Dissemination of carbapenem-resistant Acinetobacter baumannii in patients with burn injuries

Saeed Shoja; Mojtaba Moosavian; Soodabeh Rostami; Abbas Farahani; Amir Peymani; Khadijeh Ahmadi; Nasim Ebrahimifard

doi:10.1016/j.jcma.2016.10.013

Dissemination of carbapenem-resistant Acinetobacter baumannii in patients with burn injuries

J Chin Med Assoc. 2017 Apr;80(4):245-252. doi: 10.1016/j.jcma.2016.10.013. Epub 2017 Mar 6.

Authors

Saeed Shoja¹, Mojtaba Moosavian², Soodabeh Rostami³, Abbas Farahani⁴, Amir Peymani⁵, Khadijeh Ahmadi², Nasim Ebrahimifard²

Affiliations

¹ Infectious and Tropical Diseases Research Center, Hormozgan Health Institute, Hormozgan University of Medical Sciences, Bandar Abbas, Iran. Electronic address: Shojasaeed@gmail.com.
² Infectious and Tropical Diseases Research Centre, Department of Microbiology, Faculty of Medicine, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran.
³ Infectious Diseases and Tropical Medicine Research Center, Isfahan University of Medical Sciences, Isfahan, Iran.
⁴ Infectious and Tropical Diseases Research Centre, Department of Microbiology, Faculty of Medicine, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran; Student Research Committee, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran.
⁵ Department of Microbiology, Qazvin University of Medical Sciences, Qazvin, Iran.

PMID: 28268175
DOI: 10.1016/j.jcma.2016.10.013

Abstract

Background: Carbapenem-resistant Acinetobacter baumannii has emerged as an important cause of infection in burn patients. This study aimed to characterize the antimicrobial susceptibility pattern, determine the prevalence of oxacillinase and metallo-beta-lactamase (MBL) genes, and type the A. baumannii isolates obtained from burn patients.

Methods: During a 1-year period, a total of 40 nonduplicated isolates of A. baumannii were obtained from burn patients who were hospitalized in the Taleghani Burn Hospital in Ahvaz, in the southwest of Iran. Testing for antimicrobial susceptibility was carried out by disk diffusion and E-test. To screen MBL production, a double disk synergy and MBL E-test were performed. The presence of bla_OXA-23-like, bla_OXA-24-like, bla_OXA-51-like and bla_OXA-58-like, bla_VIM, bla_IMP and bla_SPM, and bla_NDM was sought by polymerase chain reaction (PCR). Repetitive extragenic palindromic sequence-based PCR was carried out for determination of isolates clonality.

Results: Overall, 92.5% of isolates were carbapenem-resistant. Polymyxin B, colistin, and ampicillin-sulbactam were the most effective agents in vitro, with a susceptibility rate of 100%, 97.5%, and 72.5%, respectively. According to the double disk synergy and E-test, 55.6% and 97.3% of isolates were MBL producers, respectively. Furthermore, 70% of isolates harbored bla_OXA-23-like and 20% were positive for bla_OXA-24-like. However, no encoding genes were detected for bla_VIM, bla_IMP and bla_SPM, bla_NDM, and bla_OXA-58-like. Repetitive extragenic palindromic sequence-based PCR revealed that carbapenem-resistant isolates belonged to four clones, including A, B, C, and D; the predominant clones were B and C.

Conclusion: The rate of carbapenem resistance was high, and it appeared that bla_OXA-23-like and bla_OXA-24-like contributed to the carbapenem resistance of A. baumannii isolates. This result suggests that the two predominant clones of A. baumannii were spread among burn patients. In order to prevent future dissemination of resistant isolates among burn patients, an effective infection control plan is necessary.

Keywords: Acinetobacter baumannii; burns; carbapenem- resistant.

MeSH terms

Acinetobacter baumannii / drug effects*
Acinetobacter baumannii / isolation & purification
Burns / microbiology*
Carbapenems / pharmacology*
Drug Resistance, Bacterial
Female
Humans
Male
Microbial Sensitivity Tests

Substances

Carbapenems