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Retrospective Analysis of Multidrug-Resistant Acinetobacter baumannii Strains Isolated During a 4-Year Period in a University Hospital

Published online by Cambridge University Press:  07 April 2017

Judith Fillaux ,
Anne Dubouix ,
Jean-Marie Conil ,
Jacky Laguerre  and
Nicole Marty
Judith Fillaux
Affiliation:
Department of Microbiology and Infection Control, Centre Hospitalier Universitaire Rangueil, Toulouse, France Department of Epidemiology and Public Health, Centre Hospitalier Universitaire Rangueil, Toulouse, France
Anne Dubouix
Affiliation:
Department of Microbiology and Infection Control, Centre Hospitalier Universitaire Rangueil, Toulouse, France
Jean-Marie Conil
Affiliation:
Department of Anesthesiology and Intensive Care, Centre Hospitalier Universitaire Rangueil, Toulouse, France
Jacky Laguerre
Affiliation:
Department of Anesthesiology and Intensive Care, Centre Hospitalier Universitaire Rangueil, Toulouse, France
Nicole Marty*
Affiliation:
Department of Microbiology and Infection Control, Centre Hospitalier Universitaire Rangueil, Toulouse, France
*
Laboratoire de Bactériologie-Hygiéne, Institut Féderatif de Biologie de Purpan, TSA 40031, 31059 Toulouse Cedex 9, France ([email protected])
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Abstract

Objective.

To describe the epidemiology of Acinetobacter baumannii infection during 2000-2003 and to determine whether the multidrug-resistant strains were already present in our Toulouse hospital before the 2003 French national outbreak.

Design.

Descriptive molecular and clinical epidemiologic study of A. baumannii isolates using a combination of antibiotyping and pulsed-field gel electrophoresis (PFGE).

Setting.

A 1,000-bed university hospital in Toulouse, France.

Methods.

All clinical samples that had tested positive for A. baumannii between January 1, 2000, and December 31, 2003, were collected. Multidrug-resistant isolates of A. baumannii were then submitted to PFGE, and clinical characteristics of the source patients were noted.

Results.

A total of 1,277 A. baumannii samples were identified, 791 of which had not been previously identified; 148 were positive for multidrug-resistant strains. These strains were more likely to have been isolated in the intensive care unit (ICU) than were susceptible strains (P<.001; relative hazard, 3.77). The positive clinical samples were of various types (eg, nonprotected respiratory samples [43%] and blood [5%]), but no difference in type of source was seen between resistant and susceptible strains. A simultaneous analysis of pulsotypes and antibiotypes proved that the outbreak in the ICU in 2003 could be linked to an initially endemic clone that had been isolated in 2001. Furthermore, a second clone responsible for an extended-spectrum β-lactamase phenotype was sporadically present in our institution. Although the strains isolated in the burn unit were also genetically related one to another, the specific responsible clone only appeared in 2003.

Conclusion.

Several multidrug-resistant clones can coexist endemically for several years and can be detected during an outbreak by close survey of epidemic sources.

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 27 , Issue 7 , July 2006 , pp. 647 - 653
Copyright
Copyright © The Society for Healthcare Epidemiology of America 2006

