Transition of blaOXA-58-like to blaOXA-23-like in Acinetobacter baumannii Clinical Isolates in Southern China: An 8-Year Study.
BACKGROUND
The prevalence of carbapenem-resistant Acinetobacter baumannii in hospitals has been increasing worldwide. This study aims to investigate the carbapenemase genes and the clonal relatedness among A. baumannii clinical isolates in a Chinese hospital.


METHODS
Carbapenemase genes and the upstream locations of insertion sequences were detected by polymerase chain reaction (PCR), and the clonal relatedness of isolates was determined by pulsed-field gel electrophoresis (PFGE) and multilocus sequence typing.


RESULTS
A total of 231 nonduplicate carbapenemase gene-harboring A. baumannii clinical isolates recovered from Shenzhen People's Hospital, were investigated between 2002 and 2009. blaOXA-23-like, blaOXA-58-like, blaOXA-40-like, and ISAba1-blaOXA-51-like were identified in 119, 107, 1, and 4 isolates, respectively. IS1008-ΔISAba3, ISAba3, and ISAba1 were detected upstream of the blaOXA-58-like gene in 69, 35, and 3 isolates, respectively. All blaOXA-23-like genes but one had an upstream insertion of ISAba1. blaOXA-58-like was the most common carbapenemase gene in A.baumannii before 2008, thereafter blaOXA-23-like became rapidly prevalent and replaced blaOXA-58-like in 2009. The majority of blaOXA-58-like-carrying isolates showed lower level of resistance to imipenem and meropenem (minimum inhibitory concentrations (MICs), 1 μg/ml to 16 μg/ml), compared with the majority of blaOXA-23-like-carrying isolates (MICs, 16 μg/ml to 64 μg/ml for both imipenem and meropenem). All 231 blaOXA carbapenemase gene-harboring isolates belonged to 14 PFGE types (A-N), and three dominant clones A, J, and H accounted for 43.3%, 42.0%, and 8.2% of the tested isolates, respectively. Clone A (sequence type ST92/ST208) with blaOXA-58-like was the most prevalent before 2008. Clone H (ST229) with blaOXA-23-like became striking between 2007 and 2008. Clone J (ST381) with blaOXA-23-like rapidly spread and replaced clones A and H in 2009.


CONCLUSIONS
This study is the first to reveal that the distinct blaOXA-23-like-carrying A. baumannii ST381 displaced the previously prevalent blaOXA-58-like-carrying A. baumannii ST92/ST208, resulting in the rapidly increasing resistance to carbapenems in A. baumannii in Shenzhen People's Hospital in 2009.
Department of Laboratory Medicine, Shenzhen People's Hospital, Second Clinical Medical College of Jinan University, Key Laboratory of Pathogenic Microorganism and Bacterial Resistance Surveillance in Shenzhen, Shenzhen, Guangdong, China.
Weiyuan
W
Wu
Department of Infectious Disease, Third People's Hospital of Shenzhen, Shenzhen, Guangdong, China.
Yi
Y
He
Department of Infectious Disease, Third People's Hospital of Shenzhen, Shenzhen, Guangdong, China.
Jian
J
Lu
Department of Laboratory Medicine, Shenzhen People's Hospital, Second Clinical Medical College of Jinan University, Key Laboratory of Pathogenic Microorganism and Bacterial Resistance Surveillance in Shenzhen, Shenzhen, Guangdong, China.
Yuemei
Y
Lu
Department of Laboratory Medicine, Shenzhen People's Hospital, Second Clinical Medical College of Jinan University, Key Laboratory of Pathogenic Microorganism and Bacterial Resistance Surveillance in Shenzhen, Shenzhen, Guangdong, China.
Jinsong
J
Wu
Department of Infectious Disease, Third People's Hospital of Shenzhen, Shenzhen, Guangdong, China.
Yingxia
Y
Liu
D000151:Acinetobacter Infections / Q000188:drug therapy / Q000453:epidemiology / Q000382:microbiology; D040981:Acinetobacter baumannii / Q000187:drug effects / Q000201:enzymology / Q000235:genetics* / Q000302:isolation & purification; D000900:Anti-Bacterial Agents / Q000494:pharmacology*; D001426:Bacterial Proteins / Q000235:genetics* / Q000378:metabolism; D002681:China / Q000453:epidemiology; D002999:Clone Cells; D003227:Conjugation, Genetic; D015870:Gene Expression; D006761:Hospitals; D006801:Humans; D015378:Imipenem / Q000494:pharmacology; D007362:Intensive Care Units; D007527:Isoenzymes / Q000235:genetics / Q000378:metabolism; D000077731:Meropenem; D010957:Plasmids / Q000737:chemistry / Q000378:metabolism; D012189:Retrospective Studies; D013845:Thienamycins / Q000494:pharmacology; D018440:beta-Lactam Resistance / Q000235:genetics*; D001618:beta-Lactamases / Q000235:genetics* / Q000378:metabolism
D000900:Anti-Bacterial Agents; D001426:Bacterial Proteins; D007527:Isoenzymes; D013845:Thienamycins; D015378:Imipenem; D001618:beta-Lactamases; C000599728:beta-lactamase OXA-23, Acinetobacter baumannii; C063912:carbapenemase; D000077731:Meropenem