Abstract Moleculare Set

1. Front Microbiol. 2021 Feb 26;12:628736. doi: 10.3389/fmicb.2021.628736.
eCollection 2021.
Molecular Epidemiology of Carbapenem-Resistant Acinetobacter baumannii From

Khartoum State, Sudan.
Al-Hassan L(1), Elbadawi H(2), Osman E(3)(4), Ali S(5), Elhag K(2), Cantillon
D(1), Wille J(6)(7), Seifert H(6)(7), Higgins PG(6)(7).
Author information:
(1)Department of Global Health and Infection, Brighton and Sussex Medical
School, Brighton, United Kingdom.
(2)Department of Microbiology, Soba University Hospital, University of Khartoum,
Khartoum, Sudan.
(3)Faculty of Medical Laboratories, Microbiology Department, Ibn Sina
University, Khartoum, Sudan.
(4)Bioscience Research Institute, Ibn Sina University, Khartoum, Sudan.
(5)College of Health Sciences, Medical Laboratory Sciences Program, Gulf Medical
University, Ajman, United Arab Emirates.
(6)Institute for Medical Microbiology, Immunology and Hygiene, University of
Cologne, Cologne, Germany.
(7)German Centre for Infection Research, Partner Site Bonn-Cologne, Cologne,
Germany.
Carbapenem resistant Acinetobacter baumannii (CRAb) is an important global

pathogen contributing to increased morbidity and mortality in hospitalized
patients, due to limited alternative treatment options. Nine international
clonal (IC) lineages have been identified in many countries worldwide, however,
data still lacks from some parts of the world, particularly in Africa. We hereby
present the molecular epidemiology of MDR A. baumannii from four hospitals in
Khartoum, Sudan, collected from 2017 to 2018. Forty-two isolates were
whole-genome sequenced, and subsequent molecular epidemiology was determined by
core genome MLST (cgMLST), and their resistomes identified. All isolates had an
array of diverse antibiotic resistance mechanisms conferring resistance to
multiple classes of antibiotics. We found a predominance (88%) of IC2 (with the
intrinsic OXA-66 and acquired OXA-23), and some with NDM-1. IC2 isolates were
sub-divided into 4 STs separated by 5 to 431 allelic differences, and with
evidence of seven transmission clusters. Isolates belonging to IC1, IC5, and IC9
were also identified. These data illustrate that MDR IC2 A. baumannii are widely
distributed in Khartoum hospitals and are in possession of multiple antibiotic
resistance determinants.
Copyright © 2021 Al-Hassan, Elbadawi, Osman, Ali, Elhag, Cantillon, Wille,

Seifert and Higgins.
DOI: 10.3389/fmicb.2021.628736
PMCID: PMC7952628
PMID: 33717019
Conflict of interest statement: The authors declare that the research was
conducted in the absence of any commercial or financial relationships that could
be construed as a potential conflict of interest.
2. Antibiotics (Basel). 2021 Mar 11;10(3):291. doi: 10.3390/antibiotics10030291.
Molecular Epidemiology of Carbapenem-Resistant Acinetobacter baumannii Isolates

from Northern Africa and the Middle East.
Higgins PG(1)(2), Hagen RM(3), Kreikemeyer B(4), Warnke P(4), Podbielski A(4),
Frickmann H(4)(5), Loderstädt U(6).
Author information:
(1)Institute for Medical Microbiology, Immunology, and Hygiene, University of
Cologne, 50935 Cologne, Germany.
(2)German Centre for Infection Research (DZIF), Partner Site Bonn-Cologne, 50935
Cologne, Germany.
(3)Department of Microbiology and Hospital Hygiene, Bundeswehr Central Hospital
Koblenz, 56070 Koblenz, Germany.
(4)Institute for Medical Microbiology, Virology and Hygiene, University Medicine
Rostock, 18057 Rostock, Germany.
(5)Department of Microbiology and Hospital Hygiene, Bundeswehr Hospital Hamburg,
20359 Hamburg, Germany.
(6)Department of Hospital Hygiene & Infectious Diseases, University Medicine
Goettingen, 37075 Göttingen, Germany.
At the Bundeswehr Hospitals of Hamburg and Westerstede, patients repatriated

from subtropical war and crisis zones of Northern Africa and the Middle East
were medically treated, including microbiological assessment. Within a six-year
interval, 16 Acinetobacter spp. strains, including 14 Acinetobacter baumannii
(Ab) isolates with resistance against carbapenems and origins in Afghanistan (n
= 4), Iraq (n = 2), Libya (n = 2), and Syria (n = 8) were collected. While
clonal relationships of Libyan and Syrian strains had been assessed by
superficial next generation sequencing (NGS) and "DiversiLab" repetitive
elements sequence-based (rep-)PCR so far, this study provides core genome-based
sequence typing and thus more detailed epidemiological information. In detail,
sequencing allowed a definitive species identification and comparison with
international outbreak-associated Ab strains by core genome multi locus sequence
typing (cgMLST) and the identification of MLST lineages, as well as the
identification of known resistance genes. The sequence analysis allowed for the
confirmation of outbreak-associated clonal clusters among the Syrian and Afghan
Ab isolates, indicating likely transmission events. The identified acquired
carbapenem resistance genes comprised blaOXA-23, blaOXA-58, blaNDM-1, and
blaGES-11, next to other intrinsic and acquired, partly mobile
resistance-associated genes. Eleven out of 14 Ab isolates clustered with the
previously described international clonal lineages IC1 (4 Afghan strains), IC2
(6 Syrian strains), and IC7 (1 Syrian strain). Identified Pasteur sequence types
of the 14 Ab strains comprised ST2 (Syrian), ST25 (Libyan), ST32 (Iraqi), ST81
(Afghan), ST85 (Libyan), and ST1112 (Syrian), respectively. In conclusion, the
study revealed a broad spectrum of resistance genes in Ab isolated from
war-injured patients from Northern Africa and the Middle East, thereby
broadening the scarcely available data on locally abundant clonal lineages and
resistance mechanisms.
DOI: 10.3390/antibiotics10030291
PMCID: PMC8002098
PMID: 33799540
Conflict of interest statement: The sponsors did not have any role in the
collection, analysis, or interpretation of data, in the writing of the report,
or in the decision to submit the article for publication.
3. Microb Drug Resist. 2016 Jan;22(1):59-68. doi: 10.1089/mdr.2015.0053. Epub 2015

Jul 10.
The Molecular Epidemiology and Genetic Environment of Carbapenemases Detected in

Africa.
Sekyere JO(1), Govinden U(1), Essack S(1).
Author information:
(1)Antimicrobial Resistance Unit, School of Health Sciences, University of
KwaZulu-Natal , Durban, South Africa .
Research articles describing carbapenemases and their genetic environments in

Gram-negative bacteria were reviewed to determine the molecular epidemiology of
carbapenemases in Africa. The emergence of resistance to the carbapenems, the
last resort antibiotic for difficult to treat bacterial infections, affords
clinicians few therapeutic options, with a resulting increase in morbidities,
mortalities, and healthcare costs. However, the molecular epidemiology of
carbapenemases throughout Africa is less described. Research articles and
conference proceedings describing the genetic environment and molecular
epidemiology of carbapenemases in Africa were retrieved from Google Scholar,
Scifinder, Pubmed, Web of Science, and Science Direct databases. Predominant
carbapenemase genes so far described in Africa include the blaOXA-48 type,
blaIMP, blaVIM, and blaNDM in Acinetobacter baumannii, Klebsiella pneumoniae,
Enterobacter cloacae, Citrobacter spp., and Escherichia coli carried on various
plasmid types and sizes, transposons, and integrons. Class D and class B
carbapenemases, mainly prevalent in A. baumannii, K. pneumoniae, E. cloacae,
Citrobacter spp., and E. coli were the commonest carbapenemases. Carbapenemases
are mainly reported in North and South Africa as under-resourced laboratories,
lack of awareness and funding preclude the detection and reporting of
carbapenemase-mediated resistance. Consequently, the true molecular epidemiology
of carbapenemases and their genetic environment in Africa is still unknown.
DOI: 10.1089/mdr.2015.0053
PMID: 26161476 [Indexed for MEDLINE]
4. PLoS One. 2016 May 25;11(5):e0156237. doi: 10.1371/journal.pone.0156237.

eCollection 2016.
Molecular Epidemiology and Clinical Impact of Acinetobacter

calcoaceticus-baumannii Complex in a Belgian Burn Wound Center.
De Vos D(1), Pirnay JP(1), Bilocq F(1), Jennes S(2), Verbeken G(1), Rose T(2),
Keersebilck E(2), Bosmans P(3), Pieters T(3), Hing M(4), Heuninckx W(4), De Pauw
F(5), Soentjens P(2), Merabishvili M(1)(6), Deschaght P(6), Vaneechoutte M(6),
Bogaerts P(7), Glupczynski Y(7), Pot B(8), van der Reijden TJ(9), Dijkshoorn
L(9).
Author information:
(1)Laboratory for Molecular and Cellular Technology, Queen Astrid Military
Hospital, Brussels, Belgium.
(2)Burn Wound Center, Queen Astrid Military Hospital, Brussels, Belgium.
(3)Hospital Hygiene and Infection Control Team, Queen Astrid Military Hospital,
Brussels, Belgium.
(4)Clinical Laboratory, Queen Astrid Military Hospital, Brussels, Belgium.
(5)Medical Communication and Information Systems, ACOS WB/Health Division, Queen
Astrid Military Hospital, Brussels, Belgium.
(6)Laboratory Bacteriology Research, University of Ghent, Ghent, Belgium.
(7)Laboratoire de Bactériologie, CHU Mont-Godinne, Université Catholique de
Louvain, Yvoir, Belgium.
(8)Applied Maths, Sint-Martens-Latem, Belgium.
(9)Department of Infectious Diseases C5-P, Leiden University Medical Center,
Leiden, The Netherlands.
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.
DOI: 10.1371/journal.pone.0156237
PMCID: PMC4880317
Conflict of interest statement: Competing Interests: BP is employed by Applied

Maths, which developed one of the software packages that were used to analyse
the data. Author BP's commercial affiliation does not alter the authors’
adherence to PLOS ONE policies on sharing data and materials.
5. Braz J Infect Dis. 2019 Nov-Dec;23(6):371-380. doi: 10.1016/j.bjid.2019.09.004.

Epub 2019 Nov 7.
Prevalence and molecular analysis of multidrug-resistant Acinetobacter baumannii

in the extra-hospital environment in Mthatha, South Africa.
Anane A Y(1), Apalata T(2), Vasaikar S(3), Okuthe GE(4), Songca S(5).
Author information:
(1)Walter Sisulu University, Faculty of Health Sciences, Department of
Laboratory Medicine & Pathology, Eastern Cape Province, South Africa.
(2)Nelson Mandela Central Hospital, National Health Laboratory Services (NHLS),
Division of Medical Microbiology, Mthatha, South Africa. Electronic address:
tapalata@wsu.ac.za.
(3)Walter Sisulu University, Faculty of Health Sciences, Department of
Laboratory Medicine & Pathology, Eastern Cape Province, South Africa; Nelson
Mandela Central Hospital, National Health Laboratory Services (NHLS), Division
of Medical Microbiology, Mthatha, South Africa.
(4)Walter Sisulu University, Department of Biological & Environmental Sciences,
Eastern Cape Province, South Africa.
(5)University of KwaZulu-Natal, College of Agriculture Engineering and Science,
School of Chemistry and Physics, Durban, South Africa.
INTRODUCTION: The presence of Acinetobacter baumannii outside hospitals remains
unclear. This study aimed to determine the prevalence of multidrug-resistance
(MDR) A. baumannii in the extra-hospital environment in Mthatha, South Africa
and to investigate the frequency of carbapenemase-encoding genes.
MATERIAL AND METHODS: From August 2016 to July 2017 a total of 598 abattoir
samples and 689 aquatic samples were collected and analyzed presumptively by
cultural methods for the presence of A. baumannii using CHROMagar™ Acinetobacter
medium. Species identiﬁcation was performed by autoSCAN-4 (Dade Behring Inc.,
IL) and confirmed by the detection of their intrinsic blaOXA-51 gene. Confirmed
MDR A. baumannii isolates were screened for the presence of
carbapenemase-encoding genes, ISAba1 insertion sequence and integrase intI1.
RESULTS: In total, 248 (19.3%) Acinetobacter species were isolated.
Acinetobacter. baumannii was detected in 183 (73.8%) of which 85 (46.4%) and 98
(53.6%) were recovered from abattoir and aquatic respectively. MDR A. baumannii
was detected in 56.5% (48/85) abattoir isolates and 53.1% (52/98) aquatic
isolates. Isolates showed high resistance to antimicrobials most frequently used
to treat Acinetobacter infections such as piperacillin/tazobactam; abattoir (98%
of isolates resistant), aquatic (94% of isolates resistant), ceftazidime (84%,
83%), ciprofloxacin (71%, 70%), amikacin (41%, 42%), imipenem (75%, 73%), and
meropenem (74%, 71%). All the isolates were susceptible to tigecycline and
colistin. All the isolates carried blaOXA-51-like. The blaOXA-23 was detected in
32 (66.7%) abattoir isolates and 11 (21.2%) aquatic isolates. The blaOXA-58-like
was positive in 7 (14.6%) and 4 (7.7%) abattoir and aquatic isolates,
respectively. Both groups of isolates lacked blaOXA-24-like, blaIMP-type,
blaVIM-type, blaNDM-1,blaSIM, blaAmpC, ISAba1 and inI1. Isolates showed high
level of Multiple Antibiotic Resistance Index (MARI) ranging from 0.20-0.52.
CONCLUSION: Extra-hospital sources such as abattoir and aquatic environments may
be a vehicle of spread of MDR A. baumannii strains in the community and hospital
settings.
Copyright © 2019. Published by Elsevier España, S.L.U.
DOI: 10.1016/j.bjid.2019.09.004
PMCID: PMC9428220
6. PLoS One. 2021 Jun 24;16(6):e0251508. doi: 10.1371/journal.pone.0251508.

eCollection 2021.
Molecular characterization of carbapenem-resistant Acinetobacter baumannii

clinical isolates from Egyptian patients.
Hassan RM(1), Salem ST(1), Hassan SIM(2), Hegab AS(3), Elkholy YS(3).
Author information:
(1)Faculty of Medicine, Department of Clinical and Chemical Pathology, Cairo
University, Cairo, Egypt.
(2)Faculty of Medicine, Department of Clinical Pathology, Beni-Suef University,
Beni-Suef, Egypt.
(3)Faculty of Medicine, Department of Medical Microbiology and Immunology, Cairo
Acinetobacter baumannii (A. baumannii) represents a global threat owing to its

ability to resist most of the currently available antimicrobial agents.
Moreover, emergence of carbapenem resistant A. baumannii (CR-AB) isolates limits
the available treatment options. Enzymatic degradation by variety of
ß-lactamases, have been identified as the most common mechanism of carbapenem
resistance in A. baumannii. The alarming increase in the prevalence of CR-AB
necessitates continuous screening and molecular characterization to appreciate
the problem. The present study was performed to assess the prevalence and
characterize carbapenemases among 206 CR-AB isolated from various clinical
specimens collected from different intensive care units at Kasr Al-Aini
Hospital. All isolates were confirmed to be A. baumannii by detection of the
blaOXA-51-like gene. Molecular screening of 13 common Ambler class bla
carbapenemases genes in addition to insertion sequence (IS-1) upstream OXA-23
were performed by using four sets of multiplex PCR, followed by identification
using gene sequencing technology. Among the investigated genes, the prevalence
of blaOXA-23, and blaOXA-58 were 77.7%, and 1.9%, respectively. The ISAba1 was
detected in 10% of the blaOXA-23 positive isolates. The prevalence of
metallo-β-lactamases (MBLs) studied; blaNDM-1, blaSPM, blaVIM, blaSIM-1 were
11.7%, 6.3%, 0.5%, and 0.5% respectively. One of class A; bla KPC was detected
in 10.7% of the investigated isolates. blaOXA-24/40, blaIMP, blaGES, blaVEB and
blaGIM were not detected in any of the studied isolates. Moreover, 18.4% of the
isolates have shown to harbor two or more of the screened bla genes. We
concluded that the most prevalent type of ß-lactamases genes among CR-AB
isolates collected from Egyptian patients were blaOXA-23 followed by blaNDM-1
and blaKPC.
PMCID: PMC8224909
Conflict of interest statement: The authors have declared that no competing

interests exist.
7. Microb Drug Resist. 2018 Apr;24(3):269-277. doi: 10.1089/mdr.2017.0057. Epub

