Abstract
Acinetobacter (A.) baumannii has gained global notoriety as a significant nosocomial pathogen because it is frequently associated with multi-drug resistance and hospital-based outbreaks. There is a substantial difference in the incidence of A. baumannii infections between different countries and within Germany. However, its continuous spread within Germany is a matter of concern. A systematic literature search and analysis of the literature published between 2000 and 2018 on A. baumannii in humans was performed. Forty-four studies out of 216 articles met the criteria for inclusion, and were selected and reviewed. The number of published articles is increasing over time gradually. Case reports and outbreak investigations are representing the main body of publications. North Rhine-Westphalia, Hesse and Baden-Wuerttemberg were states with frequent reports. Hospitals in Cologne and Frankfurt were often mentioned as specialized institutions. Multiresistant strains carrying diverse resistance genes were isolated in 13 of the 16 German states. The oxacillinase blaOXA-23-like, intrinsic blaOXA-51-like, blaOXA-58 variant, blaNDM-1, blaGES-11, blaCTX-M and blaTEM are the most predominant resistance traits found in German A. baumannii isolates. Five clonal lineages IC-2, IC-7, IC-1, IC-4 and IC-6 and six sequence types ST22, ST53, ST195, ST218, ST944/ST78 and ST348/ST2 have been reported. Due to multidrug resistance, colistin, tigecycline, aminoglycosides, fosfomycin, ceftazidime/avibactam and ceftolozan/tazobactam were often reported to be the only effective antibiotics left to treat quadruple multi-resistant Gram-negative (4MRGN) A. baumannii. Dissemination and infection rates of A. baumannii are on the rise nationwide. Hence, several aspects of resistance development and pathogenesis are not fully understood yet. Increased awareness, extensive study of mechanisms of resistance and development of alternative strategies for treatment are required. One-Health genomic surveillance is needed to understand the dynamics of spread, to identify the main reservoirs and routes of transmission and to develop targeted intervention strategies.
Highlights
Acinetobacter (A.) baumannii is a ubiquitous, Gram-negative, non-motile bacterium associated with hospital-acquired infection globally
Resistance in this pathogen is frequently associated with mobile genetic elements (MGEs) that are transferable between bacteria, enabling the rapid dissemination of resistance genes between bacteria of different species and creating a reservoir of antimicrobial-resistance (AMR) genes [7]
Nine dissertations with emphasis on isolation, molecular and functional typing, distribution and genetic composition of AMR determinants were found. Three of these were done in Bonn, three in Cologne and one each in Berlin, Freiburg and Frankfurt am Main representing the main centres of A. baumannii research
Summary
Acinetobacter (A.) baumannii is a ubiquitous, Gram-negative, non-motile bacterium associated with hospital-acquired infection globally. It has been classified among the most dangerous multiple drug-resistant (MDR) pathogens worldwide. A. baumannii emerged as an opportunistic nosocomial pathogen It has established niches for survival in hospitals as well as in primary animal production systems and the environment [4]. A. baumannii exhibits high genetic plasticity, which allows the accumulation of the acquired resistance determinants [7] Resistance in this pathogen is frequently associated with mobile genetic elements (MGEs) that are transferable between bacteria, enabling the rapid dissemination of resistance genes between bacteria of different species and creating a reservoir of antimicrobial-resistance (AMR) genes [7]
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