Multidrug-resistant Acinetobacter Species Research Articles

Multidrug resistant Acinetobacter species – Emergence of a potent pathogen from clinical isolates of tertiary care teaching centre of Central India

Multidrug resistant Acinetobacter species – Emergence of a potent pathogen from clinical isolates of tertiary care teaching centre of Central India

Potential Usefulness of Bacteriophages for the Treatment of Multidrug-Resistant Acinetobacter Infection.

Bacteriophages were discovered in early 20th century. However, the interest in bacteriophage research was reduced with the discovery of antibiotics. With the increasing number of infections due to multidrug-resistant (MDR) organisms, the potential usefulness of bacteriophages as therapeutic agents has been re-evaluated. In this review, we found that more than 30 lytic bacteriophages that infect Acinetobacter species have been characterised. These are mainly members of Caudovirales, with genome sizes ranging from 31 kb to 234 kb and G+C contents ranging from 33.5% to 45.5%. The host range can be as low as < 10% of all tested Acinetobacter strains. Fourteen published murine trials indicated positive outcomes in bacteriophage-treated groups. Only two case reports were pertaining to the use of bacteriophages in the treatment of Acinetobacter infections in humans; in both cases, the infections were resolved with bacteriophage therapy. The use of bacteriophages has been associated with reduced Acinetobacter burden in the environment, as shown in two studies. The major limitation of bacteriophage therapy is its highly selective host strain. In conclusion, the potential usefulness of bacteriophage therapy for the treatment of MDR Acinetobacter species has been documented only in limited studies and more research is needed prior to its extensive use in clinical practice.

Post-COVID-19 Pneumocystis pneumonia cases from Pakistan: an observational study.

Background. Concurrent coronavirus disease 2019 (COVID-19) and Pneumocystis jirovecii pneumonia (PJP) has been described in various reports, with a recent study describing a 9.3 % P. jirovecii detection rate in critically ill COVID-19 patients. Methods. Patients with PCR-confirmed PJP following COVID-19 infection who were admitted to Aga Khan University Hospital, Karachi, Pakistan from March 2020-June 2021 were identified through a laboratory database. Detection of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) virus was performed by RT-PCR Cobas SARS-CoV-2 qualitative assay. P. jirovecii PCR was performed using the RealStar Pneumocystis jirovecii PCR kit. Clinical, radiological and laboratory data for PJP patients were recorded. Results. During the study period, 3707 patients were admitted with COVID-19 at our hospital. P. jirovecii PCR was requested for 90 patients and was positive in 10 (11 %). Five out of 10 patients were discharged from the hospital and later developed cough and dyspnoea. Five patients remained hospitalized with severe COVID-19 and developed PJP. Eight patients in our study received systemic steroids. The trends of lymphocyte counts of all patients showed a lymphocyte count of <1000 mm-3 (<1.0×106 cells µl-1) in the week of PJP diagnosis. Four patients did not survive; one of these patients did not receive co-trimoxazole due to late diagnosis, one patient had concomitant nosocomial pneumonia and bacteraemia with multidrug-resistant Acinetobacter species, and two patients had concomitant aspergillosis. Conclusion. In summary, invasive fungal infections such as PJP should be considered as a complication in COVID-19 patients, with prompt evaluation and management.

Multidrug-Resistant Klebsiella, Pseudomonas and Acinetobacter Species at a Referral Hospital, Gondar, Ethiopia: a Retrospective Study.

Multidrug-resistant Gram-negative bacteria particularly Klebsiella, Pseudomonas and Acinetobacter species are recognized as a major health concern worldwide. As a result, the World Health Organization listed these bacteria in the critical priority pathogens group. This study aimed to assess the prevalence of carbapenem and multidrug-resistant Klebsiella, Pseudomonas, and Acinetobacter species at the University of Gondar Comprehensive Specialized Hospital. A five-year hospital based retrospective study was conducted from July to September 2021. Socio-demographic and laboratory data were collected from medical records in microbiology laboratory. The quality of the extracted data was assured through cross checking. The data were entered through Epi-data version 4.4.3.1, exported and analyzed using SPSS version 20. The variables were analyzed and presented through tables and graphics. In this study, the frequencies of male participants and neonates under the age of one week were 585 (62.8%) and 210 (22.6%), respectively. Approximately half (436; 46.8%) of the bacterial isolates were recovered from blood specimen. A total of 931 isolates were recorded, where 576 (61.9%) of these isolates were multidrug-resistant. More than two-third of Klebsiella ozaenae (87; 68.5%) and Klebsiella pneumoniae (398; 63.3%) were multidrug-resistant. Of the total bacterial isolates, 24 (13.1%) and 82 (22.9%) were resistant to imipenem and meropenem, respectively. The proportion of multidrug and carbapenem resistance in Klebsiella, Pseudomonas and Acinetobacter species were high. Therefore, urgent intervention including prevention of the spread of antimicrobial resistant strains and infection prevention practices is required. Treatment should also be guided with antimicrobial susceptibility testing.

