Abstract
Introduction. Imipenem-resistant Acinetobacter baumannii (IRAB) represents a major clinical threat. Dissemination in critical care areas necessitates effective action measures including genotyping tools to study the clonality of these strains and trace their origin. The main aim of this study is to assess the genetic relatedness between IRAB isolates in our institution intensive care units (ICU) which are at a particular risk of outbreaks. Methods Nonreplicate IRAB strains were serially collected over 3 years period (January 2016–December 2018) from patients admitted to the ICU. The isolates were phenotypically identified by a matrix-assisted laser desorption/ionization time-of-flight- (MALDI-TOF-) based system (VITEK MS), and their susceptibility was tested by the phenotypic-based VITEK 2 system. Molecular fingerprinting was performed by enterobacterial repetitive intergenic consensus (ERIC-PCR) followed by hierarchal clustering. The patterns were analysed by the software of BioNumerics package version 7.6.3 (Applied Maths, Belgium). Results A total of eighty IRAB were isolated from 31 colonization and 59 infection sites in patients admitted to the ICU. Sixty-two samples were respiratory in origin (77.5%). The generated dendrogram revealed distinct patterns for majority (95%) of the strains. Meropenem maintained activity against 43.8% of the imipenem-resistant A. baumannii. Conclusion Meropenem can be a therapeutic option for imipenem-resistant A. baumannii.
Highlights
Imipenem-resistant Acinetobacter baumannii (IRAB) represents a major clinical threat
Clinical and Epidemiological Characterization of Cases of A. baumannii. 80 nonreplicate strains of imipenem-resistant A. baumannii were obtained from intensive care units (ICU) patients between 2016 and 2018. e clinical and demographic characteristics of patients with those strains are listed in Table 1. e median age was 60 years, and the median stay in the ICU prior to isolation was 15 days
Susceptibility testing results for commonly tested agents as per the CLSI for all A. baumannii and bacteremic strains are shown in Tables 3 and 4, respectively, with >50% cross-resistance noted for the 2 carbapenems tested
Summary
Imipenem-resistant Acinetobacter baumannii (IRAB) represents a major clinical threat. Dissemination in critical care areas necessitates effective action measures including genotyping tools to study the clonality of these strains and trace their origin. E main aim of this study is to assess the genetic relatedness between IRAB isolates in our institution intensive care units (ICU) which are at a particular risk of outbreaks. E banding patterns propose that multiple IRAB strains are circulating in the intensive care units of the institution. Drivers for this diversity need to be evaluated including antimicrobial consumption. A global study covering seventy-five countries in five continents identified this pathogen as the fifth problematic organism implicated in nosocomial outbreaks and healthcare-associated infections in critical care settings [2]. Outbreaks are frequently reported with CRAB in healthcare institutions and in critical care areas [9]. ese outbreaks can be caused by clonal dissemination or spread of genetically unrelated strains. e clonality in such a case can be examined through molecular typing tools of which several methods have been used to type the organism in different settings [10]
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