Temporal evolution of carbapenem-resistant Acinetobacter baumannii in Curitiba, southern Brazil
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2010-05-01
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Gales, Ana Cristina 
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Background: in the last few years, carbapenem-resistant Acinetobacter baumannii isolates (CR-AB) have been identified worldwide. the first description of OXA-23-producing A baumannii in Brazil was from the city of Curitiba in 2003. the aim of the present study was to evaluate the persistence and dissemination of the first OXA-23-producing A baumannii clone isolated from patients in Hospital de Clinicas, Curitiba, Brazil.Methods: An antimicrobial susceptibility profile of the isolates was determined by the standard agar dilution method. Molecular detection of beta-lactamase genes was done by polymerase chain reaction. the clonal relationship of the isolates was analyzed by pulsed-field gel electrophoresis (PFGE). Epidemiologic and clinical features were evaluated as well.Results: Genotypic analysis of 172 CR-AB isolates by PFGE identified 3 distinct major PFGE clusters (A, B, and C, accounting for 36, 69, and 65 isolates, respectively). All isolates carried the bla(OXA-23)-like gene and were multidrug-resistant, but were susceptible to tigecycline and polymixin B. the mortality rate related to CR-AB infection was 45.4%, and ventilator-associated pneumonia and bloodstream infections were the most frequent clinical manifestations.Conclusions: the presence of 3 clones among the CR-AB isolates suggests that cross-transmission was the main mechanism responsible for dissemination of OXA-23 producers. PFGE pattern A was genotypically similar to that of the first OXA-23-producing A baumannii clone identified in Curitiba in 1999. This clone persisted in the same hospital until April 2004. the presence of the bla(OXA-23)-like gene was the main mechanism associated with carbapenem resistance among the isolates studied.
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American Journal of Infection Control. New York: Mosby-Elsevier, v. 38, n. 4, p. 308-314, 2010.