A Self-Forming Hydrogel from a Bactericidal Copolymer: Synthesis, Characterization, Biological Evaluations and Perspective Applications

Objects touched by patients and healthcare workers in hospitals may harbor pathogens, including multi-drug resistant (MDR) staphylococci, enterococci (VRE), Escherichia coli, Acinetobacter, and Pseudomonas species. Medical devices contaminated by these pathogens may also act as a source of severe and difficult-to-treat human infections, thus becoming a critical public health concern requiring urgent resolutions. To this end, we recently reported the bactericidal effects of a cationic copolymer (CP1). Here, aiming at developing a bactericidal formulation possibly to be used either for surfaces disinfection or to treat skin infections, CP1 was formulated as a hydrogel (CP1_1.1-Hgel). Importantly, even if not cross-linked, CP1 formed the gel upon simple dispersion in water, without requiring gelling agents or other additives which could be skin-incompatible or interfere with CP1 bactericidal effects in possible future topical applications. CP1_1.1-Hgel was characterized by attenuated-total-reflectance Fourier transform infrared (ATR-FTIR) and UV-Vis spectroscopy, as well as optic and scanning electron microscopy (OM and SEM) to investigate its chemical structure and morphology. Its stability was assessed by monitoring its inversion properties over time at room temperature, while its mechanical characteristics were assessed by rheological experiments. Dose-dependent cytotoxicity studies performed on human fibroblasts for 24 h with gel samples obtained by diluting CP_1.1-Hgel at properly selected concentrations established that the 3D network formation did not significantly affect the cytotoxic profile of CP1. Also, microbiologic investigations carried out on two-fold serial dilutions of CP1-gel confirmed the minimum inhibitory concentrations (MICs) previously reported for the not formulated CP1.Selectivity indices values up to 12 were estimated by the values of LD50 and MICs determined here on gel samples.

Antibiogram data from private hospitals in Hong Kong: 6-year retrospective study.

The surveillance of antibiotic resistance is critical for the establishment of effective control strategies. The antibiotic resistance situations in private hospitals in Hong Kong have not been systematically described. The objective of the study was to analyse antibiogram data from private hospitals and describe the temporal trends of non-susceptibility percentages in this setting. This retrospective descriptive study used antibiogram data from all private hospitals in Hong Kong that had been collected annually for 6 years (2014-2019). Data on six targeted bacteria and their corresponding multidrug-resistant organisms were included. The non-susceptibility percentages of isolates remained stable or decreased during the study period: methicillin-resistant Staphylococcus aureus had a stable prevalence of approximately 20%; extended-spectrum beta-lactamase-producing Escherichia coli and Klebsiella species had stable prevalences of 20% to 30% and 10% to 20%, respectively; multidrug-resistant Acinetobacter species had prevalences of approximately 2% to 8%, which decreased over time; multidrug-resistant Pseudomonas aeruginosa had prevalences of 0.0% to 0.3%; Streptococcus pneumoniae penicillin and macrolide non-susceptibility percentages were 2% to 9% and 71% to 79%, respectively. These values generally were comparable with findings from public hospitals and Residential Care Homes for the Elderly in Hong Kong. However, the prevalences of carbapenem-resistant Enterobacteriaceae, which are increasing in Hong Kong and other nations, were also increasing in our dataset despite their currently low values (<1% for Escherichia coli and <2% for Klebsiella species). The antibiotic resistance landscape among private hospitals in Hong Kong is satisfactory overall; there remains a need for surveillance, antibiotic stewardship, and other infection control measures.