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References

1.Bergogne-Berezin, E, Towner, KJ. Acinetobacter spp. as nosocomial pathogens: microbiological, clinical, and epidemiological features. Clin Microbiol Rev 1996; 9:148–165.Google Scholar
2.Brown, S, Bantar, C, Young, HK, Amyes, SG. Limitation of Acinetobacter baumannii treatment by plasmid-mediated carbapenemase ARI-2. Lancet 1998; 351:186–187.CrossRefGoogle ScholarPubMed
3.Nordmann, P. Acinetobacter baumannii, the nosocomial pathogen par excellence [in French]. Pathol Biol (Paris) 2004; 52:301–303.Google Scholar
4.Cisneros, JM, Rodriguez-Bano, J. Nosocomial bacteremia due to Acinetobacter baumannii: epidemiology, clinical features and treatment. Clin Microbiol Infect 2002; 8:687–693.Google Scholar
5.Mulin, B, Talon, D, Viel, JF, et al. Risk factors for nosocomial colonization with multiresistant Acinetobacter baumannii. Eur J Clin Microbiol Infect Dis 1995; 14:569–576.Google Scholar
6.Corbella, X, Montero, A, Pujol, M, et al. Emergence and rapid spread of carbapenem resistance during a large and sustained hospital outbreak of multiresistant Acinetobacter baumannii. J Clin Microbiol 2000; 38:4086–4095.Google Scholar
7.Lortholary, O, Fagon, JY, Hoi, AB, et al. Nosocomial acquisition of multiresistant Acinetobacter baumannii: risk factors and prognosis. Clin Infect Dis 1995; 20:790–796.Google Scholar
8.Mahgoub, S, Ahmed, J, Glatt, AE. Completely resistant Acinetobacter baumannii strains. Infect Control Hosp Epidemiol 2002; 23:477–479.CrossRefGoogle ScholarPubMed
9.Fierobe, L, Lucet, J-C, Decré, D, et al. An outbreak of imipenem-resistant Acinetobacter baumannii in critically ill surgical patients. Infect Control Hosp Epidemiol 2001; 22:35–40.Google Scholar
10.Dijkshoorn, L, Aucken, H, Gerner-Smidt, P, et al. Comparison of outbreak and nonoutbreak Acinetobacter baumannii strains by genotypic and phenotypic methods. J Clin Microbiol 1996; 34:1519–1525.CrossRefGoogle ScholarPubMed
11.Jawad, A, Seifert, H, Snelling, AM, Heritage, J, Hawkey, PM. Survival of Acinetobacter baumannii on dry surfaces: comparison of outbreak and sporadic isolates. J Clin Microbiol 1998; 36:1938–1941.CrossRefGoogle ScholarPubMed
12.Koeleman, JGM, van der Bijl, MW, Stoof, J, Vandenbroucke-Grauls, CMJE, Savelkoul, PHM. Antibiotic resistance is a major risk factor for epidemic behavior of Acinetobacter baumannii. Infect Control Hosp Epidemiol 2001; 22:284–288.Google Scholar
13.Wisplinghoff, H, Edmond, MB, Pfaller, MA, Jones, RN, Wenzel, RP, Seifert, H. Nosocomial bloodstream infections caused by Acinetobacter species in United States hospitals: clinical features, molecular epidemiology, and antimicrobial susceptibility. Clin Infect Dis 2000; 31:690–697.Google Scholar
14.Tankovic, J, Legrand, P, De Gatines, G, Chemineau, V, Brun-Buisson, C, Duval, J. Characterization of a hospital outbreak of imipenem-resistant Acinetobacter baumannii by phenotypic and genotypic typing methods. J Clin Microbiol 1994; 32:2677–2681.Google Scholar
15.Biendo, M, Laurans, G, Lefebvre, JF, Daoudi, F, Eb, F. Epidemiological study of an Acinetobacter baumannii outbreak by using a combination of antibiotyping and ribotyping. J Clin Microbiol 1999; 37:2170–2175.Google Scholar
16.Das, I, Lambert, P, Hill, D, Noy, M, Bion, J, Elliott, T. Carbapenem-resistant Acinetobacter and role of curtains in an outbreak in intensive care units. J Hosp Infect 2002; 50:110–114.Google Scholar
17.Weinbren, MJ, Johnson, AP, Kaufmann, ME, Livermore, DM. Acinetobacter spp. isolates with reduced susceptibilities to carbapenems in a UK burns unit. J Antimicrob Chemother 1998; 41:574–576.Google Scholar
18.Health Protection Agency. A prevalent strain of Acinetobacter baumannii. Commun Dis Rep CDR Wkly 2003; 13. Available at: http://www.hpa.org.uk/cdr/archives/2003/cdf2903.pdf. Accessed April 14, 2005.Google Scholar
19.Bou, G, Oliver, A, Martinez-Beltran, J. OXA-24, a novel class D beta-lactamase with carbapenemase activity in an Acinetobacter baumannii clinical strain. Antimicrob Agents Chemother 2000; 44:1556–1561.Google Scholar
20.Herruzo, R, de la Cruz, J, Fernandez-Acenero, MJ, Garcia-Caballero, J. Two consecutive outbreaks of Acinetobacter baumannii 1-a in a burn intensive care unit for adults. Burns 2004; 30:419–423.Google Scholar
21.Joly-Guillou, ML, Bergogne-Berezin, E, Vieu, JF. Epidemiology of Acinetobacter and resistance to antibiotics at hospitals: a 5-year evaluation [in French]. Presse Med 1990; 19:357–361.Google Scholar
22.Urban, C, Go, E, Mariano, N, et al. Effect of sulbactam on infections caused by imipenem-resistant Acinetobacter calcoaceticus biotype anitratus. J Infect Dis 1993; 167:448–451.CrossRefGoogle ScholarPubMed
