title: Diversity of carbapenem resistance mechanisms in Acinetobacter baumannii from a Taiwan hospital: spread of plasmid-borne OXA-72 carbapenemase.
abstract: OBJECTIVE
  We investigated the molecular epidemiology of carbapenem-resistant Acinetobacter baumannii from a Taiwanese hospital and determined the mechanisms responsible for resistance.
  
  
  METHODS
  Ninety-two consecutive meropenem-resistant A. baumannii isolates collected between January 2005 and June 2007 were screened for genes encoding OXA carbapenemases, metallo-beta-lactamases and for the carO gene encoding an outer membrane protein. PFGE was used to define clonal relatedness. PCR mapping was used to examine the linkage of insertion sequences and bla(OXA) genes. Southern hybridization of plasmid extracts and I-CeuI-restricted chromosomal DNA was used to locate bla(OXA-24-like) genes. Sequences of selected bla(OXA-24-like) and carO genes were determined and loss of CarO expression was confirmed by SDS-PAGE.
  
  
  RESULTS
  Most (70/92, 76%) isolates belonged to one of three PFGE pulsotypes, indicating clonal spread. Fifty-nine isolates, including the majority of those of pulsotypes I and III, produced OXA-72 carbapenemase. The bla(OXA-72) gene was located on a 54 kb plasmid in selected isolates. Thirty-three (36%) isolates, including all 16 of pulsotype II, had ISAba1 preceding the bla(OXA-51-like) gene, promoting its expression. In addition to OXA-72 carbapenemase, two pulsotype I and three pulsotype III isolates did not produce CarO protein as the carO gene was disrupted by insertion of an ISAba1 element. Two isolates of a minor pulsotype had a bla(OXA-58-like) gene and a single PFGE-unique isolate had a bla(OXA-23-like) gene.
  
  
  CONCLUSIONS
  Although diverse mechanisms were identified, production of OXA-72 carbapenemase was the most common mechanism of carbapenem resistance in A. baumannii from this Taiwanese hospital. The plasmidic location of the gene had facilitated its spread to multiple strains.
authors.affiliation: Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung City, Taiwan.
authors.forename: Po-Liang
authors.initials: PL
authors.lastname: Lu
authors.forename: Michel
authors.initials: M
authors.lastname: Doumith
authors.forename: David M
authors.initials: DM
authors.lastname: Livermore
authors.forename: Tyen-Po
authors.initials: TP
authors.lastname: Chen
authors.forename: Neil
authors.initials: N
authors.lastname: Woodford
mesh_terms: D000151:Acinetobacter Infections / Q000382:microbiology*; D040981:Acinetobacter baumannii / Q000145:classification* / Q000187:drug effects* / Q000235:genetics / Q000302:isolation & purification; D000900:Anti-Bacterial Agents / Q000494:pharmacology*; D001425:Bacterial Outer Membrane Proteins / Q000235:genetics; D001426:Bacterial Proteins / Q000235:genetics; D015373:Bacterial Typing Techniques; D015139:Blotting, Southern; D015780:Carbapenems / Q000494:pharmacology*; D016000:Cluster Analysis; D016172:DNA Fingerprinting; D004251:DNA Transposable Elements; D004269:DNA, Bacterial / Q000235:genetics*; D024881:Drug Resistance, Bacterial; D016521:Electrophoresis, Gel, Pulsed-Field; D004591:Electrophoresis, Polyacrylamide Gel; D005838:Genotype; D006761:Hospitals; D006801:Humans; D016133:Polymerase Chain Reaction; D013624:Taiwan; D001618:beta-Lactamases / Q000235:genetics
chemical_list: D000900:Anti-Bacterial Agents; D001425:Bacterial Outer Membrane Proteins; D001426:Bacterial Proteins; D015780:Carbapenems; D004251:DNA Transposable Elements; D004269:DNA, Bacterial; C000596363:OXA-72 carbapenemase, Acinetobacter baumannii; D001618:beta-Lactamases; C063912:carbapenemase