2017 Aug 7.
Molecular Epidemiology of Carbapenem-Resistant Acinetobacter baumannii in a

Tertiary Care Hospital in Egypt: Clonal Spread of blaOXA-23.
El Bannah AMS(1), Nawar NN(1), Hassan RMM(1), Salem STB(1).
Author information:
(1)Department of Clinical and Chemical Pathology, Faculty of Medicine, Cairo
University , Cairo, Egypt .
Of great concern is the increased frequency of carbapenem-resistant

Acinetobacter baumannii (CRAB) causing healthcare-associated infections.
Different classes of β-lactamases are involved in this resistance through
hydrolyzing carbapenems. Multilocus sequence typing (MLST) has been applied
successfully for characterizing different varieties of bacterial pathogens
epidemiologically. In the present study, we aimed to type and characterize the
resistance profile of clinical isolates of CRAB causing healthcare-associated
infections in patients admitted to Kasr Al-Aini hospital, using MLST, and
compare with sequence types (STs) from other countries. A total of 50 isolates
were collected from clinical samples (predominantly wound and blood), then
identified by blaOXA-51-like gene PCR, and subjected to Oxford MLST scheme. The
ST was designated according to PubMLST database, and e-BURST algorithm was used
to assign clonal complexes. Four sets of multiplex PCR were performed to detect
common carbapenem resistance genes. ST391 was the predominant ST detected in 17
cases, 70.5% of which harbored blaOXA-23 alone, both blaOXA-23 and blaKPC in
11.8%. Newly recognized 13 STs were submitted to the PubMLST database.
Carbapenem resistance due to blaOXA-23 carbapenemase was detected in 36/50
(72%), followed by blaOXA-23 concomitant with blaKPC in 7/50 (14%), while blaNDM
with blaOXA-58 in 3/50 (6%) and blaNDM alone in 1 case (2%). To conclude, this
study demonstrates the propagation of highly resistant clone of STs 391 and
1151, carrying blaOXA-23 genes, with the first report of blaKPC in blaOXA
carrying CRAB and the presence of new STs by performing the MLST technique in an
Egyptian laboratory facility.
DOI: 10.1089/mdr.2017.0057
8. Int J Microbiol. 2020 Nov 3;2020:9461901. doi: 10.1155/2020/9461901. eCollection

2020.
Carbapenemase-Producing Non-Glucose-Fermenting Gram-Negative Bacilli in Africa,

Pseudomonas aeruginosa and Acinetobacter baumannii: A Systematic Review and
Meta-Analysis.
Kindu M(1), Derseh L(2), Gelaw B(1), Moges F(1).
Author information:
(1)Department of Medical Microbiology, College of Medicine and Health Science,
University of Gondar, Gondar, P.O. Box 196, Ethiopia.
(2)Department of Epidemiology and Biostatistics Institute of Public Health
College of Medicine and Health Sciences, University of Gondar, Gondar, P.O. Box
196, Ethiopia.
BACKGROUND: Studies have reported that the existence of CP bacteria in Africa,

but, in general, comprehensive data about the molecular epidemiology of CP
organisms are limited. Therefore, this systematic review and meta-analysis
expound the pooled prevalence of CP P. aeruginosa and CP A. baumannii clinical
isolates in Africa. It also identified the diversity of carbapenemases or their
encoding genes among the isolates in Africa. Lastly, the review observed the
trends of these CP isolates in Africa.
METHODS: A comprehensive search was performed between July 2019 and October 2019
in the following databases: PubMed, Google Scholar, and African Journal online.
The included articles were published only in English. The screening was done by
two authors independently. The data extracted on Excel spreadsheet were
transferred to STATA 11 software for analysis.
RESULTS: From a total of 1,454 articles searched, 42 articles were eligible.
Most of the studies were conducted in the North Africa region. But there was no
report from Central Africa. The pooled prevalence of CP P. aeruginosa and CP A.
baumannii among the clinical specimens in Africa was 21.36% and 56.97%,
respectively. OXA-23 and VIM were the most prevailing carbapenemase among P.
aeruginosa and A. baumannii, respectively. The cumulative meta-analysis revealed
a relative increment of the prevalence of CP P. aeruginosa over time in Africa
but it showed a higher prevalence of CP A. baumannii isolates across years.
CONCLUSION: The review revealed a high pooled prevalence of CP A. baumannii
clinical isolates in Africa which needs urgent action. Moreover, the emergence
of concomitant carbapenemases, especially OXA-23 + NDM among CP A. baumannii,
was also an alarming problem.
Copyright © 2020 Mizan Kindu et al.
DOI: 10.1155/2020/9461901
PMCID: PMC7658691
PMID: 33204275
Conflict of interest statement: The authors declare that they have no conflicts
of interest.
9. J Glob Antimicrob Resist. 2022 Dec;31:286-291. doi: 10.1016/j.jgar.2022.08.024.
Epub 2022 Sep 2.
Draft genome sequences of extensively drug resistant and pandrug resistant

Acinetobacter baumannii strains isolated from hospital wastewater in South
Africa.
Eze EC(1), Falgenhauer L(2), El Zowalaty ME(3).
Author information:
(1)Department of Medical Microbiology, School of Laboratory Medicine and Medical
Sciences, College of Health Sciences, University of KwaZulu-Natal, Durban, South
Africa.
(2)Institute of Hygiene and Environmental Medicine, German Center for Infection
Research, Site Giessen-Marburg-Langen and Hessian University Competence Center
for Hospital Hygiene, Justus Liebig University Giessen, Germany.
(3)Veterinary Medicine and Food Security Research Group, Medical Laboratory
Sciences Program, Division of Health Sciences, Abu Dhabi Women's Campus, Higher
Colleges of Technology, Abu Dhabi, UAE; Zoonosis Science Center, Department of
Medical Biochemistry and Microbiology, Uppsala University, Uppsala, Sweden.
Electronic address: elzow005@gmail.com.
OBJECTIVES: Acinetobacter baumannii is a significant opportunistic pathogen

causing nosocomial infections. Infections caused by A. baumannii are often
difficult to treat because this bacterium is often multidrug-resistant and shows
high environmental adaptability. Here, we report on the analysis of three A.
baumannii strains isolated from hospital effluents in South Africa.
METHODS: Strains were isolated on Leeds Acinetobacter agar and were identified
using VITEK®2 platform. Antibiotic susceptibility testing was performed using
the Kirby-Bauer Disk diffusion method. Whole-genome sequencing was performed.
The assembled contigs were annotated. Multilocus sequence type, antimicrobial
resistance, and virulence genes were identified.
RESULTS: The strains showed two multilocus sequence types, ST231 (FA34) and
ST1552 (PL448, FG116). Based on their antibiotic susceptibility profiles, PL448
and FG116 were classified as extensively drug-resistant and FA34 as
pandrug-resistant. FA34 harbored mutations in LpxA, LpxC, and PmrB, conferring
resistance to colistin, but not mcr genes. All three strains encoded virulence
genes for immune evasion (capsule, lipopolysaccharide [LPS]), iron uptake, and
biofilm formation. FA34 was related to human strains from South Africa; PL448
and FG116 were related to a strain isolated in the United States from a human
wound.
CONCLUSIONS: The detection of extensively drug- and pandrug-resistant A.
baumannii strains in hospital effluents is of particular concern. It indicates
that wastewater might play a role in the spread of these bacteria. Our data
provide insight into the molecular epidemiology, resistance, pathogenicity, and
distribution of A. baumannii in South Africa.
Copyright © 2022 The Author(s). Published by Elsevier Ltd.. All rights reserved.
DOI: 10.1016/j.jgar.2022.08.024
10. Ann N Y Acad Sci. 2021 Oct;1502(1):54-71. doi: 10.1111/nyas.14650. Epub 2021
Jul
2.
Risk factors for, and molecular epidemiology and clinical outcomes of,
carbapenem- and polymyxin-resistant Gram-negative bacterial infections in
pregnant women, infants, and toddlers: a systematic review and meta-analyses.
Osei Sekyere J(1), Reta MA(1), Bernard Fourie P(1).
Author information:
(1)Molecular Mycobacteriology Laboratory, Department of Medical Microbiology,
Faculty of Health Sciences, School of Medicine, University of Pretoria,
Pretoria, Gauteng, South Africa.
In the following systematic review and meta-analyses, we report several

conclusions about resistance to carbapenem and polymyxin last-resort antibiotics
for treating multidrug-resistant bacterial infections among pregnant women and
infants. Resistance to carbapenems and polymyxins is increasing, even in
otherwise vulnerable groups such as pregnant women, toddlers, and infants, for
whom therapeutic options are limited. In almost all countries,
carbapenem-/polymyxin-resistant Klebsiella pneumoniae, Escherichia coli, and
Acinetobacter baumannii infect and/or colonize neonates and pregnant women,
causing periodic outbreaks with very high infant mortalities. Downregulation of
plasmid-borne blaNDM , blaKPC , blaOXA-48 , blaIMP, blaVIM , blaGES-5 , and
ompK35/36 in clonal strains accelerates the horizontal and vertical
transmissions of carbapenem resistance among these pathogens. New Delhi
metallo-β-lactamase (NDM)-positive isolates in infants/neonates have been mainly
detected in China and India, while OXA-48-positive isolates in infants/neonates
have been mainly detected in Africa. NDM-positive isolates in pregnant women
have been found only in Madagascar. Antibiotic therapy, prolonged
hospitalization, invasive procedures, mechanical ventilation, low birth weight,
and preterm delivery have been common risk factors associated with
carbapenem/polymyxin resistance. The use of polymyxins to treat
carbapenem-resistant infections may be selecting for resistance to both agents,
restricting therapeutic options for infected infants and pregnant women.
Currently, low- and middle-income countries have the highest burden of these
pathogens. Antibiotic stewardship, periodic rectal and vaginal screening, and
strict infection control practices in neonatal ICUs are necessary to forestall
future outbreaks and deaths.
© 2021 New York Academy of Sciences.
DOI: 10.1111/nyas.14650
11. Trans R Soc Trop Med Hyg. 2021 Sep 3;115(9):1080-1085. doi:
10.1093/trstmh/traa173.
Molecular characterisation of the first New Delhi metallo-β-lactamase

1-producing Acinetobacter baumannii from Tanzania.
Moyo SJ(1)(2)(3), Manyahi J(1)(2), Hubbard ATM(3), Byrne RL(3), Masoud NS(4),
Aboud S(2), Manji K(4), Blomberg B(1)(5), Langeland N(1)(5), Roberts AP(3).
Author information:
(1)Depart ment of Clinical Science, University of Bergen, Norway.
(2)Department of Microbiology and Immunology, Muhimbili University of Health and
Allied Sciences, MUHAS, Dar es Salaam, Tanzania.
(3)Department of Tropical Disease Biology, Liverpool School of Tropical
Medicine, Liverpool, L3 5QA, UK.
(4)Department of Paediatrics and Child Health, Muhimbili University of Health
and Allied Sciences, MUHAS, Dar es Salaam, Tanzania.
(5)Norwegian National Advisory Unit for Tropical Infectious Diseases, Haukeland
University Hospital, Bergen, Norway.
BACKGROUND: We aimed to characterise the genetic determinants and context of two

meropenem-resistant clinical isolates of Acinetobacter baumannii isolated from
children hospitalised with bloodstream infections in Dar es Salaam, Tanzania.
METHODS: Antimicrobial susceptibility was determined by disc diffusion E-test
and broth microdilution. Genomes were completed using a hybrid assembly of
Illumina and Oxford Nanopore Technologies sequencing reads and characterisation
of the genetic context of resistance genes, multi-locus sequence types (STs) and
phylogenetic analysis was determined bioinformatically.
RESULTS: Twelve A. baumannii were isolated from 2226 blood cultures, two of
which were meropenem-resistant. The two meropenem-resistant isolates, belonging
to distinct STs, ST374 and ST239, were found to harbour blaNDM-1, which was
chromosomally located in isolate DT0544 and plasmid-located in isolate DT01139.
The genetic environment of blaNDM-1 shows the association of insertion sequence
ISAba125 with blaNDM-1 in both isolates. Both isolates also harboured genes
conferring resistance to other β-lactams, aminoglycosides and cotrimoxazole.
CONCLUSIONS: This is the first report of New Delhi metallo-β-lactamase-producing
isolates of A. baumannii from Tanzania. The genetic context of blaNDM-1 provides
further evidence of the importance of ISAba125 in the spread of blaNDM-1 in A.
baumannii. Local surveillance should be strengthened to keep clinicians updated
on the incidence of these and other multidrug-resistant and difficult-to-treat
bacteria.
© The Author(s) 2021. Published by Oxford University Press on behalf of Royal

Society of Tropical Medicine and Hygiene.
DOI: 10.1093/trstmh/traa173
PMCID: PMC8417080
12. Int J Infect Dis. 2014 May;22:49-54. doi: 10.1016/j.ijid.2013.12.004. Epub 2014
Mar 4.
Molecular characterization of carbapenem-insensitive Acinetobacter baumannii in

Egypt.
Al-Agamy MH(1), Khalaf NG(2), Tawfick MM(3), Shibl AM(4), El Kholy A(5).
Author information:
(1)Pharmaceutics and Microbiology Department, College of Pharmacy, King Saud
University, PO Box 2457, Riyadh 11451, Saudi Arabia; Microbiology and Immunology
Department, Faculty of Pharmacy, Al-Azhar University, Cairo, Egypt. Electronic
address: malagamy@ksu.edu.sa.
(2)Microbiology and Immunology Department, Faculty of Pharmacy, Modern Arts and
Science University, Sixth of October City, Egypt.
(3)Microbiology and Immunology Department, Faculty of Pharmacy, Al-Azhar
(4)Pharmaceutics and Microbiology Department, College of Pharmacy, King Saud
University, PO Box 2457, Riyadh 11451, Saudi Arabia.
(5)Clinical Pathology Department, Faculty of Medicine, Cairo University, Cairo,
Egypt.
OBJECTIVES: This study investigated the prevalence of diverse Ambler class

β-lactamase-encoding genes in 40 carbapenem-insensitive Acinetobacter baumannii
isolates collected from two hospitals in Egypt during the period January-March
2012.
METHODS: The resistance levels to different groups of antimicrobial agents were
determined. PCR was used to detect the different Ambler class β-lactamases
encoding the following genes: blaTEM, blaSHV, blaCTX-M, blaVEB, blaPER, blaGES,
blaVIM, blaIMP, blaSIM, blaSPM, blaGIM, blaNDM, blaADC, blaOXA-23, blaOXA-24,
blaOXA-51, and blaOXA-58. ISAba1 and int1 were detected by PCR.
RESULTS: The isolates were 100% resistant to amoxicillin-clavulanate, aztreonam,
cefepime, cefotaxime, and ceftazidime. Of the isolates, 5% were resistant to
colistin, 45% to amikacin, 70% to imipenem, and 85% to ciprofloxacin. The
blaADC- and blaOXA-51-like genes were detected in the entire collection. The
prevalences of blaOXA-23, blaOXA-24, and blaOXA-58 were 50%, 7.5%, and 5%,
respectively. However, the prevalences of blaTEM-, blaPER-, and blaGES-like
genes were 87.5%, 55%, and 27.5%, respectively. SHV, CTX-M, VEB, KPC, and MBL
encoding genes were not detected. The ISAba1 was found upstream to blaOXA-51,
blaOXA-23, and blaADC in 85%, 80%, and 50%, respectively. Of note, 45% (18/40)
of the isolates co-produced extended-spectrum β-lactamases (PER and GES) and
carbapenemases (OXA-23 and OXA-58).
CONCLUSIONS: The blaADC-, blaTEM-, blaPER-, blaOXA-23-, and blaGES-like genes
were found to be the most prevalent types of β-lactamase-encoding gene in A.
baumannii collected from Egypt. A high level of carbapenem resistance is
mediated by blaOXA-23, blaOXA-24, and blaOXA-58 (minimum inhibitory
concentration (MIC) 32 to >256μg/ml), and a low level of carbapenem resistance
is mediated by blaGES (MIC 4-16μg/ml) and by up-regulation of ISAba1-OXA-51 (MIC
1-4μg/ml). Class B MBL was not identified to play a role in carbapenem
resistance in A. baumannii isolates from Egypt.
Copyright © 2014 The Authors. Published by Elsevier Ltd.. All rights reserved.
DOI: 10.1016/j.ijid.2013.12.004
13. Microb Genom. 2022 Feb;8(2):000752. doi: 10.1099/mgen.0.000752.
Diversity of carbapenem-resistant Acinetobacter baumannii and

