Research Article
ANTIBIOTIC RESISTANCE AND INTEGRON GENE CASSETTES IN ACINETOBACTER BAUMANNII ISOLATES PRODUCED IN LOWER RESPIRATORY TRACT SAMPLES TAKEN FROM THE INTENSIVE CARE UNIT
Abstract
Objective: The spread of antibiotic resistance genes among bacteria causes serious problems in the treatment of infectious diseases. Recently, it has been shown that these resistance genes are also found in integrons. This study investigated the class 1, 2 integrons and the antibiotic-resistant genes in the infection agent Acinetobacter baumannii produced in respiratory tract samples.
Material and Methods: The study involved 86 A. baumannii strains isolated from lower respiratory tract samples collected between March 2014 and March 2015 in the Intensive Care Units. Identification and antibiograms of the isolates were made using conventional methods and Vitek 2 Compact systems. The presence of integrons in strains was investigated by polymerase chain reaction method using specific primer pairs for class 1and class 2 integrase regions. All samples in which integron amplification was carried out were subjected to DNA sequence analysis both by cloning and as a PCR product. The resistance genes were screened by polymerase chain reaction.
Results: Isolates were obtained from specimens including tracheal aspirates (33.7%), bronchoalveolar lavage (29.1%), sputum (22.1%), bronchial washing fluid/bronchial brushing (4.7%), transbronchial biopsy (4.7%), pleural fluid (3.4%) and lung aspirates/abscess (2.3%). While resistance to imipenem, meropenem, ampicillin-sulbactam, ceftazidime, and piperacillin-tazobactam was determined in all isolates, resistance rates to ciprofloxacin, levofloxacin, gentamicin, amikacin and tigecycline were 97.7%, 93.0%, 60.5%, 53.5%and 9.3%, respectively. Colistin was the only antibiotic to which all strains were susceptible. The positivity rates of integrase I and II genes were 45.4%and 9.3%, respectively. Class 1 and 2 integron positivity rates in all isolates were 31.4%and 8.1%, respectively. blaTEM, blaSHV, blaCTX-M1, blaCTX-M2, blaOXA23, blaOXA40, blaOXA58 were 70.9%, 2.3%, 4.7%, 7.0%, 95.3%, 5.8%and 3.5%, respectively.
Conclusion: Increasing association of multi drug resistant strains and integron resistant genes in A. baumannii infections will lead to the failure of antibiotic treatment strategies.
Keywords
Acinetobacter baumannii Lower respiratory tract specimens Integron Antibiotic-resistant genes
Supporting Institution
Recep Tayyip Erdogan University-Scientific Research Projects Coordination Unit
Project Number
Project number: TSA-2017-541
References
- 1. Ellis D, Cohen B, Liu J, Larson E. Risk factors for hospital-acquired antimicrobial-resistant infection caused by Acinetobacter baumannii. Antimicrobial Resistance and Infection Control. 2015;4(40):1-5. Doi:10.1186/s13756-015-0083-2.
- 2. Anwar M, Ejaz H, Zafar A, Hamid H. Phenotypic Detection of metallo-beta lactamases in carbapenem resistant Acinetobacter baumannii isolated from pediatric patients in Pakistan. J Pathog. 2016;8603964. Doi:10.1155/2016/8603964.
- 3. Hussein NH, Al-Mathkhury HJF, Sabbah MA. Identification of imipenem-resistant genes in Acinetobacter baumannii isolated from Baghdad Hospitals. J Med Microb Diagn. 2014;3(6):170. Doi:10.4172/2161-0703.1000170.
- 4. Gaur A, Prakash P, Anupurba S, Mohapatra TM. Possible role of integrase gene polymerase chain reaction as an epidemiological marker: study of multidrug resistant Acinetobacter baumannii isolated from nosocomial infections. Int J Antimicrob Agents. 2007;29(4):446-50. Doi:10.1016/j.ijantimicag.2006.11.014.
- 5. Peleg AY, Seifert H, Paterson DL. Acinetobacter baumannii: emergence of a successful pathogen. Clin Microbiol Rev. 2008;21(3):538-82. Doi:10.1128/CMR.00058-07.
