Molecular epidemiology of carbapenem‐resistant Acinetobacter baumannii isolated from three major hospitals in Jordan

Abstract

Background: In the last decade, incidences of carbapenem-resistant Acinetobacter baumannii have been increasingly reported worldwide. Consequently, A. baumannii was included in the World Health Organization's new list of critical pathogens, for which new drugs are desperately needed. The objective of this research was to study the molecular epidemiology and antimicrobial susceptibility of clinical carbapenemresistant A. baumannii isolated from Jordanian hospitals. Methods: A total of 78 A. baumannii and 8 Acinetobacter spp. isolates were collected from three major hospitals in Jordan during 2018. Disc diffusion and microdilution methods were used to test their susceptibility against 19 antimicrobial agents.Multilocus sequence typing (MLST) was performed using the Pasteur scheme, followed by eBURST analysis for all isolates. PCR was used to detect β-lactam resistance genes, bla OX A-23-like , bla OX A-51-like , and bla NDM-1 .Results: Of the 86 tested isolates, 78 (90.6%) exhibited resistance to carbapenems, whereas no resistance was recorded to tigecycline or polymyxins. Based on the resistance profiles, 10.4% and 84.8% of isolates were classified into multidrug resistant (MDR) or extensively drug resistant (XDR), respectively. The most prevalent carbapenems resistance genes amongst isolates were bla OX A-51-Like (89.5%), followed by bla OXA-23-Like (88.3%) and bla NDM-1 (10.4%). MLST revealed the presence of 19 sequence types (STs), belonging to eight different international complexes. The most commonly detected clonal complex (CC) was CC2, representing 64% of all typed isolates.Conclusions: This is the first study to report the clonal diversity of A. baumannii isolates in Jordan. A high incidence of carbapenem resistance was detected in the isolates investigated. In addition, our findings provided evidence for the widespread of bla OXA-23-like harbouring carbapenem-resistant A. baumannii and belonging to CC2.The number of XDR isolates identified in this study is alarming. Thus, periodic surveillance and molecular epidemiological studies of resistance factors are important to improve treatment outcomes and prevent the spread of A. baumannii infections.

Multidrug-Resistant Acinetobacter baumannii in Jordan

“…All examined Acinetobacter isolates carried bla OXA-51 gene which is a confirmed intrinsic gene in A. baumannii [ 23 , 43 ]. OXA-23 was the commonest carbapenemase gene among these isolates, found in (98.5%) of isolates, in agreement with previous studies in Jordan [ 13 , 44 , 45 ] but higher than Obeidat et al 2014 (58%) [ 15 ]. Moreover, studies in Egypt and Qatar showed that 100% of the isolates were positive for bla OXA-23 [ 46 , 47 ].…”

Fresh produce as a potential vehicle for transmission of Acinetobacter baumannii

“…Furthermore, a number of isolates investigated in this study belonged to ST40, ST2, and ST602. A. baumannii strains belonging to these STs were previously isolated in Jordan from clinical samples (Ababneh et al 2021b) and intensive care unit environmental surfaces (Ababneh et al 2021a). This suggests a possible transmission of these isolates from the hospital sewage to the vegetable and fruit samples through irrigation water, or by crosscontamination from handling personnel who might be infected or colonized with A. baumannii.…”

Extended Spectrum- and Carbapenemase-Based β-Lactam Resistance in the Arabian Peninsula—A Descriptive Review of Recent Years

“…Subsequently, the analysis of 86 A. baumannii and Acinetobacter species isolates from three major hospitals in 2018 showed that 90.6% of them were carbapenem-resistant, with expression of the bla OXA-51-like (89.5%), bla OXA-23-like (88.3%), and bla NDM-1 (10.4%) genes. The number of extensively drug-resistant (XDR) isolates was reportedly ‘alarming’ [ 38 ]. Hayajneh et al used non-linear time-series methods to inform antibiotic policies to determine a threshold for third-generation cephalosporin and carbapenem use in a 533-bed tertiary teaching hospital in Irbid.…”