Nursing Home as a Reservoir of Carbapenem-Resistant Acinetobacter baumannii

Microb Drug Resist. 2015 Jun;21(3):270-8. doi: 10.1089/mdr.2014.0157. Epub 2015 Jan 19.

Abstract

Acinetobacter baumannii is an increasingly common pathogen in healthcare settings globally. It is frequently resistant to multiple antimicrobial agents and there are recent reports on strains that are pandrug resistant. The aim of the study was to characterize the mechanisms of carbapenem resistance of A. baumannii strains from a nursing home in Zagreb and to genotype the strains. Antimicrobial susceptibility testing was performed by the broth microdilution method according to the Clinical and Laboratory Standards Institute (CLSI). PCR was used to detect genes encoding carbapenemases of groups A, B, and D and extended-spectrum β-lactamases. Genotyping of the strains was performed by rep-PCR. All strains were found to be resistant to ceftazidime, cefotaxime, ceftriaxone, cefepime, piperacillin/tazobactam, imipenem, meropenem, and ciprofloxacin. All, but one strain, were resistant to gentamicin. PCR revealed blaOXA-23 genes in 14, blaOXA-24 in 5, and blaVIM in 11 strains. All strains positive for blaVIM genes coharbored blaOXA-23 genes. The 14 strains with OXA-23 belonged to ICL II, whereas the 5 strains positive for blaOXA-24 belonged to ICL I. In contrast to hospitals where OXA-24/40-like β-lactamases and OXA-58 were the most prevalent, OXA-23-like β-lactamases are the dominant group in the nursing home. OXA-58-like β-lactamase, which is the most widespread group, was not found. Acquisition of blaMBL genes in A. baumannii strains was observed. Rep-PCR identified two clones. Two strains A10 and A13 were alocated to a novel sequence type ST 637. Nursing homes can act as a source of dissemination of blaOXA and blaMBL genes in the environment and the possible influx to the hospital environment.

MeSH terms

  • Acinetobacter Infections / drug therapy
  • Acinetobacter Infections / epidemiology
  • Acinetobacter Infections / microbiology
  • Acinetobacter baumannii / classification
  • Acinetobacter baumannii / genetics*
  • Acinetobacter baumannii / isolation & purification
  • Aged
  • Anti-Bacterial Agents / pharmacology
  • Bacterial Typing Techniques
  • Carbapenems / pharmacology
  • Clone Cells
  • Croatia / epidemiology
  • Cross Infection / drug therapy
  • Cross Infection / epidemiology
  • Cross Infection / microbiology
  • Drug Resistance, Multiple, Bacterial / genetics*
  • Female
  • Gene Expression Regulation, Bacterial*
  • Homes for the Aged*
  • Humans
  • Male
  • Microbial Sensitivity Tests
  • Nursing Homes*
  • Phylogeny
  • Plasmids / chemistry
  • Plasmids / metabolism
  • Sequence Analysis, DNA
  • beta-Lactamases / genetics*
  • beta-Lactamases / metabolism

Substances

  • Anti-Bacterial Agents
  • Carbapenems
  • beta-Lactamases