bacteriophage-mediated spread of the Oxa23 carbapenemase.
Abouelfetouh A(1), Mattock J(2), Turner D(3), Li E(2), Evans BA(2).
Author information:
(1)Department of Microbiology and Immunology, Faculty of Pharmacy, Alexandria
University, Alexandria, Egypt.
(2)Norwich Medical School, University of East Anglia, Norwich, UK.
(3)Department of Applied Sciences, University of the West of England, Bristol,
UK.
Carbapenem-resistant Acinetobacter baumannii are prevalent in low- and

middle-income countries such as Egypt, but little is known about the molecular
epidemiology and mechanisms of resistance in these settings. Here, we
characterize carbapenem-resistant A. baumannii from Alexandria, Egypt, and place
it in a regional context. Fifty-four carbapenem-resistant isolates from
Alexandria Main University Hospital (AMUH), Alexandria, Egypt, collected between
2010 and 2015 were genome sequenced using Illumina technology. Genomes were de
novo assembled and annotated. Genomes for 36 isolates from the Middle East
region were downloaded from GenBank. The core-gene compliment was determined
using Roary, and analyses of recombination were performed in Gubbins. Multilocus
sequence typing (MLST) sequence type (ST) and antibiotic-resistance genes were
identified. The majority of Egyptian isolates belonged to one of three major
clades, corresponding to Pasteur MLST clonal complex (CCPAS) 1, CCPAS2 and
STPAS158. Strains belonging to STPAS158 have been reported almost exclusively
from North Africa, the Middle East and Pakistan, and may represent a
region-specific lineage. All isolates carried an oxa23 gene, six carried
blaNDM-1 and one carried blaNDM-2. The oxa23 gene was located on a variety of
different mobile elements, with Tn2006 predominant in CCPAS2 strains, and Tn2008
predominant in other lineages. Of particular concern, in 8 of the 13 CCPAS1
strains, the oxa23 gene was located in a temperate bacteriophage phiOXA,
previously identified only once before in a CCPAS1 clone from the USA military.
The carbapenem-resistant A. baumannii population in AMUH is very diverse, and
indicates an endemic circulating population, including a region-specific
lineage. A major mechanism for oxa23 dissemination in CCPAS1 isolates appears to
be a bacteriophage, presenting new concerns about the ability of these
carbapenemases to spread throughout the bacterial population.
DOI: 10.1099/mgen.0.000752
PMCID: PMC8942029
Conflict of interest statement: The authors declare that there are no conflicts
of interest.
14. Arch Inst Pasteur Tunis. 2007;84(1-4):11-9.
Phenotypic and molecular epidemiology of Acinetobacter baumannii strains

isolated in Rabta Hospital, Tunisia.
Ben Othman A(1), Zribi M, Masmoudi A, Abdellatif S, Ben Lakhal S, Fendri C.
Author information:
(1)Hospital Microbiological laboratory, rue Jabberi 1007 Tunis, Tunisia.
Acinetobacter baumannii (A. baumannii) is often implicated in hospital outbreaks

in Tunisia. It's a significant opportunistic pathogen that is usually associated
with serious underlying diseases such as pneumoniae, meningitis and urinary
tract infections. The aim of this prospective study was to evaluate the global
state of its endemicity and the antibiotic resistance evolution. The possibility
of nosocomial transmission of one or more epidemic strain(s) was investigated by
means of 3 methods: biotyping, antibiotyping and Random Amplified Polymorphic
DNA analysis (RAPD). MIC for imipenem by Ellipsometer-test strip (E-TEST). The
presence of metallo-beta-lactamases (MBL) was detected according to the double
synergy test of EDTA and imipenem disks. A. baumannii strains were mainly
localized in intensive care (52.2%) and surgery units (23.6%). Among 224 strains
that were studied, 4 biotypes were delineated with a predominance of biotype1.
Resistance to beta-lactams was mostly associated with the production of
cephalosporinases and penicilinases (84.3%). 45% of strains were resistant to
imipenem which were associated with MBL production. RAPD gave 5 genomic groups.
This study demonstrates the epidemic behaviour airborne spread of A. baumannii
in hospital wards. The multiresistance was often responsible for failure of
antibiotics therapy. The prevention of nosocomial infection and severe hygiene
controls must be performed.
15. BMC Infect Dis. 2015 Nov 14;15:521. doi: 10.1186/s12879-015-1246-8.
High prevalence of oxacillinases in clinical multidrug-resistant Acinetobacter

baumannii isolates from the Tshwane region, South Africa - an update.
Lowings M(1), Ehlers MM(2)(3), Dreyer AW(4), Kock MM(5)(6).
Author information:
(1)Department of Medical Microbiology, University of Pretoria, Pretoria, South
Africa. lowingsmichelle1@gmail.com.
Africa. marthie.ehlers@up.ac.za.
(3)National Health Laboratory Service, Tshwane Academic Division, Pretoria,
South Africa. marthie.ehlers@up.ac.za.
(4)Centre for Tuberculosis, National Institute for Communicable Diseases,
Johannesburg, South Africa. andriesd@nicd.ac.za.
Africa. marleen.kock@up.ac.za.
(6)National Health Laboratory Service, Tshwane Academic Division, Pretoria,
South Africa. marleen.kock@up.ac.za.
BACKGROUND: Acinetobacter baumannii is an important hospital-acquired pathogen

in healthcare facilities that frequently causes bacteraemia and
ventilator-associated pneumonia in intensive care units. Acinetobacter baumannii
can be isolated from various sites in the hospital environment like medical
equipment, bed linen, medical personnel and indwelling catheters. It is
difficult to treat A. baumannii infections because of their highly resistant
antimicrobial profiles. The purpose of this study was to determine the
prevalence of β-lactamase genes in multidrug-resistant (MDR) clinical A.
baumannii isolates using Multiplex-PCR (M-PCR) assays.
METHODS: One hundred MDR A. baumannii isolates were collected from the
diagnostic division of the Department of Medical Microbiology after routine
analysis of the submitted specimens. All collected isolates were identified and
tested for susceptibility using the VITEK 2® system (bioMérieux, France). Six
isolates were excluded from this study because the isolates were incorrectly
identified as A. baumannii with the VITEK 2® system (bioMérieux, France).
Molecular tests, namely M-PCR assays, pulsed-field gel electrophoresis (PFGE)
and multilocus sequence typing (MLST) were performed. MLST analyses were
performed on representative isolates from the four major pulsotypes (≥5 isolates
with 80 % similarity) and selective isolates from each minor pulsotype.
RESULTS: All the A. baumannii isolates showed 100 % resistance to ampicillin,
amoxicillin, cefuroxime, cefuroximine axetil, cefoxitin, cefotaxime and
nitrofurantoin. Seven percent of the isolates were resistant to amikacin. Two
percent of the isolates were classified as having intermediate susceptibility to
tigecycline. A. baumannii isolates showed an antibiotic resistance profile of 67
% and higher to antibiotics, such as ceftazidime, cefepime, imipenem, meropenem,
gentamicin, ciprofloxacin and trimethoprim/sulfamethoxazole. None of the
isolates were resistant to colistin. The M-PCR assays showed that 99 % of the
isolates contained the OXA-51 gene and 77 % contained the OXA-23 gene. None of
the isolates contained the GES, GIM, IMP, KPC, NDM, OXA-24, OXA-58, PER, SIM,
SPM, VEB and VIM genes. Representative A. baumannii isolates were grouped into
five existing sequence types (ST): ST106, ST258, ST339, ST502, ST758 and ST848.
Isolates belonging to the pan-European clonal lineages I and II (EUI and EUII)
were identified.
CONCLUSION: The high prevalence of MDR A. baumannii isolates has a severe impact
on available treatment choices and this in return impacts on treatment outcomes
in the studied healthcare facilities. The most dominant ST among the collected
isolates was ST758, member of the EUI group. The presence of the OXA-23 gene was
not restricted to a specific ST. Continuous research and surveillance is
necessary to monitor the circulating β-lactamase genes in clinical settings to
guide infection control policies in order to try and curb the spread of this
bacterium.
DOI: 10.1186/s12879-015-1246-8
PMCID: PMC4647659
16. mSphere. 2021 Dec 22;6(6):e0072521. doi: 10.1128/mSphere.00725-21. Epub 2021

Nov
17.
Deciphering Multidrug-Resistant Acinetobacter baumannii from a Pediatric Cancer

Hospital in Egypt.
Jalal D(1), Elzayat MG(1), Diab AA(1), El-Shqanqery HE(1), Samir O(1), Bakry
U(1), Hassan R(2)(3), Elanany M(2)(4), Shalaby L(5)(6), Sayed AA(1)(7).
Author information:
(1)Genomics Program, Children's Cancer Hospital Egypt 57357, Cairo, Egypt.
(2)Department of Clinical Pathology, Faculty of Medicine, Cairo University,
Cairo, Egypt.
(3)Molecular Microbiology Unit, Children's Cancer Hospital Egypt 57357, Cairo,
Egypt.
(4)Microbiology Unit, Children's Cancer Hospital Egypt 57357, Cairo, Egypt.
(5)Infectious Disease Unit, Children's Cancer Hospital Egypt 57357, Cairo,
Egypt.
(6)Department of Pediatric Oncology, National Cancer Institute, Cairo
(7)Department of Biochemistry, Faculty of Science, Ain Shams University, Cairo,
Egypt.
Infection by multidrug-resistant (MDR) Acinetobacter baumannii is one of the

major causes of hospital-acquired infections worldwide. The ability of A.
baumannii to survive in adverse conditions as well as its extensive
antimicrobial resistance make it one of the most difficult to treat pathogens
associated with high mortality rates. The aim of this study was to investigate
MDR A. baumannii that has spread among pediatric cancer patients in the
Children's Cancer Hospital Egypt 57357. Whole-genome sequencing was used to
characterize 31 MDR A. baumannii clinical isolates. Phenotypically, the isolates
were MDR, with four isolates showing resistance to the last-resort antibiotic
colistin. Multilocus sequence typing showed the presence of eight clonal groups,
two of which were previously reported to cause outbreaks in Egypt, and one novel
sequence type (ST), Oxf-ST2246. Identification of the circulating plasmids
showed the presence of two plasmid lineages in the isolates, strongly governed
by sequence type. A large number of antimicrobial genes with a range of
resistance mechanisms were detected in the isolates, including β-lactamases and
antibiotic efflux pumps. Analysis of insertion sequences (ISs) revealed the
presence of ISAba1 and ISAba125 in all the samples, which amplify β-lactamase
expression, causing extensive carbapenem resistance. Mutation analysis was used
to decipher underlying mutations responsible for colistin resistance and
revealed novel mutations in several outer membrane proteins, in addition to
previously reported mutations in pmrB. Altogether, understanding the
transmissibility of A. baumannii as well as its resistance and virulence
mechanisms will help develop novel treatment options for better management of
hospital-acquired infections. IMPORTANCE Acinetobacter baumannii represents a
major health threat, in particular among immunocompromised cancer patients. The
rise in carbapenem-resistant A. baumannii, and the development of resistance to
the last-resort antimicrobial agent colistin, complicates the management of A.
baumannii outbreaks and increases mortality rates. Here, we investigate 31
multidrug resistant A. baumannii isolates from pediatric cancer patients in
Children's Cancer Hospital Egypt (CCHE) 57357 via whole-genome sequencing.
Multilocus sequence typing (MLST) showed the presence of eight clonal groups
including a novel sequence type. In silico detection of antimicrobial-resistant
genes and virulence factors revealed a strong correlation between certain
virulence genes and mortality as well as several point mutations in outer
membrane proteins contributing to colistin resistance. Detection of CRISPR/Cas
sequences in the majority of the samples was strongly correlated with the
presence of prophage sequences and associated with failure of bacteriophage
therapy. Altogether, understanding the genetic makeup of circulating A.
baumannii is essential for better management of outbreaks.
DOI: 10.1128/mSphere.00725-21
PMCID: PMC8597740
17. Int J Antimicrob Agents. 2021 Oct;58(4):106402. doi:

10.1016/j.ijantimicag.2021.106402. Epub 2021 Jul 19.
Molecular and epidemiological investigation of a colistin-resistant

OXA-23-/NDM-1-producing Acinetobacter baumannii outbreak in the Southwest Indian
Ocean Area.
Miltgen G(1), Bour M(2), Allyn J(3), Allou N(3), Vedani T(4), Vuillemenot JB(5),
Triponney P(2), Martinet O(6), Lugagne N(7), Benoit-Cattin T(8), Dortet L(9),
Birer A(10), Jaffar-Bandjee MC(4), Belmonte O(4), Plésiat P(5), Potron A(11).
Author information:
(1)Laboratoire de Bactériologie, Centre Hospitalier Universitaire La Réunion,
Saint-Denis, France; UMR Processus Infectieux en Milieu Insulaire Tropical, CNRS
9192, INSERM U1187, IRD 249, Université de la Réunion, Sainte-Clotilde, France.
(2)Centre National de Référence de la Résistance aux Antibiotiques, Centre
Hospitalier Universitaire de Besançon, Besançon, France.
(3)Réanimation polyvalente, Centre Hospitalier Universitaire La Réunion,
Saint-Denis, France; Département d'informatique Clinique, Centre Hospitalier
Universitaire La Réunion, Saint-Denis, France.
(4)Laboratoire de Bactériologie, Centre Hospitalier Universitaire La Réunion,
Saint-Denis, France.
Hospitalier Universitaire de Besançon, Besançon, France; Laboratoire de
Bactériologie, UMR CNRS 6249 Chrono-Environnement, Faculté de
Médecine-Pharmacie, Université Bourgogne Franche-Comté, Besançon, France.
(6)Réanimation polyvalente, Centre Hospitalier Universitaire La Réunion,
(7)Service d'Hygiène hospitalière, Centre Hospitalier Universitaire La Réunion,
(8)Laboratoire de Biologie médicale, Centre Hospitalier de Mayotte, Mamoudzou,
France.
(9)Centre National de Référence de la Résistance aux Antibiotiques, Laboratoire
associé, Centre Hospitalier Universitaire de Bicêtre, Le Kremlin-Bicêtre,
France.
(10)Centre National de Référence de la Résistance aux Antibiotiques, Laboratoire
associé, Centre Hospitalier Universitaire de Clermont-Ferrand, Clermont-Ferrand,
France.
Hospitalier Universitaire de Besançon, Besançon, France; Laboratoire de
Bactériologie, UMR CNRS 6249 Chrono-Environnement, Faculté de
Médecine-Pharmacie, Université Bourgogne Franche-Comté, Besançon, France.
Electronic address: anais.potron@univ-fcomte.fr.
Dual resistance to colistin and carbapenems is a milestone reached by certain
extensively-drug resistant (XDR) Gram-negative bacteria. This study describes
the first outbreak of XDR colistin- and carbapenem-resistant
OXA-23-/NDM-1-producing Acinetobacter baumannii (CCRAB) in the European overseas
territory of Reunion Island (France, Indian Ocean). Between April 2019 and June
2020, 13 patients admitted to the University Hospital of Reunion Island were
involved in the outbreak, of whom eight were infected and six died. The first
case was traced to a medical evacuation from Mayotte Island (Comoros
archipelago). An epidemiological link could be established for 11 patients. All
of the collected CCRAB isolates showed the same resistance profile and
co-produced intrinsic β-lactamases OXA-69 and ADC-191, together with acquired
carbapenem-hydrolysing β-lactamases OXA-23 and NDM-1. A mutation likely involved
in colistin resistance was detected in the two-component system PmrAB (D82N in
PmrA). All of the isolates were found to belong to STPas1/STOx231 clonal complex
and were phylogenetically indistinguishable. Their further characterization by
whole-genome sequence analyses (whole-genome multi-locus sequence typing, single
nucleotide polymorphisms) provided hints about the transmission pathways. This
study pleads for strict application of control and prevention measures in
institutions where the risk of imported XDR bacteria is high.
Copyright © 2021 Elsevier Ltd. All rights reserved.
DOI: 10.1016/j.ijantimicag.2021.106402
18. Eur J Clin Microbiol Infect Dis. 1999 Aug;18(8):595-8. doi:

