title: First report of blaNDM-1-producing Acinetobacter baumannii isolated in Lebanon from civilians wounded during the Syrian war.
abstract: OBJECTIVE
  The emergence of carbapenem-resistant Acinetobacter baumannii has been observed worldwide. We describe the first detection of A. baumannii carrying the blaNDM-1 gene in Lebanon, isolated from Syrian patients wounded during the civil war.
  
  
  METHODS
  Four carbapenem-resistant A. baumannii strains isolated in 2012 in the Tripoli Government Hospital, Lebanon, from civilians wounded during the Syrian war, were analysed. Susceptibility was determined by disk diffusion testing, and resistance to carbapenems was confirmed by Etest. The presence of blaOXA-23-like, blaOXA-24-like, blaOXA-58-like, blaOXA-143-like, and blaNDM was investigated by PCR. Clonal relationships were studied by pulsed-field gel electrophoresis (PFGE), multilocus sequence typing (MLST), and blaOXA-51 sequence-based typing.
  
  
  RESULTS
  All isolates harboured the blaNDM-1 gene and were negative for other tested carbapenemases. They all belonged to the sequence type 85 and formed a single cluster by PFGE. Finally, blaOXA-51-like gene sequencing revealed the presence of the blaOXA-94 variant in all four isolates.
  
  
  CONCLUSIONS
  These findings show that Syria constitutes a reservoir for NDM-1-producing bacteria. These results also highlight the need for effective measures to stop the threatening spread of such strains.
authors.affiliation: Institut de Biologie en Santé - IRIS, Groupe d'Etude des Interactions Hôte-Pathogène, Université d'Angers, L'UNAM, Angers, France; Laboratoire de Microbiologie, Ecole Doctorale des Sciences et de Technologie, Université Libanaise, Tripoli, Lebanon.
authors.forename: Rayane
authors.initials: R
authors.lastname: Rafei
authors.affiliation: Laboratoire de Microbiologie, Ecole Doctorale des Sciences et de Technologie, Université Libanaise, Tripoli, Lebanon.
authors.forename: Fouad
authors.initials: F
authors.lastname: Dabboussi
authors.affiliation: Laboratoire de Microbiologie, Ecole Doctorale des Sciences et de Technologie, Université Libanaise, Tripoli, Lebanon.
authors.forename: Monzer
authors.initials: M
authors.lastname: Hamze
authors.affiliation: Institut de Biologie en Santé - IRIS, Groupe d'Etude des Interactions Hôte-Pathogène, Université d'Angers, L'UNAM, Angers, France; Laboratoire de Bactériologie, Institut de Biologie en Santé - PBH, CHU, 4 rue Larrey, 49933 Angers cedex, France.
authors.forename: Matthieu
authors.initials: M
authors.lastname: Eveillard
authors.affiliation: Laboratoire de Bactériologie, Institut de Biologie en Santé - PBH, CHU, 4 rue Larrey, 49933 Angers cedex, France.
authors.forename: Carole
authors.initials: C
authors.lastname: Lemarié
authors.affiliation: Laboratoire de Microbiologie, Ecole Doctorale des Sciences et de Technologie, Université Libanaise, Tripoli, Lebanon.
authors.forename: Hassan
authors.initials: H
authors.lastname: Mallat
authors.affiliation: Unité de Recherche sur les Maladies Infectieuses et Tropicales Emergents (URMITE), IHU Méditerranée Infection, Aix-Marseille Université, Marseille, France.
authors.forename: Jean-Marc
authors.initials: JM
authors.lastname: Rolain
authors.affiliation: Institut de Biologie en Santé - IRIS, Groupe d'Etude des Interactions Hôte-Pathogène, Université d'Angers, L'UNAM, Angers, France; Laboratoire de Bactériologie, Institut de Biologie en Santé - PBH, CHU, 4 rue Larrey, 49933 Angers cedex, France.
authors.forename: Marie-Laure
authors.initials: ML
authors.lastname: Joly-Guillou
authors.affiliation: Institut de Biologie en Santé - IRIS, Groupe d'Etude des Interactions Hôte-Pathogène, Université d'Angers, L'UNAM, Angers, France; Laboratoire de Bactériologie, Institut de Biologie en Santé - PBH, CHU, 4 rue Larrey, 49933 Angers cedex, France. Electronic address: makempf@chu-angers.fr.
authors.forename: Marie
authors.initials: M
authors.lastname: Kempf
mesh_terms: D000151:Acinetobacter Infections / Q000188:drug therapy / Q000382:microbiology*; D040981:Acinetobacter baumannii / Q000187:drug effects / Q000201:enzymology / Q000235:genetics* / Q000302:isolation & purification; D000293:Adolescent; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D015780:Carbapenems / Q000627:therapeutic use; D064868:Ethnic Violence; D005260:Female; D015870:Gene Expression; D006801:Humans; D007223:Infant; D007861:Lebanon; D008297:Male; D008826:Microbial Sensitivity Tests; D058885:Multilocus Sequence Typing; D010957:Plasmids; D014950:Wounds, Penetrating / Q000188:drug therapy / Q000382:microbiology*; D055815:Young Adult; D018440:beta-Lactam Resistance / Q000235:genetics*; D001618:beta-Lactamases / Q000235:genetics* / Q000378:metabolism
chemical_list: D000900:Anti-Bacterial Agents; D015780:Carbapenems; D001618:beta-Lactamases; C552864:beta-lactamase NDM-1
keywords: Acinetobacter baumannii; Lebanon; Multidrug-resistant bacteria; NDM-1; Syrian civil war