Antimicrobial Resistance Profiling of Routine Antibiotics and Mango Kernel (Mangifera Indica L.) Ethanolic Extract on Multidrug-Resistant Acinetobacter Isolates

Multidrug-resistant (MDR) Acinetobacter species are opportunistic pathogens that are clinically important, which causes severe infection during a prolonged stay in an Intensive Care Unit (ICU) of the hospital. In the present study, we screened clinical isolates of Acinetobacter species for its MDR nature from the ICU of a tertiary care centre at Abha, Saudi Arabia during the period of 2013-2017. Confirmed MDR Acinetobacter species clinical isolates were challenged against ethanolic extracts from mango kernel (Mangifera Indica L.) by classical disc diffusion method. In total, we characterized 124 MDR Acinetobacter isolates, out of which 62 (50%) were Acinetobacter baumannii (MDR-AB), 41 (33.1%) were Acinetobacter baumannii complex (MDR-ABC), 15 (12.1%) were Acinetobacter baumannii-haemolyticus (MDR-ABH), 3 (2.4%) were Acinetobacter haemolyticus (MDR-AH) and 3 (2.4%) were Acinetobacter iwoffii (MDR-AI). We observed that MDR-AB isolates were inhibited by ethanolic extract of M. indica with minimum inhibition concentration (MIC) of 0.25 mg/ml. Concentrations of 50 mg/mL, 5 mg/mL and 0.5 mg/mL exhibited average inhibition zones of 18.74±0.09, 15.51±0.08 and 9.74±0.06 mm respectively showing a concentration dependent antagonisms (R2= 0.947). The results of M. indica were comparable to Colistin inhibition zone of 14.98±0.72 mm with 50 mg/mL and 5 mg/mL exceeded those of the positive control (p= 0.6721 and 0.1045, respectively). However, Colistin showed minor increase over M. indica at the concentration 0.5-mg/ mL (p= 0.5384). More specifically, MDR-AB strains have shown a substantial susceptibility to mango kernel extract (0.25 mg/mL) with antagonism similar to that of Colistin. Thus, the study shows that the extracts of mango kernel as a potential drug target and could be potentially used as an adjunct treatment along with the standard agents to treat Acinetobacter infections.

Import of multidrug-resistant bacteria from abroad through interhospital transfers, Finland, 2010–2019

BackgroundWhile 20–80% of regular visitors to (sub)tropical regions become colonised by extended-spectrum β-lactamase-producing Enterobacteriaceae (ESBL-PE), those hospitalised abroad often also carry other multidrug-resistant (MDR) bacteria on return; the rates are presumed to be highest for interhospital transfers.AimThis observational study assessed MDR bacterial colonisation among patients transferred directly from hospitals abroad to Helsinki University Hospital. We investigated predisposing factors, clinical infections and associated fatalities.MethodsData were derived from screening and from diagnostic samples collected between 2010 and 2019. Risk factors of colonisation were identified by multivariable analysis. Microbiologically verified symptomatic infections and infection-related mortality were recorded during post-transfer hospitalisation.ResultsColonisation rates proved highest for transfers from Asia (69/96; 71.9%) and lowest for those within Europe (99/524; 18.9%). Of all 698 patients, 208 (29.8%) were colonised; among those, 163 (78.4%) carried ESBL-PE, 28 (13.5%) MDR Acinetobacter species, 25 (12.0%) meticillin-resistant Staphylococcus aureus, 25 (12.0%) vancomycin-resistant Enterococcus, 14 (6.7%) carbapenemase-producing Enterobacteriaceae, and 12 (5.8%) MDR Pseudomonas aeruginosa; 46 strains tested carbapenemase gene-positive. In multivariable analysis, geographical region, intensive care unit (ICU) treatment and antibiotic use abroad proved to be risk factors for colonisation. Clinical MDR infections, two of them fatal (1.0%), were recorded for 22 of 208 (10.6%) MDR carriers.ConclusionsColonisation by MDR bacteria was common among patients transferred from foreign hospitals. Region of hospitalisation, ICU treatment and antibiotic use were identified as predisposing factors. Within 30 days after transfer, MDR colonisation manifested as clinical infection in more than 10% of the carriers.