- 6. Poirel L, Naas T, Nordmann P. Diversity, epidemiology, andgenetics of class D beta-lactamases. Antimicrob Agents Chemother. 2010;54(1):24-38. Doi:10.1128/AAC.01512-08.
- 7. Clinical and Laboratory Standards Institute. Performance standards for antimicrobial susceptibility testing. M100-S24. USA. Clinical Laboratory Standards Institute, Wayne, 2014.
- 8. Navon-Venezia S, Leavitt A, Carmeli Y. High tigecycline resistance in multidrug-resistant Acinetobacter baumannii. J Antimicrob Chemother. 2007;59(4):772-774. Doi:10.1093/jac/dkm018.
- 9. Çopur Çiçek A, Düzgün AO, Saral A, Kayman T, Çizmeci Z, Balcı PÖ et al. Detection of class1integron in Acinetobacter baumannii isolates collected from nine hospitals in Turkey. Asian Pac J Trop Biomed. 2013;3(9):743-47. Doi:10.1016/S2221-1691(13)60149-5.
- 10. Çopur Çicek A, Saral A, Iraz M, Ceylan A, Duzgun AO, Peleg AY et al. OXA- and GES-type β-lactamases predominate in extensively drug-resistant Acinetobacter baumannii isolates from a Turkish University Hospital. Clin Microbiol Infect. 2014;20(5):410-5. Doi:10.1111/1469-0691.12338.
- 11. Copur Cicek A, Saral A, Ozad Duzgun A, Yasar E, Cizmeci Z, Balci PO et al. Nationwide study of Escherichia coli producing extended-spectrum β-lactamases TEM, SHV and CTX-M in Turkey. J Antibiot. 2013;66:647-650. Doi:10.1038/ja.2013.72.
- 12. Iraz M, Özad Düzgün A, Sandallı C, Doymaz MZ, Akkoyunlu Y, Saral A et al. Distribution of β-lactamase genes among carbapenem-resistant Klebsiella pneumoniae strains isolated from patients in Turkey. Ann Lab Med. 2015;35(6):595-601. Doi:10.3343/alm.2015.35.6.595.
- 13. Keskin H, Tekeli A, Dolapçı İ, Öcal D. Molecular characterization of beta-lactamase-associated resistance in Acinetobacter baumannii strains isolated from clinical samples. Mikrobiyol Bul. 2014;48(3):365-376. Doi:10.5578/mb.7796.
- 14. Sarı B, Baran I, Alaçam S, Mumcuoğlu İ, Kurşun Ş, Aksu N. Investigation of oxacillinase genes in nosocomial multidrug-resistant Acinetobacter baumannii isolates by multiplex PCR and evaluation of their clonal relationship with rep-PCR. Mikrobiyol Bul. 2015;49(2):249-58. Doi:10.5578/mb.8884.
- 15. Al-Agamy MH, Khalaf NG, Tawfick MM, Shibl AM, El Kholy A. Molecular characterization of carbapenem-insensitive Acinetobacter baumannii in Egypt. Int J Infect Dis. 2014;22:49-54. Doi:10.1016/j.ijid.2013.12.004.
- 16. Beriş FŞ, Budak EE, Gülek D, Uzun A, Çizmeci Z, Mengeloğlu FZ et al. Investigation of the frequency and distribution of beta-lactamase genes in the clinical isolates of Acinetobacter baumannii collected from different regions of Turkey: a multicenter study. Mikrobiyol Bul. 2016;50(4):511-21. Doi:10.5578/mb.29176.
- 17. Sesli Cetin E, Durmaz R, Tetik T, Otlu B, Kaya S, Çalışkan A. Epidemiologic characterization of nosocomial Acinetobacter baumannii infections in a Turkish university hospital by pulsed-field gel electrophoresis. Am J Infect Control. 2009;37(1):56-64. Doi:10.1016/j.ajic.2008.01.010.
- 18. Leila V, Dashti K, Opazo-Capurro AF, Dashti AA, Obaid KA, Evans BA. Diversity of multi-drug resistant Acinetobacter baumannii population in a major hospital in Kuwait. Front Microbiol. 2015;6:743. Doi:10.3389/fmicb.2015.00743.
