title: Identification, genotypic relation, and clinical features of colistin-resistant isolates of Acinetobacter genomic species 13BJ/14TU from bloodstreams of patients in a university hospital.
abstract: Colistin resistance remains rare among clinical isolates of Acinetobacter species. We noted the emergence of colistin-resistant bloodstream isolates of the Acinetobacter genomic species (GS) 13BJ/14TU from patients at a university hospital between 2003 and 2011. We report here, for the first time, the microbiological and molecular characteristics of these isolates, with clinical features of Acinetobacter GS 13BJ/14TU bacteremia. All 11 available patient isolates were correctly identified as Acinetobacter GS 13BJ/14TU using partial rpoB gene sequencing but were misidentified using the phenotypic methods Vitek 2 (mostly as Acinetobacter baumannii), MicroScan (mostly as A. baumannii/Acinetobacter haemolyticus), and the API 20 NE system (all as A. haemolyticus). Most isolates were susceptible to commonly used antibiotics, including carbapenems, but all were resistant to colistin, for which it is unknown whether the resistance is acquired or intrinsic. However, the fact that none of the patients had a history of colistin therapy strongly suggests that Acinetobacter GS 13BJ/14TU is innately resistant to colistin. The phylogenetic tree of multilocus sequence typing (MLST) showed that all 11 isolates formed a separate cluster from other Acinetobacter species and yielded five sequence types. However, pulsed-field gel electrophoresis (PFGE) revealed 11 distinct patterns, suggesting that the bacteremia had occurred sporadically. Four patients showed persistent bacteremia (6 to 17 days), and all 11 patients had excellent outcomes with cleared bacteremia, suggesting that patients with Acinetobacter GS 13BJ/14TU-associated bacteremia show a favorable outcome. These results emphasize the importance of precise species identification, especially regarding colistin resistance in Acinetobacter species. In addition, MLST offers another approach to the identification of Acinetobacter GS 13BJ/14TU, whereas PFGE is useful for genotyping for this species.
authors.affiliation: Department of Laboratory Medicine, Chonnam National University Medical School, Gwangju, South Korea.
authors.forename: Seung Yeob
authors.initials: SY
authors.lastname: Lee
authors.forename: Jong Hee
authors.initials: JH
authors.lastname: Shin
authors.forename: Kyung Hwa
authors.initials: KH
authors.lastname: Park
authors.forename: Ju Hee
authors.initials: JH
authors.lastname: Kim
authors.forename: Myung Geun
authors.initials: MG
authors.lastname: Shin
authors.forename: Soon Pal
authors.initials: SP
authors.lastname: Suh
authors.forename: Dong Wook
authors.initials: DW
authors.lastname: Ryang
authors.forename: Soo Hyun
authors.initials: SH
authors.lastname: Kim
mesh_terms: D000150:Acinetobacter / Q000187:drug effects* / Q000235:genetics* / Q000302:isolation & purification; D000151:Acinetobacter Infections / Q000382:microbiology* / Q000473:pathology; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000494:pharmacology*; D016470:Bacteremia / Q000382:microbiology / Q000473:pathology; D015373:Bacterial Typing Techniques; D002648:Child; D003091:Colistin / Q000494:pharmacology*; D004269:DNA, Bacterial / Q000737:chemistry / Q000235:genetics; D012321:DNA-Directed RNA Polymerases / Q000235:genetics; D024881:Drug Resistance, Bacterial; D016521:Electrophoresis, Gel, Pulsed-Field; D005260:Female; D005838:Genotype; D006785:Hospitals, University; D006801:Humans; D008297:Male; D008826:Microbial Sensitivity Tests; D008875:Middle Aged; D008969:Molecular Sequence Data; D058885:Multilocus Sequence Typing
chemical_list: D000900:Anti-Bacterial Agents; D004269:DNA, Bacterial; D012321:DNA-Directed RNA Polymerases; C105078:RNA polymerase beta subunit; D003091:Colistin