Emergence of Highly Multidrug-Resistant Bacteria Isolated from Patients with Infections Admitted to Public Hospitals in Southwest Iran.

Background The emergence of multidrug-resistant (MDR) microorganisms causing infections is increasing worldwide and becoming more serious in developing countries. Among those, Acinetobacter species are becoming prominent. Objectives The aim of this study was to determine the rate of antimicrobial resistance of the bacteria causing infections, Acinetobacter species in particular, in local public hospitals in Firuzabad, Fars province, Iran. Methods This cross-sectional study was performed on different clinical specimens collected from patients who were suspected of infections hospitalized from March 2016 to March 2019 in local hospitals of Firuzabad, Fars province, Iran. The bacterial isolates were identified following standard microbiological methods. Clinical and Laboratory Standards Institute guidelines were used to identify the antibiotic susceptibility of these isolates. Results Overall, 1778 bacterial etiologies were isolated from 1533 patients diagnosed with infection. Of these, 1401 (78.8%) were Gram-negative and the remaining were Gram-positive bacteria. Escherichia coli (37.1%), Klebsiella spp. (13.9%), and Acinetobacter species (10.4%) were the most common isolated bacteria. Antibiotic sensitivity testing in this study showed a high resistance rate of Acinetobacter species to all antibiotics tested except Colistin. During the study period, the rate of infection with highly multidrug-resistant Acinetobacter species increased from 7.2% to 13.3%. Conclusions This study highlights the emergence of MDR bacterial agents such as Acinetobacter species as a new threat in our region. However, a decrease in the rate of infection with Pseudomonas aeruginosa was noticeable.

Cerebrospinal Fluid Sterilization with Intrathecal Polymyxin in Addition to Parenteral Polymyxin in Nosocomial Acinetobacter Meningitis

Background: For the last few decades there has been a substantial concern regarding the increasing prevalence of multidrug resistant (MDR) Acinetobacter species in hospitals. Aim: To determine the outcomes with intrathecal polymyxins therapy in patients with multidrug resistant Acinetobacter species nosocomial meningitis. Place and duration of study: This Retrospective study was conducted in the Department of Infectious Diseases, Aga Khan University Hospital, Karachi Pakistan between 2010 and 2014. Methodology: Twenty six patients who developed post neurosurgical MDR Acinetobacter nosocomial meningitis age above 18 were included, while those with polymicrobial meningitis, and those patients who only received intravenous polymyxins were excluded. The primary outcome is ability and time to sterilize the cerebrospinal fluid Results: The mean age was 42.9±11.5 years. Cerebrospinal fluid sterilization was observed in 24 patients in a median of 4 days. One patient made complete recovery, 16 patients recovered with neurological deficits and five patients expired. A trend of early cerebrospinal fluid sterilization was observed in patients with continuous intrathecal therapy. The time to cerebrospinal fluid sterilization is similar with intrathecal colistin or polymyxin. Conclusion: Intrathecal polymyxins are safe and efficacious in the treatment of multidrug resistant nosocomial Acinetobacter species meningitis. Keywords: Intrathecal, Polymyxins, Multidrug resistant, Acinetobacter species, Nosocomial, Meningitis

Prevalence and risk factors associated with multi-drug resistant organisms (MDRO) carriage among pediatric patients at the time of admission in a tertiary care hospital of a developing country. A cross-sectional study

