Abstract
BackgroundA. baumannii has emerged as an important nosocomial pathogen with an outstanding ability to acquire multidrug resistant mechanisms. In this study, we investigate the molecular epidemiology and carbapenem resistance mechanisms of A. baumannii in Tripoli, Northern Lebanon.MethodsOne hundred sixteen non-duplicate isolates isolated between 2011 and 2013 in different hospitals in Tripoli, Lebanon from Lebanese patients and wounded Syrian patients during Syrian war were studied. Antibiotic susceptibility testing was determined by agar disc diffusion and Etest. Carbapenemase-encoding genes were investigated by PCR. All isolates were typed by blaOXA-51-like sequence based typing (SBT) and 57 isolates were also analysed by MLST using Pasteur’s scheme followed by eBURST analysis.ResultsOf the 116 isolates, 70 (60 %) showed a carbapenem resistance phenotype. The blaOXA-23 with an upstream insertion of ISAba1 was the major carbapenem resistance mechanism and detected in 65 isolates. Five isolates, including four from wounded Syrian patients and one from a Lebanese patient, were positive for blaNDM-1. blaOXA-51-like SBT revealed the presence of 14 variants, where blaOXA-66 was the most common and present in 73 isolates, followed by blaOXA-69 in 20 isolates. MLST analysis identified 17 sequence types (ST) and showed a concordance with blaOXA-51-like SBT. Each clonal complex (CC) had a specific blaOXA-51-like sequence such as CC2, which harboured blaOXA-66 variant, and CC1 harbouring blaOXA-69 variant. NDM-1 producing isolates belonged to ST85 (4 Syrian isolates) and ST25 (1 Lebanese isolate).ConclusionsOur results showed a successful predominance of international clone 2 with a widespread occurrence of OXA-23 carbapenemase in Lebanese hospitals. These findings emphasise the urgent need of effective measures to control the spread of A. baumannii in this country.
Highlights
A. baumannii has emerged as an important nosocomial pathogen with an outstanding ability to acquire multidrug resistant mechanisms
59 had been obtained from Syrian refugees and 57 from Lebanese patients. They were all confirmed as A. baumannii by blaOXA-51 real time PCR and RNA polymerase ß-subunit (rpoB) gene sequencing
Our study provided a global view of molecular epidemiology of A. baumannii isolates from hospitals in Tripoli, Lebanon
Summary
A. baumannii has emerged as an important nosocomial pathogen with an outstanding ability to acquire multidrug resistant mechanisms. We investigate the molecular epidemiology and carbapenem resistance mechanisms of A. baumannii in Tripoli, Northern Lebanon. A. baumannii is an opportunistic pathogen mainly involved in healthcare-associated infections, with increased mortality and morbidity [1]. In order to identify and track these clones during hospital outbreaks, numerous molecular typing methods have been proposed such as pulsed-field gel electrophoresis (PFGE), amplified fragment length polymorphism (AFLP), repetitive-sequencebased PCR (rep-PCR), and multilocus sequence typing (MLST) [10,11,12,13,14]. BlaOXA-51-like sequence-based typing (SBT), a simple typing method based on sequencing of the full length of blaOXA-51like gene has been proposed as it has shown a similar discriminatory power than rep-PCR, and MLST [16, 18,19,20]
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