title: Changing carbapenemase gene pattern in an epidemic multidrug-resistant Acinetobacter baumannii lineage causing multiple outbreaks in central Italy.
abstract: OBJECTIVE
  infections caused by multidrug-resistant (MDR) Acinetobacter baumannii are a challenging problem worldwide. Here, the molecular epidemiology and the genetic basis of antibiotic resistance in 111 MDR A. baumannii strains isolated from June 2005 to March 2009 from infected patients in 10 intensive care units (ICUs) in central Italy were investigated.
  
  
  METHODS
  epidemiological typing was performed by random amplification of polymorphic DNA, PCR-based sequence grouping and macrorestriction analysis. MICs of antibiotics were determined by the broth microdilution method. Genes for OXA carbapenemases, metallo-β-lactamases and the CarO porin were searched for by PCR.
  
  
  RESULTS
  molecular genotyping identified one predominant A. baumannii lineage, related to the international clonal lineage II, accounting for 95.6% of isolates. Isolates referable to this lineage were recovered from all ICUs surveyed and were resistant to nearly all classes of antimicrobials, with the exception of tigecycline and colistin. A high percentage (60.5%) of A. baumannii isolates showed elevated resistance to imipenem (MICs ≥  128 mg/L), concomitant with resistance to meropenem. Carbapenem resistance was associated with the presence of either bla(OXA-58)-like (22.8%) or bla(OXA-23)-like (71.1%) carbapenemase genes. Molecular typing showed that the epidemic lineage encoding OXA-23 emerged in 2007 and displaced a genetically related clone encoding OXA-58 that had been responsible for previous ICU outbreaks in the same region.
  
  
  CONCLUSIONS
  emergence of the OXA-23 epidemic lineage could result from selective advantage conferred by the bla(OXA-23)-like determinant, which provides increased resistance to carbapenems.
authors.affiliation: Istituto Nazionale per le Malattie Infettive Lazzaro Spallanzani I.R.C.C.S., Rome, Italy.
authors.forename: Silvia
authors.initials: S
authors.lastname: D'Arezzo
authors.forename: Luigi
authors.initials: L
authors.lastname: Principe
authors.forename: Alessandro
authors.initials: A
authors.lastname: Capone
authors.forename: Nicola
authors.initials: N
authors.lastname: Petrosillo
authors.forename: Andrea
authors.initials: A
authors.lastname: Petrucca
authors.forename: Paolo
authors.initials: P
authors.lastname: Visca
mesh_terms: D000151:Acinetobacter Infections / Q000453:epidemiology* / Q000382:microbiology; D040981:Acinetobacter baumannii / Q000145:classification* / Q000201:enzymology / Q000235:genetics* / Q000302:isolation & purification; D001426:Bacterial Proteins / Q000096:biosynthesis / Q000235:genetics*; D015373:Bacterial Typing Techniques; D016000:Cluster Analysis; D003428:Cross Infection / Q000453:epidemiology / Q000382:microbiology; D016172:DNA Fingerprinting; D004196:Disease Outbreaks; D024901:Drug Resistance, Multiple, Bacterial; D016521:Electrophoresis, Gel, Pulsed-Field; D005838:Genotype; D006801:Humans; D007362:Intensive Care Units; D007558:Italy / Q000453:epidemiology; D008826:Microbial Sensitivity Tests; D017720:Molecular Epidemiology; D012150:Polymorphism, Restriction Fragment Length; D019105:Random Amplified Polymorphic DNA Technique; D001618:beta-Lactamases / Q000096:biosynthesis / Q000235:genetics*
chemical_list: D001426:Bacterial Proteins; D001618:beta-Lactamases; C063912:carbapenemase