Research Article
BibTex RIS Cite

Investigation of Resistance and Clonal Relatedness Among The Nosocomial Acinetobacter Isolates

Year 2019, Volume: 5 Issue: 2, 120 - 132, 28.08.2019
https://doi.org/10.19127/mbsjohs.581706

Abstract



Objective:
This study focused on Acinetobacter
spp. that were isolated from inpatients to determine the resistance rates to
antibiotics and to monitor the resistance increase over the years.

Method:
To determine whether there was a clonal relationship between the strains using
pulsed field gel electrophoresis (PFGE), to evaluate the epidemiological and
clinical data of patients, and to determine the factors that may be effective
in the formation and spread of infection, antibiotic susceptibilities of Acinetobacter strains were evaluated by
the Kirby Bauer disk diffusion method. Molecular typing was studied with PFGE.

Results:
Netilmicin had the least resistance (7%) among the strains, while the highest
resistance was found against piperacillin (92%), ceftriaxone (81%), and
doxycycline (69%). When resistance profiles of strains were compared according
to year (2005-2007), no significant changes were found for resistance rates to
piperacillin, ceftriaxone, gentamicin, doxycycline, and trimethoprim /
sulfamethoxazole. Of all the 131 tested Acinetobacter spp., 82 (62.6%)
of the strains were clustered with the PFGE method and 72.3% of the strains
were clonally related. The increase in MDR, XDR and PDR rates among the
isolated Acinetobacter spp. is remarkable. It was determined that the
degree of transmission of the strains was quite high among patients. The clone
in the hospital was able to remain in the environment for long periods and the
general patient mortality rates were higher than other studies.







Conclusions:
According to results and with the support of molecular typing studies, the need
for more effective prevention and control measures in our hospital was
demonstrated.

Supporting Institution

TUBITAK

Project Number

SBAG 106S211

Thanks

This study was produced from the expertise thesis of Ahmet Çalışkan and includes a part of the project of SBAG 106S211 supported by TUBITAK.