BackgroundThe rise of Multidrug-resistant organisms (MDROs) poses a considerable burden on the healthcare systems, particularly in low-middle income countries like Pakistan. There is a scarcity of data on the carriage of MDRO particularly in the pediatrics population therefore, we aimed to determine MDRO carriage in pediatric patients at the time of admission to a tertiary care hospital in Karachi, Pakistan, and to identify the risk factors associated with it.MethodsA cross-sectional study conducted at the pediatric department of Aga Khan University Hospital (AKUH) from May to September 2019 on 347 children aged 1–18 years. For identification of MDRO (i.e., Extended Spectrum Beta-Lactamase (ESBL) producers, Carbapenem Resistant Enterobacteriaceae (CRE), Vancomycin Resistant Enterococci (VRE), Methicillin Resistant Staphylococcus aureus (MRSA), Multidrug-resistant (MDR) Acinetobacter species and MDR Pseudomonas aeruginosa), nasal swabs and rectal swabs or stool samples were cultured on specific media within 72 h of hospitalization. Data was collected on a predesigned structured questionnaire on demographics, prior use of antibiotics for > 48 h in the last 6 months, history of vaccination in last 6 months, exposure to health care facility regardless of the time of exposure, ICU stay for > 72 h, and about the prior use of medical devices (urinary catheter, central venous lines etc.) in last 1 year. Statistical analysis was performed by Standard statistical software.ResultsOut of 347 participants, 237 (68.3%) were found to be MDRO carriers. Forty nine nasal swabs from 346 children (14.2%) showed growth of MRSA. The majority of the stool/rectal swabs (n = 222 of 322; 69%) collected were positive for MDRO. The most isolated species were ESBL Escherichia coli 174/222 (78.3%) followed by ESBL Enterobacter species 37/222 (16.7%) and ESBL Klebsiella pneumoniae 35/222 (15.8%). On univariate analysis, none of the risk factors showed statistically significant association with MDRO carriage.ConclusionOverall, a high prevalence of MDRO carriage was identified among admitted pediatric patients. Implementation of systematic screening may help to identify true burden of MDROs carriage in the health care settings.

English

BACKGROUND Acinetobacter species are important infectious agents worldwide especially in healthcare settings. It has the ability to develop various resistance mechanisms to various antibiotics. We wanted to study the role of tigecycline and minocycline in the treatment of multidrug resistant Acinetobacter species. METHODS 254 non-repetitive isolates of Acinetobacter species from various clinical samples like exudates, blood, sputum, urine were retrospectively studied. Antibiotic susceptibility testing was done by Vitek 2 compact system. Susceptibility of the carbapenem resistant isolates towards tigecycline and minocycline were analysed. RESULTS 205 (80.7 %) isolates were resistant to either of the carbapenem drugs and 49 (19.3 %) were sensitive to all the 3 carbapenems, namely imipenem, meropenem and doripenem. 54.1 % isolates were sensitive to tigecycline while sensitivity towards minocycline was 40.5 %. The degree of sensitive concordance in the susceptibility to minocycline and tigecycline against Acinetobacter species was 31.1 %, which indicated fair agreement statistically. 21.1 % isolates were resistant / intermediate to minocycline but sensitive to tigecycline. Only 9.4 % isolates which were resistant to tigecycline were sensitive to minocycline. CONCLUSIONS The results of the present study have demonstrated that minocycline and tigecycline are effective against the carbapenem resistant Acinetobacter species. Tigecycline can be considered as a therapeutic agent for the treatment of multidrug resistant Acinetobacter which are otherwise difficult to inhibit using other antibiotics. KEY WORDS Carbapenem Resistance, Tigecycline, Minocycline, Antimicrobial Resistance

Detection of efflux pump in multidrug resistant acinetobacter Species using Naphthyl-Methyl-Piperazine

Acinetobacter, Gram negative bacterium, has proven to be recently important to research due to multidrug resistance. Multidrug resistance is directed against antibiotics like Aminoglycosides, Carbapenems, Cephalosporins, Quinolones etc. The presence of efflux pump, primarily the Resistance-Nodulation-Cell Division (RND) type, is an active transport mechanism which allows it to efficiently reduce antibiotic levels within the cell. 1-(1-naphtylmethyl)-piperazine (NMP) is an efflux pump inhibitor (EPI) which mechanically inhibits the efflux pump in bacteria resulting in increased concentration of antibiotic intracellularly, thereby killing the cell. Objectives: To detect the efflux pumps phenotypically using NMP and to establish the cut-off zone diameter to detect efflux pump in Acinetobacter species. Materials and Methods: Acinetobacter species were isolated from patient samples using conventional techniques of inoculation, identification and antibiotic susceptibility testing. The efflux pump was detected phenotypically by disc diffusion method on Mueller Hinton agar with NMP and chloramphenicol, tetracycline discs as substrates. The zone diameters were recorded & values compared using t-test. Tipping analysis was done to determine the mean zone difference to identify the presence of efflux pump. Results and Conclusion: 61% of the Acinetobacter species were multidrug resistant of which 63% had efflux pump as detected by chloramphenicol substrate which is better than Tetracycline (p Keywords: Efflux pump, Acinetobacter, Naphthyl-Methyl-Piperazine.

