The changing epidemiology of Acinetobacter spp. producing OXA carbapenemases causing bloodstream infections in Brazil: a BrasNet report

doi:10.1016/j.diagmicrobio.2015.08.006

Diagnostic Microbiology and Infectious Disease

Volume 83, Issue 4, December 2015, Pages 382-385

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https://doi.org/10.1016/j.diagmicrobio.2015.08.006 Get rights and content

Highlights

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We observed a distinct epidemiology of Acinetobacter spp. bloodstream infections within the Brazilian territory.
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In contrast to other geographic regions, bloodstream infections were more frequently caused by A. pittii than A. baumannii in the Brazilian Northern region.
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OXA-23–producing A. baumannii were mainly grouped under CC79 and CC15, which were spread out within Brazilian territory.
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We also observed an interhospital dissemination of OXA-72–producing A. baumannii in Brazil.

Abstract

We evaluated the epidemiology of Acinetobacter spp. recovered from patients diagnosed with bloodstream infections in 9 tertiary hospitals located in all Brazilian geographic regions between April and August 2014. Although OXA-23–producing Acinetobacter baumannii clones were disseminated in most hospitals, it was observed for the first time the spread of OXA-72 among clonally related A. baumannii isolated from distinct hospitals. Interestingly, Acinetobacter pittii was the most frequent species found in a Northern region hospital. Contrasting with the multisusceptible profile displayed by A. pittii isolates, the tetracyclines and polymyxins were the only antimicrobials active against all A. baumannii isolates.

Section snippets

Conflict of interests

A.C.G. has recently received research funding and/or consultation fees from AstraZeneca, MSD, and Novartis. A.S.L. provided consultation to Eurofarma. B.R.L. was a speaker for GSK and Pfizer. The other authors have nothing to declare.

Funding

This study was partially supported by a grant of Institut Mérieux. A.T.R.V. received a Mérieux Research Grants 2013 (Network–Brazil: Identification and characterization of bacterial pathogens in nosocomial infection management).

References (22)

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Characterization of carbapenem-resistant Acinetobacter baumannii in Brazil (2008-2011): countrywide spread of OXA-23-producing clones (CC15 and CC79)
Diagn Microbiol Infect Dis
(2014)
F.L. de Sá Cavalcanti et al.
Emergence of extensively drug-resistant OXA-72-producing Acinetobacter baumannii in Recife, Brazil: risk of clonal dissemination?
Diagn Microbiol Infect Dis
(2013)
P. Espinal et al.
Rapid and accurate identification of genomic species from the Acinetobacter baumannii (Ab) group by MALDI-TOF MS
Clin Microbiol Infect
(2012)
A.C. Gales et al.
Antimicrobial resistance among Gram-negative bacilli isolated from Latin America: results from SENTRY Antimicrobial Surveillance Program (Latin America, 2008-2010)
Diagn Microbiol Infect Dis
(2012)
P.G. Higgins et al.
Inclusion of OXA-143 primers in a multiplex polymerase chain reaction (PCR) for genes encoding prevalent OXA carbapenemases in Acinetobacter spp
Int J Antimicrob Agents
(2010)
A.K. Mostachio et al.
High prevalence of OXA-143 and alteration of outer membrane proteins in carbapenem-resistant Acinetobacter spp. isolates in Brazil
Int J Antimicrob Agents
(2012)
X. Schleicher et al.
Molecular epidemiology of Acinetobacter baumannii and Acinetobacter nosocomialis in Germany over a 5-year period (2005–2009)
Clin Microbiol Infect
(2013)
M.S. Stietz et al.
Acinetobacter baumannii extensively drug resistant lineages in Buenos Aires hospitals differ from the international clones I-III
Infect Genet Evol
(2013)
K.J. Towner
Acinetobacter: an old friend, but a new enemy
J Hosp Infect
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C.S. Antonio et al.
High prevalence of carbapenem-resistant Acinetobacter baumannii carrying the bla_OXA-143 gene in Brazilian hospitals
Antimicrob Agents Chemother
(2011)

Brazilian Health Surveillance Agency (ANVISA)