References

  • Aber CR, Mackel DC. Epidemiologic typing of nosocomial microorganisms. The American Journal of Medicine. 1981;70:898–905.
  • Aparajita Richard V, Goering Shabbir S, Foley SL, Zervos M. Application of Molecular Techniques to the Study of Hospital Infection. Clinical Microbiology. 2006;19:512- 530.
  • Arbeit RD. Laboratory procedures for the epidemiologic analysis of microorganisms1995., p. 190–208. In Murray PR, Baron EJ, Pfaller MA, Tenover FC, Yolken RH (ed.), Manual of clinical microbiology, 6th ed. American Society for Microbiology, Washington, D.C.
  • Beck-Sague CM, Jarvis WR, Brook JH, Culver DH, Potts A, Gay A et al. Epidemic bacteremia due to Acinetobacter baumannii in five intensive care unit. American Journal of Epidemiology. 1990;132:723–733.
  • Bergogne-Berezin E, Towner KJ. Acinetobacter spp.as nosocomial pathogens: microbiological, clinical, and epidemilogical features. Clinical Microbiology Review. 1996;9:148–165.
  • Bou G, Cervero G, Dominguez MA, Querada C, Martínez-Beltrána J. PCR-based DNA fingerprinting(REP-PCR, AP-PCR) and pulsed-field gel electrophoresis characterization of a nosocomial outbreak caused by imipenem and meropenem- resistant Acinetobacter baumannii. Clinical Microbiology and Infection. 2000;6:635–643.
  • Buxton AE, Anderson RL, Werdegar D, Ernest Atlas MD. Nosocomial respiratory tract infection and colonization with Acinetobacter calcoaceticus. The American Journal of Medicine. 1978;65:507–513.
  • Catchpole CR, Andrews JM, Brenwald N, Wise R. A reassessment of the in-vitro activity of colistin sulphomethate sodium. Journal of Antimicrobial Chemotheraphy. 1997;39:255–60.
  • Clinical and Laboratory Standards Institute 2008. Performance standart for antimicrobial disk susceptibility Testing; Approved standard M2-A9 and M7-A7, 18 th ed. CLSI, Wayne, PA.
  • Corbella X, Pujol M, Ayast J, Sendra M, Ardanury C, Dominguez MA, Linares J, Ariza J, Gudiol F. Relevance of digestive tract colonization in the epidemiology of nasocomial infections due to multi resistant Acinetobacter baumannii. Clinical Microbiology and Infectious Disease. 1996;23:329–334.
  • Durmaz R, Otlu B, Calıskan A, Gursoy N. A Rapid Pulsed-field Gel Electrophoresis (PFGE) Protocol Developed for Subtyping Acinetobacter baumannii, Escherichia coli, and Klebsiella spp. ANKEM. 2007;21(2):113–117
  • Cetin Sesli E, Durmaz R, Tetik T, Otlu B, Kaya S, Caliskan A. Epidemiologic characterization of nosocomial Acinetobacter baumannii infections in a Turkish university hospital by pulsed-field gel electrophoresis. American Journal of Infection Control. 2009;37: 56-64.
  • Falagas ME, Bliziotis IA, Kasiakou SK, Samonis G. Outcome of infections due to pandrug-resistance gram-negative bacteria. BMC Infectious Disease 2005; 5: 24.
  • Falagas ME, Bliziotis IA. Pandrug-resistant Gram-negative bacteria: the dawn of the post-antibiotic era? International Journal of Antimicrobial Agents 2007;29: 630–636
  • Falagas ME, Kopterides P. Risk factors for the isolation of multi-drug-resistant Acinetobacter baumannii and Pseudomonas aeruginosa: a systematic review of the literature. Journal of Hospital Infection. 2006; 64: 7–15.
  • Gales AC, Jones RN, Sader HS. Global assessment of the antimicrobial activity of polymyxin B against 54 731 clinical isolates of Gram negative bacilli: report from the SENTRY antimicrobial surveillance programme (2001–2004). Clinical Microbiology Infection. 2006;12:315–21.
  • Gazi H, Surucuoglu S, Kurutepe S, Inmez E, Dinc G, Ozbakkaloglu B. In vitro Antibiotic Susceptibilities in Nosocomial Acinetobacter baumannii Strains Isolated from Intensive Care Unit and other Clinics. ANKEM. 2005;19(3):115–118.
  • Giske CG, Monnet DL, Cars O, Carmeli Y. On behalf of ReAct-Action on Antibiotic Resistance. Antimicrobial Agents and Chemotheraphy. 2008; 52: 813–21
  • Goering RV. Molecular epidemiology of nosocomial infection: analysis of chromosomal restriction fragment patterns by pulsed-field gel electrophoresis. Infection Control and Hospital Epidemiology. 1993;14:595–600.
  • Gulhan B, Ozekinci T, Atmaca S, Bilek H. Antibiotic Resistance of Acinetobacter baumannii Strains Isolated in 2004-2006 Years. ANKEM. 2007;21(1):32–36.
