title: Molecular Epidemiology and Clinical Impact of Acinetobacter calcoaceticus-baumannii Complex in a Belgian Burn Wound Center.
abstract: Multidrug resistant Acinetobacter baumannii and its closely related species A. pittii and A. nosocomialis, all members of the Acinetobacter calcoaceticus-baumannii (Acb) complex, are a major cause of hospital acquired infection. In the burn wound center of the Queen Astrid military hospital in Brussels, 48 patients were colonized or infected with Acb complex over a 52-month period. We report the molecular epidemiology of these organisms, their clinical impact and infection control measures taken. A representative set of 157 Acb complex isolates was analyzed using repetitive sequence-based PCR (rep-PCR) (DiversiLab) and a multiplex PCR targeting OXA-51-like and OXA-23-like genes. We identified 31 rep-PCR genotypes (strains). Representatives of each rep-type were identified to species by rpoB sequence analysis: 13 types to A. baumannii, 10 to A. pittii, and 3 to A. nosocomialis. It was assumed that isolates that belonged to the same rep-type also belonged to the same species. Thus, 83.4% of all isolates were identified to A. baumannii, 9.6% to A. pittii and 4.5% to A. nosocomialis. We observed 12 extensively drug resistant Acb strains (10 A. baumannii and 2 A. nosocomialis), all carbapenem-non-susceptible/colistin-susceptible and imported into the burn wound center through patients injured in North Africa. The two most prevalent rep-types 12 and 13 harbored an OXA-23-like gene. Multilocus sequence typing allocated them to clonal complex 1 corresponding to EU (international) clone I. Both strains caused consecutive outbreaks, interspersed with periods of apparent eradication. Patients infected with carbapenem resistant A. baumannii were successfully treated with colistin/rifampicin. Extensive infection control measures were required to eradicate the organisms. Acinetobacter infection and colonization was not associated with increased attributable mortality.
authors.affiliation: Laboratory for Molecular and Cellular Technology, Queen Astrid Military Hospital, Brussels, Belgium.
authors.forename: Daniel
authors.initials: D
authors.lastname: De Vos
authors.affiliation: Laboratory for Molecular and Cellular Technology, Queen Astrid Military Hospital, Brussels, Belgium.
authors.forename: Jean-Paul
authors.initials: JP
authors.lastname: Pirnay
authors.affiliation: Laboratory for Molecular and Cellular Technology, Queen Astrid Military Hospital, Brussels, Belgium.
authors.forename: Florence
authors.initials: F
authors.lastname: Bilocq
authors.affiliation: Burn Wound Center, Queen Astrid Military Hospital, Brussels, Belgium.
authors.forename: Serge
authors.initials: S
authors.lastname: Jennes
authors.affiliation: Laboratory for Molecular and Cellular Technology, Queen Astrid Military Hospital, Brussels, Belgium.
authors.forename: Gilbert
authors.initials: G
authors.lastname: Verbeken
authors.affiliation: Burn Wound Center, Queen Astrid Military Hospital, Brussels, Belgium.
authors.forename: Thomas
authors.initials: T
authors.lastname: Rose
authors.affiliation: Burn Wound Center, Queen Astrid Military Hospital, Brussels, Belgium.
authors.forename: Elkana
authors.initials: E
authors.lastname: Keersebilck
authors.affiliation: Hospital Hygiene and Infection Control Team, Queen Astrid Military Hospital, Brussels, Belgium.
authors.forename: Petra
authors.initials: P
authors.lastname: Bosmans
authors.affiliation: Hospital Hygiene and Infection Control Team, Queen Astrid Military Hospital, Brussels, Belgium.
authors.forename: Thierry
authors.initials: T
authors.lastname: Pieters
authors.affiliation: Clinical Laboratory, Queen Astrid Military Hospital, Brussels, Belgium.
authors.forename: Mony
authors.initials: M
authors.lastname: Hing
authors.affiliation: Clinical Laboratory, Queen Astrid Military Hospital, Brussels, Belgium.
authors.forename: Walter
authors.initials: W
authors.lastname: Heuninckx
authors.affiliation: Medical Communication and Information Systems, ACOS WB/Health Division, Queen Astrid Military Hospital, Brussels, Belgium.
authors.forename: Frank
authors.initials: F
authors.lastname: De Pauw
authors.affiliation: Burn Wound Center, Queen Astrid Military Hospital, Brussels, Belgium.
authors.forename: Patrick
authors.initials: P
authors.lastname: Soentjens
authors.affiliation: Laboratory for Molecular and Cellular Technology, Queen Astrid Military Hospital, Brussels, Belgium.|Laboratory Bacteriology Research, University of Ghent, Ghent, Belgium.
authors.forename: Maia
authors.initials: M
authors.lastname: Merabishvili
authors.affiliation: Laboratory Bacteriology Research, University of Ghent, Ghent, Belgium.
authors.forename: Pieter
authors.initials: P
authors.lastname: Deschaght
authors.affiliation: Laboratory Bacteriology Research, University of Ghent, Ghent, Belgium.
authors.forename: Mario
authors.initials: M
authors.lastname: Vaneechoutte
authors.affiliation: Laboratoire de Bactériologie, CHU Mont-Godinne, Université Catholique de Louvain, Yvoir, Belgium.
authors.forename: Pierre
authors.initials: P
authors.lastname: Bogaerts
authors.affiliation: Laboratoire de Bactériologie, CHU Mont-Godinne, Université Catholique de Louvain, Yvoir, Belgium.
authors.forename: Youri
authors.initials: Y
authors.lastname: Glupczynski
authors.affiliation: Applied Maths, Sint-Martens-Latem, Belgium.
authors.forename: Bruno
authors.initials: B
authors.lastname: Pot
authors.affiliation: Department of Infectious Diseases C5-P, Leiden University Medical Center, Leiden, The Netherlands.
authors.forename: Tanny J
authors.initials: TJ
authors.lastname: van der Reijden
authors.affiliation: Department of Infectious Diseases C5-P, Leiden University Medical Center, Leiden, The Netherlands.
authors.forename: Lenie
authors.initials: L
authors.lastname: Dijkshoorn
mesh_terms: D000151:Acinetobacter Infections / Q000188:drug therapy* / Q000453:epidemiology* / Q000382:microbiology; D040981:Acinetobacter baumannii / Q000235:genetics / Q000302:isolation & purification*; D016954:Acinetobacter calcoaceticus / Q000235:genetics / Q000302:isolation & purification*; D000293:Adolescent; D000328:Adult; D000352:Africa, Northern / Q000453:epidemiology; D000368:Aged; D000369:Aged, 80 and over; D015373:Bacterial Typing Techniques; D001530:Belgium / Q000453:epidemiology; D002056:Burns / Q000382:microbiology*; D002648:Child; D002675:Child, Preschool; D003091:Colistin / Q000627:therapeutic use*; D024881:Drug Resistance, Bacterial; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D008875:Middle Aged; D058885:Multilocus Sequence Typing; D060885:Multiplex Polymerase Chain Reaction; D012329:RNA, Bacterial / Q000032:analysis; D012336:RNA, Ribosomal, 16S / Q000032:analysis; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D012329:RNA, Bacterial; D012336:RNA, Ribosomal, 16S; D003091:Colistin