10.1007/s100960050354.
Molecular and antibiogram relationships of Acinetobacter isolates from two

contrasting hospitals in the United Kingdom and South Africa.
Webster CA(1), Towner KJ, Saunders GL, Crewe-Brown HH, Humphreys H.
Author information:
(1)Department of Microbiology & PHLS Laboratory, University Hospital,
Nottingham, UK.
The aim of this study was to compare the molecular relationships and
antibiograms of nosocomial isolates of Acinetobacter spp. from two acute-care
hospitals in Nottingham, UK, and Soweto, South Africa, with different hospital
infection control problems and procedures. In contrast to Nottingham, where
randomly amplified polymorphic DNA fingerprinting demonstrated that a single
multiresistant strain of Acinetobacter baumannii has predominated in the
hospital intensive care unit over an 11-year period, the Soweto isolates formed
a heterogeneous group of unrelated molecular clusters of different antibiograms,
with numerous different strains of Acinetobacter baumannii, Acinetobacter sp. 3
and Acinetobacter sp. 13TU apparently being endemic throughout the Soweto
hospital. The contrasting results illustrate the need to maintain exemplary
infection control procedures in hospitals where high standards have been
achieved and warn of what might result if such measures are diminished.
DOI: 10.1007/s100960050354
19. Int J Antimicrob Agents. 2018 Dec;52(6):916-921. doi:

10.1016/j.ijantimicag.2018.05.017. Epub 2018 May 30.
Whole-genome sequencing of NDM-1-producing ST85 Acinetobacter baumannii isolates
from Tunisia.
Jaidane N(1), Naas T(2), Oueslati S(3), Bernabeu S(3), Boujaafar N(4),
Bouallegue O(5), Bonnin RA(6).
Author information:
(1)UR 12 SP 37, Emerging Bacterial Resistance and Safety of Care, Department of
Clinical Microbiology, University Hospital of Sahloul, Sousse, Tunisia; Clinical
Microbiology Laboratory, University Hospital of Sahloul, Sousse, Tunisia;
EA7361, Université Paris-Sud, Université Paris-Saclay, LabEx Lermit,
Bacteriology-Hygiene Unit, APHP, Hôpital Bicêtre, Le Kremlin-Bicêtre, France;
Faculty of Pharmacy, University of Monastir, Monastir, Tunisia.
(2)EA7361, Université Paris-Sud, Université Paris-Saclay, LabEx Lermit,
EERA 'Evolution and Ecology of Resistance to Antibiotics' Unit, Institut
Pasteur-APHP-Université Paris Sud, Paris, France; Associated French National
Reference Centre for Antibiotic Resistance 'Carbapenemase-producing
Enterobacteriaceae', Le Kremlin-Bicêtre, France.
Associated French National Reference Centre for Antibiotic Resistance
'Carbapenemase-producing Enterobacteriaceae', Le Kremlin-Bicêtre, France.
Faculty of Pharmacy, University of Monastir, Monastir, Tunisia.
Faculty of Medicine Ibn El Jazzar, University of Sousse, Sousse, Tunisia.
EERA 'Evolution and Ecology of Resistance to Antibiotics' Unit, Institut
Pasteur-APHP-Université Paris Sud, Paris, France; Associated French National
Reference Centre for Antibiotic Resistance 'Carbapenemase-producing
Enterobacteriaceae', Le Kremlin-Bicêtre, France. Electronic address:
remy.bonnin@u-psud.fr.
BACKGROUND: New Delhi metallo-β-lactamase (NDM)-producing Acinetobacter

baumannii have been described in several countries worldwide, and studies have
suggested that Acinetobacter spp. could play the role of intermediate progenitor
of the blaNDM-1 gene between environmental progenitor and Enterobacteriaceae.
MATERIALS AND METHODS: In total, 246 carbapenem-resistant A. baumannii isolates
from a teaching hospital in Sousse, Tunisia were investigated between 1st June
2013 and 31st December 2015 to detect metallo-ß-lactamase (MBL) production.
Polymerase chain reaction (PCR), antibiotic susceptibility testing, and genetic
and whole-genome sequencing tools were used to study the underlying carbapenem
resistance mechanisms.
RESULTS: PCR screening of the 246 carbapenem-resistant A. baumannii isolates
revealed that 242 of 246 isolates harboured carbapenemase genes (seven of 246
positive for blaNDM-1, four of 246 positive for blaNDM-1 and blaOXA-23, 231
positive for blaOXA-23). Conjugation and electroporation experiments suggested
that the blaNDM-1 gene is likely to be chromosomally located. All the
NDM-1-producing A. baumannii isolates were clonally related, and belonged to
ST85 according to the Pasteur Institute's multi-locus sequence typing scheme.
Analysis of the immediate genetic environment of the blaNDM-1 gene revealed that
the gene was located within a truncated isoform of Tn125 transposon (ΔTn125).
The blaOXA-23 gene was located within transposon Tn2008.
CONCLUSION: This study showed the dissemination of a single clone of
NDM-1-producing A. baumannii in a Tunisian hospital. Countries in north Africa
may constitute a significant reservoir for NDM-1-producing A. baumannii. The
spread of the blaNDM-1 gene in A. baumannii was linked to clonal spread in this
study.
DOI: 10.1016/j.ijantimicag.2018.05.017
20. J Antimicrob Chemother. 2010 Feb;65(2):233-8. doi: 10.1093/jac/dkp428. Epub

2009
Dec 8.
Global spread of carbapenem-resistant Acinetobacter baumannii.
Higgins PG(1), Dammhayn C, Hackel M, Seifert H.
Author information:
Cologne, Goldenfelsstrasse 19-21, 50935 Cologne, Germany.
paul.higgins@uni-koeln.de
Erratum in
J Antimicrob Chemother. 2010 Jun;65(6):1317.
OBJECTIVES: We have investigated the molecular epidemiology and distribution of

carbapenemase genes in 492 imipenem-non-susceptible Acinetobacter baumannii
worldwide isolates (North and Latin America, Europe, Asia, South Africa and
Australia).
METHODS: MICs were determined by broth microdilution and Etest. The presence of
carbapenemase-encoding genes was investigated by PCR. Molecular epidemiology was
performed by repetitive sequence-based PCR (rep-PCR; DiversiLab), sequence-type
multiplex PCR and PFGE.
RESULTS: Imipenem non-susceptibility was associated with ISAba1 upstream of the
intrinsic bla(OXA-51-like) or the acquired carbapenemase bla(OXA-23-like),
bla(OXA-40-like) or bla(OXA-58-like). Isolates were grouped into eight distinct
clusters including European clones I, II and III. European clone II was the
largest (246 isolates) and most widespread group (USA, pan-Europe, Israel, Asia,
Australia and South Africa).
CONCLUSIONS: The global dissemination of eight carbapenem-resistant lineages
illustrates the success this organism has had in epidemic spread. The acquired
OXA enzymes are widely distributed but are not the sole carbapenem resistance
determinant in A. baumannii.
DOI: 10.1093/jac/dkp428
21. PLoS One. 2019 Jan 10;14(1):e0209425. doi: 10.1371/journal.pone.0209425.

eCollection 2019.
Intestinal carriage of antibiotic resistant Acinetobacter baumannii among

newborns hospitalized in Moroccan neonatal intensive care unit.
Arhoune B(1)(2), Oumokhtar B(1), Hmami F(3), El Fakir S(4), Moutaouakkil K(1),
Chami F(2), Bouharrou A(3).
Author information:
(1)Laboratory of Microbiology and Molecular biology, Faculty of Medicine and
Pharmacy, Sidi Mohammed Ben Abdellah University, Fez, Morocco.
(2)Laboratory of Biotechnology, Faculty of Sciences Dhar El Mahraz, Sidi
Mohammed Ben Abdellah University, Fez, Morocco.
(3)Neonatal Intensive Care Unit, University Hospital Hassan II, Fez, Morocco.
(4)Laboratory of Epidemiology and Clinical Research, Faculty of Medicine and
Pharmacy, Sidi Mohammed Ben Abdellah University, Fez, Morocco.
This study was conducted in order to assess the acquisition rate of

Acinetobacter baumannii by newborn screening, on admission and during the
discharge process of neonatal intensive care unit. (NICU). Furthermore, we
investigated risk factors for potential colonization and molecular epidemiology
of isolated resistant bacteria. This prospective study was conducted in the
neonatal unit of Hassan II University Hospital of Fez from February 2013 to July
2015. During this period, all consecutive admitted neonates were screened for A.
baumannii intestinal carriage, on admission and during the discharge process.
Bacteriological and molecular tests were evaluated according to the
international standards. This study examines the screening on admission of 455
newborns, 59% of whom were male. The average gestational age and birth weight
were 35.2 weeks and 2612.1 g respectively. In total, 277 patients were included
in the acquisition study on admission. The prevalence of multi-drug resistant
(MDR) A. baumannii strain carriage was 6.5%, while the acquisition rate during
the hospital recovery was 13.7%. In this study, 68 MDR A. baumannii isolates
were collected. The resistance rates to different antibiotic classes including,
Ceftazidime, Gentamycin and Ciprofloxacin varied between 92 and 100%. Moreover,
13% of MDR A. baumannii isolates were carbapenemase producers and 88% harbored
blaOXA-23 gene. On admission, three risk factors were significantly associated
with A. baumannii colonization: age (OR, 2.803; IC95%, 1.191-6.596; P = 0.01),
gender (OR, 0.382; IC95%, 0.158-0.921; P = 0.03) and the delivery birth at the
Maternity of University Hospital (MUH), (OR, 0.196; IC95%, 0.071-0.540; P =
0.002). However during hospitalization, the only risk factor associated with
acquisition of A. baumannii was the respiratory distress (OR, 2.270; IC95%,
1.055-4.881; P = 0.03). A high intestinal carriage rate of A. baumannii and
multiple antibiotic resistance were found in our NICU. Thus, the spread of MDR
A. baumannii should be monitored by an active surveillance strategy.
PMCID: PMC6328159
Conflict of interest statement: The authors have declared that no competing

interests exist.
22. mSystems. 2020 Nov 24;5(6):e00897-20. doi: 10.1128/mSystems.00897-20.
Genomic and Resistance Epidemiology of Gram-Negative Bacteria in Africa: a

Systematic Review and Phylogenomic Analyses from a One Health Perspective.
Osei Sekyere J(1), Reta MA(2).
Author information:
(1)Department of Medical Microbiology, School of Medicine, Faculty of Health
Sciences, University of Pretoria, Pretoria, South Africa jod14139@yahoo.com.
(2)Department of Medical Microbiology, School of Medicine, Faculty of Health
Sciences, University of Pretoria, Pretoria, South Africa.
Antibiotic resistance (AR) remains a major threat to public and animal health
globally. However, AR ramifications in developing countries are worsened by
limited molecular diagnostics, expensive therapeutics, inadequate numbers of
skilled clinicians and scientists, and unsanitary environments. The epidemiology
of Gram-negative bacteria, their AR genes, and geographical distribution in
Africa are described here. Data were extracted and analyzed from
English-language articles published between 2015 and December 2019. The genomes
and AR genes of the various species, obtained from the Pathosystems Resource
Integration Center (PATRIC) and NCBI were analyzed phylogenetically using
Randomized Axelerated Maximum Likelihood (RAxML) and annotated with Figtree. The
geographic location of resistant clones/clades was mapped manually. Thirty
species from 31 countries and 24 genera from 41 countries were analyzed from 146
articles and 3,028 genomes, respectively. Genes mediating resistance to
β-lactams (including bla TEM-1, bla CTX-M, bla NDM, bla IMP, bla VIM, and bla
OXA-48/181), fluoroquinolones (oqxAB, qnrA/B/D/S, gyrA/B, and parCE mutations,
etc.), aminoglycosides (including armA and rmtC/F), sulfonamides (sul1/2/3),
trimethoprim (dfrA), tetracycline [tet(A/B/C/D/G/O/M/39)], colistin (mcr-1),
phenicols (catA/B, cmlA), and fosfomycin (fosA) were mostly found in
Enterobacter spp. and Klebsiella pneumoniae, and also in Serratia marcescens,
Escherichia coli, Salmonella enterica, Pseudomonas, Acinetobacter baumannii,
etc., on mostly IncF-type, IncX3/4, ColRNAI, and IncR plasmids, within IntI1
gene cassettes, insertion sequences, and transposons. Clonal and multiclonal
outbreaks and dissemination of resistance genes across species and countries and
between humans, animals, plants, and the environment were observed; Escherichia
coli ST103, K. pneumoniae ST101, S. enterica ST1/2, and Vibrio cholerae ST69/515
were common strains. Most pathogens were of human origin, and zoonotic
transmissions were relatively limited.IMPORTANCE Antibiotic resistance (AR) is
one of the major public health threats and challenges to effective containment
and treatment of infectious bacterial diseases worldwide. Here, we used
different methods to map out the geographical hot spots, sources, and
evolutionary epidemiology of AR. Escherichia coli, Klebsiella pneumoniae,
Salmonella enterica, Acinetobacter baumannii, Pseudomonas aeruginosa,
Enterobacter spp., Neisseria meningitis/gonorrhoeae, Vibrio cholerae,
Campylobacter jejuni, etc., were common pathogens shuttling AR genes in Africa.
Transmission of the same clones/strains across countries and between animals,
humans, plants, and the environment was observed. We recommend Enterobacter spp.
or K. pneumoniae as better sentinel species for AR surveillance.
Copyright © 2020 Osei Sekyere and Reta.
DOI: 10.1128/mSystems.00897-20
PMCID: PMC7687029
PMID: 33234606
23. Int J Infect Dis. 2012 Sep;16(9):e680-3. doi: 10.1016/j.ijid.2012.05.1024. Epub

2012 Jul 6.
Detection of Acinetobacter baumannii in human head and body lice from Ethiopia
and identification of new genotypes.
Kempf M(1), Abdissa A, Diatta G, Trape JF, Angelakis E, Mediannikov O, La Scola

B, Raoult D.
Author information:
(1)URMITE, UMR IRD 198/CNRS 6236, Faculté de Médecine, 27 Bd Jean Moulin, 13385
Marseille cedex 05, France.
BACKGROUND: Acinetobacter baumannii has previously been detected and genotyped

in human body lice. The objectives of this study were to determine the presence
of this bacterium in head and body lice collected from healthy individuals in
Ethiopia by molecular methods and to characterize the genotype.
METHODS: Human lice from locations at different altitudes in Ethiopia were
screened for the presence of Acinetobacter sp by targeting the rpoB gene.
Acinetobacter baumannii was detected and genotyped using recA PCR amplification.
RESULTS: A total of 115 head and 109 body lice were collected from 134 healthy
individuals. Acinetobacter sp were found in 54 head (47%) and 77 body (71%)
lice. The recA gene was sequenced for 60 of the Acinetobacter sp and 67% were
positive for A. baumannii; genotype 1 was retrieved the most frequently.
CONCLUSION: Our study is the first to show the presence of A. baumannii in human
body lice, and also in head lice, in Ethiopia.
Copyright © 2012 International Society for Infectious Diseases. Published by

Elsevier Ltd. All rights reserved.
DOI: 10.1016/j.ijid.2012.05.1024
24. Vector Borne Zoonotic Dis. 2018 May;18(5):243-251. doi: 10.1089/vbz.2017.2206.

Epub 2018 Mar 20.
Molecular Survey of Head and Body Lice, Pediculus humanus, in France.
Candy K(1)(2), Amanzougaghene N(3), Izri A(1)(2), Brun S(1), Durand R(1), Louni
M(4), Raoult D(3), Fenollar F(4), Mediannikov O(3).
Author information:
(1)1 Department of Parasitology-Mycology, AP-HP, Hôpital Avicenne , Bobigny,
France .
(2)2 UMR "Émergence des Pathologies Virales" (EPV: Aix-Marseille University-IRD
190-Inserm 1207-EHESP-IHU Méditerranée Infection) , Marseille, France .
(3)3 IRD, APHM, MEPHI, IHU-Méditerranée Infection, Aix Marseille University ,
Marseille, France .
(4)4 IRD, APHM, VITROME, IHU-Méditerranée Infection, Aix Marseille University ,
Marseille, France .
Human lice, Pediculus humanus, are obligate blood-sucking parasites.

