Molecular Characterization of Invasive Carbapenem-Resistant Acinetobacter baumannii from a Tertiary Care Hospital in South India.

INTRODUCTION: Acinetobacter baumannii is an important opportunistic pathogen responsible for causing nosocomial infections. Carbapenems are considered to be the drug of choice to treat infections caused by multidrug-resistant A. baumannii. The prevalent mechanism of carbapenem resistance in A. baumannii is enzymatic degradation by β-lactamases. Therefore, the aim of the study is to determine the prevalence and distribution of molecular determinants among the clinical isolates of carbapenem-resistant A. baumannii.

METHODS: A total of 103 consecutive, non-duplicate carbapenem-resistant A. baumannii isolated from blood and endotracheal aspirates (ETAs) were included in the study. The CarbAcineto NP test was performed for the screening of carbapenemase production. Polymerase chain reaction (PCR) was performed to detect extended spectrum β-lactamases (ESBLs), metallo-β-lactamases (MBLs) and oxacillinases (OXAs). PCR was done for the detection of ISAba1 elements, and mapping PCR was performed to identify the position of ISAba1 with respect to the OXA-23-like gene.

RESULTS: Among the 103 A. baumannii isolates, 94 were phenotypically identified as carbapenemase producers. blaPER was the most common among the ESBLs. Among MBLs, blaNDM was predominant followed by the blaVIM gene. blaOXA-51 and blaOXA-23 were the most common and present in all 103 isolates. Almost 80% of the isolates had ISAba1 upstream blaOXA-23 gene.

CONCLUSION: The blaOXA-23 and blaNDM genes are the most common type of oxacillinases and metallo β-lactamases, respectively, and contribute to carbapenem resistance in clinical isolates of A. baumannii. The presence of ISAba1 upstream of the blaOXA-23 gene suggests that the insertion element acts as a promoter for its increased expression.

FUNDING: Indian Council of Medical Research, New Delhi, India (ref. no. AMR/TF/54/13ECDHII dated 23 October 2013).