title: Molecular epidemiology of Acinetobacter baumannii in different hospitals in Tripoli, Lebanon using bla(OXA-51-like) sequence based typing.
abstract: BACKGROUND
  A. baumannii has emerged as an important nosocomial pathogen with an outstanding ability to acquire multidrug resistant mechanisms. In this study, we investigate the molecular epidemiology and carbapenem resistance mechanisms of A. baumannii in Tripoli, Northern Lebanon.
  
  
  METHODS
  One hundred sixteen non-duplicate isolates isolated between 2011 and 2013 in different hospitals in Tripoli, Lebanon from Lebanese patients and wounded Syrian patients during Syrian war were studied. Antibiotic susceptibility testing was determined by agar disc diffusion and Etest. Carbapenemase-encoding genes were investigated by PCR. All isolates were typed by bla OXA-51-like sequence based typing (SBT) and 57 isolates were also analysed by MLST using Pasteur's scheme followed by eBURST analysis.
  
  
  RESULTS
  Of the 116 isolates, 70 (60 %) showed a carbapenem resistance phenotype. The bla OXA-23 with an upstream insertion of ISAba1 was the major carbapenem resistance mechanism and detected in 65 isolates. Five isolates, including four from wounded Syrian patients and one from a Lebanese patient, were positive for bla NDM-1. bla OXA-51-like SBT revealed the presence of 14 variants, where bla OXA-66 was the most common and present in 73 isolates, followed by bla OXA-69 in 20 isolates. MLST analysis identified 17 sequence types (ST) and showed a concordance with bla OXA-51-like SBT. Each clonal complex (CC) had a specific bla OXA-51-like sequence such as CC2, which harboured bla OXA-66 variant, and CC1 harbouring bla OXA-69 variant. NDM-1 producing isolates belonged to ST85 (4 Syrian isolates) and ST25 (1 Lebanese isolate).
  
  
  CONCLUSIONS
  Our results showed a successful predominance of international clone 2 with a widespread occurrence of OXA-23 carbapenemase in Lebanese hospitals. These findings emphasise the urgent need of effective measures to control the spread of A. baumannii in this country.
authors.affiliation: ATOMycA, Inserm Atip-Avenir Team, CRCNA, Inserm U892, 6299 CNRS, University and Centre Hospitalier Universitaire d'Angers, Angers, France. rayanerafei@hotmail.com.|Laboratoire Microbiologie Santé et Environnement (LMSE), Centre AZM pour la recherche en Biotechnologie et ses applications, Université Libanaise, Tripoli, Lebanon. rayanerafei@hotmail.com.
authors.forename: Rayane
authors.initials: R
authors.lastname: Rafei
authors.affiliation: ATOMycA, Inserm Atip-Avenir Team, CRCNA, Inserm U892, 6299 CNRS, University and Centre Hospitalier Universitaire d'Angers, Angers, France. helene.pailhories@chu-angers.fr.|Laboratoire de Bactériologie, Institut de Biologie en Santé - PBH, CHU, 4 rue Larrey, 49933, Angers Cedex, France. helene.pailhories@chu-angers.fr.
authors.forename: Hélène
authors.initials: H
authors.lastname: Pailhoriès
authors.affiliation: Laboratoire Microbiologie Santé et Environnement (LMSE), Centre AZM pour la recherche en Biotechnologie et ses applications, Université Libanaise, Tripoli, Lebanon. mhamze@monzerhamze.com.
authors.forename: Monzer
authors.initials: M
authors.lastname: Hamze
authors.affiliation: ATOMycA, Inserm Atip-Avenir Team, CRCNA, Inserm U892, 6299 CNRS, University and Centre Hospitalier Universitaire d'Angers, Angers, France. maeveillard@chu-angers.fr.|Laboratoire de Bactériologie, Institut de Biologie en Santé - PBH, CHU, 4 rue Larrey, 49933, Angers Cedex, France. maeveillard@chu-angers.fr.
authors.forename: Matthieu
authors.initials: M
authors.lastname: Eveillard
authors.affiliation: Laboratoire Microbiologie Santé et Environnement (LMSE), Centre AZM pour la recherche en Biotechnologie et ses applications, Université Libanaise, Tripoli, Lebanon. hmallat.dr@gmail.com.
authors.forename: Hassan
authors.initials: H
authors.lastname: Mallat
authors.affiliation: Laboratoire Microbiologie Santé et Environnement (LMSE), Centre AZM pour la recherche en Biotechnologie et ses applications, Université Libanaise, Tripoli, Lebanon. fdaboussi@hotmail.com.
authors.forename: Fouad
authors.initials: F
authors.lastname: Dabboussi
authors.affiliation: ATOMycA, Inserm Atip-Avenir Team, CRCNA, Inserm U892, 6299 CNRS, University and Centre Hospitalier Universitaire d'Angers, Angers, France. mljoly-guillou@chu-angers.fr.|Laboratoire de Bactériologie, Institut de Biologie en Santé - PBH, CHU, 4 rue Larrey, 49933, Angers Cedex, France. mljoly-guillou@chu-angers.fr.
authors.forename: Marie-Laure
authors.initials: ML
authors.lastname: Joly-Guillou
authors.affiliation: ATOMycA, Inserm Atip-Avenir Team, CRCNA, Inserm U892, 6299 CNRS, University and Centre Hospitalier Universitaire d'Angers, Angers, France. makempf@chu-angers.fr.|Laboratoire de Bactériologie, Institut de Biologie en Santé - PBH, CHU, 4 rue Larrey, 49933, Angers Cedex, France. makempf@chu-angers.fr.
authors.forename: Marie
authors.initials: M
authors.lastname: Kempf
mesh_terms: D000151:Acinetobacter Infections / Q000453:epidemiology* / Q000382:microbiology; D040981:Acinetobacter baumannii / Q000145:classification* / Q000201:enzymology / Q000235:genetics* / Q000302:isolation & purification; D003428:Cross Infection / Q000453:epidemiology / Q000382:microbiology; D014644:Genetic Variation; D005838:Genotype; D006761:Hospitals; D006801:Humans; D007861:Lebanon / Q000453:epidemiology; D008826:Microbial Sensitivity Tests; D017720:Molecular Epidemiology; D008969:Molecular Sequence Data; D058889:Molecular Typing; D016133:Polymerase Chain Reaction; D017422:Sequence Analysis, DNA; D001618:beta-Lactamases / Q000235:genetics*
chemical_list: D001618:beta-Lactamases; C577373:beta-lactamase OXA-51, Acinetobacter baumannii