Endemic carbapenem-nonsusceptible Acinetobacter baumannii-calcoaceticus complex in intensive care units of the national referral hospital in Jakarta, Indonesia

Antimicrob Resist Infect Control. 2018 Jan 12:7:5. doi: 10.1186/s13756-017-0296-7. eCollection 2018.

Abstract

Background: Carbapenem-nonsusceptible A. baumannii-calcoaceticus complex have emerged worldwide, but the epidemiology in Indonesian hospitals has not been studied.

Methods: A prospective observational study was performed on the intensive care units (ICUs) of the national referral hospital in Jakarta-Indonesia, in 2013 and 2014. All consecutive adult patients admitted and hospitalized for >48 h in ICUs were included. Basic and clinical data at admission were recorded. Carbapenem-nonsusceptible A. baumannii-calcoaceticus complex from clinical cultures and standardized screening were included. Environmental niches and healthcare workers (HCWs) were also screened. PCR was used to detect carbapenemase genes, and Raman spectroscopy as well as multilocus sequence typing (MLST) for typing.

Results: Of 412 included patients, 69 (16.7%) carried carbapenem-nonsusceptible A. baumannii-calcoaceticus complex on admission, and 89 (25.9%) became positive during ICU stay. The acquisition rate was 43 per 1000 patient-days at risk. Six isolates were cultured from environment and one from a HCW. Acquisition of carbapenem-nonsusceptible A. baumannii-calcoaceticus complex was associated with longer ICU stay (median interquartile range [IQR]: 11 days [5-18], adjusted hazard ratio [aHR]: 2.56 [99% confidence interval (CI):1.76-3.70]), but not with mortality (adjusted odds ratio: 1.59 [99%CI: 0.74-3.40] at the chosen level of significance). The blaOXA-23-like gene was detected in 292/318 (91.8%) isolates, including isolates from the environment and HCW. Typing revealed five major clusters. Sequence types (ST)195, ST208, ST218, ST642 as well as new STs were found. The dominant clone consisted of isolates from patients and environment throughout the study period.

Conclusions: Carbapenem-nonsusceptible A. baumannii-calcoaceticus complex are endemic in this setting. Prevention requires source control and limiting transmission of strains.

Trial registration: The study was retrospectively registered at www.trialregister.nl (No:5541). Candidate number: 23,527, NTR number: NTR5541, Date registered NTR: 22nd December 2015.

Keywords: Acinetobacter baumannii-calcoaceticus complex; Antimicrobial resistance; Carbapenemase; Carbapenems; Indonesia; Intensive care unit.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Acinetobacter Infections / epidemiology*
  • Acinetobacter Infections / microbiology
  • Acinetobacter baumannii / classification
  • Acinetobacter baumannii / drug effects
  • Acinetobacter baumannii / genetics*
  • Acinetobacter baumannii / isolation & purification
  • Acinetobacter calcoaceticus / classification
  • Acinetobacter calcoaceticus / drug effects
  • Acinetobacter calcoaceticus / genetics*
  • Acinetobacter calcoaceticus / isolation & purification
  • Adult
  • Anti-Bacterial Agents / pharmacology
  • Bacterial Proteins / genetics
  • Carbapenems / pharmacology*
  • DNA, Bacterial
  • Drug Resistance, Bacterial / genetics
  • Female
  • Health Personnel
  • Humans
  • Indonesia / epidemiology
  • Intensive Care Units*
  • Male
  • Microbial Sensitivity Tests
  • Middle Aged
  • Molecular Epidemiology*
  • Multilocus Sequence Typing / methods
  • Polymerase Chain Reaction / methods
  • Prevalence
  • Prospective Studies
  • Referral and Consultation*
  • Retrospective Studies
  • beta-Lactamases / genetics

Substances

  • Anti-Bacterial Agents
  • Bacterial Proteins
  • Carbapenems
  • DNA, Bacterial
  • beta-Lactamases
  • carbapenemase

Associated data

  • NTR/NTR5541