Yonsei Med J.  2009 Dec;50(6):764-770. 10.3349/ymj.2009.50.6.764.

Outbreaks of Imipenem Resistant Acinetobacter Baumannii Producing OXA-23 beta-Lactamase in a Tertiary Care Hospital in Korea

• Yang HY
• Lee HJ
• Suh JT
• Lee KM

• KMID: 1777088
• DOI: http://doi.org/10.3349/ymj.2009.50.6.764

Abstract

PURPOSE
Since November 2006, imipenem-resistant Acinetobacter baumannii isolates have increased in Kyung Hee University Hospital in Seoul, Korea. The purpose of this study was to determine the genetic basis and molecular epidemiology of outbreak isolates.
MATERIALS AND METHODS
Forty-nine non-repetitive isolates of the 734 IRAB strains were investigated in order to determine their characteristics. The modified Hodge and the ethylenediaminetetraacetic acid (EDTA)-disk synergy test were performed for the screening of carbapenemase and metallo-beta-lactamase production. Multiplex polymerase chain reaction (PCR) assays were performed for the detection of genes encoding for OXA-23-like, OXA-24-like, OXA-58-like and OXA-51-like carbapenemase. Pulsed-field gel electrophoresis (PFGE) was performed for strain identification.
RESULTS
All isolates showed 100% resistance to ciprofloxacin and gentamicin, 97.9% resistance to cefepime, piperacillin/tazobactam, aztreonam, ceftazidime and piperacillin, 93.9% resistance to tobramycin and 57.1% resistance to amikacin. All of the 49 isolates (100%) showed positive results in the modified Hodge test and negative results in the EDTA-disk synergy test. They all (100%) possessed the encoding gene for an intrinsic OXA-51-like carbapenemase and an acquired OXA-23-like carbapenemase in the multiplex PCR assay. PFGE patterns revealed that all isolates were clonally related from A1 to A14.
CONCLUSION
It is concluded that all of the 49 IRAB isolates acquired resistance to imipenem by producing OXA-23 carbapenemase and they might have originated from a common source.

Keyword

Imipenem resistant Acinetobacter baumannii; outbreak; OXA-23

MeSH Terms

Acinetobacter Infections/epidemiology/*microbiology
Acinetobacter baumannii/*drug effects/genetics
Anti-Bacterial Agents/*pharmacology
Cephalosporins/pharmacology
Ciprofloxacin/pharmacology
Disease Outbreaks
Drug Resistance, Multiple, Bacterial/genetics/physiology
Electrophoresis, Gel, Pulsed-Field
Gentamicins/pharmacology
Humans
Imipenem/*pharmacology
Korea/epidemiology
Microbial Sensitivity Tests
beta-Lactamases/genetics/*metabolism
beta-Lactams/*pharmacology

Figure

• 

  Fig. 1 Detection of genes encoding OXA carbapenemase by Multiplex PCR. Lane 1,100 bp Plus DNA Ladder (Bioneer, Daejeon, Korea); Lane 2-12, OXA-23-like and OXA-51-like. PCR, polymerase chain reaction.

• 

  Fig. 2 PFGE profiles of ApaI-digested genomic DNA from isolates of A. baumannii., PFGE, pulsed-field gel electrophoresis; A. baumannii, Acinetobacter baumannii.

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