Boletim Informativo: Segurança e qualidade em serviço de saúde n° 9: Relatório da resistência microbiana em infecções primárias de corrente sanguínea confirmadas laboratorialmente relacionadas ao uso de cateter venoso central em unidades de terapia intensiva

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Genomic analysis of Klebsiella pneumoniae high-risk clone ST11 co-harbouring MCR-1.27 and KPC-2 recovered at a paediatric oncologic hospital in the Brazilian Amazon region
2023, Journal of Global Antimicrobial Resistance
The horizontal transfer of antibiotic resistance genes in Gram-negative bacteria, mainly through plasmids, is one of the greatest concerns for health systems worldwide and has been a growing threat in hospitals related to healthcare-associated infections by multidrug-resistant bacteria. Here we present p
henotypic and genomic characterization of a KPC-2 and MCR-1.27-producing Klebsiella pneumoniae strain isolated from a paediatric patient at an oncologic hospital in Belém, Pará State, Brazilian Amazon region.
Antibiotic susceptibility test, whole genome sequencing, and in silico analysis were used to characterize the bacterial isolate (IEC48020) received in the Evandro Chagas Institute.
The isolate was resistant to carbapenems, colistin, polymyxin B, and several other antimicrobials and was susceptible in vitro just to tigecycline, classified as an extensively drug-resistant phenotype. Genomic analysis revealed IEC48020 strain belonged to sequence type 11, clonal complex 258 high-risk clone and the presence of eight plasmids, two of them harbouring mcr-1.27 and bla_KPC-2 genes, and the presence of virulence-related genes encoding yersiniabactin, phospholipase D, and traT genes.
The presence and dissemination of high-risk clone bacteria with high disseminating plasmids containing antibiotic resistance genes for last resource antibiotics treatment options is a threat to the healthcare system and demands efforts in surveillance and epidemiological research for better knowledge of the actual situation of antibiotic resistance in the healthcare system, especially in the Amazon region, Brazil.
Genomic and phenotypic characterisation of antimicrobial resistance in carbapenem-resistant Acinetobacter baumannii hyperendemic clones CC1, CC15, CC79 and CC25
2020, International Journal of Antimicrobial Agents
Dissemination of carbapenem-resistant Acinetobacter baumannii (CRAB) is mainly driven by the spread of clonal lineages. High frequencies of CRAB are reported in South America, and clonal complexes CC1, CC15, CC79 and CC25 are predominant. A total of 79 non-redundant CRAB recovered from 26 Brazilian hospitals were selected for antimicrobial susceptibility testing by microdilution and whole-genome sequencing (WGS). Multilocus sequence typing (MLST), acquired antimicrobial resistance genes and phylogeny based on high-quality SNPs were extracted from WGS data. XDR (86.1%), MDR (12.7%) and one PDR isolate from CC15 (1.3%) were identified. Colistin resistance was more frequent in CC25 isolates (P < 0.01). Prevalence of CC79 (n = 22; 27.8%) CC1 (n = 21; 26.6%), CC15 (n = 21; 26.6%) and CC25 (n = 12; 15.2%) was observed. Regarding carbapenem-hydrolysing class D β-lactamases (CHDLs), bla_OXA-23 was frequently detected in CC1, CC15 and CC25 isolates, whereas bla_OXA-72 was the most frequent CHDL in CC79 isolates [n = 12/22 (54.5%); P < 0.01]. High-quality SNP analysis correlated well with sequence type and revealed that CRAB clones are highly conversed and present some clone-specific resistance determinants. This study provides essential information to understand the antimicrobial resistance patterns of CRAB in Brazilian hospitals, where hyperendemic XDR-CRAB clones are disseminated. Phenotypic and genomic analysis of CRAB recovered from Brazilian hospitals revealed the predominance of XDR phenotype in the majority of international clonal complex CC79, CC1, CC15 and CC25. Dissemination of specific CRAB lineages in Brazil is suggested to be driven by their resistance determinants under antimicrobial selective pressure.
Healthcare-associated carbapenem-resistant OXA-72-producing Acinetobacter baumannii of the clonal complex CC79 colonizing migratory and captive aquatic birds in a Brazilian Zoo
2020, Science of the Total Environment
Citation Excerpt :
