bAcinetobacter baumannii is a globally important nosocomial pathogen characterized by an evolving multidrug resistance. A total of 35 representative clinical A. baumannii strains isolated from 13 hospitals in nine cities in China from 1999 to 2011, including 32 carbapenem-resistant and 3 carbapenem-susceptible A. baumannii strains, were selected for whole-genome sequencing and comparative genomic analysis. Phylogenetic analysis revealed that the earliest strain, strain 1999BJAB11, and two strains isolated in Zhejiang Province in 2004 were the founder strains of carbapenem-resistant A. baumannii. Ten types of AbaR resistance islands were identified, and a previously unreported AbaR island, which comprised a two-component response regulator, resistance-related proteins, and RND efflux system proteins, was identified in two strains isolated in Zhejiang in 2004. Multiple transposons or insertion sequences (ISs) existed in each strain, and these gradually tended to diversify with evolution. Some of these IS elements or transposons were the first to be reported, and most of them were mainly found in strains from two provinces. Genome feature analysis illustrated diversified resistance genes, surface polysaccharides, and a restriction-modification system, even in strains that were phylogenetically and epidemiologically very closely related. IS-mediated deletions were identified in the type VI secretion system region, the csuE region, and core lipooligosaccharide (LOS) loci. Recombination occurred in the heme utilization region, and intrinsic resistance genes (bla ADC and bla OXA-51-like variants) and three novel bla OXA-51-like variants (bla OXA-424 , bla OXA-425 , and bla OXA-426 ) were identified. Our results could improve the understanding of the evolutionary processes that contribute to the emergence of carbapenem-resistant A. baumannii strains and help elucidate the molecular evolutionary mechanism in A. baumannii.
Acinetobacter baumannii is an important opportunistic pathogen that has caused severe nosocomial infections worldwide (1). Multidrug-resistant A. baumannii strains resistant to carbapenems have been increasingly reported worldwide, which raises serious concerns about the limited antimicrobial treatment options available (2). Our previous study indicated that the percentage of imipenem-and meropenem-resistant A. baumannii strains in China increased from 4.5% in 2003 to 61.7% in 2010 and from 4.5% in 2003 to 62.8% in 2010, respectively. In 2012, according to the Chinese Meropenem Surveillance Study (CMSS), the rates of A. baumannii susceptibility to imipenem and meropenem were 37.8% and 36.0%, respectively (3).A. baumannii rapidly develops multidrug resistance due to the presence of mobile genetic elements (MGEs), such as insertion sequences (ISs), transposons, and resistance islands (4). Many recent studies have highlighted the diversity in the genomic location, architecture, and content of resistance islands, demonstrating the dynamic nature of A. baumannii antibiotic resistance mechanisms and the adapt...