ◽  
Farrukh Azeem ◽  
Muhammad Naeem ◽  
...  
Keyword(s):  
Acinetobacter Baumannii ◽  
Molecular Mechanisms ◽  
Antimicrobial Agents ◽  
Tertiary Care ◽  
Antibiotic Resistance Genes ◽  
Polymyxin B ◽  
Beta Lactam ◽  
Genetic Determinants ◽  
Carbapenem Resistant ◽  
Tertiary Care Hospitals

Introduction: The spread of carbapenem-resistant Acinetobacter baumannii (CRAB) is difficult to control especially in the hospitals due to the successful mobilization and evolution of the genetic elements harboring the resistant determinants. The study was conducted to examine the distribution of aminoglycosides, tetracycline, and sulfonamide-resistant determinants among CRAB isolates that carry the blaOXA-23 gene. Methodology: For a total of 160 CRAB strains isolated at tertiary care hospitals of Pakistan that mainly carried blaOXA-23 gene were included in the study to evaluate the assortment of antibiotic resistance genes. Results: The susceptibility rates of CRAB for other than beta-lactam drugs were 2.5% for both ciprofloxacin and aminoglycosides and 18% and 25% for sulfonamides and tetracyclines, respectively. Polymyxin B (MIC90, 1 g/mL) Colistin (MIC90, 1 g/mL) and Tigecycline (MIC90, 2 g/mL) were most active against these extensively drug-resistant CRAB isolates. The isolates were found to possess various genes mainly the tetB and sul2 for tetracycline and sulfonamide but the genes conferring resistance to aminoglycosides were varied with various combinations. Conclusion: Despite the CRAB clones containing blaOXA-23 have been previously reported in Pakistani hospitals, the screening of genetic determinants responsible for other antimicrobial agents is crucial for developing an effective surveillance and mitigation system for infection management.

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