The First Report on the Outbreak of OXA-24/40-Like Carbapenemase-Producing <i>Acinetobacter baumannii</i> in Turkey

Abstract

Carbapenem resistance due to OXA-type carbapenemases seriously limits therapeutic options in nosocomial infections caused by Acinetobacter baumannii. Previous studies have shown the presence of OXA-51, OXA-58, and OXA-23 carbapenemases but not OXA-24/40 in A. baumannii in Turkey. In this study, we investigated carbapenem-hydrolyzing class D b-lactamases (CHDLs) in A. baumannii and the molecular epidemiology of CHDL producers at the Dokuz Eylul Hospital, Izmir Turkey, and detected bla OXA-24/40 in a clinical isolate from a patient in the medical intensive care unit (ICU). The specific enzyme type was OXA-72. Additional studies revealed 22 more isolates from 20 patients and that the OXA-72-producing strain caused an outbreak in the medical ICU from September 2012 to March 2013, which still continues. To our knowledge, this is the first report of OXA-24/40 carbapenemases in A. baumannii in Turkey. Emergency infection control should be implemented following the arrival of a new OXA at a hospital where A. baumannii is highly endemic. Acinetobacter baumannii is an opportunistic pathogen, which causes nosocomial infections and outbreaks worldwide, particularly in the intensive care units (ICUs) (1,2). Although carbapenems are frequently used for the treatment of infections due to multidrugresistant (MDR) A. baumannii isolates, the increasing resistance to these antimicrobial agents has significantly limited treatment options (3,4). The underlying resistance mechanisms may be related to efflux pump overexpression, decreased permeability, and carbapenemase production. Among the carbapenemases, carbapenem-hydrolyzing class D b-lactamases (CHDLs) are considered the most prevalent cause of carbapenem resistance in A. baumannii (4-6). The CHDLs in A. baumannii can be grouped into six subclasses: chromosomal OXA-51-like, acquired OXA-23-like, OXA-24/40-like, OXA-58-like, OXA-143-like, and OXA-235-like b-lactamases (7,8). OXA-23-like enzymes are the most prevalent CHDLs and have been reported worldwide (1-9). In Turkey, data regarding CHDLs and their epidemiology in A. baumannii are limited. Outbreaks due to OXA-23-like and OXA-58-like enzyme-producing strains were reported in 2008-2010 (10-12). Previous reports have shown that OXA-58-like enzymes were the most prevalent b-lactamases in Turkish strains; however, a recent study reported that OXA-23-like enzymes have become more prevalent since 2010 (13). There is no report regarding OXA-24/40-like enzymes in A. baumannii isolates from Turkey. Here, we describe a small outbreak caused by MDR A. baumannii that produced OXA-72, a member of

Spread of imipenem-resistant Acinetobacter baumannii co-expressing OXA-23 and GES-11 carbapenemases in Lebanon

“…This agrees with reports of a progressive change from bla OXA-58 to bla OXA-23 carriage worldwide (33). In addition, a recent rise of metallo-β-lactamases in A. baumannii has been observed in some European countries (34,35). However, even though NDM-1 has been detected recently in A. baumannii isolated from Syrian patients hospitalized in Lebanon (18), this metallo-β-lactamase has apparently not diffused to Lebanese patients according to our findings.…”

“…baumannii from close countries like Turkey, where it was responsible for a hospital outbreak in an intensive care ward (34). The OXA-58 oxacillinase, previously reported in a Lebanese hospital (17), was not detected among our isolates.…”

Investigation of Metallo Beta Lactamases and Oxacilinases in Carbapenem Resistant Acinetobacter baumannii Strains Isolated from Inpatients

“…OXA-51-like, OXA-58-like, OXA-23-like carbapenemase-producing strains were detected widely (3,4). Also, in a recent study, it was reported that a small outbreak was caused by A. baumannii which produced OXA-72, a member of OXA-24/40-like enzymes in a Turkish hospital (5). Four types of MBL enzymes have been identified in A. baumannii isolates including Imipenemase (IMP), Verona Imipenemase (VIM), Seoul Imipenemase (SIM) and New Delhi Metallo betalactamase (NDM)-1-types throughout the World (6).…”

Spread of carbapenem-resistant international clones of Acinetobacter baumannii in Turkey and Azerbaijan: a collaborative study

“…The results of this study supported the proposal that bla OXA-51-like genes are detected in A. baumannii and Acinetobacter nosocomialis strains. The bla OXA-24-like gene was first identified in Izmir in the far western region of Turkey in 2013 [13]. In this study, the rarely identified bla OXA-24-like gene in Turkey and for the first time from Azerbaijan has been reported.…”