- 19. Gao L, Lyu Y, Li Y. Trends in Drug Resistance of Acinetobacter baumannii over a 10year period: Nationwide data from the China surveillance of antimicrobial resistnace program. Chin Med J(Engl). 2017;130(6):659-64. Doi:10.4103/0366-6999.201601.
- 20. Li P, Wang X, Wang W, Zhao X. Comparision of the efficacies of three empirically selected antibiotics for treating Acinetobacter baumannii pulmonary infection: experience from a teaching hospital China. Int J Clin Pharmacol Ther. 2017;55(7):588-93. Doi:10.5414/CP202557.
- 21. Direkel Ş, Çopur Çiçek A, Karagöz A, Aydoğan Ejder N, Oktay E, Delialioğlu N et al. Antimicrobial susceptibility and molecular characterization of multidrug-resistant Acinetobacter baumannii isolated in a university hospital. Mikrobiyol Bul. 2016;50(4):522-34. Doi:10.5578/mb.34158.
- 22. Çıkman A, Parlak M, Gültepe B, Güdücüoğlu H, Berktaş M. Investigation of tigecycline sensitivity rates in nosocomial Acinetobacter baumannii isolates by E-Test. ANKEM Derg. 2011;25(2):79-83. Doi:10.5222/ankem.2011.079.
- 23. Deng Y, Bao X, Ji L, Chen L, Liu J, Miao J et al. Resistance integrons: class 1, 2 and 3 integrons. Ann Clin Microbiol Antimicrob. 2015;14:45. Doi:10.1186/s12941-015-0100-6. 24. Joshi PR, Acharya M, Kakshapati T, Leungtongkam U, Thummeepak R, Sitthisak S. Co-existence of blaOXA-23 and NDM-1 genes Acinetobacter baumannii isolated from Nepal: antimicrobial resistance and clinical significance. Antimicrob Resist Infect Control. 2017;6(21):1-7. Doi:10.1186/s13756-017-0180-5.
- 25. Khajuria A, Praharaj AK, Kumar M, Grover N. Molecular characterization of carbapenem resistant isolates of Acinetobacter baumannii in an intensive care unit of a tertiary care centre at Central India. J Clin Diagn Res. 2014;8(5):38-40. Doi:10.7860/JCDR/2014/7749. 4398.
- 26. Keyik S, Arslan U, Türk Dağı H, Seyhan T, Fındık D. Investigation of OXA type beta-lactamases and PFGE patterns in Acinetobacter baumannii strains resistant to carbapenems. Mikrobiyol Bul. 2014;48(4):556-65. Doi:10.5578/mb.8274.
- 27. Alyamani EJ, Khiyami MA, Booq RY, Alnafjan BM, Altammami MA, Bahwerth FS. Molecular characterization of extended spectrum-beta-lactamases (ESBLs) produced by clinical isolates of Acinetobacter baumannii in Saudi Arabia. Ann Clin Microbiol Antimicrob. 2015;14(38):1-9. Doi:10.1186/s12941-015-0098-9.
- 28. Safari M, Mozaffari Nejad AS, Bahador A, Jafari R, Alikhani MY. Prevalence of ESBL and MBL encoding genes in Acinetobacter baumannii strains isolated from patients of intensive care units (ICU). Saudi J Biol Sci. 2015;22(4):424-29. Doi:10.1016/j.sjbs.2015.01.004.
- 29. El-Shazly S, Dashti A, Vali L, Bolaris M, Ibrahim AS. Molecular epidemiology and characterization of multiple drug-resistant (MDR) clinical isolates of Acinetobacter baumannii. Int J Infect Dis. 2015;41:42–9. Doi:10.1016/j.ijid.2015.10.016.
- 30. Zeka AN, Poirel L, Sipahi OR, Bonnin RA, Arda B, Ozinel MA et al. GES-type and OXA-23 carbapenemase-producing Acinetobacter baumannii in Turkey. J Antimicrob Chemother. 2014;69(4):1145-6. Doi:10.1093/jac/dkt465.
- 31. Moubareck C, Brémont S, Conroy MC, Courvalin P, Lambert T. GES-11, a novel integron-associated GES variant in Acinetobacter baumannii. Antimicrob Agents Chemother. 2009;53(8):3579-81. Doi:10.1128/AAC.00072-09.
