Co-infection of ST2IP carbapenem-resistant Acinetobacter baumannii with SARS-CoV-2 in the patients admitted to a Tehran tertiary referral hospital

Mohammadreza Salehi,Amir Aliramezani,Mahsa Norouzi Shadehi,Masoumeh Douraghi,Alireza Abdollahi,Sedighe Ghourchian

doi:10.1186/s12879-021-06642-2

Mohammadreza Salehi, Amir Aliramezani + Show 4 more

Open Access

https://doi.org/10.1186/s12879-021-06642-2

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Abstract

BackgroundCarbapenem-resistant Acinetobacter baumannii (CRAB) is among the most concerning cause of healthcare-associated infections (HAI) due to its high level of antibiotic resistance and high mortality. In the era of the COVID-19 pandemic, the key priority of infection control committees is to contain the dissemination of antibiotic resistant Gram-negative bacteria. Here, we aimed to timely recognize the emergence of CRAB in COVID-19 cases admitted to the wards of a tertiary referral hospital and to identify the genetic relatedness of the isolates.MethodsFrom 30 March to 30 May 2020, a total of 242 clinical samples from COVID-19 cases were screened for CRAB isolates using standard microbiologic and antibiotic susceptibility tests. The PCRs targeting oxa23, oxa24, oxa58, blaTEM and blaNDM-1 genes were performed. Two multiplex PCRs for identifying the global clones (GC) of A. baumannii were also performed. The sequence type of CRABs was determined using Institut Pasteur (IP) multilocus sequence typing (MLST) scheme.ResultsEighteen CRAB isolates were recovered from COVID-19 patients with the mean age of 63.94 ± 13.8 years. All but 4 COVID-19 patients co-infected with CRAB were suffering from an underlying disease. Death was recorded as the outcome in ICUs for 9 (50%) COVID-19 patients co-infected with CRAB. The CRAB isolates belong to GC2 and ST2IP and carried the oxa23 carbapenem resistance gene.ConclusionThis study demonstrated the co-infection of CRAB isolates and SARS-CoV-2 in the patients admitted to different ICUs at a referral hospital in Tehran. The CRAB isolates were found to belong to ST2IP, share the oxa23 gene and to have caused several outbreaks in the wards admitting COVID-19 patients.

Highlights

Carbapenem-resistant Acinetobacter baumannii (CRAB) is among the most concerning cause of healthcare-associated infections (HAI) due to its high level of antibiotic resistance and high mortality
Properties of the CARB isolates From 18 CRAB isolates, 11 (61.2%) isolates were recovered from tracheal discharge and the remaining 7 (38.8%) isolates were obtained from blood
All CRAB isolates belonged to GC2 and were found to contain the same multilocus sequence typing (MLST) profile of 2-2-2-2-2-2-2, which corresponds to ST2IP

Summary

Introduction

Carbapenem-resistant Acinetobacter baumannii (CRAB) is among the most concerning cause of healthcare-associated infections (HAI) due to its high level of antibiotic resistance and high mortality. In the era of the COVID-19 pandemic, the key priority of infection control committees is to contain the dissemination of antibiotic resistant Gram-negative bacteria. The Centre for Disease Control (CDC) listed the multidrug-resistant Acinetobacter as “Serious threat” in 2013 [8]; it reported CRAB as “Urgent threat” in 2019. This threat level increased due to the lack of new antibiotics for treatment as well as the widespread dissemination of resistance among the isolates in healthcare settings [9]. The carbapenem resistance in A. baumannii is significantly associated with the carbapenem hydrolysing oxacillinases encoded by the oxa, oxa and oxa genes which are found on mobile genetic elements and can be disseminated among bacteria [10, 11]

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