Phylogenetically, they belong to several mitochondrial clades exhibiting some
geographic differences. Currently, the body louse is the only recognized disease
vector, with the head louse being proposed as an additional vector. In this
article, we study the genetic diversity of head and body lice collected from
Bobigny, a town located close to Paris (France), and look for louse-borne
pathogens. By amplifying and sequencing the cytb gene, we confirmed the presence
of clades A and B in France. Besides, by amplifying and sequencing both cytb and
cox1 gene, we reported, for the first time, the presence of clade E, which has
thus far only been found in lice from West Africa. DNA from Bartonella quintana
was detected in 16.7% of body lice from homeless individuals, but in none of the
head lice collected from 47 families. Acinetobacter DNA was detected in 11.5% of
head lice belonging to all three clades and 29.1% of body lice. Six species of
Acinetobacter were identified, including two potential new ones. Acinetobacter
baumannii was the most prevalent, followed by Candidatus Acinetobacter
Bobigny-1, Acinetobacter calcoaceticus, Acinetobacter nosocomialis,
Acinetobacter junii, and Candidatus Acinetobacter Bobigny-2. Body lice were
found to be infected only with A. baumannii. These findings show for the first
time, the presence of clade E head lice in France. This study is also the first
to report the presence of DNAs of several species of Acinetobacter in human head
lice in France.
DOI: 10.1089/vbz.2017.2206
25. Microb Drug Resist. 2018 Mar;24(2):136-141. doi: 10.1089/mdr.2016.0306. Epub

2017 Jul 10.
Incidence of OXA-23 and OXA-58 Carbapenemases Coexpressed in Clinical Isolates

of Acinetobacter baumannii in Tunisia.
Mathlouthi N(1)(2)(3), Ben Lamine Y(4), Somai R(2), Bouhalila-Besbes S(4),

Bakour S(1), Rolain JM(1), Chouchani C(2)(3).
Author information:
(1)1 Unité de Recherche sur les Maladies Infectieuses et Tropicales Emergentes
(URMITE), UM 63, CNRS 7278, IRD 198, INSERM 1095, IHU Méditerranée Infection,
Faculté de Médecine et de Pharmacie, Aix-Marseille-Université , Marseille,
France .
(2)2 Laboratoire des Microorganismes et Biomolécules Actives, Faculté des
Sciences de Tunis, Campus Universitaire, Université Tunis El-Manar , Tunis,
Tunisie.
(3)3 Laboratoire de Recherche Sciences et Technologies de l'Environnement,
Institut Supérieur des Sciences et Technologies de l'Environnement de
Borj-Cedria, Université de Carthage , Technopôle de Borj-Cedria, Hammam-Lif,
Tunisie.
(4)4 Laboratoire de Biologie Clinique, Unité de Microbiologie, Institut Mohamed
Kassab d'orthopédie Tunis , Tunis, Tunisie.
Acinetobacter baumannii is an important opportunistic and multidrug-resistant

pathogen responsible for nosocomial infections in health facilities. The aim of
this study was to characterize the molecular mechanisms of carbapenem resistance
in A. baumannii isolates isolated from Mohamed Kassab Orthopedic Institute in
Tunis, Tunisia. Twenty-five imipenem-resistant A. baumannii clinical isolates
collected between 2013 and 2016 were identified using API 20NE and were
confirmed by matrix-assisted laser desorption/ionization time-of-flight mass
spectrometry (MALDI-TOF/MS). Carbapenemase activity was detected using
microbiological tests and PCR. The epidemiological relatedness of the isolates
was studied using multilocus sequence typing (MLST). The isolates were resistant
to all antibiotics tested with increased minimum inhibitory concentration values
(>32 mg/L). The microbiological tests showed that the 25 A. baumannii were
positive for modified Hodge test and for the Carba NP test; however, β-lactamase
activity was not inhibited by EDTA. All the isolates harbored the naturally
occurring blaOXA-51-like gene and the blaOXA-23-like carbapenemase gene. Among
these isolates, one isolate coexpressed the blaOXA-58 gene. MLST revealed
several sequence types (STs) with the predominance of ST2 imipenem-resistant A.
baumannii (14/25; 56%). In this study we report the prevalence of ST2 imipenem
resistance and for the first time the coexpression of blaOXA-23 and blaOXA-58 in
clinical isolates of A. baumannii in a Tunisian hospital.
DOI: 10.1089/mdr.2016.0306
26. Microb Drug Resist. 2019 May;25(4):480-488. doi: 10.1089/mdr.2018.0141. Epub

2018 Nov 3.
Prevalence and Mechanisms of Carbapenem Resistance Among Acinetobacter baumannii

Clinical Isolates in Egypt.
Benmahmod AB(1), Said HS(1), Ibrahim RH(1).
Author information:
(1)Department of Microbiology and Immunology, Faculty of Pharmacy, Mansoura
University, Mansoura, Egypt.
The increasing number of carbapenem-resistant Acinetobacter baumannii clinical

isolates is a major concern, which restricts therapeutic options for treatment
of serious infections caused by this emerging pathogen. The aim of this work is
to assess the antimicrobial resistance profile and identify the molecular
mechanisms involved in carbapenem resistance in A. baumannii isolated from
different clinical sources in Mansoura University Hospitals, Egypt.
Antimicrobial susceptibility testing has shown that resistance to carbapenem has
dramatically increased (98%) with concomitant elevated levels of resistance to
quinolones, trimethoprim/sulfamethoxazole, and aminoglycosides. Polymyxin B and
colistin are considered the last resort. Random amplified polymorphic DNA (RAPD)
typing method revealed great diversity among A. baumannii isolates. Coexistence
of diverse intrinsic and acquired carbapenem-hydrolyzing β-lactamases has been
detected in the tested isolates: Ambler class A: blaKPC (56%) and blaGES (48%),
and Ambler class B: blaNDM (30%), blaSIM (28%), blaVIM (20%), and blaIMP (10%).
Most isolates (94%) carried blaOXA-23-like and blaOXA-51-like simultaneously.
blaOXA-23-like was preceded by ISAba1 providing a potent promoter activity for
its expression. Sequencing analysis revealed that ISAba1 has been also inserted
in carbapenem resistance-associated outer membrane protein (OMP) (carO) gene in
three isolates, two of which were clonal based on RAPD typing, leading to
interruption of its expression as confirmed by SDS-PAGE analysis of OMP
fractions. Carbapenem resistance genes are widely distributed among A. baumannii
clinical isolates from different clinical sources. Therefore, enhanced infection
control measures, effective barriers, and rational use of antimicrobials should
be enforced in hospitals for minimizing the widespread resistance to carbapenems
and all other antibiotics.
DOI: 10.1089/mdr.2018.0141
27. Antimicrob Agents Chemother. 2021 Jul 16;65(8):e0027721. doi:

10.1128/AAC.00277-21. Epub 2021 Jul 16.
Diversity of Sequence Types and Impact of Fitness Cost among

Carbapenem-Resistant Acinetobacter baumannii Isolates from Tripoli, Libya.
Abou Fayad AG(#)(1)(2)(3), Haraoui LP(#)(4), Sleiman A(1)(2)(3), Jaafar

M(1)(2)(3), Zorgani A(5), Matar GM(1)(2)(3), Higgins PG(6)(7).
Author information:
(1)Department of Experimental Pathology, Immunology and Microbiology, Faculty of
Medicine, American University of Beirut, Beirut, Lebanon.
(2)Center for Infectious Diseases Research, American University of Beirut,
Beirut, Lebanon.
(3)World Health Organization (WHO) Collaborating Center for Reference and
Research on Bacterial Pathogens, Beirut, Lebanon.
(4)Department of Microbiology and Infectious Diseases, Faculty of Medicine and
Health Sciences, Université de Sherbrooke, Sherbrooke, Quebec, Canada.
(5)National Center for Disease Control Libya, Reference Laboratory, Tripoli,
Libya.
Cologne, Cologne, Germany.
(7)German Centre for Infection Research (DZIF), Partner Site Bonn-Cologne,
Cologne, Germany.
(#)Contributed equally
We investigated the molecular epidemiology of 21 carbapenem-resistant

Acinetobacter baumannii isolates from Libya and assessed their relative fitness.
Core genome multilocus sequence typing (MLST) revealed five interhospital
transmission clusters. Three clusters were associated with the international
clones (IC) IC1, IC2, and IC7. Carbapenem-resistance was associated with
blaOXA-23, blaGES-11, or blaNDM-1. Compared to that of A. baumannii DSM 30008,
the doubling time was similar over 10 h, but after 16 h, half the isolates grew
to higher densities, suggesting a fitness advantage.
DOI: 10.1128/AAC.00277-21
PMCID: PMC8373249
28. BMC Res Notes. 2018 Aug 31;11(1):629. doi: 10.1186/s13104-018-3738-2.
A systematic review: the current status of carbapenem resistance in East Africa.
Ssekatawa K(1)(2), Byarugaba DK(3), Wampande E(3), Ejobi F(3).
Author information:
(1)College of Veterinary Medicine, Animal Resources and Biosecurity, Makerere
University, P. O. Box 7062, Kampala, Uganda. Kssekatee@gmail.com.
(2)Department of Biochemistry, Faculty of Biomedical Sciences, Kampala
International University-Western Campus, P. O. Box 71, Bushenyi, Uganda.
Kssekatee@gmail.com.
(3)College of Veterinary Medicine, Animal Resources and Biosecurity, Makerere
University, P. O. Box 7062, Kampala, Uganda.
OBJECTIVE: In this systematic review, we present the molecular epidemiology and

knowledge gaps of the carbapenem resistance in East Africa as well as the future
probable research interventions that can be used to address the emergence of
carbapenem resistance in the region.
RESULTS: The 17 articles which presented concrete information about the
prevalence of carbapenem resistance in East Africa were reviewed. Tanzania
exhibited the highest level of carbapenem resistance at 35% while DRC had the
lowest level at 0.96%. Uganda was the only country with studies documenting CR
obtained amongst hospital environment isolates with incidence ranging from 21%
in Pseudomonas aeruginosa to 55% in Acinetobacter baumannii. Carbapenem
resistance was more exhibited in A. baumannii (23%), followed by P. aeruginosa
(17%), Klebsiella pneumoniae (15%), Proteus mirabilis (14%) and Escherichia coli
(12%) mainly isolated from respiratory tract, blood, urine and wound/pus. The
regional genetic determinants of carbapenem resistance detected were blaIMP,
blaVIM-1 blaSPM-l, blaNDM-1, blaOXA-23 blaOXA-24, blaOXA-58 and blaKPC.
DOI: 10.1186/s13104-018-3738-2
PMCID: PMC6119249
29. Vet Res Commun. 2022 Jun;46(2):487-498. doi: 10.1007/s11259-021-09876-2. Epub

2022 Jan 27.
Diversity of bacterial pathogens and their antimicrobial resistance profile

among commensal rodents in Qatar.
Islam MM(1)(2), Farag E(3), Hassan MM(4), Enan KA(5)(6), Mohammad Sabeel KV(5),
Alhaddad MM(5), Smatti MK(7), Al-Marri AM(5), Al-Zeyara AA(5), Al-Romaihi H(3),
Yassine HM(7), Sultan AA(8), Bansal D(3), Mkhize-Kwitshana Z(9)(10).
Author information:
(1)Department of Animal Resources, Ministry of Municipality and Environment,
Doha, Qatar. mmmohammed@mme.gov.qa.
(2)School of Laboratory Medicine and Medical Sciences, College of Health
Sciences, University of KwaZulu Natal, Durban, 4000, South Africa.
mmmohammed@mme.gov.qa.
(3)Ministry of Public Health, Doha, Qatar.
(4)Faculty of Veterinary Medicine, Chottogram Veterinary and Animal Sciences
University, Khulshi, Chattogram, 4225, Bangladesh.
(5)Department of Animal Resources, Ministry of Municipality and Environment,
Doha, Qatar.
(6)Department of Virology, Central Laboratory, The Ministry of Higher Education
and Scientific Research, 7099, Khartum, Sudan.
(7)Biomedical Research Center, Qatar University, Doha, Qatar.
(8)Department of Microbiology and Immunology, Weill Cornell Medicine, Cornell
University, Doha, Qatar.
(9)School of Laboratory Medicine and Medical Sciences, College of Health
Sciences, University of KwaZulu Natal, Durban, 4000, South Africa.
(10)Division of Research Capacity Development, South African Medical Research
Council, Tygerberg, Cape Town, 7505, South Africa.
Rodents are sources of many zoonotic pathogens that are of public health
concern. This study investigated bacterial pathogens and assessed their
antimicrobial resistance (AMR) patterns in commensal rodents in Qatar. A total
of 148 rodents were captured between August 2019 and February 2020, and blood,
ectoparasites, and visceral samples were collected. Gram-negative bacteria were
isolated from the intestines, and blood plasma samples were used to detect
antibodies against Brucella spp., Chlamydophila abortus, and Coxiella burnetii.
PCR assays were performed to detect C. burnetii, Leptospira spp., Rickettsia
spp., and Yersinia pestis in rodent tissues and ectoparasite samples.
Antimicrobial resistance by the isolated intestinal bacteria was performed using
an automated VITEK analyzer. A total of 13 bacterial species were isolated from
the intestine samples, namely Acinetobacter baumannii, Aeromonas salmonicida,
Citrobacter freundii, Citrobacter koseri, Enterobacter aerogenes, Enterobacter
cloacae, Escherichia coli, Hafnia alvei, Klebsiella pneumoniae, Providencia
stuartii, Proteus mirabilis, Pseudomonas aeruginosa, and Salmonella enterica.
The majority of them were E. coli (54.63%), followed by P. mirabilis (17.59%)
and K. pneumoniae (8.33%). Most of the pathogens were isolated from rodents
obtained from livestock farms (50.46%), followed by agricultural farms (26.61%)
and other sources (22.94%). No antibodies (0/148) were detected against Brucella
spp., C. abortus, or C. burnetii. In addition, 31.58% (6/19) of the flea pools
and one (1/1) mite pool was positive for Rickettsia spp., and no sample was
positive for C. burnetii, Leptospira spp., and Y. pestis by PCR. A total of 43
(38%) bacterial isolates were identified as multidrug resistant (MDR), whereas
A. salmonicida (n = 1) did not show resistance to any tested antimicrobials.
Over 50% of bacterial MDR isolates were resistant to ampicillin, cefalotin,
doxycycline, nitrofurantoin, and tetracycline. The presence of MDR pathogens was
not correlated with rodent species or the location of rodent trapping. Seven
(11.86%) E. coli and 2 (22.2%) K. pneumoniae were extended-spectrum
beta-lactamases (ESBL) producers. These findings suggest that rodents can be a
source of opportunistic bacteria for human and animal transmission in Qatar.
Further studies are needed for the molecular characterization of the identified
bacteria in this study.
© 2022. The Author(s), under exclusive licence to Springer Nature B.V.
DOI: 10.1007/s11259-021-09876-2
30. Clin Microbiol Infect. 2013 Nov;19(11):1082-8. doi: 10.1111/1469-0691.12143.

Epub 2013 Feb 15.
Diversity in Acinetobacter baumannii isolates from paediatric cancer patients in

Egypt.
Al-Hassan L(1), El Mehallawy H, Amyes SG.
Author information:
(1)Medical Microbiology, University of Edinburgh, Edinburgh, UK.
Acinetobacter baumannii is an important nosocomial pathogen, commonly causing

infections in immunocompromised patients. It is increasingly reported as a
multidrug-resistant organism, which is alarming because of its capability to
resist all available classes of antibiotics including carbapenems. The aim of
this study was to examine the genetic and epidemiological diversity of
A. baumannii isolates from paediatric cancer patients in Egypt, by sequencing
the intrinsic blaOXA -51-like gene, genotyping by pulsed-field gel
electrophoresis and multi-locus sequence typing in addition to identifying the
carbapenem-resistance mechanism. Results showed a large diversity within the
isolates, with eight different blaOXA -51-like genes, seven novel sequence types
and only 28% similarity by pulsed-field gel electrophoresis. All three acquired
class-D carbapenemases (OXA-23, OXA-40 and OXA-58) were also identified among
these strains correlating with resistance to carbapenems. In addition, we report
the first identification of ISAba2 upstream of blaOXA -51-like contributing to
high-level carbapenem resistance. This indicates the presence of several clones
of A. baumannii in the hospitals and illustrates the large genetic and
epidemiological diversity found in Egyptian strains.
© 2013 The Authors Clinical Microbiology and Infection © 2013 European Society
of Clinical Microbiology and Infectious Diseases.
DOI: 10.1111/1469-0691.12143
31. J Glob Antimicrob Resist. 2017 Mar;8:55-59. doi: 10.1016/j.jgar.2016.10.008.