- 32. Aşık G, Özdemir M, Kurtoğlu MG, Yağcı S. Detection of the frequency of PER-1 type extended-spectrum β-lactamase–producing Acinetobacter baumannii clinical isolates in Turkey: a multicenter study. Turk J Med Sci. 2014;44(6):1041-6. Doi:10.3906/sag-1309-126.
- 33. Pritsch M, Zeynudin A, Messerer M, Baumer S, Liegl G, Schubert S et al. First report on bla NDM-1 producing Acinetobacter baumannii in three clinical isolates from Ethiopia. BMC Infect Dis. 2017;17(1):180. Doi:10.1186/s12879-017-2289-9.
- 34. Voulgari E, Politi L, Pitiriga V, Dendrinos J, Poulou A, Georgiadis G et al. First report of an NDM-1 metallo-β-lactamase-producing Acinetobacter baumannii clinical isolate in Greece. Int J Antimicrob Agents. 2016;48(6):761-62. Doi:10.1016/j.ijantimicag.2016.09.006.
- 35. Shoja S, Moosavian M, Roztami S, Abbasi F, Tabatabaiefer MA, Peymani A et al. Characterization of oxacillinase and metallo-β- lactames genes and moleculer typing of clinical isolates of Acinetobacter baumannii in Ahvaz, South-West of Iran. Jundishapur J Microbiol. 2016;9(5):e32388. Doi:10.5812/jjm.32388.
Yoğun Bakım Ünitesinden Alınan Alt Solunum Yolu Örneklerinde Üretilen Acinetobacter baumannii İzolatlarında Antibiyotik Direnci ve İntegron Gen Kasetleri
Abstract
Amaç: Antibiyotik direnç genlerinin bakteriler arasındaki yayılımı, enfeksiyon hastalıklarının tedavisinde ciddi sorunlara yol açmaktadır. Son zamanlarda bu direnç genlerin integronlarda da bulunduğu gösterilmiştir. Bu çalışmada alt solunum yollarından alınan kültürlerde üretilen infeksiyon etkeni olan Acinetobacter baumannii suşlarında sınıf 1, sınıf 2 integron varlığı ve antibiyotik direnç genleri araştırıldı.
Gereç ve Yöntemler: Çalışmaya, Mart 2014- Mart 2015 tarihleri arasında alt solunum yolu örneklerinden izole edilen toplam 86 A. baumannii suşu dahil edildi. İzolatların tanımlanması ve antibiyogramları konvansiyonel metodlar ve Vitek 2 Compact sistemleriyle yapıldı. Suşlarda integron varlığı, sınıf 1 (intI1) ve sınıf 2 (intI2) integraz bölgeleri için özgül primer çiftleri kullanılarak PCR yöntemiyle araştırıldı. İntegron amplifikasyonunun gerçekleştirildiği tüm örnekler hem klonlanarak hem de PCR ürünü olarak DNA dizi analizine tabi tutuldu. Direnç genleri polimeraz zincir reaksiyonu ile tarandı.
Bulgular: İzolatlar trakeal aspiratlar (%33.7), bronkoalveoler lavaj (%29,1), balgam (%22.1), bronşiyal yıkama sıvısı / bronşiyal fırçalama (%4.7), transbronşiyal biyopsi (%4.7), plevral sıvı (%3.4) ve akciğer aspirasyonları / apse (%2.3) örneklerinden elde edildi. Tüm izolatlarda imipenem, meropenem, seftazidim, piperasillin-tazobaktam, ampisilin-sulbaktama karşı direnç saptanırken, siprofloksasin, levofloksasin, gentamisin, amikasin ve tigesikline karşı direnç sırasıyla %97.7, %93.0, %60.5, %53.5 ve %9.3 olarak tespit edildi. Kolistin, tüm suşlara karşı tek etkin antibiyotikti. Integraz I ve II gen pozitiflik oranı sırasıyla %45.4 ve %9.3 iken, sınıf 1 ve 2 integron pozitiflik oranı tüm izolatlarda sırasıyla %31.4 ve %8.1 olarak bulundu. blaTEM, blaSHV, blaCTX-M1, blaCTX-M2, blaOXA23, blaOXA40, blaOXA58 sırasıyla %70.9, %2.3, %4.7, %7.0, %95.3, %5.8 ve %3.5 bulundu.