Multidrug Resistant Acinetobacter Isolates Release Resistance Determinants Through Contact-Dependent Killing and Bacteriophage Lysis.

Antimicrobial resistance is an ancient bacterial defense mechanism that has rapidly spread due to the frequent use of antibiotics for disease treatment and livestock growth promotion. We are becoming increasingly aware that pathogens, such as members of the genus Acinetobacter, are precipitously evolving drug resistances through multiple mechanisms, including the acquisition of antibiotic resistance genes. In this study, we isolated three multidrug resistant Acinetobacter species from birds on a free-range farm. Acinetobacter radioresistens, Acinetobacter lwoffii, and Acinetobacter johnsonii were isolated from hens, turkeys and ducks and were resistant to 14 clinically relevant antibiotics, including several listed by the World Health Organization as essential medicines. Co-culturing any of the three Acinetobacter species with Acinetobacter baumannii resulted in contact-dependent release of intact resistance determinants. We also isolated several lytic bacteriophages and selected two of these phages to be included in this study based on differences in plaquing characteristics, nucleic acid content and viral morphology. Both phages released host DNA, including antibiotic resistance genes during cell lysis and we demonstrated that these resistance determinants were transferable to a naïve strain of Escherichia coli. This study demonstrates that contact-dependent competition between bacterial species can readily contribute to DNA release into the environment, including antibiotic resistance determinants. We also highlight that the constant lysis and turnover of bacterial populations during the natural lifecycle of a lytic bacteriophage is an underappreciated mechanism for the liberation of DNA and subsequent genetic exchange.

Multicentre study of risk factors for mortality in patients with Acinetobacter bacteraemia receiving colistin treatment

Colistin remains a last-line antibiotic for the treatment of infections by multidrug-resistant Acinetobacter species. However, mortality rates are high in patients with Acinetobacter infection receiving colistin treatment. This multicentre study evaluated whether colistin susceptibility, additional antimicrobial agents or other prognostic factors influenced the clinical outcomes of patients receiving colistin treatment for Acinetobacter bacteraemia. This retrospective study enrolled 122 adults receiving colistin for monomicrobial Acinetobacter bacteraemia at six medical centres in the ACTION Study Group over an 8-year period. Clinical information, antimicrobial susceptibility and colistin resistance determinants were analysed. The primary outcome measure was 14-day mortality. Among 122 patients, 18 and 104 were infected with colistin-resistant (ColR) isolates [minimum inhibitory concentration (MIC) ≥4 mg/L] and colistin-susceptible (ColS) isolates (MIC ≤2 mg/L), respectively. Patients infected with ColR and ColS isolates did not differ significantly with regard to Charlson comorbidity index, invasive procedures, sources of bacteraemia, disease severity and 14-day mortality rate (44.4% vs. 34.6%; P=0.592). No specific additional antimicrobial agent was independently associated with higher or lower mortality. Coronary artery disease, higher Acute Physiology and Chronic Health Evaluation (APACHE) II score and bacteraemia caused Acinetobacter baumannii were independent risk factors associated with 14-day mortality. Mechanisms of colistin resistance were associated with amino acid variants in the pmrCAB operon. Finally, previously unreported Acinetobacter nosocomialis amino acid variants related to colistin resistance were identified. In conclusion, colistin susceptibility and colistin combination antimicrobial treatment were not associated with decreased 14-day mortality in patients with Acinetobacter bacteraemia receiving colistin treatment.

Prevalence of Tigecycline resistance in Multidrug-Resistant Acinetobacter species isolates from clinical specimens

