The population structure of 71 carbapenem-resistant Acinetobacter baumannii clinical isolates from several hospitals in Brazil was investigated by ApaI pulsed-field gel electrophoresis, bla OXA-51 -like subtyping, and multilocus sequence typing (Institute Pasteur scheme). In addition to the predominance of strains carrying bla OXA-23 , we detected the presence of bla OXA-72 and bla OXA-231 . We observed a predominance of clonal complex 1 (CC1), CC15, and CC79 and representative strains of the worldwide-disseminated international clone I.
The epidemiology of carbapenem-resistant Acinetobacter baumannii (CRAB) strains indicates the predominance of major lineages around the world (1), reinforcing the need to monitor their spread. We evaluated the population structure of CRAB strains circulating in different hospitals in Brazil.Seventy-one CRAB strains, recovered from clinical specimens of nonrepetitive patients who attended 1 of 64 different health institutions located in 23 different cities across the state of São Paulo, Brazil, and were referred to Instituto Adolfo Lutz (a public health laboratory), were studied. Each strain was definitively identified as A. baumannii species (2), and resistances to imipenem and meropenem (Sigma-Aldrich, St. Louis, MO) were confirmed by the broth microdilution technique (3); the MIC 50 and MIC 90 were 16 and 32 g/ml, respectively, for both drugs. bla OXA group genes were detected by multiplex PCR (4, 5) and fully sequenced (6-8). The bla OXA-23 gene was detected in 68 strains (95.8%), and all of them were associated with ISAba1 upstream (9). The frequencies of bla and bla OXA-231 were 2.8% (two strains) and 1.4% (one strain), respectively; none of them were associated with upstream ISAba1. The bla OXA-58 -like gene was not detected. The bla KPC , bla NDM , bla SPM , bla VIM , and bla OXA-48 genes (10) were also not detected. Sequencing of the bla OXA-51 -like gene (11) revealed the predominance of the bla OXA-51 allele in 23 strains (32.4%), of bla OXA-69 in 21 strains (29.6%), and of bla OXA-65 in 21 strains (29.6%); three strains (4.2%) presented the bla OXA-64 allele, two (4.2%) presented the bla OXA-70 allele, and only one (1.4%) presented the bla OXA-88 variant. Pulsed-field gel electrophoresis (PFGE) (12) revealed the occurrence of 64 restriction profiles that were grouped into seven clusters (A to G) on the basis of a 70% cutoff. Multilocus sequence typing (MLST; Institute Pasteur scheme [see http://pubmlst.org/abaumannii/]) and the eBURST algorithm (http://eburst.mlst.net/) identified the predominance of three major clonal complexes (CC1, CC15, and CC79) comprising more than 90% (Table 1) of the CRAB strains circulating in different hospitals across the state of São Paulo in recent years. Considering that CC1, CC15, and CC79 in isolates of OXA-23-producing A. baumannii strains circulating in other regions of Brazil have already been described (14-18), we found evidence for the role of a limited number of clonal complexes of CRAB circulating in this subcontinental country...