Epub 2016 Dec 19.
Genetic characterisation of carbapenem-resistant Gram-negative bacteria isolated

from the University Hospital Mohamed Boudiaf in Ouargla, southern Algeria.
Yagoubat M(1), Ould El-Hadj-Khelil A(1), Malki A(2), Bakour S(3), Touati A(4),
Rolain JM(5).
Author information:
(1)Laboratoire de protection des écosystèmes en zones arides et semi-arides,
FSNV, Université de Ouargla, 30000 Ouargla, Algeria.
(2)Service de laboratoire central, Hôpital militaire universitaire spécialisé de
Staoueli, Staoueli, Algeria.
(3)Unité de recherche sur les maladies infectieuses et tropicales émergentes
Faculté de médecine et de pharmacie, Aix-Marseille Université, Marseille,
France.
(4)Laboratoire d'Ecologie Microbienne, FSNV, Université de Bejaia, 06000 Bejaia,
Algeria.
Faculté de médecine et de pharmacie, Aix-Marseille Université, Marseille,
France. Electronic address: jean-marc.rolain@univ-amu.fr.
OBJECTIVES: The aim of this study was to investigate the molecular epidemiology
and the genetic support of carbapenem-resistant Enterobacteriaceae and
Acinetobacter spp. isolates collected in the University Hospital of Ouargla,
southern Algeria.
METHODS: A total of 99 Gram-negative bacteria (GNB) were collected from stool
samples of colonised patients and from inanimate surfaces in the hospital
environment between December 2014 and August 2015. Selected Enterobacteriaceae
and Acinetobacter spp. isolates with reduced susceptibility to carbapenems were
subjected to phenotypic study, including antibiotic susceptibility testing
according to CA-SFM-EUCAST 2015 guidelines and modified Carba NP test. Genes
encoding carbapenemases, extended-spectrum β-lactamases (ESBLs) and AmpC
β-lactamases were screened by PCR and sequencing. Clonal relatedness was
determined by multilocus sequencing typing (MLST).
RESULTS: Of the 99 GNB isolates, 10 (10.1%) showed reduced susceptibility to
carbapenems were studied further, including 7 Acinetobacter baumannii, 1
Acinetobacter nosocomialis, 1 Escherichia coli and 1 Klebsiella pneumoniae. PCR
and sequencing showed that four A. baumannii isolates and the single A.
nosocomialis isolate harboured blaNDM-1. In addition, blaOXA-23 was observed in
three A. baumannii isolates, and blaOXA-48 was detected in the two
Enterobacteriaceae isolates. MLST assigned the K. pneumoniae to ST999 and the E.
coli to ST38. The seven A. baumannii isolates belonged to ST85 and ST2.
CONCLUSIONS: This study describes the epidemiology of carbapenemases produced by
Enterobacteriaceae and Acinetobacter spp. in southern Algeria and reports the
first description of metallo-β-lactamase NDM-1-producing A. nosocomialis in
Algeria.
Copyright © 2016 International Society for Chemotherapy of Infection and Cancer.

Published by Elsevier Ltd. All rights reserved.
DOI: 10.1016/j.jgar.2016.10.008
32. Microb Drug Resist. 2015 Jun;21(3):335-41. doi: 10.1089/mdr.2014.0235. Epub

2015
Jan 14.
Emergence of Carbapenem-Resistant Pseudomonas aeruginosa and Acinetobacter

baumannii Clinical Isolates Collected from Some Libyan Hospitals.
Mathlouthi N(1)(2), Areig Z(3)(4), Al Bayssari C(1), Bakour S(1), Ali El Salabi
A(3)(5), Ben Gwierif S(4)(6), Zorgani AA(7), Ben Slama K(2), Chouchani C(2)(8),
Rolain JM(1).
Author information:
(1)1Unité de recherche sur les maladies infectieuses et tropicales émergentes
Faculté de Médecine et de Pharmacie, Aix-Marseille-Université, Marseille,
France.
(2)2Laboratoire des Microorganismes et Biomolécules Actives, Faculté des
Sciences de Tunis, Campus Universitaire, Université de Tunis El-Manar, El-Manar,
Tunisie.
(3)3Infection Control Office, Benghazi Medical Centre, Benghazi, Libya.
(4)4Department of Microbiology, The Libyan Academy, Benghazi, Libya.
(5)5Department of Environmental Health, Faculty of Public Health, University of
Benghazi, Benghazi, Libya.
(6)6Department of Botany, University of Benghazi, Benghazi, Libya.
(7)7Department of Medical Microbiology and Immunology, Faculty of Medicine,
University of Tripoli, Libya.
(8)8Université de Carthage, Institut Supérieur des Sciences et Technologies de
l'Environnement de Borj-Cedria, Hammam-Lif, Tunisie.
The aim of the present study was to investigate the molecular mechanism of
carbapenem resistance in Pseudomonas aeruginosa and Acinetobacter baumannii
clinical isolates recovered from Libyan hospitals between April 2013 and April
2014. In total, 49 strains (24 P. aeruginosa and 25 A. baumannii) were isolated,
including 21 P. aeruginosa and 22 A. baumannii isolates (87.75%) resistant to
imipenem (minimum inhibitory concentrations ≥16 μg/ml). The blaVIM-2 gene was
detected in 19 P. aeruginosa isolates. All imipenem-resistant P. aeruginosa
isolates showed the presence of OprD mutations. Acquired
OXA-carbapenemase-encoding genes were present in all A. baumannii isolates:
blaOXA-23 (n=19) and blaOXA-24 (n=3). Finally, a total of 13 and 17 different
sequence types were assigned to the 21 P. aeruginosa and the 22 A. baumannii
carbapenem-resistant isolates, respectively. This study is the first report
describing imipenem-resistant P. aeruginosa and A. baumannii isolated from
patients in Libya. We report the first case of co-occurrence of blaVIM-2 with
oprD porin loss in identical isolates of P. aeruginosa in Libya and demonstrate
that these oprD mutations can be used as a tool to study the clonality in P.
aeruginosa isolates. We also report the first identification of
multidrug-resistant A. baumannii isolates harboring blaOXA-23-like,
blaOXA-24-like, and blaOXA-48-like genes in Libya.
DOI: 10.1089/mdr.2014.0235

10.1016/j.ijantimicag.2018.04.008. Epub 2018 Apr 14.
NDM-1- and OXA-23-producing Acinetobacter baumannii isolated from intensive care

unit patients in Tunisia.
Maamar E(1), Alonso CA(2), Ferjani S(3), Jendoubi A(4), Hamzaoui Z(3), Jebri
A(4), Saidani M(5), Ghedira S(4), Torres C(2), Boubaker IB(5).
Author information:
(1)University of Tunis El Manar, Faculty of Medicine of Tunis-LR99ES09 Research
Laboratory 'Antimicrobial resistance', 15 Rue Djebel Akhdhar, La Rabta, 1007
Tunis, Tunisia. Electronic address: alaa_maamar@hotmail.com.
(2)Universidad de La Rioja, Area de Bioquímica y Biología Molecular, Logroño,
Spain.
Tunis, Tunisia.
(4)Charles Nicolle Hospital, Intensive Care Unit, 1006 Tunis, Tunisia.
Tunis, Tunisia; Charles Nicolle Hospital, Laboratory of Microbiology, 1006
Tunis, Tunisia.
Gastrointestinal colonisation by carbapenem-resistant Acinetobacter baumannii
(CRAB) is a critical step before nosocomial infection. This study evaluated CRAB
intestinal carriage in patients admitted to a Tunisian ICU and determined the
antimicrobial resistance mechanisms involved. From December 2014 to February
2015, all 63 patients admitted to the ICU were screened for rectal CRAB
colonisation upon admission and once weekly thereafter. ICU patients who
acquired a CRAB nosocomial infection were also included. β-Lactamases and
associated resistance genes were screened by PCR sequencing, and molecular
typing was performed by PFGE and MLST. The CRAB faecal carriage rate at
admission was 4.8% (3/63). The CRAB acquisition rate during ICU stay was
analysed in 39 of the remaining 60 patients and the rate of acquired CRAB faecal
carriage was 15.4% (6/39); 4 patients also showed an ICU-acquired CRAB infection
(one patient was a faecal carrier and suffered infection). Overall, 13 CRAB
isolates were collected from 12 patients, of which 11 isolates showed resistance
to all antibiotics tested except colistin. blaOXA-23 and blaNDM-1 were detected
in 11 and 2 isolates, respectively. All OXA-23-producing strains carried armA,
tetB, sul1 and catB, and some of them carried aph(3')-VIa, blaTEM-1, aph(3')-Ia
and ant(2'')-Ia. The blaNDM-1-positive isolates harboured aph(3')-VIa and catB.
Three PFGE patterns and two STs were identified [ST195 (n = 11), ST1089 (n = 2,
NDM-1-positive)]. Whether imported or acquired during ICU stay, CRAB
colonisation is a major risk factor for the occurrence of serious nosocomial
infection. Systematic screening of faecal carriage is mandatory to prevent their
spread.
Copyright © 2018 Elsevier B.V. and International Society of Chemotherapy. All

rights reserved.
34. Ann Clin Microbiol Antimicrob. 2010 Jun 30;9:17. doi: 10.1186/1476-0711-9-17.
Dissemination of multidrug resistant Acinetobacter baumannii in various

hospitals of Antananarivo Madagascar.
Andriamanantena TS(1), Ratsima E, Rakotonirina HC, Randrianirina F, Ramparany L,

Carod JF, Richard V, Talarmin A.
Author information:
(1)Institut Pasteur de Madagascar, BP 1274, Antananarivo 101, Madagascar.
atalarmin@pasteur-guadeloupe.fr
This study reports the dissemination of multidrug-resistant (MDR)

OXA-23-producing Acinetobacter baumannii clones in hospitals in Antananarivo,
Madagascar. A total of 53 carbapenem-resistant A. baumannii isolates were
obtained from September 2006 to March 2009 in five hospitals. These resistant
strains represent 44% of all A. baumannii isolates. The double disk synergy test
was performed to screen for production of metallo-beta-lactamases. Polymerase
chain reaction (PCR) and DNA sequencing were performed for the detection of
bla(AmpC), bla(OXA-51),bla(OXA-23), bla(OXA-24), bla(IMP), bla(VIM). The
presence of the insertion sequence ISAba1 relative to blaOXA-23 and blaOXA-51
was assessed by PCR. Isolates were typed by Rep-PCR. All the isolates were MDR
and produced the OXA-23 carbapenemase, which was confirmed by sequencing. PCR
analysis for AmpC and OXA-51 gave positive results for all strains studied. No
isolates produced metallo-beta-lactamases. In all isolates ISAba1 laid upstream
of blaOXA-23. The A. baumannii isolates were separated into two genotypes;
genotype A had a higher prevalence (41 strains) than genotype B (12 strains).
Genotype A was present in four hospitals, whilst genotype B had spread in two
hospitals. The high frequency of MDR OXA-23-producing A. baumannii in various
hospitals in Antananarivo is curious since carbapenems are not available in
Madagascar, but it emphasises the need for infection control procedures and
strict adherence to them to prevent the spread of these resistant organisms in
Antananarivo and also the need to control the use of carbapenems in the future.
DOI: 10.1186/1476-0711-9-17
PMCID: PMC2910008
35. Microb Drug Resist. 2022 Nov;28(11):1028-1036. doi: 10.1089/mdr.2022.0112. Epub

2022 Oct 12.
Molecular Screening of Clinical Multidrug-Resistant Gram-Negative Bacteria Shows

Endemicity of Carbapenemases, Coexistence of Multiple Carbapenemases, and Rarity
of mcr in South Africa.
Mmatli M(1), Leshaba TMS(1), Skosana LB(1)(2), Mbelle NM(1), Osei Sekyere
J(1)(3).
Author information:
(1)Department of Medical Microbiology, School of Medicine, University of
Pretoria, Pretoria, South Africa.
(2)Tshwane Academic Division, Department of Medical Microbiology, National
Health Laboratory Service, Pretoria, South Africa.
(3)Department of Dermatology, School of Medicine, University of Pretoria,
Pretoria, South Africa.
Background: Extensive use of carbapenems to treat multidrug-resistant (MDR)

Gram-negative bacteria (GNB) facilitates the wide dissemination of
carbapenemase-producing carbapenem-resistant GNB. Colistin was reintroduced into
clinical settings to manage these GNB infections. However, there is currently an
increase in the dissemination of mobile colistin resistance (mcr)-producing
colistin-resistant GNB isolates in clinical settings. The epidemiology of
carbapenemases and mcr in Pretoria was evaluated. Methods: Clinical MDR GNB were
collected and screened for carbapenemases and mcr using polymerase chain
reaction (PCR); their antibiotic susceptibility profiles were elucidated using
the Vitek® 2 automated system (Biomerieux, France) and microbroth dilution (for
colistin). Results and Discussion: A total of 306 isolates were collected; a
majority of these were Klebsiella pneumoniae (n = 208) and were collected from
males (n = 158). The isolates were retrieved from a variety of infection sites,
including urine, blood cultures, and rectal swabs. The Vitek 2 system found that
these isolates were largely resistant to β-lactams, where 217 (70.9%) had
reduced susceptibility to at least one carbapenem (ertapenem, meropenem, or
imipenem), and 81 isolates (26.5%) were resistant to colistin. PCR screening
identified 201 (65.7%) isolates harboring carbapenemase genes consisting of
blaOXA-48 (170, 84.2%), blaNDM (31, 15.4%), blaIMP (5, 2%), blaKPC (4, 1%), and
blaVIM (5, 2%). Furthermore, 14 blaOXA-48-producing isolates were coharboring
blaVIM (2), blaNDM (9), blaKPC (1), and blaIMP (2) genes. Only one isolate
harbored the mobile colistin resistance (mcr)-1 gene, and this is the first
report of an mcr-1-producing Acinetobacter baumannii isolate in South Africa.
Conclusion: There is high endemicity of carbapenemase genes and a low prevalence
of mcr genes in GNB, particularly in K. pneumoniae, in health care facilities in
Pretoria and surrounding regions of South Africa. Significance: Health care
facilities in Pretoria are becoming breeding grounds for MDR infections that
threaten public health. Careful use of carbapenems and other antibiotics is
necessary to prevent further escalation and outbreak of these MDR strains that
can claim several lives.
DOI: 10.1089/mdr.2022.0112

Epub 2019 Aug 2.
Tracing the dissemination of the international clones of multidrug-resistant

Acinetobacter baumannii among cancer patients in Egypt using the PCR-based open
reading frame typing (POT) method.
El Far MY(1), El-Mahallawy HA(2), Attia AS(3).
Author information:
(1)Department of Microbiology and Immunology, Faculty of Pharmacy, Ahram
Canadian University, Giza, Egypt.
(2)Department of Clinical Pathology, National Cancer Institute, Cairo
(3)Department of Microbiology and Immunology, Faculty of Pharmacy, Cairo
University, Cairo 11562, Egypt. Electronic address:
ahmed.s.attia@staff.cu.edu.eg.
OBJECTIVES: The aim of this study was to perform an epidemiological surveillance

of multidrug-resistant (MDR) Acinetobacter baumannii genetic lineages among
cancer patients in Egypt using the PCR-based open reading frame typing (POT)
method.
METHODS: A total of 160 MDR A. baumannii isolates were collected between January
2015 and December 2017 at a tertiary-care centre in Egypt. VITEK®2 system was
used for preliminary species identification and antimicrobial susceptibility
testing. The POT method was applied for confirmation of species identification
and molecular epidemiological typing of the isolates.
RESULTS: MDR A. baumannii isolates were classified into 15 POT types, including
POT 122 (n=69), POT 69 (n=22) and other miscellaneous POT types (MPOTs)
including POT 0, 8, 10, 12, 14, 40, 44, 52, 56, 93, 104, 106 and 108 (n=69). POT
122 isolates infected or colonised 61% of patients hospitalised in surgical
wards and 54% of patients diagnosed with solid tumours and 51% were adults;
whereas MPOT isolates infected or colonised 51% of patients hospitalised in
paediatric wards and 49% of patients diagnosed with haematological malignancies
and 51% were paediatric patients (P=0.007, 0.001 and 0.004, respectively). MPOT
isolates were recovered from 46% of the collected blood specimens, whilst POT
122 isolates were recovered from 61% of the collected respiratory specimens
(P=0.05).
CONCLUSION: The current study demonstrates that the easy, low-cost POT method is
convenient for rapid delineation of A. baumannii clonal diversity in a
tertiary-care hospital in Egypt.
Copyright © 2019 International Society for Antimicrobial Chemotherapy. Published

by Elsevier Ltd. All rights reserved.
DOI: 10.1016/j.jgar.2019.07.025
37. Infect Genet Evol. 2016 Aug;42:41-5. doi: 10.1016/j.meegid.2016.04.031. Epub

