Molecular epidemiology and clinical impact of Acinetobacter calcoaceticus-baumannii complex in a Belgian burn wound center

Daniel De Vos, Jean-Paul Pirnay, Florence Bilocq, Serge Jennes, Gilbert Verbeken, Thomas Rose, Elkana Keersebilck, Petra Bosmans, Thierry Pieters, Mony Hing, Walter Heuninckx, Frank De Pauw, Patrick Soentjens, Maia Merabishvili, Pieter Deschaght, Mario Vaneechoutte, Pierre Bogaerts, Youri Glupczynski, Bruno Pot, Tanny J van der ReijdenLenie Dijkshoorn

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Abstract

Multidrug resistant Acinetobacter baumannii and its closely related species A. pittii and A. nosocomialis, all members of the Acinetobacter calcoaceticus-baumannii (Acb) complex, are a major cause of hospital acquired infection. In the burn wound center of the Queen Astrid military hospital in Brussels, 48 patients were colonized or infected with Acb complex over a 52-month period. We report the molecular epidemiology of these organisms, their clinical impact and infection control measures taken. A representative set of 157 Acb complex isolates was analyzed using repetitive sequence-based PCR (rep-PCR) (DiversiLab) and a multiplex PCR targeting OXA-51-like and OXA-23-like genes. We identified 31 rep-PCR genotypes (strains). Representatives of each rep-type were identified to species by rpoB sequence analysis: 13 types to A. baumannii, 10 to A. pittii, and 3 to A. nosocomialis. It was assumed that isolates that belonged to the same rep-type also belonged to the same species. Thus, 83.4% of all isolates were identified to A. baumannii, 9.6% to A. pittii and 4.5% to A. nosocomialis. We observed 12 extensively drug resistant Acb strains (10 A. baumannii and 2 A. nosocomialis), all carbapenem-non-susceptible/colistin-susceptible and imported into the burn wound center through patients injured in North Africa. The two most prevalent rep-types 12 and 13 harbored an OXA-23-like gene. Multilocus sequence typing allocated them to clonal complex 1 corresponding to EU (international) clone I. Both strains caused consecutive outbreaks, interspersed with periods of apparent eradication. Patients infected with carbapenem resistant A. baumannii were successfully treated with colistin/rifampicin. Extensive infection control measures were required to eradicate the organisms. Acinetobacter infection and colonization was not associated with increased attributable mortality.

Original languageEnglish
Article numbere0156237
JournalPLoS ONE
Volume11
Issue number5
Number of pages26
ISSN1932-6203
DOIs
Publication statusPublished - 2016

Keywords

  • Acinetobacter Infections/drug therapy
  • Acinetobacter baumannii/genetics
  • Acinetobacter calcoaceticus/genetics
  • Adolescent
  • Adult
  • Africa, Northern/epidemiology
  • Aged
  • Aged, 80 and over
  • Bacterial Typing Techniques
  • Belgium/epidemiology
  • Burns/microbiology
  • Child
  • Child, Preschool
  • Colistin/therapeutic use
  • Drug Resistance, Bacterial
  • Female
  • Humans
  • Infant
  • Infant, Newborn
  • Male
  • Middle Aged
  • Multilocus Sequence Typing
  • Multiplex Polymerase Chain Reaction
  • RNA, Bacterial/analysis
  • RNA, Ribosomal, 16S/analysis
  • Treatment Outcome
  • Young Adult

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