title: Genetic relatedness and molecular characterization of multidrug resistant Acinetobacter baumannii isolated in central Ohio, USA.
abstract: BACKGROUND
  Over the last decade, nosocomial infections due to Acinetobacter baumannii have been described with an increasing trend towards multidrug resistance, mostly in intensive care units. The aim of the present study was to determine the clonal relatedness of clinical isolates and to elucidate the genetic basis of imipenem resistance.
  
  
  METHODS
  A. baumannii isolates (n = 83) originated from two hospital settings in central Ohio were used in this study. Pulsed-field gel electrophoresis genotyping and antimicrobial susceptibility testing for clinically relevant antimicrobials were performed. Resistance determinants were characterized by using different phenotypic (accumulation assay for efflux) and genotypic (PCR, DNA sequencing, plasmid analysis and electroporation) approaches.
  
  
  RESULTS
  The isolates were predominantly multidrug resistant (>79.5%) and comprised of thirteen unique pulsotypes, with genotype VII circulating in both hospitals. The presence of bla(OXA-23) in 13% (11/83) and IS(Aba1) linked bla(OXA-66) in 79.5% (66/83) of clinical isolates was associated with high level imipenem resistance. In this set of OXA producing isolates, multidrug resistance was bestowed by bla(ADC-25), class 1 integron-borne aminoglycoside modifying enzymes, presence of sense mutations in gyrA/parC and involvement of active efflux (with evidence for the presence of adeB efflux gene).
  
  
  CONCLUSIONS
  This study underscores the major role of carbapenem-hydrolyzing class D beta-lactamases, and in particular the acquired OXA-23, in the dissemination of imipenem-resistant A. baumannii. The co-occurrence of additional resistance determinant could also be a significant threat.
authors.affiliation: Department of Veterinary Preventive Medicine, College of Veterinary Medicine, Columbus, Ohio, USA. vijirmohan@gmail.com
authors.forename: Vijaya B
authors.initials: VB
authors.lastname: Srinivasan
authors.forename: Govindan
authors.initials: G
authors.lastname: Rajamohan
authors.forename: Preeti
authors.initials: P
authors.lastname: Pancholi
authors.forename: Kurt
authors.initials: K
authors.lastname: Stevenson
authors.forename: Daniel
authors.initials: D
authors.lastname: Tadesse
authors.forename: Prapas
authors.initials: P
authors.lastname: Patchanee
authors.forename: Mario
authors.initials: M
authors.lastname: Marcon
authors.forename: Wondwossen A
authors.initials: WA
authors.lastname: Gebreyes
mesh_terms: D000151:Acinetobacter Infections / Q000453:epidemiology* / Q000382:microbiology*; D040981:Acinetobacter baumannii / Q000145:classification* / Q000187:drug effects / Q000235:genetics* / Q000302:isolation & purification; D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001426:Bacterial Proteins / Q000235:genetics; D015373:Bacterial Typing Techniques / Q000379:methods; D016000:Cluster Analysis; D003428:Cross Infection / Q000453:epidemiology / Q000382:microbiology; D016172:DNA Fingerprinting; D004269:DNA, Bacterial / Q000235:genetics; D024901:Drug Resistance, Multiple, Bacterial; D016521:Electrophoresis, Gel, Pulsed-Field; D006801:Humans; D008826:Microbial Sensitivity Tests; D008875:Middle Aged; D017720:Molecular Epidemiology; D009820:Ohio / Q000453:epidemiology; D055815:Young Adult; D001618:beta-Lactamases / Q000235:genetics
chemical_list: D001426:Bacterial Proteins; D004269:DNA, Bacterial; D001618:beta-Lactamases