Detection and Characterization of Carbapenem Resistant Acinetobacter baumannii Isolated from Different Clinical Specimens in Duhok Province–Iraq
Keywords:
Acinetobacter baumannii, Carbapenem-resistance genes, Oxacilinases, Metallo-beta lactamase, Genotyping, Carbapenemase-encoding genes.Abstract
Objective: Acinetobacter baumannii is an opportunistic troublesome pathogen responsible for numerous nosocomial infections, and it commonly develops multi-drug resistance (MDR). The study aimed to assess the carbapenemase production from A. baumannii clinical isolates using various phenotypic and genotypic methods in Dohuk province-Iraq. Methods: A cross-sectional study was conducted on 486 hospitalized and 269 non-hospitalized patients, who were between 10-70 years old, starting from September 2021 through August 2022. The isolated A. baumannii were tested for antimicrobial susceptibility and carbapenemase production via different phenotypic tests. Furthermore, the isolates were screened to detect some carbapenemase- encoding genes through polymerase chain reaction (PCR). Results: A. baumannii was detected in 54 (7.2%) clinical samples, 49(10.1%) were from hospitalized patients, and 5(1.8%) from non-hospitalized patients. The highest percentage was observed in the age group of 51-60 years at 33.3%. The study showed that 94.4% of isolates exhibited multidrug resistance using disc diffusion method, and 66.6% of isolates presented extended drug resistance (XDR). The highest sensitivity rate was seen toward trimethoprim-sulfamethoxazole at 31.5%, followed by levofloxacin and doxycycline at 18.5%. Out of 54 A. baumannii isolates, the modified Carbapenem Inactivation Method (mCIM) reported the highest percentage of sensitivity (98.1%), followed by the Modified Hodge Test (MHT) (94.4%) and Combined Disc Test (CDT) (57.4%). Using PCR, the blaOXA-51 genes have been identified in all isolates, while 96.3% of isolates carried blaOXA-23 and ISAba1. blaVIM gene was found in 68.5% of isolates only. However, blaNDM, blaIMP, and blaKPC genes were not detected in any isolates. Conclusion: An increase in carbapenem-resistant in A. baumannii is a critical global challenge. The study determined a high carbapenem resistance rate in A. baumannii, commonly by carbapenemase-encoding genes on plasmids. Furthermore, effective infection control procedures and antibiotic programs are required to reduce the spread of these bacteria. The modified carbapenem inactivation method is an excellent test for the early detection of carbapenemase. The study found high prevalence of blaOXA-51, blaOXA-23, and blaVIM resistance genes from isolated A. baumannii, which is a significant alarm
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