The production of OXA-type carbapenemases has been the main mechanism of carbapenem resistance in Acinetobacter baumannii. In Brazil, whereas OXA-23 and OXA-143 CHDLs have been prevalent, OXA-72 (enzyme belonged to OXA-24/40 group) has begun to be increasingly reported also (Vasconcelos et al., 2015; Pagano et al., 2017). Molecular epidemiological studies on carbapenem-resistant A. baumannii have highlighted the worldwide dissemination of the international clone 1 (Clonal Complex, CC1), whereas international clones 2 (CC2) and 3 (CC3) have been prevalent in Europe and the United States of America (Zarrilli et al., 2013).
Carbapenem resistance in Acinetobacter baumannii is a public health issue globally, mainly due to the production of carbapenem hydrolyzing class D β-lactamases (CHDLs). In Brazil, OXA-23 and OXA-143 CHDLs have been prevalent in A. baumannii from clinical settings, with some OXA-23 reports in the environmental samples, whereas OXA-72 has begun to be increasingly reported. This study aims to perform the genomic and microbiological characterization of carbapenem-resistant A. baumannii isolates recovered from migratory birds and captive birds inhabiting a lake within a Brazilian Zoo. Four hundred and eighty-one gram-negative bacilli were recovered from choanal and cloacal swabs obtained from 50 migratory birds and 37 captive birds present at the zoo's lake between July and August of 2012. Among all GNB, nine OXA-72-producing A. baumannii were detected from the microbiota of four migratory and five captive aquatic birds. The OXA-72-producing A. baumannii isolates were submitted to antimicrobial susceptibility test and PFGE, exhibiting a multidrug-resistant profile and clonal relatedness with OXA-72-positive human isolates circulating for eighteen years in a hospital setting. MLST, plasmid analysis and whole-genome sequencing revealed which all carbapenem-resistant A. baumannii from bird and human hosts belonged to clonal complex 79, and harboured a small plasmid (⁓16.6-kb in size), named pAC1-BRL, which carried bla_OXA-72 gene, macrolide resistance genes msrE and mphE, and the toxin-antitoxin system AbkAB. To determine the impact of pAC1-BRL acquisition in the the capacity of a microorganism to survive in a competitive environment (in the following called fitness), the laboratory strain A. baumannii ATCC 19606 was used in the fitness experiments and suggested an increase of its relative fitness after the pAC1-BRL acquisition. In summary, the detection of OXA-72-producing A. baumannii strains belonging to CC79 in aquatic birds is a piece of epidemiological evidence demonstrating that dissemination of high-risk bacteria is extending beyond the hospital.
Molecular epidemiology of carbapenem-resistant isolates of Acinetobacter baumannii in Argentina
2019, Revista Argentina de Microbiologia
Se estudiaron 100 aislados consecutivos y no epidemiológicamente relacionados de Acinetobacter baumannii resistentes a los carbapenems, recuperados entre enero y agosto de 2016 de muestras clínicas en 11 hospitales de 10 provincias de la Argentina, ubicadas en distintas regiones del país. Los genes que codifican las carbapenemasas de Ambler clase D y clase B se investigaron mediante la técnica de PCR utilizando cebadores específicos. Todos los aislados se agruparon mediante las técnicas de 3-locus sequence typing y la secuenciación del gen bla_OXA-51-like. El gen bla_OXA-23 se recuperó en todos los aislados estudiados. La población de A. baumannii resistente a carbapenems en Argentina estuvo asociada, principalmente, con ST1 (45%), ST25 (34%) y ST79 (15%). ST25 se recuperó en todas las regiones estudiadas y no se detectó CC2.
One hundred sequential, epidemiologically unrelated carbapenem-resistant- Acinetobacter baumannii isolates from 11 hospitals in 10 Argentine provinces were collected between January and August 2016. Genes coding for Ambler class D and B carbapenemases were investigated by PCR using specific primers. All isolates were typed using the 3-locus sequence typing and bla_OXA-51-like sequence-based typing techniques. The bla_OXA-23 gene was recovered in all isolates studied. The population of carbapenem-resistant- A. baumannii in Argentina was principally associated with ST1 (45%), ST25 (34%) and ST79 (15%). ST25 was recovered in all the regions studied and CC2 was not detected.
