title: Early detection of metallo-β-lactamase NDM-1- and OXA-23 carbapenemase-producing Acinetobacter baumannii in Libyan hospitals.
abstract: Acinetobacter baumannii is an opportunistic pathogen causing various nosocomial infections. The aim of this study was to characterise the molecular support of carbapenem-resistant A. baumannii clinical isolates recovered from two Libyan hospitals. Bacterial isolates were identified by matrix-assisted laser desorption/ionisation time-of-flight mass spectrometry (MALDI-TOF/MS). Antibiotic susceptibility testing was performed using disk diffusion and Etest methods, and carbapenem resistance determinants were studied by PCR amplification and sequencing. Multilocus sequence typing (MLST) was performed for typing of the isolates. All 36 imipenem-resistant isolates tested were identified as A. baumannii. The blaOXA-23 gene was detected in 29 strains (80.6%). The metallo-β-lactamase blaNDM-1 gene was detected in eight isolates (22.2%), showing dissemination of multidrug-resistant (MDR) A. baumannii in Tripoli Medical Center and Burn and Plastic Surgery Hospital in Libya, including one isolate that co-expressed the blaOXA-23 gene. MLST revealed several sequence types (STs). Imipenem-resistant A. baumannii ST2 was the predominant clone (16/36; 44.4%). This study shows that NDM-1 and OXA-23 contribute to antibiotic resistance in Libyan hospitals and represents the first incidence of the association of these two carbapenemases in an autochthonous MDR A. baumannii isolated from patients in Libya, indicating that there is a longstanding infection control problem in these hospitals.
authors.affiliation: Unité de recherche sur les maladies infectieuses et tropicales émergentes (URMITE), UM 63, CNRS 7278, IRD 198, INSERM 1095, IHU Méditerranée Infection, Faculté de Médecine et de Pharmacie, Aix-Marseille Université, Marseille, France; Laboratoire des Microorganismes et Biomolécules Actives, Faculté des Sciences de Tunis, Campus Universitaire, Université de Tunis El Manar, 2098 El Manar II, Tunis, Tunisia.
authors.forename: Najla
authors.initials: N
authors.lastname: Mathlouthi
authors.affiliation: Department of Environmental Health, Faculty of Public Health, University of Benghazi, Benghazi, Libya; Infection Control Office, Benghazi Medical Centre, Benghazi, Libya.
authors.forename: Allaaeddin Ali
authors.initials: AA
authors.lastname: El Salabi
authors.affiliation: Laboratoire de recherche Résistance aux antimicrobiens, Faculty of Medicine of Tunis, Université de Tunis El Manar, Tunis, Tunisia.
authors.forename: Mariem
authors.initials: M
authors.lastname: Ben Jomàa-Jemili
authors.affiliation: Unité de recherche sur les maladies infectieuses et tropicales émergentes (URMITE), UM 63, CNRS 7278, IRD 198, INSERM 1095, IHU Méditerranée Infection, Faculté de Médecine et de Pharmacie, Aix-Marseille Université, Marseille, France.
authors.forename: Sofiane
authors.initials: S
authors.lastname: Bakour
authors.affiliation: Unité de recherche sur les maladies infectieuses et tropicales émergentes (URMITE), UM 63, CNRS 7278, IRD 198, INSERM 1095, IHU Méditerranée Infection, Faculté de Médecine et de Pharmacie, Aix-Marseille Université, Marseille, France.
authors.forename: Charbel
authors.initials: C
authors.lastname: Al-Bayssari
authors.affiliation: Department of Medical Microbiology, Faculty of Medicine, Tripoli University, Tripoli, Libya.
authors.forename: Abdulaziz A
authors.initials: AA
authors.lastname: Zorgani
authors.affiliation: Postgraduate Academy, Tripoli, Libya.
authors.forename: Abdulmajeed
authors.initials: A
authors.lastname: Kraiema
authors.affiliation: National Libyan Center for Infectious Disease Prevention and Control, Tripoli, Libya.
authors.forename: Omar
authors.initials: O
authors.lastname: Elahmer
authors.affiliation: Unité de recherche sur les maladies infectieuses et tropicales émergentes (URMITE), UM 63, CNRS 7278, IRD 198, INSERM 1095, IHU Méditerranée Infection, Faculté de Médecine et de Pharmacie, Aix-Marseille Université, Marseille, France.
authors.forename: Liliane
authors.initials: L
authors.lastname: Okdah
authors.affiliation: Unité de recherche sur les maladies infectieuses et tropicales émergentes (URMITE), UM 63, CNRS 7278, IRD 198, INSERM 1095, IHU Méditerranée Infection, Faculté de Médecine et de Pharmacie, Aix-Marseille Université, Marseille, France. Electronic address: jean-marc.rolain@univ-amu.fr.
authors.forename: Jean-Marc
authors.initials: JM
authors.lastname: Rolain
authors.affiliation: Laboratoire des Microorganismes et Biomolécules Actives, Faculté des Sciences de Tunis, Campus Universitaire, Université de Tunis El Manar, 2098 El Manar II, Tunis, Tunisia; Institut Supérieur des Sciences et Technologies de l'Environnement de Borj-Cedria, Technopôle de Borj-Cedria, Université de Carthage, BP-1003, Hammam-Lif, Tunis 2050, Tunisia. Electronic address: chdoula77@yahoo.fr.
authors.forename: Chedly
authors.initials: C
authors.lastname: Chouchani
mesh_terms: D000151:Acinetobacter Infections / Q000382:microbiology*; D040981:Acinetobacter baumannii / Q000201:enzymology* / Q000302:isolation & purification*; D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000494:pharmacology; D001431:Bacteriological Techniques; D002648:Child; D002675:Child, Preschool; D005260:Female; D006761:Hospitals; D006801:Humans; D015378:Imipenem / Q000494:pharmacology; D008002:Libya; D008297:Male; D008875:Middle Aged; D058885:Multilocus Sequence Typing; D016133:Polymerase Chain Reaction; D019032:Spectrometry, Mass, Matrix-Assisted Laser Desorption-Ionization; D055815:Young Adult; D018440:beta-Lactam Resistance; D001618:beta-Lactamases / Q000032:analysis* / Q000235:genetics
chemical_list: D000900:Anti-Bacterial Agents; D015378:Imipenem; C466679:beta-lactamase OXA-23; D001618:beta-Lactamases; C552864:beta-lactamase NDM-1
keywords: Acinetobacter baumannii; Carbapenemase; Libya; NDM-1; OXA-23