Emergence of ISAba1 harboring carbapenem-resistant Acinetobacter baumannii isolates in Pakistan
Abstract
Aim: The ISAba1 insertion sequence supports the overexpression of various oxacillinases genes by providing promoter and therefore, confers carbapenem resistance. The study aimed to determine the clonal diversity, genetic attributes of carbapenem resistance and the role of ISAba1 in the expression of oxacillinases genes among Acinetobacter baumannii clinical isolates. Materials & methods: PCR was performed to amplify various antimicrobial resistance determinants and ISAba1 insertion elements in 137 A. baumannii clinical isolates. Results: The blaOXA51 and blaOXA23-like genes and ISAba1 upstream to these genes were found in almost all multidrug-resistant isolates belonging to multiple clones. Conclusion: This is the first comprehensive study from Pakistan that highlighted the emergence of ISAba1 harboring carbapenems resistant A. baumannii stains in tertiary care hospitals.
Graphical Abstract
Papers of special note have been highlighted as: • of interest; •• of considerable interest
References
- 1 Antimicrobial susceptibility of Acinetobacter clinical isolates and emerging antibiogram trends for nosocomial infection management. Rev. Soc. Bras. Med. Trop. 49(3), 300–304 (2016).
- 2 . Treatment options for carbapenem-resistant and extensively drug-resistant Acinetobacter baumannii infections. Drugs 74(12), 1315–1333 (2014).
- 3 An investigation of drug-resistant Acinetobacter baumannii infections in a comprehensive hospital of East China. Ann. Clin. Microbiol. Antimicrob. 14, 7 (2015).
- 4 . Carbapenem-resistant Acinetobacter baumannii from Serbia: revision of CarO classification. PLoS ONE 10(3), e0122793 (2015).
- 5 . Co-existence of blaOXA-23 and blaNDM-1 genes of Acinetobacter baumannii isolated from Nepal: antimicrobial resistance and clinical significance. Antimicrob. Resist. Infect. Control. 6, 21 (2017).
- 6 . Emergence of carbapenem-resistant Acinetobacter baumannii in hospitals in Pakistan. J. Med. Microbiol. 63(Pt. 1), 50–55 (2014).
- 7 . Emerging carbapenemases: a global perspective. Int. J. Antimicrob. Agents 36(Suppl. 3), S8–S14 (2010). •• Comprehensive review on the impact of carbapenemases on antimicrobial resistance.
- 8 . A novel insertion sequence, ISAba10, inserted into ISAba1 adjacent to the bla(OXA-23) gene and disrupting the outer membrane protein gene carO in Acinetobacter baumannii. Antimicrob. Agents Chemother. 55(1), 361–363 (2011).
- 9 . Imipenem-resistant Acinetobacter baumannii carrying the ISAba1-bla OXA-23,51 and ISAba1-bla ADC-7 genes in Monteria, Colombia. Braz. J. Microbiol. 43(4), 1274–1280 (2012).
- 10 . Functional analysis of insertion sequence ISAba1, responsible for genomic plasticity of Acinetobacter baumannii. J. Bacteriol. 191(7), 2414–2418 (2009).
- 11 . First report of carbapenem-resistant Acinetobacter nosocomialis isolates harboring ISAba1-blaOXA-23 genes in Latin America. J. Clin. Microbiol. 51(8), 2739–2741 (2013).
- 12 . Genotypic and antimicrobial susceptibility of carbapenem-resistant Acinetobacter baumannii: analysis of is Aba elements and bla OXA-23-like genes including a new variant. Front. Microbiol. 6, 1249 (2015).
- 13 Comparison of one-tube multiplex PCR, automated ribotyping and intergenic spacer (ITS) sequencing for rapid identification of Acinetobacter baumannii. Clin. Microbiol. Infect. 13(8), 801–806 (2007). • Descibes the method for easy species level identification of Acinetobacter baumannii.
- 14 . Contemporary assessment of antimicrobial susceptibility testing methods for polymyxin B and colistin: review of available interpretative criteria and quality control guidelines. J. Clin. Microbiol. 39(1), 183–190 (2001).
- 15 Performance Standards for Antimicrobial Susceptibility Testing; Twenty-Fourth Informational Supplement. M100-S24. Clinical and Laboratory Standards Institute (CLSI), Wayne, PA, USA (2014).
- 16 Multidrug-resistant, extensively drug-resistant and pandrug-resistant bacteria: an international expert proposal for interim standard definitions for acquired resistance. Clin. Microbiol. Infect. 18(3), 268–281 (2012). •• International proposal for a standardized terminology to describe acquired resistance.
- 17 . Antibiotic resistance determinants of a group of multidrug-resistant Acinetobacter baumannii in China. J. Antibiot. 67(6), 439–444 (2014). • Comprehensive study for wider list of antibiotic-resistant determinants in Acinetobacter baumannii isolates from China.
- 18 Multiplex PCR for genes encoding prevalent OXA carbapenemases in Acinetobacter spp. Int. J. Antimicrob. Agents 27(4), 351–353 (2006).
