Dissemination of an NDM-2-Producing Acinetobacter baumannii Clone in an Israeli Rehabilitation Center

Abstract

New Delhi metallo-␤-lactamase (NDM-1) was initially identified in various Enterobacteriaceae and recently in Acinetobacter baumannii. This study described the clonal dissemination of an NDM-2-producing A. baumannii isolate in an Israeli rehabilitation ward and the genetic surroundings of the gene. The bla NDM-2 gene was surrounded by the ble and trpF genes downstream and two copies of the ISAba125 on both sides. These are the first NDM-producing A. baumannii strains in Israel from patients with no previous travel or hospitalization on the Indian subcontinent.Carbapenem resistance in Gram-negative bacteria is an important worldwide problem, particularly because of the production of class A, D, and B metallo-␤-lactamase enzymes (MBLs) as a resistance mechanism and the facility to spread by mobile genetic elements (12). The new MBL, New Delhi metallo-␤-lactamase 1 (NDM-1), initially reported in Klebsiella pneumoniae and Escherichia coli recovered from a Swedish patient who was previously hospitalized in India (23), has disseminated to several countries and other Enterobacteriaceae (4,9,13,(15)(16)(17)(18)22). Recently, cases of NDM-producing Acinetobacter baumannii have been described in India, Egypt, and China (1, 6, 8).Five carbapenem-resistant A. baumannii isolates were recovered from female patients at the TA-Sourasky-MA Rehabilitation hospital in Tel Aviv, Israel (Table 1). The five elderly patients (mean age, 81) were hospitalized in the same geriatric rehabilitation ward. The cultures were taken as a point prevalence study from 70 patients hospitalized in two wards in the rehabilitation center. Surveillance skin cultures were taken from six body sites (armpit, thigh, and groin, bilaterally). Four of the five patients were admitted to rehabilitation after orthopedic surgery in two different orthopedic wards located in the same hospital, adjacent to the rehabilitation center. Three of the patients shared a room with each other at a point during their hospital stay, and others shared with them common facilities. None of the patients had any clinical culture that grew Acinetobacter spp., and no signs of infection due to Acinetobacter were evident. There was no specific history taken regarding travel (Table 1). Isolates were initially identified using the Vitek-2 automatic system (bioMérieux, Marcy, France) and confirmed by amplified rRNA gene restriction analysis (ARDRA) (20). The epidemiological relationship was corroborated by pulsed-field gel electrophoresis (PFGE) under conditions described elsewhere (10). PFGE results showed an identical pattern for all the strains. Multiplex PCR to identify clonal lineages (19) showed that the strains did not belong to pan-European clone I, II, or III. Multilocus sequence typing (MLST) indicated that the strain corresponded to sequence type (ST) 103 according to the Pasteur system (http://www.pasteur.fr /recherche/genopole/PF8/mlst/Abaumannii.html), which is in agreement with the ST found in the NDM-2-producing A. baumannii isolate reported from Egypt (6).Antibiotic suscep...

High Frequency of Acinetobacter soli among Acinetobacter Isolates Causing Bacteremia at a Tertiary Hospital in Japan

“…All isolates were further characterized by employing PCR for the detection of the following genes: OXA-51-like, OXA-23-like, OXA-24-like, OXA-58-like, OXA-143-like, OXA-245-like, ISAba1/bla OXA-58 -like complex, ISAba2/bla OXA-58 -like complex, ISAba3/bla OXA-58 -like complex, IS18/bla OXA-58 -like complex, metallo-␤-lactamase (MBL) genes (including IMP-1, IMP-2, VIM-1, VIM-2, SIM-1, and NDM-1), and the carO (outer membrane protein) gene (13)(14)(15)(16)(17).…”

NDM-4 Metallo-β-Lactamase with Increased Carbapenemase Activity from Escherichia coli

“…The bla NDM-1 gene has been widely identified in Enterobacteriaceae but also in Acinetobacter baumannii from Germany, India, the United Kingdom, and China (4,5,10,11). In addition, NDM-2-producing A. baumannii isolates have been reported from Egypt and Israel (7,10). NDM-2 differs from NDM-1 by a single amino acid substitution (Pro28Ala) located in the leader peptide of the enzyme that does not modify its hydrolytic properties compared to those of NDM-1 (7,21).…”

Plasmid Carriage of bla NDM-1 in Clinical Acinetobacter baumannii Isolates from India

“…Carbapenem resistance in the opportunistic pathogen, Acinetobacter baumannii, is mostly associated with OXA-type ␤-lactamases (4), but NDM-1-like enzymes have been increasingly reported (5)(6)(7)(8)(9)(10). In all bacterial species, the bla NDM-1 gene is associated with at least one copy of a complete or partial ISAba125 gene, which provides bla NDM-1 with a strong promoter (11)(12)(13).…”