Detection of antibiotic resistant Acinetobacter baumannii in various hospital environments: potential sources for transmission of Acinetobacter infections

Environmental Health and Preventive Medicine, May 2017

Background Antibiotic resistant Acinetobacter baumannii has emerged as one of the most problematic hospital acquired pathogens around the world. This study was designed to investigate the presence of antibiotic resistant A. baumannii in various hospital environments. Methods Air, water and inanimate surface samples were taken in different wards of four hospitals and analyzed for the presence of A. baumannii. Confirmed A. baumannii isolates were analyzed for antimicrobial susceptibility and also screened for the presence of three most common OXA- type carbapenemase-encoding genes. Results A. baumannii was detected in 11% (7/64) of air samples with the highest recovery in intensive care units (ICUs). A. baumannii was also detected in 17% (7/42) and 2% (1/42) of surface and water samples, respectively. A total of 40 A. baumannii isolates were recovered and analysis of antimicrobial susceptibility showed the highest resistance towards ceftazidime (92.5%, 37/40). 85% (34/40) and 80% (32/40) of the isolates were also resistant to imipenem and gentamicin, respectively. Resistance genes analysis showed that 77.5% (31/40) strains contained OXA-23 and 5% (2/40) strains contained OXA-24, but OXA-58 was not detected in any of the strains. Conclusion Detection of antibiotic resistant A. baumannii in various samples revealed that hospital environments could act as a potential source for transmission of A. baumannii infections especially in ICUs. These results emphasize the importance of early detection and implementation of control measures to prevent the spread of A. baumannii in hospital environments.

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Detection of antibiotic resistant Acinetobacter baumannii in various hospital environments: potential sources for transmission of Acinetobacter infections

Shamsizadeh et al. Environmental Health and Preventive Medicine Detection of antibiotic resistant Acinetobacter baumannii in various hospital environments: potential sources for transmission of Acinetobacter infections Zahra Shamsizadeh 0 Mahnaz Nikaeen 0 Bahram Nasr Esfahani 2 Seyed Hamed Mirhoseini 1 Maryam Hatamzadeh 0 Akbar Hassanzadeh 3 0 Department of Environmental Health Engineering, School of Health, Isfahan University of Medical Sciences , Hezar Jerib Avenue, Isfahan , Iran 1 Department of Environmental Health Engineering, School of Health, Arak University of Medical Sciences , Arak , Iran 2 Department of Microbiology, School of Medicine, Isfahan University of Medical Sciences , Isfahan , Iran 3 Department of Statistics and Epidemiology, School of Health, Isfahan University of Medical Sciences , Isfahan , Iran Background: Antibiotic resistant Acinetobacter baumannii has emerged as one of the most problematic hospital acquired pathogens around the world. This study was designed to investigate the presence of antibiotic resistant A. baumannii in various hospital environments. Methods: Air, water and inanimate surface samples were taken in different wards of four hospitals and analyzed for the presence of A. baumannii. Confirmed A. baumannii isolates were analyzed for antimicrobial susceptibility and also screened for the presence of three most common OXA- type carbapenemase-encoding genes. Results: A. baumannii was detected in 11% (7/64) of air samples with the highest recovery in intensive care units (ICUs). A. baumannii was also detected in 17% (7/42) and 2% (1/42) of surface and water samples, respectively. A total of 40 A. baumannii isolates were recovered and analysis of antimicrobial susceptibility showed the highest resistance towards ceftazidime (92.5%, 37/40). 85% (34/40) and 80% (32/40) of the isolates were also resistant to imipenem and gentamicin, respectively. Resistance genes analysis showed that 77.5% (31/40) strains contained OXA-23 and 5% (2/40) strains contained OXA-24, but OXA-58 was not detected in any of the strains. Conclusion: Detection of antibiotic resistant A. baumannii in various samples revealed that hospital environments could act as a potential source for transmission of A. baumannii infections especially in ICUs. These results emphasize the importance of early detection and implementation of control measures to prevent the spread of A. baumannii in hospital environments. Acinetobacter baumannii; Hospital; Antibiotic resistance; Air; Water; Surface - Background Nosocomial infections have become increasingly a major health concern in many hospitals worldwide [1, 2]. Nosocomial infections account for about 1.4 million infections every year [3]. Acinetobacter infections have frequently been reported as a major of nosocomial infections [1, 4, 5]. Acinetobacter species, ubiquitous gram-negative coccobacilli, are widespread in nature, water and soil [5, 6]. More than 20 species of Acinetobacter have been characterized but only few species including Acinetobacter baumannii, A. calcoaceticus and A. lwoffii play a significant role in nosocomial infections [6]. However, A. baumannii has the greatest clinical significance and identified as the causative agent of the majority of nosocomial infections especially in intensive care units (ICU) [6–8]. A. baumannii can cause a wide range of infections including bacteremia, meningitis, urinary tract, bloodstream or surgical wound infections and ventilator associated pneumonia [5, 6]. However, the emergence of antibiotics-resistant A. baumannii especially, multiresistant strains seriously © The Author(s). 2017 Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated. challenges the treatment of these infections [9]. This is of special concern in developing countries, since antibiotic prescription rates and intake without prescription is markedly higher [9]. Antibiotic resistance causing increased morbidity, mortality, and economic impacts on health services [2]. Vulnerable groups of inpatients such as people with impaired host defenses are especially at high risk [4, 10]. A. baumannii has the ability to survive for long periods and could easily spread in hospital environments [5]. These traits could define its propensity for causing extended outbreaks [5, 6]. A. baumannii is mainly transmitted by direct contact with infected persons or indirect contact with contaminated environments. However, airborne route al (...truncated)


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Zahra Shamsizadeh, Mahnaz Nikaeen, Bahram Nasr Esfahani, Seyed Hamed Mirhoseini, Maryam Hatamzadeh, Akbar Hassanzadeh. Detection of antibiotic resistant Acinetobacter baumannii in various hospital environments: potential sources for transmission of Acinetobacter infections, Environmental Health and Preventive Medicine, 2017, pp. 44, Volume 22, Issue 1, DOI: 10.1186/s12199-017-0653-4