- 19 . High-level carbapenem resistance in a Klebsiella pneumoniae clinical isolate is due to the combination of bla(ACT-1) beta-lactamase production, porin OmpK35/36 insertional inactivation, and down-regulation of the phosphate transport porin phoe. Antimicrob. Agents Chemother. 50(10), 3396–3406 (2006).
- 20 . Multiplex PCR for rapid detection of genes encoding acquired metallo-beta-lactamases. J. Antimicrob. Chemother. 59(2), 321–322 (2007).
- 21 . Multiplex PCR for detection of acquired carbapenemase genes. Diagn. Microbiol. Infect. Dis. 70(1), 119–123 (2011).
- 22 . A novel variant, NDM-5, of the New Delhi metallo-beta-lactamase in a multidrug-resistant Escherichia coli ST648 isolate recovered from a patient in the United Kingdom. Antimicrob. Agents Chemother. 55(12), 5952–5954 (2011).
- 23 . Phenotypic and molecular characterization of multidrug resistant Klebsiella pneumoniae isolated from a university teaching hospital, China. PLoS ONE 9(4), e95181 (2014).
- 24 The role of ISAba1 in expression of OXA carbapenemase genes in Acinetobacter baumannii. FEMS Microbiol. Lett. 258(1), 72–77 (2006). • Depicts the role of ISAba1 in the expression of carbapenemase genes.
- 25 . Distribution of repetitive DNA sequences in eubacteria and application to fingerprinting of bacterial genomes. Nucleic Acids Res. 19(24), 6823–6831 (1991).
- 26 . High prevalence of unrelated multidrug-resistant Acinetobacter baumannii isolates in Pakistani military hospitals. Int. J. Antimicrob. Agents 37(6), 580–581 (2011).
- 27 Molecular and epidemiological characterisation of clinical isolates of carbapenem-resistant Acinetobacter baumannii from public and private sector intensive care units in Karachi, Pakistan. J. Hosp. Infect. 78(2), 143–148 (2011).
- 28 Genetic diversity of OXA-51-like genes among multidrug-resistant Acinetobacter baumannii in Riyadh, Saudi Arabia. Eur. J. Clin. Microbiol. Infect. Dis. 33(7), 1223–1228 (2014).
- 29 . Identification of Acinetobacter baumannii by detection of the blaOXA-51-like carbapenemase gene intrinsic to this species. J. Clin. Microbiol. 44(8), 2974–2976 (2006).
- 30 Limited genetic diversity and extensive antimicrobial resistance in clinical isolates of Acinetobacter baumannii in north–east Iran. J. Med. Microbiol. 64(7), 767–773 (2015).
- 31 OXA- and GES-type beta-lactamases predominate in extensively drug-resistant Acinetobacter baumannii isolates from a Turkish University Hospital. Clin. Microbiol. Infect. 20(5), 410–415 (2014).
- 32 . Carbapenem-susceptible Acinetobacter baumannii carrying the ISAba1 upstream blaOXA-51-like gene in Porto Alegre, southern Brazil. Epidemiol. Infect. 141(2), 330–333 (2013).
- 33 . Growing group of extended-spectrum beta-lactamases: the CTX-M enzymes. Antimicrob. Agents Chemother. 48(1), 1–14 (2004).
- 34 . Occurrence of virulence genes, 16S rRNA methylases, and plasmid-mediated quinolone resistance genes in CTX-M-producing Escherichia coli from Pakistan. Eur. J. Clin. Microbiol. Infect. Dis. 33(3), 399–409 (2014).
- 35 Prevalence of faecal carriage of Enterobacteriaceae with NDM-1 carbapenemase at military hospitals in Pakistan, and evaluation of two chromogenic media. J. Antimicrob. Chemother. 66(10), 2288–2294 (2011).
- 36 . The emergence of pan-resistant Gram-negative pathogens merits a rapid global political response. J. Antimicrob. Chemother. 67(1), 1–3 (2012). • Excellent article regarding the funding of health initiatives to control antibiotic resistance.
- 37 . New Delhi metallo-beta-lactamase (NDM-1): towards a new pandemia? Clin. Microbiol. Infect. 16(12), 1699–1701 (2010).
- 38 . NDM-1-producing Acinetobacter baumannii from Algeria. Antimicrob. Agents Chemother. 56(4), 2214–2215 (2012).
- 39 . Plasmid carriage of bla NDM-1 in clinical Acinetobacter baumannii isolates from India. Antimicrob. Agents Chemother. 58(7), 4211–4213 (2014).
- 40 First report on bla NDM-1-producing Acinetobacter baumannii in three clinical isolates from Ethiopia. BMC Infect. Dis. 17(1), 180 (2017).
- 41 Emergence of a new antibiotic resistance mechanism in India, Pakistan, and the UK: a molecular, biological, and epidemiological study. Lancet Infect. Dis. 10(9), 597–602 (2010).
- 42 Validation of use of whole-cell repetitive extragenic palindromic sequence-based PCR (REP-PCR) for typing strains belonging to the Acinetobacter calcoaceticus–Acinetobacter baumannii complex and application of the method to the investigation of a hospital outbreak. J. Clin. Microbiol. 34(5), 1193–1202 (1996).