Sonuç: A. baumannii infeksiyonlarında çoklu ilaç direnci olan suşların ve integron direnç genlerinin birlikte artışı, antibiyotik tedavi stratejilerinin başarısızlığına yol açacaktır.
Project Number
Project number: TSA-2017-541
References
- 1. Ellis D, Cohen B, Liu J, Larson E. Risk factors for hospital-acquired antimicrobial-resistant infection caused by Acinetobacter baumannii. Antimicrobial Resistance and Infection Control. 2015;4(40):1-5. Doi:10.1186/s13756-015-0083-2.
- 2. Anwar M, Ejaz H, Zafar A, Hamid H. Phenotypic Detection of metallo-beta lactamases in carbapenem resistant Acinetobacter baumannii isolated from pediatric patients in Pakistan. J Pathog. 2016;8603964. Doi:10.1155/2016/8603964.
- 3. Hussein NH, Al-Mathkhury HJF, Sabbah MA. Identification of imipenem-resistant genes in Acinetobacter baumannii isolated from Baghdad Hospitals. J Med Microb Diagn. 2014;3(6):170. Doi:10.4172/2161-0703.1000170.
- 4. Gaur A, Prakash P, Anupurba S, Mohapatra TM. Possible role of integrase gene polymerase chain reaction as an epidemiological marker: study of multidrug resistant Acinetobacter baumannii isolated from nosocomial infections. Int J Antimicrob Agents. 2007;29(4):446-50. Doi:10.1016/j.ijantimicag.2006.11.014.
- 5. Peleg AY, Seifert H, Paterson DL. Acinetobacter baumannii: emergence of a successful pathogen. Clin Microbiol Rev. 2008;21(3):538-82. Doi:10.1128/CMR.00058-07.
- 6. Poirel L, Naas T, Nordmann P. Diversity, epidemiology, andgenetics of class D beta-lactamases. Antimicrob Agents Chemother. 2010;54(1):24-38. Doi:10.1128/AAC.01512-08.
- 7. Clinical and Laboratory Standards Institute. Performance standards for antimicrobial susceptibility testing. M100-S24. USA. Clinical Laboratory Standards Institute, Wayne, 2014.
- 8. Navon-Venezia S, Leavitt A, Carmeli Y. High tigecycline resistance in multidrug-resistant Acinetobacter baumannii. J Antimicrob Chemother. 2007;59(4):772-774. Doi:10.1093/jac/dkm018.
- 9. Çopur Çiçek A, Düzgün AO, Saral A, Kayman T, Çizmeci Z, Balcı PÖ et al. Detection of class1integron in Acinetobacter baumannii isolates collected from nine hospitals in Turkey. Asian Pac J Trop Biomed. 2013;3(9):743-47. Doi:10.1016/S2221-1691(13)60149-5.
- 10. Çopur Çicek A, Saral A, Iraz M, Ceylan A, Duzgun AO, Peleg AY et al. OXA- and GES-type β-lactamases predominate in extensively drug-resistant Acinetobacter baumannii isolates from a Turkish University Hospital. Clin Microbiol Infect. 2014;20(5):410-5. Doi:10.1111/1469-0691.12338.
- 11. Copur Cicek A, Saral A, Ozad Duzgun A, Yasar E, Cizmeci Z, Balci PO et al. Nationwide study of Escherichia coli producing extended-spectrum β-lactamases TEM, SHV and CTX-M in Turkey. J Antibiot. 2013;66:647-650. Doi:10.1038/ja.2013.72.
- 12. Iraz M, Özad Düzgün A, Sandallı C, Doymaz MZ, Akkoyunlu Y, Saral A et al. Distribution of β-lactamase genes among carbapenem-resistant Klebsiella pneumoniae strains isolated from patients in Turkey. Ann Lab Med. 2015;35(6):595-601. Doi:10.3343/alm.2015.35.6.595.
