Molecular Epidemiology of Carbapenem-Resistant Acinetobacter baumannii in a Tertiary Care Hospital in Egypt: Clonal Spread of blaOXA-23

Abstract

Of great concern is the increased frequency of carbapenem-resistant Acinetobacter baumannii (CRAB) causing healthcare-associated infections. Different classes of β-lactamases are involved in this resistance through hydrolyzing carbapenems. Multilocus sequence typing (MLST) has been applied successfully for characterizing different varieties of bacterial pathogens epidemiologically. In the present study, we aimed to type and characterize the resistance profile of clinical isolates of CRAB causing healthcare-associated infections in patients admitted to Kasr Al-Aini hospital, using MLST, and compare with sequence types (STs) from other countries. A total of 50 isolates were collected from clinical samples (predominantly wound and blood), then identified by blaOXA-51-like gene PCR, and subjected to Oxford MLST scheme. The ST was designated according to PubMLST database, and e-BURST algorithm was used to assign clonal complexes. Four sets of multiplex PCR were performed to detect common carbapenem resistance genes. ST391 was the predominant ST detected in 17 cases, 70.5% of which harbored blaOXA-23 alone, both blaOXA-23 and blaKPC in 11.8%. Newly recognized 13 STs were submitted to the PubMLST database. Carbapenem resistance due to blaOXA-23 carbapenemase was detected in 36/50 (72%), followed by blaOXA-23 concomitant with blaKPC in 7/50 (14%), while blaNDM with blaOXA-58 in 3/50 (6%) and blaNDM alone in 1 case (2%). To conclude, this study demonstrates the propagation of highly resistant clone of STs 391 and 1151, carrying blaOXA-23 genes, with the first report of blaKPC in blaOXA carrying CRAB and the presence of new STs by performing the MLST technique in an Egyptian laboratory facility.