title: Clinical epidemiology and resistance mechanisms of carbapenem-resistant Acinetobacter baumannii, French Guiana, 2008-2014.
abstract: This study investigated the clinical epidemiology and resistance mechanisms of Acinetobacter baumannii and characterised the clonal diversity of carbapenem-resistant A. baumannii (CRAB) during an ICU-associated outbreak at Cayenne Hospital, French Guiana. All non-duplicate A. baumannii isolates from 2008 to 2014 were tested for antibiotic susceptibility by disk diffusion. Multilocus sequence typing, pulsed-field gel electrophoresis (PFGE) and characterisation of carbapenemase-encoding genes were performed on CRAB. Of the 441 A. baumannii isolates, most were from males (54.0%) and were detected mainly from the ICU (30.8%) and medicine wards (21.8%). In the ICU, strains were mainly isolated from the respiratory tract (44.1%) and bloodstream (14.0%), whereas in medicine wards they mainly were from wound/drainage (36.5%) and bloodstream (25.0%). A. baumannii showed the greatest susceptibility to piperacillin/tazobactam (92.7%), imipenem (92.5%), colistin (95.6%) and amikacin (97.2%), being lower in the ICU and medicine wards compared with other wards. An outbreak of OXA-23-producing CRAB occurred in the 13-bed ICU in 2010. CRAB strains were more co-resistant to other antimicrobials compared with non-CRAB. Molecular genetics analysis revealed five sequence types [ST78, ST107 and ST642 and two new STs (ST830 and ST831)]. Analysis of PFGE profiles indicated cross-transmissions of CRAB within the ICU, between the ICU and one medicine ward during transfer of patients, and within that medicine ward. This study provides the first clinical and molecular data of A. baumannii from French Guiana and the Amazon basin. The ICU was the highest risk unit of this nosocomial outbreak of OXA-23-producing CRAB, which could subsequently disseminate within the hospital.
authors.affiliation: Infection Control Unit, Infectious Diseases and Tropical Medicine, Centre hospitalier de Cayenne, Cayenne, French Guiana; EPAT EA 3595, Université de Guyane, Cayenne, French Guiana. Electronic address: mahamataba@gmail.com.
authors.forename: Aba
authors.initials: A
authors.lastname: Mahamat
authors.affiliation: Service d'hygiène hospitalière, Centre hospitalier universitaire de Besançon, Besançon Cedex, France.
authors.forename: Xavier
authors.initials: X
authors.lastname: Bertrand
authors.affiliation: Laboratoire de biologie polyvalente, Centre hospitalier de Cayenne, Cayenne, French Guiana.
authors.forename: Brigitte
authors.initials: B
authors.lastname: Moreau
authors.affiliation: Service de réanimation adulte, Centre hospitalier de Cayenne, Cayenne, French Guiana.
authors.forename: Didier
authors.initials: D
authors.lastname: Hommel
authors.affiliation: EPAT EA 3595, Université de Guyane, Cayenne, French Guiana; Service de dermatologie, Centre hospitalier de Cayenne, Cayenne, French Guiana.
authors.forename: Pierre
authors.initials: P
authors.lastname: Couppie
authors.affiliation: Laboratoire de biologie polyvalente, Centre hospitalier de Cayenne, Cayenne, French Guiana.
authors.forename: Christine
authors.initials: C
authors.lastname: Simonnet
authors.affiliation: Service de réanimation adulte, Centre hospitalier de Cayenne, Cayenne, French Guiana.
authors.forename: Hatem
authors.initials: H
authors.lastname: Kallel
authors.affiliation: Infection Control Unit, Infectious Diseases and Tropical Medicine, Centre hospitalier de Cayenne, Cayenne, French Guiana; EPAT EA 3595, Université de Guyane, Cayenne, French Guiana.
authors.forename: Magalie
authors.initials: M
authors.lastname: Demar
authors.affiliation: Infection Control Unit, Infectious Diseases and Tropical Medicine, Centre hospitalier de Cayenne, Cayenne, French Guiana; EPAT EA 3595, Université de Guyane, Cayenne, French Guiana.
authors.forename: Felix
authors.initials: F
authors.lastname: Djossou
authors.affiliation: EPAT EA 3595, Université de Guyane, Cayenne, French Guiana; Centre d'Investigation Clinique Epidémiologie Clinique CIC-EC CIE 802, Centre hospitalier de Cayenne, Cayenne, French Guiana.
authors.forename: Mathieu
authors.initials: M
authors.lastname: Nacher
mesh_terms: D000151:Acinetobacter Infections / Q000453:epidemiology* / Q000382:microbiology*; D040981:Acinetobacter baumannii / Q000187:drug effects* / Q000201:enzymology / Q000235:genetics / Q000302:isolation & purification; D000328:Adult; D001426:Bacterial Proteins / Q000235:genetics; D015780:Carbapenems / Q000494:pharmacology*; D003428:Cross Infection / Q000453:epidemiology / Q000382:microbiology; D004196:Disease Outbreaks; D052978:Disk Diffusion Antimicrobial Tests; D016521:Electrophoresis, Gel, Pulsed-Field; D005260:Female; D005616:French Guiana / Q000453:epidemiology; D006761:Hospitals; D006801:Humans; D008297:Male; D008875:Middle Aged; D017720:Molecular Epidemiology; D058885:Multilocus Sequence Typing; D012189:Retrospective Studies; D055815:Young Adult; D018440:beta-Lactam Resistance; D001618:beta-Lactamases / Q000235:genetics
chemical_list: D001426:Bacterial Proteins; D015780:Carbapenems; D001618:beta-Lactamases; C063912:carbapenemase
keywords: Acinetobacter baumannii; Carbapenem-resistant; Epidemiology; Intensive care unit; Nosocomial; Outbreak