  • Henwood CJ, Gatward T,Warner M, James D, Stockdale MW, Spence RP, et al. Antibiotic resistance among clinical isolates of Acinetobacter in the UK, and in vitro evaluation of tigecycline (GAR–936). Journal of Antimicrobial Chemotheraphy. 2002;49:479–87.
  • Hsueh PR, LJ, Chen CY, Chen WE, Ho SW, Luh KT. Pandrug-resistant Acinetobacter baumannii causing nasocomial infections in a university hospital, Taiwan. Emerging Infectious Disease. 2002;8:827–832.
  • Jain R, Danziger LH. Multidrug-resistant Acinetobacter infections: an emerging challenge to clinicians. Annals of Pharmacotherapy. 2004;38:1449–1459.
  • Jarvis WR. Usefulness of molecular epidemiology for outbreak investigations. Infection Control & Hospital Epidemiology. 1994;15:500–503
  • Jones R, Feraro M, Relle L, Schreckenbeger P, Swenson J, Sader H. Multicenter studies of tigecycline Disk Diffusion Susceptibity Results for Acinetobacter spp. Journal of Clinical Microbiology. 2007;6.227–230.
  • Li J, Nation RL, Milne RW, Turnidge JD, Coulthard K. Evaluation of colistin as an agent against multi-resistant gram-negative bacteria. International Journal of Antimicrobial Agents 2005;25:11–25.
  • Lortholary O, Fagon JY, Hoi AB, Slama MA, Pierre J, Giral P, Rosenzweig R, Gutmann L, Safar M, Acar J. Nosocomial acquisition of multiresistant Acinetobacter baumannii: risk factors and prognosis. Clinical Infectious Disease. 1995, 20:790–796.
  • Lyons RW. Ecology, clinical significance and antimicrobial susceptibilty of Acinetobacter and Moraxella. In: Gilardi GL. Ed. Nonfermantative Gram Negative Rods: Laboratory Identification and Clinical Aspects: New York: Marcel dekker, 1985;159-179.
  • Maslow JN, Slutsky AM, Arbeit RD. Application of pulsed-field gel electrophoresis to molecular epidemiology. In: Persing HD, Smith TF, Tenover FC, White TJ, eds. Diagnostic molecular microbiology: principles and applications. Washington, DC: American Society for Microbiology; 1993:563–72.
  • Mulin B, Talon D, Viel JF, Vincent C, Leprat R, Thouverez M, et al. Risk factors for nosocomial colonization with multiresistant Acinetobacter baumannii, European Journal of Clinical Microbiology and Infectious Diseases. 1995;14(7):569–76.
  • Parvez FM, Jarvis WR. Nosocomial infections in the nursery. Seminar in Pediatric Infectious Disease. 1999;10:119–29.
  • Prashanth K, Badrinath S. Epidemiological investigation of nosocomial Acinetobacter infections using arbitrarily primed PCR & pulse field gel electrophoresis. Indian Journal of Medical Research. 2005:11;122:408–418
  • Ruiz J, Nunez ML, Perez J, Simarro E, Martinez-Campos L, Gomez J. Evolution of resistance among clinical isolates of Acinetobacter over a 6-year period, European Journal of Clinical Microbiology and Infectious Disease. 1999;18(4):292–5.
  • Seifert H, Baginski R, Schulze A, Pulverer G. Antimicrobial susceptibility of Acinetobacter species. Zentralblatt fur Bakteriologie: International Journal of Medical Microbiology. 1993;37:750–753.
  • Siegman-Igra Y, Bar-Yosef S, Gorea A, Avram J. Nosocomial Acinetobacter meningitis secondary to invasive procedues: report of 25 cases and review. Clinical Infectious Disease. 1993;17:843–849.
  • Tenover FC, Arbeit RD, Goering RV. How to select and interpret molecular strain typing methods for epidemiological studies of bacterial infections: a review for healthcare epidemiologists. Molecular Typing Working Group of the Society for Healthcare Epidemiology of America. Infection Control and Hospital Epidemiology. 1997;18(6):426–39.
  • Villari P, Iacuzio L, Vozzella EA, Bosco U. 1999. Unusual genetic heterogeneity of Acinetobacter baumanni isolates in a university hospital in Italy. The American Journal of Infection Control. 27: 247–253.
  • Villegas MV, Hartstein Al. Acinetobacter outbreaks,1977–2000. Infection Control and Hospital Epidemiology. 2003;24:284–295.
  • Wang H, Guo P, Sun H, Wang, H, Yang O, Chen, M, et al. Molecular Epidemiology of Clinical Isolates of Carbapenem-Resistant Acinetobacter spp. from Chinese Hospitals. Antimicrobial Agents and Chemotherapy. 2007;10: 4022–4028
  • Webster CA, Crove M, Humphreys H, Towner KJ. Surveillance of and adult intensive care unit for long-term persistence of a multi-resistant strain of Acinetobacter baumannii. Journal of Clinical Microbiology. 1998;17:171–176.
Year 2019, Volume: 5 Issue: 2, 120 - 132, 28.08.2019
https://doi.org/10.19127/mbsjohs.581706

