Dissemination of Clinical Acinetobacter baumannii Isolate to Hospital Environment during the COVID-19 Pandemic

Abstract

The aim of this study was to find the source of Acinetobacter baumannii in the intensive care unit (ICU) after an outbreak during the coronavirus disease 2019 (COVID-19) pandemic, as there was no A. baumannii detected on usually screened susceptible surfaces. The screening of the ICU environment was done in April 2021 when eleven different samples were taken. One A. baumannii isolate was recovered from the air conditioner and was compared with four clinical A. baumannii isolates obtained from patients hospitalized in January 2021. Isolates were confirmed by matrix-assisted laser desorption ionization-time of flight mass spectrometry (MALDI-TOF MS), minimum inhibitory concentrations (MICs) were determined, and the multilocus sequence typing (MLST) was performed. The molecular identification of A. baumannii isolates as ST208, the presence of the same blaOXA-23 carbapenemase gene, and the same antibiotic susceptibility profile suggest that the isolate recovered from the air conditioner is the same as the isolates recovered from hospitalized patients. The environmental isolate was recovered three months later than the clinical isolates, emphasizing the ability of A. baumannii to survive on dry abiotic surfaces. The air conditioner in the clinical environment is an important but undoubtedly neglected source of A. baumannii outbreaks, hence, frequent disinfection of hospital air conditioners with appropriate disinfectants is mandatory to mitigate the circulation of A. baumannii between patients and the hospital environment.

International Clones of High Risk of Acinetobacter Baumannii—Definitions, History, Properties and Perspectives

“…A. baumannii exhibits an outstanding tendency to cause hospital outbreaks [ 15 , 16 ], which became an additional problem during the COVID-19 pandemic [ 17 ]. One of the reasons for this lies in its exceptional ability to survive for up to 60 days on various surfaces, including human skin and dry inanimate materials such as filter paper, glass, cotton, and metal, as well as on hospital surfaces [ 18 , 19 ], which underlies the necessity for accurate and reliable isolate typing in order to discriminate outbreak-causing strains. In general, typing techniques can be divided into phenotypic-based methods, DNA banding pattern-based methods, partial sequence-based methods, and whole genome sequencing (WGS)-based methods [ 16 ].…”

“…Members of the three major ‘European’ lineages are associated with the majority of hospital outbreaks caused by A. baumannii worldwide and a higher percentage of resistance to many antimicrobial drugs [ 17 , 19 , 80 , 81 ]. IC2 isolates frequently showed higher resistance rates to all antimicrobial agents than the other genotypes [ 82 ].…”

Changes in Antibiotic Resistance of Acinetobacter baumannii and Pseudomonas aeruginosa Clinical Isolates in a Multi-Profile Hospital in Years 2017–2022 in Wroclaw, Poland

“…The second, on the other hand, suggests that lipid A is present, but in a form altered by mutation of the pmrA and/or pmrB gene, which affects the lowering of colistin's affinity for LPS [47]. Increasingly, clinicians are also encountering multidrug-resistant strains, which is probably due to prior antibiotic therapy, very often inappropriately administered [48]. It is believed that for infections caused by A. baumannii, monotherapy should not be used, but rather a combination of compounds that would condition protection against the development of resistance.…”

The Dark Side of Nosocomial Infections in Critically Ill COVID-19 Patients

“…Co-infection with A. baumannii MDR significantly increases morbidity and mortality, especially in COVID-19 patients in intensive care [ 72 ]. In addition, this bacterium has been implicated in several outbreaks in healthcare facilities [ 23 , 73 ]. Inappropriate use of personal protective equipment, poor adherence to hand hygiene protocols, and irresponsible use of antibiotics are among the main factors contributing to the outbreak of this nosocomial MDR organism [ 73 ].…”

“…In addition, this bacterium has been implicated in several outbreaks in healthcare facilities [ 23 , 73 ]. Inappropriate use of personal protective equipment, poor adherence to hand hygiene protocols, and irresponsible use of antibiotics are among the main factors contributing to the outbreak of this nosocomial MDR organism [ 73 ]. As with K. pneumoniae , several studies worldwide have reported that A. baumannii strains with complete resistance to all tested antibiotics except colistin are increasingly being isolated from blood samples collected from ICU patients [ 8 , 71 ].…”