Epidemiology of extensive drug resistant Acinetobacter baumannii (XDRAB) at Security Forces Hospital (SFH) in Kingdom of Saudi Arabia (KSA). (June 2015)

• Record Type: Journal Article
• Authors: Al-Obeid, Suleiman; Jabri, Lina; Al-Agamy, Mohammad; Al-Omari, Awad; Shibl, Atef
• Is Part Of: Journal of chemotherapy. Volume 27:Number 3(2015:Jun.)
• Page Start: 156
• Page End: 162
• Publication Date: 2015-06
• Subjects: Chemotherapy -- Periodicals; Drug Therapy -- Periodicals; 615.58
• DOI: 10.1179/1973947815Y.0000000019
• Languages: German
• ISSNs: 1120-009X

Abstract

<abstract> <title> <x content-type="archive" xml:space="preserve">Abstract</x> </title> <sec> <sec> <title>Objectives:</title> <p>Extensively drug-resistant <italic>Acinetobacter baumannii</italic> (XDRAB) became a worldwide nosocomial threat. The aim of this study was to assess the epidemiology and to evaluate the prevalence of carbapenem-resistant <italic>A. baumannii</italic> (CRAB). We also discuss therapeutic options for the management of their infections.</p> </sec> <sec> <title>Methods:</title> <p>Antibiotic susceptibility was determined in 506, 510 and 936 duplicate isolates of <italic>A. baumannii</italic> isolated in 2006, 2009 and 2012, respectively. In 2012, 12 unique XDRAB strains were isolated from patients with serious ventilator-associated pneumonia (VAP). Susceptibility tests were performed using the microdilution method according to Clinical and Laboratory Standards Institute (CLSI) recommendations. MICs were determined in triplicate by E-test according to the manufacturer's recommendations. Susceptible and multidrug-resistant <italic>A. baumannii</italic> (MDRAB) strains were detected using CHROMagar <italic>Acinetobacter</italic> medium. Carbapenem resistant A. baumannii was investigated for carbapenemase production by the modified Hodge test (MHT) and by multiplex PCR. A Synergy test was performed using the E-test method.</p> </sec> <sec> <title>Results:</title> <p>Considering years 2006, 2009 and 2012, the susceptibilities to meropenem and imipenem were 64–81.2%, 34.5–45.3%, and 8.3–11%, respectively. Concerning the 12 XDRAB strains, all isolates were susceptible to colistin and resistant to meropenem and imipenem. Culture on CHROMagar <italic>Acinetobacter</italic> confirmed that all are MDRAB. The gene profiles detected in PCR assays showed that all the strains possess OXA-51.Out of the 12 isolates, 11 possess the <italic>oxa-23</italic> gene and one harbours the gene 24/40. A good synergistic effect was detected between colistin and tigecycline.</p> </sec> <sec> <title>Conclusions:</title> <p>In this study, <italic>A. baumannii</italic> susceptibility to carbapenems showed a drastic reduction and represents a major epidemiological concern. The main carbapenem resistance mechanism is mediated by class D-OXA-type enzymes (oxa-23 and oxa-24/40<italic>)</italic> with Carbapenemase activity. Therapeutic options are exceedingly limited, relying on polymyxin combinations with other antibiotics. We are clearly missing new active agents against XDRAB.</p> </sec> </sec> </abstract>