title: Molecular epidemiology of carbapenem-resistant Acinetobacter baumannii isolates in the Gulf Cooperation Council States: dominance of OXA-23-type producers.
abstract: The molecular epidemiology and mechanisms of resistance of carbapenem-resistant Acinetobacter baumannii (CRAB) were determined in hospitals in the states of the Cooperation Council for the Arab States of the Gulf (Gulf Cooperation Council [GCC]), namely, Saudi Arabia, United Arab Emirates, Oman, Qatar, Bahrain, and Kuwait. Isolates were subjected to PCR-based detection of antibiotic resistance genes and repetitive sequence-based PCR (rep-PCR) assessments of clonality. Selected isolates were subjected to multilocus sequence typing (MLST). We investigated 117 isolates resistant to carbapenem antibiotics (either imipenem or meropenem). All isolates were positive for OXA-51. The most common carbapenemases were the OXA-23-type, found in 107 isolates, followed by OXA-40-type (OXA-24-type), found in 5 isolates; 3 isolates carried the ISAba1 element upstream of blaOXA-51-type. No OXA-58-type, NDM-type, VIM-type, or IMP-type producers were detected. Multiple clones were detected with 16 clusters of clonally related CRAB. Some clusters involved hospitals in different states. MLST analysis of 15 representative isolates from different clusters identified seven different sequence types (ST195, ST208, ST229, ST436, ST450, ST452, and ST499), as well as three novel STs. The vast majority (84%) of the isolates in this study were associated with health care exposure. Awareness of multidrug-resistant organisms in GCC states has important implications for optimizing infection control practices; establishing antimicrobial stewardship programs within hospital, community, and agricultural settings; and emphasizing the need for establishing regional active surveillance systems. This will help to control the spread of CRAB in the Middle East and in hospitals accommodating transferred patients from this region.
authors.affiliation: The University of Queensland, UQ Centre for Clinical Research, Herston, Queensland, Australia King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia World Health Organization Collaborating Centre for Infection Prevention and Control and Gulf Cooperation Council Center for Infection Control, Riyadh, Saudi Arabia h.zowawi@uq.edu.au.
authors.forename: Hosam M
authors.initials: HM
authors.lastname: Zowawi
authors.affiliation: The University of Queensland, UQ Centre for Clinical Research, Herston, Queensland, Australia.
authors.forename: Anna L
authors.initials: AL
authors.lastname: Sartor
authors.affiliation: The University of Queensland, UQ Centre for Clinical Research, Herston, Queensland, Australia.
authors.forename: Hanna E
authors.initials: HE
authors.lastname: Sidjabat
authors.affiliation: King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia World Health Organization Collaborating Centre for Infection Prevention and Control and Gulf Cooperation Council Center for Infection Control, Riyadh, Saudi Arabia King Abdullah International Medical Research Centre, Riyadh, Saudi Arabia.
authors.forename: Hanan H
authors.initials: HH
authors.lastname: Balkhy
authors.affiliation: The University of Queensland, UQ Centre for Clinical Research, Herston, Queensland, Australia Department of Medical Microbiology and Infectious Diseases, School of Medicine, Cardiff University, Heath Park, Cardiff, United Kingdom.
authors.forename: Timothy R
authors.initials: TR
authors.lastname: Walsh
authors.affiliation: King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia Microbiology, Department of Pathology and Lab Medicine, King Abdulaziz Medical City, Riyadh, Saudi Arabia.
authors.forename: Sameera M
authors.initials: SM
authors.lastname: Al Johani
authors.affiliation: University of Dammam, College of Medicine, Dammam, Saudi Arabia.
authors.forename: Reem Y
authors.initials: RY
authors.lastname: AlJindan
authors.affiliation: Zayed Military Hospital, Clinical Microbiology Department, Abu Dhabi, United Arab Emirates Pathology and Laboratory Medicine Department, Sheikh Khalifa General Hospital, Umm Al Quwain, United Arab Emirates.
authors.forename: Mubarak
authors.initials: M
authors.lastname: Alfaresi
authors.affiliation: Hamad Medical Cooperation, Clinical Microbiology Department, Doha, Qatar.
authors.forename: Emad
authors.initials: E
authors.lastname: Ibrahim
authors.affiliation: The Royal Hospital, Medical Microbiology Department, Muscat, Oman.
authors.forename: Amina
authors.initials: A
authors.lastname: Al-Jardani
authors.affiliation: Samlaniya Medical Complex, Infectious Diseases Unit, Manama, Bahrain World Health Organization Collaborating Centre for Infection Prevention and Control and Gulf Cooperation Council Center for Infection Control, Riyadh, Saudi Arabia.
authors.forename: Jameela
authors.initials: J
authors.lastname: Al Salman
authors.affiliation: Medical Laboratory Department, Faculty of Allied Health Sciences, Health Science Center, Kuwait University, Kuwait City, Kuwait.
authors.forename: Ali A
authors.initials: AA
authors.lastname: Dashti
authors.affiliation: Division of Microbiology, Prince Sultan Military Medical City, Riyadh, Saudi Arabia Surgical Infection Research Group, Australian School of Advanced Medicine, Macquarie University, Sydney, New South Wales, Australia.
authors.forename: Khalid
authors.initials: K
authors.lastname: Johani
authors.affiliation: The University of Queensland, UQ Centre for Clinical Research, Herston, Queensland, Australia.
authors.forename: David L
authors.initials: DL
authors.lastname: Paterson
mesh_terms: D000151:Acinetobacter Infections / Q000453:epidemiology* / Q000382:microbiology; D040981:Acinetobacter baumannii / Q000145:classification* / Q000187:drug effects / Q000201:enzymology* / Q000302:isolation & purification; D000900:Anti-Bacterial Agents / Q000494:pharmacology*; D015780:Carbapenems / Q000494:pharmacology*; D002675:Child, Preschool; D016000:Cluster Analysis; D005260:Female; D005838:Genotype; D006761:Hospitals; D006801:Humans; D007223:Infant; D008297:Male; D008877:Middle East / Q000453:epidemiology; D017720:Molecular Epidemiology; D058885:Multilocus Sequence Typing; D016133:Polymerase Chain Reaction; D018440:beta-Lactam Resistance; D001618:beta-Lactamases / Q000235:genetics
chemical_list: D000900:Anti-Bacterial Agents; D015780:Carbapenems; D001618:beta-Lactamases