Fereshteh Ezadi1, Ailar Jamali1, Ahmad Heidari2, Naemeh Javid1, Abdollah Ardebili3. 1. Laboratory Sciences Research Center, Golestan University of Medical Sciences, Gorgan, Iran; Department of Microbiology, Faculty of Medicine, Golestan University of Medical Sciences, Gorgan, Iran. 2. Congenital Malformations Research Center, Golestan University of Medical Sciences, Gorgan, Iran. 3. Laboratory Sciences Research Center, Golestan University of Medical Sciences, Gorgan, Iran; Department of Microbiology, Faculty of Medicine, Golestan University of Medical Sciences, Gorgan, Iran. Electronic address: dr.ardebili@goums.ac.ir.
Abstract
OBJECTIVES: Colistin resistance rates are rising globally among multidrug-resistant Gram-negative bacilli, including Acinetobacter baumannii (A. baumannii). A new type of resistance - heteroresistance - has also been reported to colistin in clinical A. baumannii isolates. This study investigated the presence of colistin heteroresistance in carbapenem-resistant A. baumannii clinical isolates. METHODS: Different clinical specimens from hospitalised patients were investigated for A. baumannii. The MICs to imipenem, meropenem and colistin were determined by broth microdilution. PCR was performed to detect OXA-type carbapenemase genes (blaOXA-23-like, blaOXA-24/40-like, blaOXA-51-like, blaOXA-58-like, and blaOXA-143-like). Heteroresistance to colistin was examined using the population analysis profiles method. Genotypic relatedness of the isolates was analysed by enterobacterial repetitive intergenic consensus-PCR (ERIC-PCR). RESULTS: Overall, 71 A. baumannii isolates were recovered from clinical specimens. Of these, 27 (38.03%) and 44 (61.97%) isolates were carbapenem-susceptible and carbapenem-resistant, respectively. In addition, 67 (94.36%) isolates were susceptible to colistin, with MICs between 0.25-2 μg/mL. Among the 44 selected carbapenem-resistant colistin-susceptible isolates, the frequency of blaOXA-51-like, blaOXA-23-like and blaOXA-24/40-like genes was 100%, 77.27% and 43.18%, respectively. Nine of 44 (20.45%) isolates were characterised as colistin-heteroresistant with subpopulations growing at 6-8 μg/mL, whereas two of 44 (4.54%) presented heterogeneous subpopulations growing at up to 1 μg/mL of colistin. ERIC‑PCR typing clustered A. baumannii isolates to 10 common types (CT1-CT10) containing isolates from different hospitals and 12 single types (ST1-ST12). CONCLUSIONS: A. baumannii with a colistin heteroresistance phenotype was common. This could be of great concern since colistin is often used as a last-resort drug for treating A. baumannii infections, highlighting that care is necessary with colistin monotherapy. In addition, more effective strategies and surveillance are required to confine and prevent the inter-hospital and/or intra-hospital dissemination of A. baumannii between therapeutic centres.
OBJECTIVES:Colistin resistance rates are rising globally among multidrug-resistant Gram-negative bacilli, including Acinetobacter baumannii (A. baumannii). A new type of resistance - heteroresistance - has also been reported to colistin in clinical A. baumannii isolates. This study investigated the presence of colistin heteroresistance in carbapenem-resistant A. baumannii clinical isolates. METHODS: Different clinical specimens from hospitalised patients were investigated for A. baumannii. The MICs to imipenem, meropenem and colistin were determined by broth microdilution. PCR was performed to detect OXA-type carbapenemase genes (blaOXA-23-like, blaOXA-24/40-like, blaOXA-51-like, blaOXA-58-like, and blaOXA-143-like). Heteroresistance to colistin was examined using the population analysis profiles method. Genotypic relatedness of the isolates was analysed by enterobacterial repetitive intergenic consensus-PCR (ERIC-PCR). RESULTS: Overall, 71 A. baumannii isolates were recovered from clinical specimens. Of these, 27 (38.03%) and 44 (61.97%) isolates were carbapenem-susceptible and carbapenem-resistant, respectively. In addition, 67 (94.36%) isolates were susceptible to colistin, with MICs between 0.25-2 μg/mL. Among the 44 selected carbapenem-resistant colistin-susceptible isolates, the frequency of blaOXA-51-like, blaOXA-23-like and blaOXA-24/40-like genes was 100%, 77.27% and 43.18%, respectively. Nine of 44 (20.45%) isolates were characterised as colistin-heteroresistant with subpopulations growing at 6-8 μg/mL, whereas two of 44 (4.54%) presented heterogeneous subpopulations growing at up to 1 μg/mL of colistin. ERIC‑PCR typing clustered A. baumannii isolates to 10 common types (CT1-CT10) containing isolates from different hospitals and 12 single types (ST1-ST12). CONCLUSIONS:A. baumannii with a colistin heteroresistance phenotype was common. This could be of great concern since colistin is often used as a last-resort drug for treating A. baumannii infections, highlighting that care is necessary with colistin monotherapy. In addition, more effective strategies and surveillance are required to confine and prevent the inter-hospital and/or intra-hospital dissemination of A. baumannii between therapeutic centres.
Authors: Mohammad Abavisani; Mansoor Kodori; Fariba Akrami; Ali Radfar; Ali Hashemi Journal: Can J Infect Dis Med Microbiol Date: 2022-09-19 Impact factor: 2.585