- 13. Keskin H, Tekeli A, Dolapçı İ, Öcal D. Molecular characterization of beta-lactamase-associated resistance in Acinetobacter baumannii strains isolated from clinical samples. Mikrobiyol Bul. 2014;48(3):365-376. Doi:10.5578/mb.7796.
- 14. Sarı B, Baran I, Alaçam S, Mumcuoğlu İ, Kurşun Ş, Aksu N. Investigation of oxacillinase genes in nosocomial multidrug-resistant Acinetobacter baumannii isolates by multiplex PCR and evaluation of their clonal relationship with rep-PCR. Mikrobiyol Bul. 2015;49(2):249-58. Doi:10.5578/mb.8884.
- 15. Al-Agamy MH, Khalaf NG, Tawfick MM, Shibl AM, El Kholy A. Molecular characterization of carbapenem-insensitive Acinetobacter baumannii in Egypt. Int J Infect Dis. 2014;22:49-54. Doi:10.1016/j.ijid.2013.12.004.
- 16. Beriş FŞ, Budak EE, Gülek D, Uzun A, Çizmeci Z, Mengeloğlu FZ et al. Investigation of the frequency and distribution of beta-lactamase genes in the clinical isolates of Acinetobacter baumannii collected from different regions of Turkey: a multicenter study. Mikrobiyol Bul. 2016;50(4):511-21. Doi:10.5578/mb.29176.
- 17. Sesli Cetin E, Durmaz R, Tetik T, Otlu B, Kaya S, Çalışkan A. Epidemiologic characterization of nosocomial Acinetobacter baumannii infections in a Turkish university hospital by pulsed-field gel electrophoresis. Am J Infect Control. 2009;37(1):56-64. Doi:10.1016/j.ajic.2008.01.010.
- 18. Leila V, Dashti K, Opazo-Capurro AF, Dashti AA, Obaid KA, Evans BA. Diversity of multi-drug resistant Acinetobacter baumannii population in a major hospital in Kuwait. Front Microbiol. 2015;6:743. Doi:10.3389/fmicb.2015.00743.
- 19. Gao L, Lyu Y, Li Y. Trends in Drug Resistance of Acinetobacter baumannii over a 10year period: Nationwide data from the China surveillance of antimicrobial resistnace program. Chin Med J(Engl). 2017;130(6):659-64. Doi:10.4103/0366-6999.201601.
- 20. Li P, Wang X, Wang W, Zhao X. Comparision of the efficacies of three empirically selected antibiotics for treating Acinetobacter baumannii pulmonary infection: experience from a teaching hospital China. Int J Clin Pharmacol Ther. 2017;55(7):588-93. Doi:10.5414/CP202557.
- 21. Direkel Ş, Çopur Çiçek A, Karagöz A, Aydoğan Ejder N, Oktay E, Delialioğlu N et al. Antimicrobial susceptibility and molecular characterization of multidrug-resistant Acinetobacter baumannii isolated in a university hospital. Mikrobiyol Bul. 2016;50(4):522-34. Doi:10.5578/mb.34158.
- 22. Çıkman A, Parlak M, Gültepe B, Güdücüoğlu H, Berktaş M. Investigation of tigecycline sensitivity rates in nosocomial Acinetobacter baumannii isolates by E-Test. ANKEM Derg. 2011;25(2):79-83. Doi:10.5222/ankem.2011.079.
- 23. Deng Y, Bao X, Ji L, Chen L, Liu J, Miao J et al. Resistance integrons: class 1, 2 and 3 integrons. Ann Clin Microbiol Antimicrob. 2015;14:45. Doi:10.1186/s12941-015-0100-6. 24. Joshi PR, Acharya M, Kakshapati T, Leungtongkam U, Thummeepak R, Sitthisak S. Co-existence of blaOXA-23 and NDM-1 genes Acinetobacter baumannii isolated from Nepal: antimicrobial resistance and clinical significance. Antimicrob Resist Infect Control. 2017;6(21):1-7. Doi:10.1186/s13756-017-0180-5.
- 25. Khajuria A, Praharaj AK, Kumar M, Grover N. Molecular characterization of carbapenem resistant isolates of Acinetobacter baumannii in an intensive care unit of a tertiary care centre at Central India. J Clin Diagn Res. 2014;8(5):38-40. Doi:10.7860/JCDR/2014/7749. 4398.