Abstract

Project Number

SBAG 106S211

References

  • Aber CR, Mackel DC. Epidemiologic typing of nosocomial microorganisms. The American Journal of Medicine. 1981;70:898–905.
  • Aparajita Richard V, Goering Shabbir S, Foley SL, Zervos M. Application of Molecular Techniques to the Study of Hospital Infection. Clinical Microbiology. 2006;19:512- 530.
  • Arbeit RD. Laboratory procedures for the epidemiologic analysis of microorganisms1995., p. 190–208. In Murray PR, Baron EJ, Pfaller MA, Tenover FC, Yolken RH (ed.), Manual of clinical microbiology, 6th ed. American Society for Microbiology, Washington, D.C.
  • Beck-Sague CM, Jarvis WR, Brook JH, Culver DH, Potts A, Gay A et al. Epidemic bacteremia due to Acinetobacter baumannii in five intensive care unit. American Journal of Epidemiology. 1990;132:723–733.
  • Bergogne-Berezin E, Towner KJ. Acinetobacter spp.as nosocomial pathogens: microbiological, clinical, and epidemilogical features. Clinical Microbiology Review. 1996;9:148–165.
  • Bou G, Cervero G, Dominguez MA, Querada C, Martínez-Beltrána J. PCR-based DNA fingerprinting(REP-PCR, AP-PCR) and pulsed-field gel electrophoresis characterization of a nosocomial outbreak caused by imipenem and meropenem- resistant Acinetobacter baumannii. Clinical Microbiology and Infection. 2000;6:635–643.
  • Buxton AE, Anderson RL, Werdegar D, Ernest Atlas MD. Nosocomial respiratory tract infection and colonization with Acinetobacter calcoaceticus. The American Journal of Medicine. 1978;65:507–513.
  • Catchpole CR, Andrews JM, Brenwald N, Wise R. A reassessment of the in-vitro activity of colistin sulphomethate sodium. Journal of Antimicrobial Chemotheraphy. 1997;39:255–60.
  • Clinical and Laboratory Standards Institute 2008. Performance standart for antimicrobial disk susceptibility Testing; Approved standard M2-A9 and M7-A7, 18 th ed. CLSI, Wayne, PA.
  • Corbella X, Pujol M, Ayast J, Sendra M, Ardanury C, Dominguez MA, Linares J, Ariza J, Gudiol F. Relevance of digestive tract colonization in the epidemiology of nasocomial infections due to multi resistant Acinetobacter baumannii. Clinical Microbiology and Infectious Disease. 1996;23:329–334.
  • Durmaz R, Otlu B, Calıskan A, Gursoy N. A Rapid Pulsed-field Gel Electrophoresis (PFGE) Protocol Developed for Subtyping Acinetobacter baumannii, Escherichia coli, and Klebsiella spp. ANKEM. 2007;21(2):113–117
  • Cetin Sesli E, Durmaz R, Tetik T, Otlu B, Kaya S, Caliskan A. Epidemiologic characterization of nosocomial Acinetobacter baumannii infections in a Turkish university hospital by pulsed-field gel electrophoresis. American Journal of Infection Control. 2009;37: 56-64.
  • Falagas ME, Bliziotis IA, Kasiakou SK, Samonis G. Outcome of infections due to pandrug-resistance gram-negative bacteria. BMC Infectious Disease 2005; 5: 24.
  • Falagas ME, Bliziotis IA. Pandrug-resistant Gram-negative bacteria: the dawn of the post-antibiotic era? International Journal of Antimicrobial Agents 2007;29: 630–636
  • Falagas ME, Kopterides P. Risk factors for the isolation of multi-drug-resistant Acinetobacter baumannii and Pseudomonas aeruginosa: a systematic review of the literature. Journal of Hospital Infection. 2006; 64: 7–15.
  • Gales AC, Jones RN, Sader HS. Global assessment of the antimicrobial activity of polymyxin B against 54 731 clinical isolates of Gram negative bacilli: report from the SENTRY antimicrobial surveillance programme (2001–2004). Clinical Microbiology Infection. 2006;12:315–21.
  • Gazi H, Surucuoglu S, Kurutepe S, Inmez E, Dinc G, Ozbakkaloglu B. In vitro Antibiotic Susceptibilities in Nosocomial Acinetobacter baumannii Strains Isolated from Intensive Care Unit and other Clinics. ANKEM. 2005;19(3):115–118.
  • Giske CG, Monnet DL, Cars O, Carmeli Y. On behalf of ReAct-Action on Antibiotic Resistance. Antimicrobial Agents and Chemotheraphy. 2008; 52: 813–21
  • Goering RV. Molecular epidemiology of nosocomial infection: analysis of chromosomal restriction fragment patterns by pulsed-field gel electrophoresis. Infection Control and Hospital Epidemiology. 1993;14:595–600.
  • Gulhan B, Ozekinci T, Atmaca S, Bilek H. Antibiotic Resistance of Acinetobacter baumannii Strains Isolated in 2004-2006 Years. ANKEM. 2007;21(1):32–36.
  • Henwood CJ, Gatward T,Warner M, James D, Stockdale MW, Spence RP, et al. Antibiotic resistance among clinical isolates of Acinetobacter in the UK, and in vitro evaluation of tigecycline (GAR–936). Journal of Antimicrobial Chemotheraphy. 2002;49:479–87.
  • Hsueh PR, LJ, Chen CY, Chen WE, Ho SW, Luh KT. Pandrug-resistant Acinetobacter baumannii causing nasocomial infections in a university hospital, Taiwan. Emerging Infectious Disease. 2002;8:827–832.