Background and Objectives: Acinetobacter baumanii is ubiquitous, aerobic non fermentative, gram negative cocobacilli, emerging globally as an important cause of nosocomial infection. This study was conducted to determine the prevalence and antibiogram of clinically isolated multidrug-resistant Acinetobacter species. &#x0D; Material and methods: Antibiotic susceptibility of 93 Acinetobacter baumannii isolates were performed against ampicillin, ampicillin/sulbactam, piperacillin/tazobactam, ceftazidime, cefepime, ceftriaxone, cefotaxime, ciprofloxacin, levofloxacin, amikacin, gentamicin, imipenem, meropenem, tigecycline, polymyxin B and colistin as per standard methods in microbiology laboratory of Nepal Mediciti Hospital, Kathmandu, Nepal from January to December 2018. Ethical clearance was taken from the Institutional review committee of Nepal Mediciti Hospital. &#x0D; Results: A total of 93 Acinetobacter baumannii isolates were obtained from sputum, blood, pus, wound swabs , catheter tips and others. Antibiotic susceptibility analyses of the isolates revealed that the resistance to ampicillin was most common (100%), followed by cefotaxime (75.2%), ceftazidime (74.1%), ampicillin/sulbactam (73.1%), cefepime (67.7%). However, almost all isolates were susceptible to tigecycline (100%), followed by colistin (98.9%), and polymyxin B (87.0%). &#x0D; Conclusion: The present study showed the increasing trends of resistance of Acinetobacter speciesto various classes of antimicrobials. Treatment options for infections due to MDR and XDR Acinetobacter baumanii are very limited and tigecycline and colistin may be considered as one of the therapeutic option for the treatment of hospital acquired infections

Antimicrobial Susceptibility Pattern of Acinetobacter calcoaceticus-Acinetobacter baumannii Complex Isolated from Sputum in a Tertiary Care Hospital

Introduction Acinetobacter calcoaceticus-Acinetobacter baumanni (ACB) complex is one of the commonest cause of hospital acquired and ventilator associated pneumonia. Multidrug resistant Acinetobacter species have become a matter of huge concern. This study was done to find out the antibiotic susceptibility pattern of Acinetobacter calcoaceticus-Acinetobacter baumanii complex from sputum samples.&#x0D; MethodsThis descriptive cross-sectional study was carried out in Clinical Microbiology laboratory from July 2018 to Jan 2019 after ethical approval. Acinetobacter calcoaceticus-Acinetobacter baumannii complex was identified on the basis of its microscopy and morphological characteristics followed by biochemical tests. Antibiotic sensitivity test of isolated pathogens was done using Muller Hinton Agar by Kirby-Bauer method.&#x0D; ResultsOf the 384 culture positive sputum specimen, 76 (19.80%) were Acinetobacter calcoaceticus-Acinetobacter baumannii complex. Most of the isolates were resistant to commonly used antibiotics, 72.36% of the isolates were multidrug resistance and 3.95% isolates were resistant to tigecycline.&#x0D; ConclusionThis study provides valuable information regarding prevalence of Acinetobacter calcoaceticus-Acinetobacter baumannii complex from sputum specimen. The alarming number of Multidrug resistance isolates is worrisome finding. Antibiotics like Tigecycline and Colistin which is still sensitive to isolates should be cautiously used only in MDR cases.

Beta-Lactamases Production in Multi-drug Resistant Acinetobacter species Isolated from Different Clinical Specimens

Objectives: To determine the prevalence of Acinetobacter spp. from different clinical specimens and detect different types of β-lactamase enzymes.&#x0D; Methods: Different clinical samples were collected and 125 Acinetobacter spp. were isolated. Various biochemical tests were carried out to speciate the Acinetobacter spp. The antibiotic susceptibility pattern and β-lactamase enzymes like Extended spectrum β-lactamase (ESBL), Metallo β-lactamase (MBL) and AmpC β-lactamase were determined.&#x0D; Results: Of the total 125 isolates, the most predominant species was Acinetobacter calcoaceticus-A. baumannii (Acb) complex (80%). Highest rate of isolation of Acinetobacter species were from in-patients (neonates’ blood sample). Among all, 44.8% isolates were found to be MDR with the majority being resistant to aminoglycosides, carbapenems and fluoroquinolones but not to colistin. ESBL, MBL and AmpC beta-lactamase was detected in 43.2%, 15.2% and 1.6% of the isolates respectively.&#x0D; Conclusion: Acinetobacter calcoaceticus-A. baumannii complex should be considered for detection in hospitalized patients. The analysis of antibiotic susceptibility pattern and β-lactamases would be helpful to establish network surveillance in order to maintain and control the spread of these resistant strains.

