Dissemination of multidrug-resistant Acinetobacter baumannii carrying BlaOxA-23 from hospitals in central Taiwan.

Imipenem-resistant Acinetobacter baumannii (IRAB) poses a great threat to healthcare systems. Production of carbapenem-hydrolyzing class D β-lactamases (CHDLs) is the major mechanism for imipenem resistance. In this study, we found a high prevalence of IRAB carrying a gene encoding CHDL, bla(OxA-23), in central Taiwan and elucidated the molecular characteristics and possible mechanisms of the spread of these isolates. During 2007, we collected 291 nonrepetitive A baumannii isolates from 10 teaching hospitals in Taiwan. The antimicrobial susceptibility of the isolates was determined by agar dilution or Etest. The genes encoding carbapenemase and related structure were detected by polymerase chain reaction mapping and sequencing, and the clonal relationship of the isolates was analyzed by pulsed-field gel electrophoresis. Plasmid localization of bla(OxA-23) was determined by extraction of plasmid with commercial kit and Southern blot analysis. Among 142 IRAB isolates, 30 harbored the bla(OxA-23). The prevalence of IRAB with bla(OxA-23) was highest in central Taiwan compared to other areas [24.8% (27/109) vs. 1.6% (3/182); p < 0.001]. These IRAB with bla(OxA-23) were also resistant to other antimicrobial agents, except colistin. The PCR methods showed the presence of bla(OxA-51) in all isolates. We could exclude clonal spreading due to the diversity of the pulsotype. The bla(OxA-23) gene was detected in the plasmids of 6 isolates. Tn2006 was present in 22 (73.3%) isolates, and Tn2008, in 6 other isolates (26.7%). Two strains had bla(oxa-23)-ΔATPase but lacked upstream ISAba1. The high prevalence of bla(OxA-23)-harboring IRAB in central Taiwan might be attributed to the transposition event of Tn2006.

Lee MH ，Chen TL ，Lee YT ，Huang L ，Kuo SC ，Yu KW ，Hsueh PR ，Dou HY ，Su IJ ，Fung CP ... -  《-》

Wide spread of Tn2006 in an AbaR4-type resistance island among carbapenem-resistant Acinetobacter baumannii clinical isolates in Taiwan.

Carbapenem resistance in Acinetobacter baumannii is a global problem. The purpose of this study was to elucidate current resistance mechanisms of imipenem-resistant A. baumannii (IRAB) in Taiwan and their correlation with patient outcomes. Acinetobacter baumannii clinical isolates from two teaching hospitals in Taiwan were collected in 2009 and were examined by Etest for determination of the minimum inhibitory concentrations (MICs) of imipenem, ceftazidime and ceftriaxone. Primers specific for carbapenemase genes and upstream regions were designed for PCR amplification. Bacterial isolates were genotyped by pulsed-field gel electrophoresis (PFGE). Clinical presentations of patients were analysed retrospectively. Upstream insertion sequence ISAba1 was found in 34 isolates that carried bla(OXA-23), including 28 with transposon Tn2006 (ISAba1-bla(OXA-23)-ISAba1) in an AbaR4-type resistance island and 6 with Tn2008 (ISAba1-bla(OXA-23)), as well as in 8 isolates carrying ISAba1-bla(OXA-51-like). All of these isolates expressed full resistance to imipenem (MIC>32 mg/L). Forty-one different PFGE genotypes were found among 62 isolates. Tn2006 was found in 19 genotypes (46.3%), which is more common than ISAba1-bla(OXA-51-like) (12.2%) (P=0.001). Prior use of carbapenems or extended-spectrum cephalosporins for ≥5 days was the only independent risk factor significantly associated with IRAB infection (odds ratio=361.175). Higher mortality was significantly associated with infection caused by IRAB and ISAba1-bla(OXA-23)-carrying strains compared with infection caused by imipenem-susceptible A. baumannii and ISAba1-bla(OXA-51-like)-carrying strains (P=0.009 and 0.027, respectively). Tn2006 is currently the most common imipenem resistance determinant, which showed a higher ability to spread among A. baumannii and was associated with a higher mortality in IRAB-infected patients.