23.Costa, SF, Woodcock, J, Gill, M, et al. Outer-membrane proteins pattern and detection of beta-lactamases in clinical isolates of imipenem-resistant Acinetobacter baumannii from Brazil. Int J Antimicrob Agents 2000; 13: 175–182.Google Scholar
24.Afzal-Shah, M, Livermore, DM. Worldwide emergence of carbapenem-resistant Acinetobacter spp. J Antimicrob Chemother 1998; 41:576–577.Google Scholar
25.Afzal-Shah, M, Woodford, N, Livermore, DM. Characterization of OXA 25, OXA-26, and OXA-27, molecular class D beta-lactamases associated with carbapenem resistance in clinical isolates of Acinetobacter baumannii. Antimicrob Agents Chemother 2001; 45:583–588.Google Scholar
26.Chu, YW, Afzal-Shah, M, Houang, ET, et al. IMP-4, a novel metallo-beta-lactamase from nosocomial Acinetobacter spp. collected in Hong Kong between 1994 and 1998. Antimicrob Agents Chemother 2001; 45:710–714.Google Scholar
27.Poirel, L, Menuteau, O, Agoli, N, Cattoen, C, Nordmann, P. Outbreak of extended-spectrum beta-lactamase VEB-1-producing isolates of Acinetobacter baumannii in a French hospital. J Clin Microbiol 2003; 41: 3542–3547.CrossRefGoogle Scholar
28.Institut National de Veille Sanitaire. Enquête de prévalence nationale 2001—résultants: réseau d'alerte d'investigations et de surveillance des infections nosocomiales (RAISIN). Available at: http://www.invs.sante.fr/publications/2003/raisin_enp_2001/index.html. Accessed April 14, 2005.Google Scholar
29.Institut National de Veille Sanitaire. Infections ou colonisations à Acinetobacter baumannii multirésistant aux antibiotiques, France: point sur la situation au 10 février 2004. Available at: http://www.invs.sante.fr/presse/2004/le_point_sur/inf_a_baumanii_110204.html. Accessed April 14, 2005.Google Scholar
30.Institut National de Veille Sanitaire. Réseau d'alerte d'investigations et de surveillance des infections nosocomiales (RAISIN): infections ou colonisations à Acinetobacter baumannii multi-résistant aux antibiotiques, France, juin 2004. Available at: http://www.invs.sante.fr/presse/2004/le_point_sur/inf_a_baumannii_300704/index.html. Accessed April 14, 2005.Google Scholar
31.Heritier, C, Dubouix, A, Poirel, L, Marty, N, Nordmann, P. A nosocomial outbreak of Acinetobacter baumannii isolates expressing the carbapenem-hydrolysing oxacillinase OXA-58. J Antimicrob Chemother 2005; 55: 115–118.Google Scholar
32.Société Française de Microbiologic Comité de l'antibiogramme. Available at: http://www.sfm.asso.fr/. Accessed April 14, 2005.Google Scholar
33.Tenover, FC, Arbeit, RD, Goering, RV, et al. Interpreting chromosomal DNA restriction patterns produced by pulsed-field gel electrophoresis: criteria for bacterial strain typing. J Clin Microbiol 1995; 33:2233–2239.CrossRefGoogle ScholarPubMed
34.McDonald, LC, Banerjee, SN, Jarvis, WR, Nosocomial Infections Surveillance System. Seasonal variation of Acinetobacter infections: 1987-1996. Clin Infect Dis 1999; 29:1133–1137.Google Scholar
35.Circulaire no. DHOS/ED2-DGS/SD5C no. 21 du 22 janvier 2004 relative au signalement des infections nosocomiales et à l'information des patients dans les établissments de santé. Council order no. 2000-697, July 26, 2001. Paris: Ministère de la santé, de la famille, et des personnes handicapées; 2004.Google Scholar
36.Christie, C, Mazon, D, Hierholzer, W Jr, Patterson, JE. Molecular heterogeneity of Acinetobacter baumannii isolates during seasonal increase in prevalence. Infect Control Hosp Epidemiol 1995; 16:590–594.Google Scholar
37.Zarrilli, R, Crispino, M, Bagattini, M, et al. Molecular epidemiology of sequential outbreaks of Acinetobacter baumannii in an intensive care unit shows the emergence of carbapenem resistance. J Clin Microbiol 2004; 42:946–953.Google Scholar
38.Villari, P, Iacuzio, L, Vozzella, EA, Bosco, U. Unusual genetic heterogeneity of Acinetobacter baumannii isolates in a university hospital in Italy. Am J Infect Control 1999; 27:247–253.Google Scholar
39.Austin, DJ, Kristinsson, KG, Anderson, RM. The relationship between the volume of antimicrobial consumption in human communities and the frequency of resistance. Proc Natl Acad Sci USA 1999; 96:1152–1156.Google Scholar
40.Randegger, CC, Keller, A, Irla, M, Wada, A, Hachler, H. Contribution of natural amino acid substitutions in SHV extended-spectrum beta-lactamases to resistance against various beta-lactams. Antimicrob Agents Chemother 2000; 44:2759–2763.Google Scholar
41.Perez-Roth, E, Lorenzo-Diaz, F, Batista, N, Moreno, A, Méndez-Alvarez, S. Tracking methicillin-resistant Staphylococcus aureus clones during a 5-year period (1998 to 2002) in a Spanish hospital. J Clin Microbiol 2004; 42:4649–4656.Google Scholar