Distribution of Carbapenemase Genes among Carbapenem-Non-Susceptible Acinetobacter baumanii Blood Isolates in Indonesia: A Multicenter Study

Abstract

Carbapenem non-susceptible Acinetobacter baumannii (CNSAB) is an important pathogen that causes nosocomial bacteremia among critically ill patients worldwide. The magnitude of antibiotic resistance of A. baumanii in Indonesia is expected to be significant; however, the data available are limited. The aim of this study was to analyze the genetic profiles of CNSAB isolates from patients with bacteremia in Indonesia. CNSAB isolates from blood cultures of bacteremia patients in 12 hospitals in Indonesia were included. The blood cultures were conducted using the BacT/Alert or BACTEC automated system. The CNSAB were identified with either Vitek 2 system or Phoenix platform followed by a confirmation test using a multiplex polymerase chain reaction (PCR) assay, targeting the specific gyrB gene. The carbapenemase genes were detected by multiplex PCR. In total, 110 CNSAB isolates were collected and were mostly resistant to nearly all antibiotic classes. The majority of CNSAB isolates were susceptible to tigecycline and trimethoprim-sulfamethoxazole (TMP-SMX), 45.5% and 38.2%, respectively. The blaOXA-51-like gene was identified in all CNSAB isolates. Out of the total, 83.6% of CNSAB isolates had blaOXA-23-like gene, 37.3% blaOXA-24-like gene, 4.5% blaNDM-1 gene, 0.9% blaIMP-1 gene, and 0.9% blaVIM gene. No blaOXA-48-like gene was identified. The blaOXA-23-like gene was the predominant gene in all except two hospitals. The presence of the blaOXA-24-like gene was associated with resistance to tigecycline, amikacin, TMP-SMX and cefoperazone-sulbactam, while blaOXA-23-like gene was associated with resistance to TMP-SMX and cefoperazone-sulbactam. In conclusion, the blaOXA-23-like gene was the predominant gene among CNSAB isolates throughout Indonesia. A continuous national surveillance system needs to be established to further monitor the genetic profiles of CNSAB in Indonesia.

Multicenter Study of the Risk Factors and Outcomes of Bloodstream Infections Caused by Carbapenem-Non-Susceptible Acinetobacter baumannii in Indonesia

“…Patients admitted to the ICU are in severe condition, have already been exposed to multiple antibiotics, and have a compromised immune system. This condition makes the patients are susceptible to cross-transmission infection from health workers or other patients and invasive procedures after a lengthy hospital stay [9,10,12,14,16].…”

“…To confirm the carbapenemase production of CNSAB isolates, a molecular examination to identify the carbapenemase genes was conducted. All of the tested isolates carried carbapenemase genes; the results have been published elsewhere [25].…”

“…The prevalence of bacteremia caused by CNSAB is increasing globally, including in Indonesia [13]. According to the Indonesian National Surveillance on Antimicrobial Resistance data in 2020, 61% of A. baumannii isolates from blood specimens were confirmed as carbapenem-resistant [14].…”

Molecular Epidemiology of Clinical Carbapenem-Resistant Acinetobacter baumannii-calcoaceticus complex Isolates in Tertiary Care Hospitals in Java and Sulawesi Islands, Indonesia

“…The key mechanism of carbapenem-resistant A. baumannii is the ability to produce ß-lactamase enzymes. Oxacillinase (OXA), particularly the OXA-23-like enzyme encoded by blaOXA-23-like , is the predominantly ß-lactamase enzyme found in several countries, such as France, Saudi Arabia, China, and Indonesia [ 19 , 22 , 23 ].…”

Growth kinetics of multiple Acinetobacter baumannii resistotype after meropenem-based antibiotic combination exposure

“…Nevertheless, antibiotic studies take a long time to complete and are difficult to implement in developing countries with limited access to the latest antibiotics. The alternative strategy that has gathered the most interest is antibiotic combination therapy, which is theoretically supposed to boost antibiotic effectiveness compared to single antibiotics [5][6][7] .…”