Lee HY ，Chang RC ，Su LH ，Liu SY ，Wu SR ，Chuang CH ，Chen CL ，Chiu CH ... -  《-》

Diversity of carbapenem resistance mechanisms in Acinetobacter baumannii from a Taiwan hospital: spread of plasmid-borne OXA-72 carbapenemase.

Lu PL ，Doumith M ，Livermore DM ，Chen TP ，Woodford N ... -  《-》

Evolution of carbapenem resistance in Acinetobacter baumannii: an 18-year longitudinal study from a medical center in northern Taiwan.

Carbapenem-resistant Acinetobacter baumannii has emerged as an important cause of nosocomial infections with high morbidity and mortality. The carbapenemases, especially class D carbapenem-hydrolyzing oxacillinases (CHDLs), play an important role, but the relationship between their prevalence trend and carbapenem resistance remains unclear. Between 1995 and 2012, we collected 667 isolates of A. baumannii from a single medical center in northern Taiwan. Pulsed-field gel electrophoresis (PFGE) was used to determine clonality. Antimicrobial susceptibility was determined. Carbapenemase genes and associated genetic structures were detected by polymerase chain reaction. Isolates were heterogeneous on PFGE. Susceptibility to carbapenem decreased steadily over the study period from 88.1% (2001-2003) to <25% (2010-2012), whereas the isolates remained susceptible to colistin (nearly 100%) and partially susceptible to tigecycline (80%). Starting in 2001, isolates carrying the ISAba1-blaOXA-51-like allele were consistently identified. Isolates containing the transposons Tn2006 or Tn2008 first appeared in 2007 with increasing carriage rates from 17.5% (2007-2009) to 50.0% (2010-2012). The IS1008-ΔISAba3-blaOXA-58-like, blaOXA-72 and metallo-β-lactamase genes were detected only sporadically. Isolates carrying CHDL genes were resistant to multiple drugs, including carbapenem, but remained susceptible to colistin (100.0%). Increased carbapenem resistance in A. baumannii may be caused by the increased prevalence of isolates containing the ISAba1-blaOXA-51-like allele and the transposons Tn2006 and Tn2008.

Ku WW ，Kung CH ，Lee CH ，Tseng CP ，Wu PF ，Kuo SC ，Chen TL ，Lee YT ，Wang FD ，Fung CP ... -  《-》

Characterization of bla(OxA-23) gene regions in isolates of Acinetobacter baumannii.

To investigate the characterization of bla(OxA-23) gene regions in isolates of Acinetobacter baumannii from Taizhou Municipal Hospital. Fifty-nine non-repetitive, multiresistant (including imipenem-resistant) isolates of A. baumannii were recovered from clinical infections in hospitalized patients from January 2010 to August 2011 in Taizhou Municipal Hospital (affiliated with Taizhou University) in China. These isolates were genotyped using pulsed-field gel electrophoresis (PFGE). bla(OxA-23) β-lactamase and associated genetic structures were analyzed using polymerase chain reaction (PCR), and recombination plasmids were analyzed by BamHI- or SacI- restriction enzyme digestion; predicted promoter structures of bla(OxA-23) genes were determined and compared using protein-protein BLAST analysis. Fifteen out of 59 isolates expressing imipenem-resistant A. baumannii clinical isolates acquired either a bla(OxA-23) β-lactamase gene. A new gene cluster (ISAba1-bla(OxA-23)-AMP) with three previously identified transposons (Tn2006, Tn2007, and Tn2008) and one previously identified gene cluster (ISAba1- bla(OxA-23)) was found in the isolates. Recombination plasmids were analyzed by restriction enzyme digestion. Our results indicate that pattern A was the most prevalent molecular type based on PFGE, and that different clones might be widespread with a majority of ISAba1-bla(OxA-23) clonal lineages in the 15 PCR positive isolates of A. baumannii in the hospital.

Wang D ，Yan D ，Hou W ，Zeng X ，Qi Y ，Chen J ... -  《-》