- 26. Keyik S, Arslan U, Türk Dağı H, Seyhan T, Fındık D. Investigation of OXA type beta-lactamases and PFGE patterns in Acinetobacter baumannii strains resistant to carbapenems. Mikrobiyol Bul. 2014;48(4):556-65. Doi:10.5578/mb.8274.
- 27. Alyamani EJ, Khiyami MA, Booq RY, Alnafjan BM, Altammami MA, Bahwerth FS. Molecular characterization of extended spectrum-beta-lactamases (ESBLs) produced by clinical isolates of Acinetobacter baumannii in Saudi Arabia. Ann Clin Microbiol Antimicrob. 2015;14(38):1-9. Doi:10.1186/s12941-015-0098-9.
- 28. Safari M, Mozaffari Nejad AS, Bahador A, Jafari R, Alikhani MY. Prevalence of ESBL and MBL encoding genes in Acinetobacter baumannii strains isolated from patients of intensive care units (ICU). Saudi J Biol Sci. 2015;22(4):424-29. Doi:10.1016/j.sjbs.2015.01.004.
- 29. El-Shazly S, Dashti A, Vali L, Bolaris M, Ibrahim AS. Molecular epidemiology and characterization of multiple drug-resistant (MDR) clinical isolates of Acinetobacter baumannii. Int J Infect Dis. 2015;41:42–9. Doi:10.1016/j.ijid.2015.10.016.
- 30. Zeka AN, Poirel L, Sipahi OR, Bonnin RA, Arda B, Ozinel MA et al. GES-type and OXA-23 carbapenemase-producing Acinetobacter baumannii in Turkey. J Antimicrob Chemother. 2014;69(4):1145-6. Doi:10.1093/jac/dkt465.
- 31. Moubareck C, Brémont S, Conroy MC, Courvalin P, Lambert T. GES-11, a novel integron-associated GES variant in Acinetobacter baumannii. Antimicrob Agents Chemother. 2009;53(8):3579-81. Doi:10.1128/AAC.00072-09.
- 32. Aşık G, Özdemir M, Kurtoğlu MG, Yağcı S. Detection of the frequency of PER-1 type extended-spectrum β-lactamase–producing Acinetobacter baumannii clinical isolates in Turkey: a multicenter study. Turk J Med Sci. 2014;44(6):1041-6. Doi:10.3906/sag-1309-126.
- 33. Pritsch M, Zeynudin A, Messerer M, Baumer S, Liegl G, Schubert S et al. First report on bla NDM-1 producing Acinetobacter baumannii in three clinical isolates from Ethiopia. BMC Infect Dis. 2017;17(1):180. Doi:10.1186/s12879-017-2289-9.
- 34. Voulgari E, Politi L, Pitiriga V, Dendrinos J, Poulou A, Georgiadis G et al. First report of an NDM-1 metallo-β-lactamase-producing Acinetobacter baumannii clinical isolate in Greece. Int J Antimicrob Agents. 2016;48(6):761-62. Doi:10.1016/j.ijantimicag.2016.09.006.
- 35. Shoja S, Moosavian M, Roztami S, Abbasi F, Tabatabaiefer MA, Peymani A et al. Characterization of oxacillinase and metallo-β- lactames genes and moleculer typing of clinical isolates of Acinetobacter baumannii in Ahvaz, South-West of Iran. Jundishapur J Microbiol. 2016;9(5):e32388. Doi:10.5812/jjm.32388.
There are 34 citations in total.
Details
| Primary Language | English |
|---|---|
| Subjects | Health Care Administration |
| Journal Section | Articles |
| Authors | |
| Project Number | Project number: TSA-2017-541 |
| Publication Date | December 31, 2020 |
| Submission Date | November 3, 2020 |
| Published in Issue | Year 2020 Volume: 22 Issue: 3 |
Cite
Cited By
Evaluating molecular epidemiology of carbapenem non-susceptible Klebsiella pneumoniae isolates with MLST, MALDI-TOF MS, PFGE
Annals of Clinical Microbiology and Antimicrobials
https://doi.org/10.1186/s12941-023-00640-9
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