Abstract
BackgroundMultidrug-resistant (MDR) Acinetobacter baumannii infections are considered as emerging nosocomial infections particularly in patients hospitalized in intensive care units (ICUs). Therefore, reliable detection of MDR strains is crucial for management of treatment but also for epidemiological data collections. The purpose of this study was to compare antimicrobial resistance and the clonal distribution of MDR clinical and environmental A. baumannii isolates obtained from the ICUs of 10 different hospitals from five geographical regions of Turkey in the context of the demographic and clinical characteristics of the patients.MethodsA multicenter-prospective study was conducted in 10 medical centers of Turkey over a 6 month period. A total of 164 clinical and 12 environmental MDR A. baumannii isolates were included in the study. Antimicrobial susceptibility testing was performed for amikacin (AN), ampicillin–sulbactam (SAM), ceftazidime (CAZ), ciprofloxacin (CIP), imipenem (IMP) and colistin (COL) by microdilution method and by antibiotic gradient test for tigecycline (TIG). Pulsed-field gel electrophoresis (PFGE) was performed to determine the clonal relationship between the isolates. The detection of the resistance genes, blaOXA-23, blaOXA-24, blaOXA-51,blaOXA-58,blaIMP,blaNDM, blaKPC, blaOXA-48 and blaPER-1 was carried out using the PCR method.ResultsThe mortality rate of the 164 patients was 58.5%. The risk factors for mortality included diabetes mellitus, liv1er failure, the use of chemotherapy and previous use of quinolones. Antimicrobial resistance rates for AN, SAM, CAZ, CIP, IMP, COL and TIG were 91.8%, 99.4%, 99.4%, 100%, 99.4%, 1.2% and 1.7% respectively. Colistin showed the highest susceptibility rate. Four isolates did not grow on the culture and were excluded from the analyses. Of 172 isolates, 166 (96.5%) carried blaOXA-23, 5 (2.9%) blaOXA-58 and one isolate (0.6%) was positive for both genes. The frequency of blaPER-1 was found to be 2.9%. None of the isolates had blaIMP, blaKPC, blaNDM and blaOXA-48 genes. PFGE analysis showed 88 pulsotypes. Fifteen isolates were clonally unrelated. One hundred fifty-seven (91.2%) of the isolates were involved in 14 different clusters.ConclusionsColistin is still the most effective antibiotic for A. baumannii infections. The gene blaOXA-23 has become the most prevalent carbapenemase in Turkey. The distribution of invasive A. baumannii isolates from different regions of Turkey is not diverse so, infection control measures at medical centers should be revised to decrease the MDR A. baumannii infections across the country. The results of this study are expected to provide an important baseline to assess the future prophylactic and therapeutic options.
Highlights
Invasive infections due to Acinetobacter baumannii are among the leading nosocomial infections in patients hospitalized in intensive care unit (ICU) [1]
A. baumannii accounts for almost 90% of all reported Acinetobacter infections including ventilator-associated pneumonia, bacteremia, meningitis, peritonitis, urinary tract infections and wound infections [2]
All patients who were admitted to the ICUs of medical centers with the diagnosis of invasive A. baumannii infections were included in the study
Summary
Invasive infections due to Acinetobacter baumannii are among the leading nosocomial infections in patients hospitalized in intensive care unit (ICU) [1]. The increasing number of these infections and the emergence of multidrug-resistant (MDR) strains make A. baumannii a troublesome pathogen especially in a hospital environment [1]. A. baumannii accounts for almost 90% of all reported Acinetobacter infections including ventilator-associated pneumonia, bacteremia, meningitis, peritonitis, urinary tract infections and wound infections [2]. A. baumannii is a common cause of bloodstream infections in ICUs [3]. Ventilator- associated respiratory failure, previous antibiotic therapy, colonization with A. baumannii and invasive procedures [5]. Multidrug-resistant (MDR) Acinetobacter baumannii infections are considered as emerging nosocomial infections in patients hospitalized in intensive care units (ICUs). The purpose of this study was to compare antimicrobial resistance and the clonal distribution of MDR clinical and environmental A. baumannii isolates obtained from the ICUs of 10 different hospitals from five geographical regions of Turkey in the context of the demographic and clinical characteristics of the patients
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