2016 Apr 25.
A new trilocus sequence-based multiplex-PCR to detect major Acinetobacter

baumannii clones.
Martins N(1), Picão RC(2), Cerqueira-Alves M(3), Uehara A(4), Barbosa LC(5),
Riley LW(6), Moreira BM(7).
Author information:
(1)Instituto de Microbiologia Paulo Góes, Universidade Federal do Rio de
Janeiro, Rio de Janeiro, Brazil. Electronic address: natachamartins@gmail.com.
Janeiro, Rio de Janeiro, Brazil. Electronic address: renata.picao@micro.ufrj.br.
Janeiro, Rio de Janeiro, Brazil. Electronic address: mcerqueira@ufrj.br.
Janeiro, Rio de Janeiro, Brazil. Electronic address: aline_uehara@yahoo.com.br.
Janeiro, Rio de Janeiro, Brazil. Electronic address: livia_cb@yahoo.com.br.
(6)School of Public Health, University of California, Berkeley, CA, USA.
Electronic address: lwriley@berkeley.edu.
Janeiro, Rio de Janeiro, Brazil. Electronic address: bmeurer@micro.ufrj.br.
A collection of 163 Acinetobacter baumannii isolates detected in a large

Brazilian hospital, was potentially related with the dissemination of four
clonal complexes (CC): 113/79, 103/15, 109/1 and 110/25, defined by University
of Oxford/Institut Pasteur multilocus sequence typing (MLST) schemes. The urge
of a simple multiplex-PCR scheme to specify these clones has motivated the
present study. The established trilocus sequence-based typing (3LST, for ompA,
csuE and blaOXA-51-like genes) multiplex-PCR rapidly identifies international
clones I (CC109/1), II (CC118/2) and III (CC187/3). Thus, the system detects
only one (CC109/1) out of four main CC in Brazil. We aimed to develop an
alternative multiplex-PCR scheme to detect these clones, known to be present
additionally in Africa, Asia, Europe, USA and South America. MLST, performed in
the present study to complement typing our whole collection of isolates,
confirmed that all isolates belonged to the same four CC detected previously.
When typed by 3LST-based multiplex-PCR, only 12% of the 163 isolates were
classified into groups. By comparative sequence analysis of ompA, csuE and
blaOXA-51-like genes, a set of eight primers was designed for an alternative
multiplex-PCR to distinguish the five CC 113/79, 103/15, 109/1, 110/25 and
118/2. Study isolates and one CC118/2 isolate were blind-tested with the new
alternative PCR scheme; all were correctly clustered in groups of the
corresponding CC. The new multiplex-PCR, with the advantage of fitting in a
single reaction, detects five leading A. baumannii clones and could help
preventing the spread in healthcare settings.
Copyright © 2016 Elsevier B.V. All rights reserved.
DOI: 10.1016/j.meegid.2016.04.031
38. Microb Drug Resist. 2021 Jan;27(1):18-24. doi: 10.1089/mdr.2020.0134. Epub 2020
Jun 9.
Prevalence and Molecular Characterization of Extended Spectrum β-Lactamase,

Plasmid-Mediated Quinolone Resistance, and Carbapenemase-Producing Gram-Negative
Bacilli in Burkina Faso.
Sanou S(1), Ouedraogo AS(1), Aberkane S(2), Vendrell J(2), Ouchar O(2), Bouzimbi
N(2), Hema A(3), Poda A(4), Zoungrana J(4), Ouedraogo GA(5), Carrière C(2),
Jean-Pierre H(2), Ouedraogo-Traore R(6), Godreuil S(2).
Author information:
(1)Laboratoire de Bactériologie-Virologie, CHU Sourô Sanou, Bobo-Dioulasso,
Burkina Faso.
(2)Laboratoire de Bactériologie, CHU Montpellier, MIVEGEC-IRD-CNRS-Université de
Montpellier, Montpellier, France.
(3)Direction de la qualité, CHU Sourô Sanou, Bobo-Dioulasso, Burkina Faso.
(4)Service de Maladies Infectieuses, CHU Sourô Sanou, Bobo-Dioulasso, Burkina
Faso.
(5)Laboratoire d'Enseignement et de Recherche en Santé et Biotechnologies
Animales (LARESBA), Institut du Développement Rural, Université Nazi Boni de
Bobo-Dioulasso, Bobo-Dioulasso, Burkina Faso.
(6)Laboratoire de Bactériologie-Virologie, CHU Pédiatrique Charles De Gaulle,
Ouagadougou, Burkina Faso.
The spreading of carbapenemase-producing gram-negative bacilli (GNB) must be

considered as an "urgent" threat. The aim of this study was to determine the
prevalence of extended spectrum β-lactamase (ESBL), plasmid-mediated quinolone
resistance (PMQR), and carbapenemase-producing GNB and to characterize the
supporting genes in GNB specimens isolated from patients and healthy volunteers
in Burkina Faso. From April to June 2016, carbapenemase-producing GNB screening
was performed in 1,230 consecutive clinical specimens, and 158 fecal samples
from inpatients and healthy volunteers without digestive pathology at Souro
Sanou University Hospital, Bobo Dioulasso. Strains were identified by
matrix-assisted laser desorption ionization-time of flight and antimicrobial
susceptibility was tested with the disk diffusion method on Müller-Hinton agar.
The presence of carbapenemase, ESBL, and PMQR genes was assessed by multiplex
PCR. The molecular epidemiological study was performed using multilocus sequence
typing analysis. From the 1,230 clinical samples, 443 GNB strains were isolated
among which 4 (0.9%) were carbapenemase-producing isolates (Escherichia coli,
n = 1; Acinetobacter baumannii, n = 3). Among the 158 fecal samples tested for
carbapenemase-producing Enterobacteriaceae carriage, 13 (8.2%) were
carbapenemase-producing isolates (E. coli, n = 4; Klebsiella pneumoniae, n = 6;
A. baumannii, n = 2; Acinetobacter nosocomialis, n = 1; Acinetobacter
bereziniae, n = 1). The strains from the two groups were resistant to
broad-spectrum cephalosporins (100% for both), gentamicin (100% and 64.3%),
levofloxacin (100% and 85.7%), and to amikacin (0% and 7.1%). The
carbapenemase-encoding genes blaNDM-1, blaOxa-58, blaOxa-181, and blaVIM-2 were
detected in clinical and in fecal samples. The majority (10/11) of the
enterobacterial strains carried also blaCTX-M-15. The majority of the strains
belonged to ST692 for E. coli, to ST147 for K. pneumoniae and to ST2 for A.
baumannii. This study confirms the presence of carbapenemase-producing GNB in
samples from patients and healthy volunteers. More effective active surveillance
activities are needed.
DOI: 10.1089/mdr.2020.0134
39. World J Microbiol Biotechnol. 2018 Dec 3;34(12):189. doi:

10.1007/s11274-018-2571-z.
Co-production of AmpC and extended spectrum beta-lactamases in

cephalosporin-resistant Acinetobacter baumannii in Egypt.
Said HS(1), Benmahmod AB(2), Ibrahim RH(2).
Author information:
University, Mansoura, 35516, Egypt. hebashehta@mans.edu.eg.
University, Mansoura, 35516, Egypt.
Acinetobacter baumannii is an opportunistic pathogen that has been held

responsible for a lot of infections worldwide. Infections caused by this
pathogen are difficult to control because of the widespread of antimicrobial
resistance mechanisms. The aim of the present study is to assess the prevalence
of extended spectrum β-lactamases (ESBLs) and AmpC β-lactamases among isolates
of A. baumannii collected from different clinical sources in Mansoura University
Hospitals, Egypt. Antimicrobial susceptibility testing has demonstrated elevated
resistance level to β-lactams, quinolones and aminoglycosides. All isolates were
sensitive to colistin and polymyxin B. ESBL activity was detected in 86% of the
isolates. Among the tested ESBL encoding genes, blaTEM gene was the most
prevalent gene as it was detected in 52% of the isolates. While blaPER, blaSHV
and blaVEB were detected in 12%, 4%, and 2%, respectively. AmpC activity and
blaADC gene were detected in 90% of the tested isolates. Insertion sequence
ISAba1 was located 9 bp upstream of blaADC gene in 88.9% of the ADC-expressing
isolates providing a potent promoter activity for its expression. To our
knowledge this is the first report of loss of intrinsic ADC activity, in 10% of
the tested isolates, as a result of insertional inactivation by an element
belonging to IS5 family transposase. Co-expression of both ESBLs and AmpC
β-lactamases was detected in 78% of the isolates. The study demonstrates high
prevalence of resistance to β-lactam antibiotics through ESBLs and AmpC
β-lactamases production among A. baumannii clinical isolates. Prevalence of
β-lactamases should be detected routinely and reported in hospitals to avoid
inappropriate use of antibiotics and therapeutic failure.
DOI: 10.1007/s11274-018-2571-z

Epub 2016 Oct 17.
Molecular epidemiology of environmental and clinical carbapenemase-producing

Gram-negative bacilli from hospitals in Guelma, Algeria: Multiple genetic
lineages and first report of OXA-48 in Enterobacter cloacae.
Bouguenoun W(1), Bakour S(2), Bentorki AA(3), Al Bayssari C(2), Merad T(4),
Rolain JM(5).
Author information:
Faculté de Médecine et de Pharmacie, Aix-Marseille Université, Marseille,
France; Laboratoire de Biochimie et Microbiologie appliquée, Université de
Annaba, Annaba, Algeria.
France.
(3)Laboratoire de Microbiologie, CHU Dorban, Annaba, Algeria.
(4)Laboratoire d'Amélioration Génétique des Plantes, Université de Annaba,
Annaba, Algeria.
France. Electronic address: jean-marc.rolain@univ-amu.fr.
This study was designed to investigate environmental colonisation in Algerian
hospitals by carbapenem-resistant Gram-negative bacilli (GNB), including
molecular characterisation of their resistance, and to perform a comparative
molecular analysis between clinical and environmental strains. GNB isolated from
hospitalised patients and the hospital environment were identified using
microbiological methods and matrix-assisted laser desorption/ionisation
time-of-flight mass spectrometry (MALDI-TOF/MS). Antibiotic susceptibility
testing was performed by disk diffusion and Etest methods. Carbapenemase- and
extended-spectrum β-lactamase (ESBL)-encoding genes were searched for using PCR
and sequencing. Clonality of the environmental and clinical strains was assessed
by multilocus sequencing typing (MLST). A total of 32 carbapenem-resistant GNB
were isolated, including 16 (29%) of 56 multidrug-resistant (MDR) GNB from
clinical specimens and 16 (48%) of 33 MDR-GNB from inanimate surfaces. Of the 32
carbapenem-resistant isolates, 14 produced a carbapenemase. The blaOXA-48 gene
was detected both in clinical and surface isolates of Klebsiella pneumoniae
(n=3) and Enterobacter cloacae (n=2). Clinical and surface isolates of
Acinetobacter baumannii were found to produce the carbapenemases NDM-1 (7
isolates) and OXA-23 (2 isolates). MLST revealed clonal diversity and a
relationship between environmental and clinical strains with identical sequence
types. Here we report the first description of an OXA-48-producing E. cloacae
isolate in Algeria. We also highlight the important role of inanimate surfaces
in the spread of carbapenem-resistant bacteria and the emergence of nosocomial
infections.
Copyright Â© 2016 International Society for Chemotherapy of Infection and

Cancer. Published by Elsevier Ltd. All rights reserved.
DOI: 10.1016/j.jgar.2016.08.011
41. Tunis Med. 2008 Apr;86(4):312-5.
Spread of multidrug resistant Acinetobacter baumannii in a teaching hospital.
Hammami S(1), Ghozzi R, Ben Redjeb S.
Author information:
(1)Laboratoire de Recherche Résistance aux Antibiotiques Faculté de Médecine de
Tunis.
BACKGROUND: A. baumannii is an important opportunistic pathogen widely

distributed in the hospital environment and responsible for a variety of
nosocomial infections especially in patients from intensive care units.
AIM: We describe an outbreak of Acinetobacter baumannii (16 stains) in 3
intensive care units (I, II, III) at Charles Nicolle hospital of Tunis over a 5
month period (March to July 2005).
METHODS: The antimicrobial susceptibility was determined by disc diffusion test
and the genetic relatedness of isolates was done by Random Amplified Polymorphic
DNA (RAPD) analysis. Two strains not related to the outbreak were used for the
discrimination of the technique.
RESULTS: Samples were collected from blood (44%), materials (31%), pus (6.5%),
urines (6.5%) and respiratory tract (12.5%). Antibiotic resistance pattern
showed 2 different profiles. However, molecular typing of isolates revealed 3
distinct profiles (A, B, C) represented respectively by 8, 7 and one isolates.
The major profile was the profile A found in 5 patients and in materials. It was
appeared firstly in intensive care unit I, then in the 2 other units (II and
III). The profile B was observed also in the 3 units. However, the profile C was
found in one patient in unit I.
CONCLUSION: These data emphasize the need for active surveillance for
multidrug-resistant Acinetobacter baumannii, and the value of molecular typing
of strains in hospital settings to investigate spread of infection.

10.1016/j.ijantimicag.2018.06.002. Epub 2018 Jun 15.
Metallo-β-lactamases and class D carbapenemases in south-east Tunisia:

Implication of mobile genetic elements in their dissemination.
Dziri O(1), Alonso CA(2), Dziri R(1), Gharsa H(1), Maraoub A(3), Torres C(2),
Chouchani C(4).
Author information:
(1)Laboratoire des Microorganismes et Biomolécules Actives, Faculté des Sciences
de Tunis, Université de Tunis El Manar, 2098 El-Manar II, Tunisia.
(2)Area de Bioquímica y BiologíaMolecular, Universidad de La Rioja, Logroño,
Spain.
(3)Hôpital régional SadokMkaddem de Djerba, Avenue Habib Bourguiba Houmet Souk
Djerba, Tunisia.
(4)Laboratoire des Microorganismes et Biomolécules Actives, Faculté des Sciences
de Tunis, Université de Tunis El Manar, 2098 El-Manar II, Tunisia; Laboratoire
de Recherche Sciences et Technologies de l'Environnement, Institut Supérieur des
Sciences et Technologies de l'Environnement de Borj-Cedria, Université de
Carthage, Technopôle de Borj-Cedria, BP-1003, Hammam-Lif, Tunisia. Electronic
address: chedly.chouchani@gmail.com.
Carbapenem resistance in Gram-negative bacteria constitutes a major clinical

problem. We characterized molecular features among carbapenem-resistant
Gram-negative clinical isolates collected from Southeastern Tunisian Island
Hospital. Eighteen carbapenem-resistant clinical isolates (13 Klebsiella
pneumoniae, 1 Proteus mirabilis, 1 Enterobacter cloacae, 3 Acinetobacter
baumannii) were recovered during April 2015-August 2016. Molecular
characterization of antimicrobial resistance was performed using polymerase
chain reaction (PCR) and sequencing. Molecular typing of carbapenemase-producing
K. pneumoniae was performed by pulsed-field gel electrophoresis (PFGE) after
XbaI digestion and multilocus sequence typing (MLST). Conjugation experiments
were conducted and type/number/size of plasmids were characterized by
PCR-Based-Replicon-Typing and PFGE after S1 digestion. Carbapenemase genes were
detected in K. pneumoniae [blaNDM-1(8), blaNDM-1+blaOXA-48(1), blaOXA-48(4)], P.
mirabilis [blaOXA-48(1)], E. cloacae [blaVIM-2(1)] and A. baumannii
[blaOXA-23(3)]. K. pneumoniae isolates were typed as ST15, ST1412 and ST147 and
showed seven different pulsotypes. The genetic structure surrounding blaNDM-1
was composed of ISAba125 and ble. The blaVIM-2 carried by E. cloacae was located
within the variable region of a class1 integron and blaOXA-48 gene was inserted
into Tn1999.2. IncA/C and IncFIIA replicons were implicated in dissemination of
blaNDM-1 and a non-typeable 48.5 kb plasmid in the propagation of blaOXA-48. The
emergence of carbapenemase-producing Gram-negative species in a Tunisian
hospital shows the need for preventive strategies and hygiene measures to
minimize their spread. Although conjugative plasmids play an important role in
rapid carbapenemase genes dissemination, other mobile genetic elements, such as
insertion sequences, transposons and integrons, are involved in acquisition of
these resistances.
Copyright © 2018 Elsevier B.V. and International Society of Chemotherapy. All

rights reserved.
43. PLoS One. 2013 Jul 25;8(7):e69507. doi: 10.1371/journal.pone.0069507. Print

