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. 2016 Nov 9:7:1717.
doi: 10.3389/fmicb.2016.01717. eCollection 2016.

Multilocus Sequence Typing Analysis of Carbapenem-Resistant Acinetobacter baumannii in a Chinese Burns Institute

Guangtao Huang  1 , Supeng Yin  1 , Yali Gong  1 , Xia Zhao  2 , Lingyun Zou  2 , Bei Jiang  1 , Zhiwei Dong  1 , Yu Chen  1 , Jing Chen  1 , Shouguang Jin  3 , Zhiqiang Yuan  1 , Yizhi Peng  1
Affiliations

Multilocus Sequence Typing Analysis of Carbapenem-Resistant Acinetobacter baumannii in a Chinese Burns Institute

Guangtao Huang et al. Front Microbiol. .

Abstract

Acinetobacter baumannii is a leading pathogen responsible for nosocomial infections. The emergence of carbapenem-resistant A. baumannii (CRAB) has left few effective antibiotics for clinicians to use. To investigate the temporal evolutionary relationships among CRAB strains, we collected 248 CRAB isolates from a Chinese burns institute over 3 years. The prevalence of the OXA-23 gene was detected by polymerase chain reaction. Multilocus sequence typing was used to type the CRAB strains and eBURST was used to analyze their evolutionary relationships. Wound surfaces (41%), sputa (24%), catheters (15%), and bloods (14%) were the four dominant isolation sources. Except for minocycline (33.5%) and sulbactam/cefoperazone (74.6%), these CRAB strains showed high resistance rates (>90%) to 16 tested antibiotics. The 248 isolates fall into 26 sequence types (STs), including nine known STs and 17 unknown STs. The majority (230/248) of these isolates belong to clonal complex 92 (CC92), including eight isolates belonging to seven unreported STs. A new CC containing 11 isolates grouped into four new STs was identified. The OXA-23 gene was detected at high prevalence among the CRAB isolates and the prevalence rate among the various STs differed. The majority of the isolates displayed a close evolutionary relationship, suggesting that serious nosocomial spreading and nosocomial infections of CRAB have occurred in the burn unit. In conclusion, the main CC for CRAB in this Chinese burn unit remained unchanged during the 3-year study period, and a new CC was identified. CC92 was the dominant complex, and more attention should be directed toward monitoring the new CC we have identified herein.

Keywords: A. baumannii; clonal complex (CC); multi locus sequence typing (MLST); nosocomial infection; β-lactamases.

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Figures

FIGURE 1
FIGURE 1
(A) Sources of the 248 strains. Wd (wound surface), Sp (sputa), Ca (catheter), Bl (bloodstream), Ps (purulent secretion), Ts (tissue), and Ur (urine). (B) Antibiotic resistance rates. AMK, amikacin; SAM, ampicillin/sulbactam; POL, Polymyxin B; SXT, sulfamethoxazole/trimethoprim; CIP, ciprofloxacin; MEM, meropenem; MNO, minocycline; NET, netilmicin; GEN, gentamicin; TCY, tetracycline; CAZ, ceftazidime; FEP, cefepime; CSL, sulbactam/cefoperazone; CT, cefotaxime; TOB, tobramycin; IPM, imipenem; LVX, levofloxacin; PIP, piperacillin; TZP, piperacillin/tazobactam.
FIGURE 2
FIGURE 2
Multi locus sequence typing population analysis. STs in the 248 isolates (A) and the STs identified in 2012 (B), 2013 (C), and 2014 (D).
FIGURE 3
FIGURE 3
eBURST analysis results. (A) Relationships among the STs found in this study. Two clonal complexes were identified. Blue dot denotes the founder and yellow dots denote the sub-founder. The size of the dot indicates the number of isolates. (B) Current members (STs) of CC92. Seven CC92 STs identified in this study are shown in red, and seven new CC92 STs are shown in black. Other previously reported CC92 STs are shown in green.
FIGURE 4
FIGURE 4
OXA-23 gene prevalence among Acinetobacter baumannii isolates in each year (A) and in different STs (B). New∗ represent all the new STs except new9.
FIGURE 5
FIGURE 5
Phylogenetic analysis based on concatenated sequences of seven loci. All 248 isolates are mainly divided into four clusters.
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