2657. Clinical Prediction Tool for Multidrug-Resistant Organisms Among Deceased Donors at the Time of Donor Evaluation

BackgroundTransplant guidelines recommend exercising caution when considering organs that may be infected or colonized with multidrug-resistant organisms (MDROs) and treating the organ recipient with perioperative antibiotics active against the donor MDRO. Unfortunately, donor MDROs are often identified only after transplantation. We developed a clinical prediction tool to stratify donors’ MDRO risk at the time of donor evaluation.MethodsA retrospective cohort study was conducted at four transplant centers in Philadelphia between January1, 2015 and June 30, 2016. All deceased organ donors who donated ≥1 organ to one of the centers were included. Multivariate logistic regression was used to determine predictors of donor MDROs, including methicillin-resistant S. aureus (MRSA), vancomycin-resistant enterococci, extended-spectrum cephalosporin-resistant (ESC-R) or carbapenem-resistant Enterobacteriaceae, multidrug-resistant (MDR) P. aeruginosa, or MDR Acinetobacter species. Manual forward selection was utilized to maximize the area under the receiver operating characteristic curve (AUC). A scoring system was developed based on the odds ratios for each covariate. Internal validity was assessed using the Hosmer–Lemeshow statistic, specificity, and negative predictive value (NPV).ResultsOf 440 total donors, 62 (14%) grew MDROs on culture. The majority were MRSA (40) or ESC-R Enterobacteriaceae (20). The most parsimonious model that predicted donor MDROs included: a terminal hospitalization ≥ 7 days (1 point), ≥ 2 antibiotics administered during the terminal hospitalization (1 point), receipt of extracorporeal membrane oxygenation (ECMO) (1 point), and presence of opacities on donor chest imaging concerning for lower respiratory tract infection (2 points). With this scoring system, the maximum attainable score is 5; any donor with a score of ≥ 2 points would be considered high risk for an MDRO, with an AUC of 0.71, specificity of 99%, and NPV of 86%. The Hosmer–Lemeshow P = 0.68.ConclusionThe risk of an MDRO among deceased organ donors can be predicted using the above scoring system. This tool will inform decisions about organ utilization and perioperative prophylaxis for solid-organ transplant recipients. Disclosures All authors: No reported disclosures.

1250. Prevalence and Risk Factors for Acquiring Carbapenem-Resistant Enterobacteriaceae in an Intensive Care Unit at a Tertiary Hospital

BackgroundActive surveillance testing of carbapenem-resistant Enterobacteriaceae (AST-CRE) is recommended in high-risk settings, such as intensive care units (ICUs), to prevent CRE outbreaks or invasive infections. This study aimed to investigate the effects of AST-CRE by analyzing the prevalence and risk factors for acquiring CRE during the ICU care.MethodsWe conducted AST-CRE on rectal swabs of patients admitted to the ICU in the emergency room at a tertiary hospital in South Korea for 12.5 months. AST-CRE was performed upon admission and weekly thereafter. To assess the risk factors of acquiring AST-CRE during the admission period in adult patients, those colonized with CRE upon admission and aged <18 years were excluded. AST-CRE was performed using Centers for Disease Control and Prevention methods. A polymerase chain reaction assay was performed to detect five carbapenemase genes (NDM, KPC, VIM, IMP, and OXA).ResultsA total of 810 patients were admitted during the study period. The acquisition rate and carbapenemase-producing CRE were 2.6% (21/810) and 42.9% (9/21), respectively. No invasive infection due to CRE was found. The most common species were Klebsiella pneumoniae (71.4%, 15/21), and eight KPC and one NDM genes were detected. In CRE-positive patients, in-hospital mortality and length of hospitalization were higher (P = 0.003) and longer (P < 0.001), respectively. Multivariate analyses showed that male gender (adjusted odds ratio [aOR] 8.0; 95% confidence interval [CI] 1.7–36.8), previous hospitalization in the last year (aOR 5.1; 95% CI 1.6–16.4), co-colonization with multidrug-resistant Acinetobacter species (aOR 18.3; 95% CI, 4.2–79.2) and extended-spectrum β-lactamase-producing bacteria (aOR 3.4; 95% CI, 1.1–10.9), and length of ICU admission until CRE detection for ≥10 days (aOR 6.5; 95% CI 2.2–19.2) were independently associated with CRE acquisition.ConclusionTo prevent CRE outbreak or invasive infections, patients admitted in the ICU should be screened using AST-CRE.Disclosures All authors: No reported disclosures.