2013.
Molecular characterization of multidrug resistant hospital isolates using the

antimicrobial resistance determinant microarray.
Leski TA(1), Vora GJ, Barrows BR, Pimentel G, House BL, Nicklasson M, Wasfy M,
Abdel-Maksoud M, Taitt CR.
Author information:
(1)Center for Bio/Molecular Science and Engineering, US Naval Research
Laboratory, Washington, DC, United States of America.
Molecular methods that enable the detection of antimicrobial resistance

determinants are critical surveillance tools that are necessary to aid in
curbing the spread of antibiotic resistance. In this study, we describe the use
of the Antimicrobial Resistance Determinant Microarray (ARDM) that targets 239
unique genes that confer resistance to 12 classes of antimicrobial compounds,
quaternary amines and streptothricin for the determination of multidrug
resistance (MDR) gene profiles. Fourteen reference MDR strains, which either
were genome, sequenced or possessed well characterized drug resistance profiles
were used to optimize detection algorithms and threshold criteria to ensure the
microarray's effectiveness for unbiased characterization of antimicrobial
resistance determinants in MDR strains. The subsequent testing of Acinetobacter
baumannii, Escherichia coli and Klebsiella pneumoniae hospital isolates revealed
the presence of several antibiotic resistance genes [e.g. belonging to TEM, SHV,
OXA and CTX-M classes (and OXA and CTX-M subfamilies) of β-lactamases] and their
assemblages which were confirmed by PCR and DNA sequence analysis. When combined
with results from the reference strains, ~25% of the ARDM content was confirmed
as effective for representing allelic content from both Gram-positive and
-negative species. Taken together, the ARDM identified MDR assemblages
containing six to 18 unique resistance genes in each strain tested,
demonstrating its utility as a powerful tool for molecular epidemiological
investigations of antimicrobial resistance in clinically relevant bacterial
pathogens.
PMCID: PMC3723915
Conflict of interest statement: Competing Interests: The authors have declared

that no competing interests exist.
44. J Clin Microbiol. 2000 Oct;38(10):3636-45. doi:

10.1128/JCM.38.10.3636-3645.2000.
Molecular surveillance of European quinolone-resistant clinical isolates of

Pseudomonas aeruginosa and Acinetobacter spp. using automated ribotyping.
Brisse S(1), Milatovic D, Fluit AC, Kusters K, Toelstra A, Verhoef J, Schmitz

FJ.
Author information:
(1)Eijkman-Winkler Institute, Utrecht University, 3584 CX Utrecht, The
Netherlands. sbrisse@lab.azu.nl
Nosocomial isolates of Pseudomonas aeruginosa and Acinetobacter spp. exhibit

high rates of resistance to antibiotics and are often multidrug resistant. In a
previous study (D. Milatovic, A. Fluit, S. Brisse, J. Verhoef, and F. J.
Schmitz, Antimicrob. Agents Chemother. 44:1102-1107, 2000), isolates of these
species that were resistant to sitafloxacin, a new advanced-generation
fluoroquinolone with a high potency and a broad spectrum of antimicrobial
activity, were found in high proportion in 23 European hospitals. Here, we
investigate the clonal diversity of the 155 P. aeruginosa and 145 Acinetobacter
spp. sitafloxacin-resistant isolates from that study by automated ribotyping.
Numerous ribogroups (sets of isolates with indistinguishable ribotypes) were
found among isolates of P. aeruginosa (n = 34) and Acinetobacter spp. (n = 16),
but the majority of the isolates belonged to a limited number of major
ribogroups. Sitafloxacin-resistant isolates (MICs > 2 mg/liter, used as a
provisional breakpoint) showed increased concomitant resistance to piperacillin,
piperacillin-tazobactam, ceftriaxone, ceftazidime, amikacin, gentamicin, and
imipenem. The major ribogroups were repeatedly found in isolates from several
European hospitals; these isolates showed higher levels of resistance to
gentamicin and imipenem, and some of them appeared to correspond to previously
described multidrug-resistant international clones of P. aeruginosa (serotype
O:12) and Acinetobacter baumannii (clones I and II). Automated ribotyping, when
used in combination with more discriminatory typing methods, may be a convenient
library typing system for monitoring future epidemiological dynamics of
geographically widespread multidrug-resistant bacterial clones.
DOI: 10.1128/JCM.38.10.3636-3645.2000
PMCID: PMC87449
45. J Infect Public Health. 2020 Apr;13(4):637-643. doi:

10.1016/j.jiph.2019.08.012.
Epub 2019 Sep 16.
The clinical and epidemiological risk factors of infections due to multi-drug

resistant bacteria in an adult intensive care unit of University Hospital Center
in Marrakesh-Morocco.
El Mekes A(1), Zahlane K(2), Ait Said L(2), Tadlaoui Ouafi A(3), Barakate M(4).
Author information:
(1)Laboratory of Medical Analysis, Ibn Tofail Hospital, University Hospital
Center-Mohammed VI, Marrakesh, Morocco; Laboratory of Biology and Biotechnology
of Microorganisms, Faculty of Sciences Semlalia, Cadi Ayyad University,
Marrakesh, Morocco.
(2)Laboratory of Medical Analysis, Ibn Tofail Hospital, University Hospital
Center-Mohammed VI, Marrakesh, Morocco.
(3)Laboratory of Biotechnology and Molecular Bioengineering, Faculty of Science
and Technology Gueliz, Cadi Ayyad University, Marrakesh, Morocco.
(4)Laboratory of Biology and Biotechnology of Microorganisms, Faculty of
Sciences Semlalia, Cadi Ayyad University, Marrakesh, Morocco. Electronic
address: mbarakate@uca.ma.
BACKGROUND: Intensive care units (ICUs) are considered epicenters of antibiotic

resistance. The aim of this study is to determine clinical risk factors,
epidemiology and the causative agents of multi-drug resistant bacteria in the
ICU of the University Hospital in Marrakesh-Morocco.
METHODS: A one year case control study was carried out in our 10-bed clinical
and surgical ICU from March 2015 to March 2016. The epidemiological surveillance
was done by collecting data in the medical records with the help of a
questionnaire. The antibiotic susceptibility testing was used following the
recommendations of the Antibiogram Committee of the French Society of
Microbiology and the European Committee for Antimicrobial Susceptibility
Testing, 2015.
RESULTS: Among the 479 admitted patients, 305 bacteria were isolated and
identified as Acinetobacter baumannii (31%), Enterobactereacae species (30%),
and Staphylococcus (24%), P. aeruginosa (10%) and other bacterial strains (5%).
The rate of MDR bacteria acquisition was 41% (124/305) with domination of A.
baumannii resistant to imipenem (70%) and followed by Extended Spectrum
β-lactamases producing Enterobacteriaceae, P. aeruginosa resistant to
Ceftazidime, and Methicillin-resistant S. aureus (18%, 7%, and 5% respectively).
The distribution of the common nosocomial infections were dominated by
pneumonia, bacteremia, and catheter-related blood stream infections (39%, 29%,
and 17%) respectively. Multivariate analysis identified lack of patient
isolation precautions (OR: 7.500), use of quadri or triple therapy (OR: 5.596;
OR: 5.175), and mechanical ventilation (OR: 4.926), as the most significant
clinical and epidemiological factors associated with acquisition of MDR
bacteria. The attributable mortality, in this ICU, of patients with MDR
bacteria, is about 12%.
CONCLUSIONS: The incidence of MDR was higher compared with that of developed
countries. The implementation of standard infection control protocols, active
surveillance of MDR and generation of data on etiological agents and their
antimicrobial susceptibility patterns are urgently needed in our hospital.
Copyright © 2019 The Author(s). Published by Elsevier Ltd.. All rights reserved.
DOI: 10.1016/j.jiph.2019.08.012
46. Am J Trop Med Hyg. 2022 Dec 19;108(2):268-274. doi: 10.4269/ajtmh.22-0168.

Print
2023 Feb 1.
Prevalence and Phenotypic and Molecular Characterization of

Carbapenemase-Producing Gram-Negative Bacteria in Gabon.
Dikoumba AC(1)(2)(3), Onanga R(2), Jean-Pierre H(3)(4), Didelot MN(3)(4), Dumont

Y(3)(4), Ouedraogo AS(5)(6), Ngoungou EB(7), Godreuil S(3)(4)(6).
Author information:
(1)Hôpital d'Instruction des Armées Omar Bongo Ondimba, Libreville, Gabon.
(2)Centre Interdisciplinaire de Recherches Médicales de Franceville,
Franceville, Gabon.
(3)Laboratoire de Bactériologie, Centre Hospitalier Universitaire de
Montpellier, Montpellier, France.
(4)Maladies Infectieuses et Vecteurs: Ecologie, Génétique, evolution et
Contrôle, Institut de Recherche pour le Développement, Centre National de la
Recherche Scientifique, Université de Montpellier, Montpellier, France.
(5)Department of Medical Bacteriology and Virology, National Reference
Laboratory for Antimicrobial Resistance, University Hospital Centre Sanou
Sourou, Bobo Dioulasso, Burkina.
(6)Jeune Equipe Associée à Institut de Recherche pour le Développement,
Résistance aux Antimicrobiens au Burkina Faso, Montpellier, France.
(7)Département d'Epidémiologie, Biostatistiques et Informatique Médicale/Unité
de Recherche en Epidémiologie des Maladies Chroniques et Santé Environnement,
Faculté de Médecine, Université des Sciences de la Santé, Libreville, Gabon.
Data collection and monitoring of carbapenemase-producing (CP) Gram-negative

bacteria (GNB) are often limited. This study determined CP-GNB prevalence in
Gabon and the genetic origins of the resistance genes. From January 2016 to
March 2018, 869 clinically significant GNB isolates from inpatients and
outpatients, and 19 fecal samples (inpatients) were analyzed in the main
hospitals of Gabon. Fecal samples were screened using ChromID® CARBA SMART
selective chromogenic medium biplates. Species were identified by
matrix-assisted laser desorption ionization-time of flight mass spectrometry.
Antibiotic susceptibility was tested using the disk diffusion method on
Müller-Hinton agar, and resistance genes were assessed by multiplex polymerase
chain reaction and sequencing. Overall, 1.61% of clinical isolates (14 of 869)
and 5.26% of fecal samples (1 of 19) were CP-GNB. The CP-GNB rate was higher
among inpatients (2.98%) than outpatients (0.33%), in intensive care units
(28.57%, 4 of 14), and in urine samples (35.71%, 5 of 14). The most common
CP-GNB were Klebsiella pneumoniae (53.33%) and Acinetobacter baumannii (26.67%).
blaOXA-48 was the predominant carbapenemase-encoding gene (40%), followed by
blaNDM-5 (33.33%). The A. baumannii multilocus sequence types ST2 and ST78,
Enterobacter cloacae ST78, Escherichia coli ST2, and K. pneumonia ST48 and ST147
were found. These data indicate that CP bacteria are present in clinical and
carriage samples. Preventive measures are needed to avoid the spread of
resistance genes.
DOI: 10.4269/ajtmh.22-0168
PMCID: PMC9896342
47. Comp Immunol Microbiol Infect Dis. 2017 Aug;53:33-39. doi:

10.1016/j.cimid.2017.06.003. Epub 2017 Jun 28.
Human head lice and pubic lice reveal the presence of several Acinetobacter
species in Algiers, Algeria.
Mana N(1), Louni M(2), Parola P(3), Bitam I(4).
Author information:
(1)Laboratoire de Biodiversité et Environnement: Interactions et Génomes,
Faculté des Sciences Biologiques, Université des Sciences et de la Technologie
Houari Boumediene, BP 32, El Alia Bab Ezzouar, Algiers, Algeria.
(2)Laboratoire de Valorisation et Conservation des Ressources Biologiques
(VALCORE), Faculté des Sciences, Université M'Hamed Bougara, Boumerdes, Algeria.
(3)Unité de Recherche en Maladies Infectieuses et Tropicales Emergentes
(URMITE), Aix-Marseille Université UM63, CNRS 7278, IRD 198 (Dakar), Inserm
1095, AP-HM Institut Hospitalo-Universitaire Méditerranée Infection, Marseille,
France.
(4)Laboratoire de Biodiversité et Environnement: Interactions et Génomes,
Faculté des Sciences Biologiques, Université des Sciences et de la Technologie
Houari Boumediene, BP 32, El Alia Bab Ezzouar, Algiers, Algeria; Laboratoire de
Valorisation et Conservation des Ressources Biologiques (VALCORE), Faculté des
Sciences, Université M'Hamed Bougara, Boumerdes, Algeria; Unité de Recherche en
Maladies Infectieuses et Tropicales Emergentes (URMITE), Aix-Marseille
Université UM63, CNRS 7278, IRD 198 (Dakar), Inserm 1095, AP-HM Institut
Hospitalo-Universitaire Méditerranée Infection, Marseille, France; Ecole
Supérieure des Sciences de l'Aliment et des Industries Agro-Alimentaires,
Algiers, Algeria. Electronic address: idirbitam@gmail.com.
There are two majorspecies of medically important lice that parasitize humans:
Phthirus pubis, found in pubic hair, and Pediculus humanus. Pediculus humanus
consists of two eco types that live in specific niches on the human host: body
lice (Pediculus humanus humanus), found on the human body and clothing, and head
lice (Pediculus humanus capitis), found on the scalp. To date, only body lice
are known to be vectors of human disease; however, it has recently been reported
that the DNA of several bacterial agents has been detected in head lice, raising
questions about their role in the transmission of pathogens. This issue caught
our attention, in addition to the fact that the pathogenic bacteria associated
with P. pubis and P. humanus capitis have never been investigated in Algeria. To
investigate this,molecular techniques (real-time PCR) were used to screen for
the presence of Acinetobacter spp., Bartonella spp., Borrelia spp. and
Rickettsia prowazekii DNA from P. humanus capitis (64 lice) collected from
schoolchildren,and P. pubis (4 lice),collected from one adultman living in
Algiers. Positive samples for Acinetobacter spp.were identified by sequencing
therpoBgene. Conventional PCR targeting the partial Cytb gene was used to
determine the phylogenetic clade of the collected lice. Of the 64 samples
collected, Acinetobacter spp. DNA was detected in 17/64 (27%) of head lice,
identified as: A. baumannii (14%), A. johnsonii (11%) and A. variabilis (2%). Of
the four P. pubissamples, 2(50%) were positive for A. johnsonii. The
phylogenetic tree based on the Cytb gene revealed that P. humanus capitis were
grouped into clades A and B. In this study, we report andidentify for the first
time Acinetobacter spp.in Algerian P. pubis and P. humanus capitis. The
detection of the genus Acinetobacter in lice should not be underestimated,
especially in P. humanus capitis, which is distributed worldwide. However,
additional epidemiological data are required to determine if human lice may act
as an environmental reservoir and are actively involved in the propagation of
these bacteria to humans.
DOI: 10.1016/j.cimid.2017.06.003
48. Microb Drug Resist. 2015 Jun;21(3):279-85. doi: 10.1089/mdr.2014.0214. Epub

2015
Jan 14.
Emergence of Colistin- and Carbapenem-Resistant Acinetobacter baumannii ST2

Clinical Isolate in Algeria: First Case Report.
Bakour S(1)(2), Olaitan AO(1), Ammari H(3), Touati A(2), Saoudi S(2), Saoudi
K(2), Rolain JM(1).
Author information:
(1)1Unité de Recherche sur les Maladies Infectieuses et Tropicales Émergentes
Faculté de Médecine et de Pharmacie, Aix-Marseille-Université, Marseille,
France.
(2)2Laboratoire d'Ecologie Microbienne, FSNV, Université de Bejaia, 06000
Bejaia, Algérie.
(3)3Laboratoire Central de Biologie Médicale, Unité de Microbiologie, CHU
Béni-Messous, Alger, Algérie.
AIM: The aim of this study was to investigate the prevalence and the mechanisms
of carbapenem and colistin resistance in Acinetobacter baumannii clinical
isolates in an Algerian hospital.
RESULTS: Twelve isolates were collected between October 2013 and March 2014. All
isolates were resistant to almost all antibiotics tested with a high-level
resistance to imipenem (minimum inhibitory concentrations [MICs] >32 mg/L) with
one strain showing resistance to colistin (MIC=16 mg/L). The results of the
modified Hodge test and the modified Carba NP test were positive for all
isolates. Besides, the activity of β-lactamases was inhibited by EDTA in only
two isolates. All the 12 isolates contained the naturally occurring
blaOXA-51-like gene. Ten of them harbored the OXA β-lactamases: blaOXA-23 (six
isolates) and blaOXA-24 (four isolates) genes, while two isolates were positive
for blaNDM-1 gene. The colistin-resistant isolate producing OXA-24 enzyme
harbored a single mutation in the pmrB gene. Multilocus sequence typing
demonstrated that the 12 isolates belonged to 2 clones: 10 to ST2 and 2 to ST85.
CONCLUSIONS: Here, we describe the mechanisms of carbapenem resistance and we
report the first colistin and carbapenemase-producing A. baumannii clinical
isolate from a patient in Algeria.
DOI: 10.1089/mdr.2014.0214

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Draft genome sequences of extensively drug resistant and pandrug resistant

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