Temporal evolution of Acinetobacter baumannii ST107 clone: conversion of bla <inf>OXA-143</inf> into bla <inf>OXA-231</inf> coupled with mobilization of ISAba1 upstream occAB1
2019, Research in Microbiology
Citation Excerpt :
Although carbapenems have long been considered the first choice treatment for A. baumannii infections, nosocomial outbreaks caused by carbapenem-resistant clones are now frequently reported [1,5,6]. The production of carbapenem-hydrolyzing class D β-lactamases (CHDLs) has been the main mechanism associated with carbapenem resistance in this pathogen [4–6]. In Brazil, during the past decade, high carbapenem resistance rates were observed in A. baumannii according to the last bulletin of Brazilian Health Surveillance Agency (ANVISA) of 2017, being mainly associated with the spread of clones carrying blaOXA-23 [5,6].
Nine carbapenem-resistant Acinetobacter baumannii isolates carrying bla_OXA-231 and an ISAba1 upstream occAB1 were evaluated. They were clonally related and belonged to ST107. An OXA-143-producing A. baumannii ST107 strain (Ac-148) that did not possess ISAba1 upstream occAB1 was included in the analysis. Reduction in the expression of occAB1 and a 4-fold increase of carbapenem MICs were observed for all isolates, except for the Ac-148 strain, probably due to the presence of ISAba1 upstream occAB1 but in the same transcriptional orientation. We reported an A. baumannii ST107 clone carrying bla_OXA-143 that acquired a mutation resulting into bla_OXA-231 and mobilized ISAba1 upstream occAB1.
Carbapenemases in Acinetobacter baumannii. Review of their dissemination in Latin America
2018, Revista Argentina de Microbiologia
Citation Excerpt :
The worldwide dissemination of blaOXA-23 would be related to International clones I or II. In South America (SA) this carbapenemase has been commonly associated with CC113/CC79; however, it has also been detected in clones recovered in a lower proportion (CC104/CC15, CC110/ST25, CC109/CC1) and in many sporadic isolates3,6,9,14–17,28–30,34,36. Some OXA-23 allelic variants, such as OXA-239, have been described, which showed a major presence in studies conducted in the south of Mexico in the year 20141.
Carbapenem resistance in gram-negative bacteria by production of carbapenemases is one of the most challenging issues regarding healthcare worldwide. We review the epidemiology and prevalence of carbapenemases in carbapenem-resistant Acinetobacter baumannii isolates from Latin American countries. High resistance rates to antimicrobial agents, particularly to carbapenems, are observed in this region. OXA-23 is the most widely disseminated class D-carbapenemase; it is present in all the countries of the region and is frequently associated to endemic clones CC113/CC79, CC104/CC15, CC110/ST25 and CC109/CC1. The emergence of OXA-72 and NDM-1 represents a novel finding which is observed simultaneously and without clonal relatedness in different countries, some of which are distant from one another, whereas OXA-143 is only present in Brazil. Further collaborative intraregional studies would provide a better understanding of these issues in most of the countries and thus, policies to control the spread of these isolates could be implemented.
En bacilos gram negativos, la resistencia a carbapenemes por producción de carbapenemasas es uno de los mayores problemas en la atención de la salud a nivel mundial. Reseñamos en este artículo la epidemiologia y la prevalencia de las carbapenemasas descritas en aislamientos de Acinetobacter baumannii recuperados en América Latina. En esta región se ha observado un alto porcentaje de resistencia a los antimicrobianos, particularmente a los carbapenemes. La carbapenemasa más frecuentemente descrita es OXA-23, que ha sido recuperada en todos los países de la región y fue asociada a los clones endémicos CC113/CC79, CC104/CC15, CC110/ST25 y CC109/CC1. La emergencia de OXA-72 y NDM-1 representa un nuevo hallazgo en varios países, algunos de los cuales se encuentran muy distantes entre sí. Por el momento, OXA-143 solo se recuperó de aislamientos obtenidos en Brasil. Serían necesarios estudios colaborativos dentro de la región para lograr una mejor comprensión de la resistencia a carbapenemes en Acinetobacter baumannii, a fin de poder instaurar medidas de control que eviten una mayor diseminación de esta bacteria.

