title: Molecular Epidemiology of Carbapenem-Resistant Acinetobacter Baumannii Complex Isolates from Patients that were Injured During the Eastern Ukrainian Conflict.
abstract: This study addressed carbapenem-resistant Acinetobacter baumannii complex (ABC) isolates from patients that were injured during the military conflict in the Eastern Ukraine and treated at German Armed Forces Hospitals in 2014 and 2015. Clonal diversity of the strains and potential ways of transmission were analyzed. Patients with one or several isolation events of carbapenem-resistant ABC were included. Isolates were characterized by VITEK II-based identification and resistance testing, molecular screening for frequent carbapenemase genes, and DiversiLab rep-PCR-based typing. Available clinical information of the patients was assessed. From 21 young male Ukrainian patients with battle injuries, 32 carbapenem- and fluoroquinolone-resistant ABC strains were isolated. Four major clonal clusters were detected. From four patients (19%), ABC isolates from more than one clonal cluster were isolated. The composition of the clusters suggested transmission events prior to the admission to the German hospitals. The infection and colonization pressure in the conflict regions of the Eastern Ukraine with ABC of low clonal diversity is considerable. Respective infection risks have to be considered in case of battle-related injuries in these regions. The low number of local clones makes any molecular exclusion of transmission events difficult.
authors.affiliation: Laboratory Department I, Central Institute of the German Armed Forces in Koblenz , Germany.
authors.forename: Heike
authors.initials: H
authors.lastname: Granzer
authors.affiliation: North Atlantic Treaty Organization Center of Excellence in Military Medicine (NATO MilMedCOE) , Munich, Germany.
authors.forename: Ralf Matthias
authors.initials: RM
authors.lastname: Hagen
authors.affiliation: Institute for Medical Microbiology, Virology and Hygiene, University Medicine Rostock , Germany.
authors.forename: Philipp
authors.initials: P
authors.lastname: Warnke
authors.affiliation: Laboratory Department I, Central Institute of the German Armed Forces in Munich , Germany.
authors.forename: Wolfgang
authors.initials: W
authors.lastname: Bock
authors.affiliation: Laboratory Department I, Central Institute of the German Armed Forces in Kiel (branch office in Berlin) , Germany.
authors.forename: Tobias
authors.initials: T
authors.lastname: Baumann
authors.affiliation: Infectious Disease Epidemiology Group, Bernhard Nocht Institute of Tropical Medicine Hamburg , Germany.
authors.forename: Norbert Georg
authors.initials: NG
authors.lastname: Schwarz
authors.affiliation: Institute for Medical Microbiology, Virology and Hygiene, University Medicine Rostock , Germany.
authors.forename: Andreas
authors.initials: A
authors.lastname: Podbielski
authors.affiliation: Institute for Medical Microbiology, Virology and Hygiene, University Medicine Rostock, Germany; Department of Tropical Medicine at the Bernhard Nocht Institute, German Armed Forces Hospital of Hamburg, Germany.
authors.forename: Hagen
authors.initials: H
authors.lastname: Frickmann
authors.affiliation: Institute for Medical Microbiology, Virology and Hygiene, University Medicine Rostock , Germany.
authors.forename: Thomas
authors.initials: T
authors.lastname: Koeller
keywords: Acinetobacter baumannii complex; Ukraine; carbapenem resistance; clonal distribution; colonization; epidemiology; rep-PCR; typing; war