  • Jain R, Danziger LH. Multidrug-resistant Acinetobacter infections: an emerging challenge to clinicians. Annals of Pharmacotherapy. 2004;38:1449–1459.
  • Jarvis WR. Usefulness of molecular epidemiology for outbreak investigations. Infection Control & Hospital Epidemiology. 1994;15:500–503
  • Jones R, Feraro M, Relle L, Schreckenbeger P, Swenson J, Sader H. Multicenter studies of tigecycline Disk Diffusion Susceptibity Results for Acinetobacter spp. Journal of Clinical Microbiology. 2007;6.227–230.
  • Li J, Nation RL, Milne RW, Turnidge JD, Coulthard K. Evaluation of colistin as an agent against multi-resistant gram-negative bacteria. International Journal of Antimicrobial Agents 2005;25:11–25.
  • Lortholary O, Fagon JY, Hoi AB, Slama MA, Pierre J, Giral P, Rosenzweig R, Gutmann L, Safar M, Acar J. Nosocomial acquisition of multiresistant Acinetobacter baumannii: risk factors and prognosis. Clinical Infectious Disease. 1995, 20:790–796.
  • Lyons RW. Ecology, clinical significance and antimicrobial susceptibilty of Acinetobacter and Moraxella. In: Gilardi GL. Ed. Nonfermantative Gram Negative Rods: Laboratory Identification and Clinical Aspects: New York: Marcel dekker, 1985;159-179.
  • Maslow JN, Slutsky AM, Arbeit RD. Application of pulsed-field gel electrophoresis to molecular epidemiology. In: Persing HD, Smith TF, Tenover FC, White TJ, eds. Diagnostic molecular microbiology: principles and applications. Washington, DC: American Society for Microbiology; 1993:563–72.
  • Mulin B, Talon D, Viel JF, Vincent C, Leprat R, Thouverez M, et al. Risk factors for nosocomial colonization with multiresistant Acinetobacter baumannii, European Journal of Clinical Microbiology and Infectious Diseases. 1995;14(7):569–76.
  • Parvez FM, Jarvis WR. Nosocomial infections in the nursery. Seminar in Pediatric Infectious Disease. 1999;10:119–29.
  • Prashanth K, Badrinath S. Epidemiological investigation of nosocomial Acinetobacter infections using arbitrarily primed PCR & pulse field gel electrophoresis. Indian Journal of Medical Research. 2005:11;122:408–418
  • Ruiz J, Nunez ML, Perez J, Simarro E, Martinez-Campos L, Gomez J. Evolution of resistance among clinical isolates of Acinetobacter over a 6-year period, European Journal of Clinical Microbiology and Infectious Disease. 1999;18(4):292–5.
  • Seifert H, Baginski R, Schulze A, Pulverer G. Antimicrobial susceptibility of Acinetobacter species. Zentralblatt fur Bakteriologie: International Journal of Medical Microbiology. 1993;37:750–753.
  • Siegman-Igra Y, Bar-Yosef S, Gorea A, Avram J. Nosocomial Acinetobacter meningitis secondary to invasive procedues: report of 25 cases and review. Clinical Infectious Disease. 1993;17:843–849.
  • Tenover FC, Arbeit RD, Goering RV. How to select and interpret molecular strain typing methods for epidemiological studies of bacterial infections: a review for healthcare epidemiologists. Molecular Typing Working Group of the Society for Healthcare Epidemiology of America. Infection Control and Hospital Epidemiology. 1997;18(6):426–39.
  • Villari P, Iacuzio L, Vozzella EA, Bosco U. 1999. Unusual genetic heterogeneity of Acinetobacter baumanni isolates in a university hospital in Italy. The American Journal of Infection Control. 27: 247–253.
  • Villegas MV, Hartstein Al. Acinetobacter outbreaks,1977–2000. Infection Control and Hospital Epidemiology. 2003;24:284–295.
  • Wang H, Guo P, Sun H, Wang, H, Yang O, Chen, M, et al. Molecular Epidemiology of Clinical Isolates of Carbapenem-Resistant Acinetobacter spp. from Chinese Hospitals. Antimicrobial Agents and Chemotherapy. 2007;10: 4022–4028
  • Webster CA, Crove M, Humphreys H, Towner KJ. Surveillance of and adult intensive care unit for long-term persistence of a multi-resistant strain of Acinetobacter baumannii. Journal of Clinical Microbiology. 1998;17:171–176.
There are 40 citations in total.

Details

Primary Language English
Subjects Health Care Administration
Journal Section Research articles
Authors

Ahmet Çalışkan This is me

Rıza Durmaz This is me

Canan Ateş Gürsoy This is me

Nilay Ildız 0000-0002-3799-856X

Project Number SBAG 106S211
Publication Date August 28, 2019
Published in Issue Year 2019 Volume: 5 Issue: 2

Cite

Vancouver Çalışkan A, Durmaz R, Ateş Gürsoy C, Ildız N. Investigation of Resistance and Clonal Relatedness Among The Nosocomial Acinetobacter Isolates. Mid Blac Sea J Health Sci. 2019;5(2):120-32.

2310022108  22107  22106  22105  22103  22109 22137 22102  22110    e-ISSN 2149-7796