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Diagnostic Microbiology and Infectious Disease

Highlights

Abstract

Section snippets

Conflict of interests

Funding

References (22)

Characterization of carbapenem-resistant Acinetobacter baumannii in Brazil (2008-2011): countrywide spread of OXA-23-producing clones (CC15 and CC79)

Diagn Microbiol Infect Dis

Emergence of extensively drug-resistant OXA-72-producing Acinetobacter baumannii in Recife, Brazil: risk of clonal dissemination?

Diagn Microbiol Infect Dis

Rapid and accurate identification of genomic species from the Acinetobacter baumannii (Ab) group by MALDI-TOF MS

Clin Microbiol Infect

Antimicrobial resistance among Gram-negative bacilli isolated from Latin America: results from SENTRY Antimicrobial Surveillance Program (Latin America, 2008-2010)

Diagn Microbiol Infect Dis

Inclusion of OXA-143 primers in a multiplex polymerase chain reaction (PCR) for genes encoding prevalent OXA carbapenemases in Acinetobacter spp

Int J Antimicrob Agents

High prevalence of OXA-143 and alteration of outer membrane proteins in carbapenem-resistant Acinetobacter spp. isolates in Brazil

Int J Antimicrob Agents

Molecular epidemiology of Acinetobacter baumannii and Acinetobacter nosocomialis in Germany over a 5-year period (2005–2009)

Clin Microbiol Infect

Acinetobacter baumannii extensively drug resistant lineages in Buenos Aires hospitals differ from the international clones I-III

Infect Genet Evol

Acinetobacter: an old friend, but a new enemy

J Hosp Infect

High prevalence of carbapenem-resistant Acinetobacter baumannii carrying the bla_OXA-143 gene in Brazilian hospitals

Antimicrob Agents Chemother

Boletim Informativo: Segurança e qualidade em serviço de saúde n° 9: Relatório da resistência microbiana em infecções primárias de corrente sanguínea confirmadas laboratorialmente relacionadas ao uso de cateter venoso central em unidades de terapia intensiva

Cited by (43)

Genomic analysis of Klebsiella pneumoniae high-risk clone ST11 co-harbouring MCR-1.27 and KPC-2 recovered at a paediatric oncologic hospital in the Brazilian Amazon region

Genomic and phenotypic characterisation of antimicrobial resistance in carbapenem-resistant Acinetobacter baumannii hyperendemic clones CC1, CC15, CC79 and CC25

Healthcare-associated carbapenem-resistant OXA-72-producing Acinetobacter baumannii of the clonal complex CC79 colonizing migratory and captive aquatic birds in a Brazilian Zoo

Molecular epidemiology of carbapenem-resistant isolates of Acinetobacter baumannii in Argentina

Temporal evolution of Acinetobacter baumannii ST107 clone: conversion of bla <inf>OXA-143</inf> into bla <inf>OXA-231</inf> coupled with mobilization of ISAba1 upstream occAB1

Carbapenemases in Acinetobacter baumannii. Review of their dissemination in Latin America

Antimicrobial Susceptibility StudiesThe changing epidemiology of Acinetobacter spp. producing OXA carbapenemases causing bloodstream infections in Brazil: a BrasNet report

Highlights

Abstract

Section snippets

Conflict of interests

Funding

Diagn Microbiol Infect Dis

Diagn Microbiol Infect Dis

Clin Microbiol Infect

Diagn Microbiol Infect Dis

Int J Antimicrob Agents

Int J Antimicrob Agents

Clin Microbiol Infect

Infect Genet Evol

J Hosp Infect

High prevalence of carbapenem-resistant Acinetobacter baumannii carrying the blaOXA-143 gene in Brazilian hospitals

Antimicrob Agents Chemother

Boletim Informativo: Segurança e qualidade em serviço de saúde n° 9: Relatório da resistência microbiana em infecções primárias de corrente sanguínea confirmadas laboratorialmente relacionadas ao uso de cateter venoso central em unidades de terapia intensiva

Antimicrobial Susceptibility Studies
The changing epidemiology of Acinetobacter spp. producing OXA carbapenemases causing bloodstream infections in Brazil: a BrasNet report

High prevalence of carbapenem-resistant Acinetobacter baumannii carrying the bla_OXA-143 gene in Brazilian hospitals