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Journal of Clinical Microbiology, March 2004, p. 946-953, Vol. 42, No. 3
0095-1137/04/$08.00+0     DOI: 10.1128/JCM.42.3.946-953.2004
Copyright © 2004, American Society for Microbiology. All Rights Reserved.

Molecular Epidemiology of Sequential Outbreaks of Acinetobacter baumannii in an Intensive Care Unit Shows the Emergence of Carbapenem Resistance

Raffaele Zarrilli,1,2* Margherita Crispino,1 Maria Bagattini,1 Elena Barretta,1 Anna Di Popolo,1,2 Maria Triassi,1 and Paolo Villari3

Dipartimento di Scienze Mediche Preventive,1 Dipartimento di Biologia e Patologia Cellulare e Molecolare "L. Califano," Università di Napoli "Federico II," Naples,2 Dipartimento di Medicina Sperimentale e Patologia, Università di Roma "La Sapienza," Rome, Italy3

Received 25 June 2003/ Returned for modification 6 August 2003/ Accepted 26 November 2003

The molecular epidemiology of multidrug-resistant Acinetobacter baumannii was investigated in the medical-surgical intensive care unit (ICU) of a university hospital in Italy during two window periods in which two sequential A. baumannii epidemics occurred. Genotype analysis by pulsed-field gel electrophoresis (PFGE) of A. baumannii isolates from 131 patients identified nine distinct PFGE patterns. Of these, PFGE clones B and I predominated and occurred sequentially during the two epidemics. A. baumannii epidemic clones showed a multidrug-resistant antibiotype, being clone B resistant to all antimicrobials tested except the carbapenems and clone I resistant to all antimicrobials except ampicillin-sulbactam and gentamicin. Type 1 integrons of 2.5 and 2.2 kb were amplified from the chromosomal DNA of epidemic PFGE clones B and I, respectively, but not from the chromosomal DNA of the nonepidemic clones. Nucleotide analysis of clone B integron identified four gene cassettes: aacC1, which confers resistance to gentamicin; two open reading frames (ORFs) coding for unknown products; and aadA1a, which confers resistance to spectinomycin and streptomycin. The integron of clone I contained three gene cassettes: aacA4, which confers resistance to amikacin, netilmicin, and tobramycin; an unknown ORF; and blaOXA-20, which codes for a class D ß-lactamase that confers resistance to amoxicillin, ticarcillin, oxacillin, and cloxacillin. Also, the blaIMP allele was amplified from chromosomal DNA of A. baumannii strains of PFGE type I. Class 1 integrons carrying antimicrobial resistance genes and blaIMP allele in A. baumannii epidemic strains correlated with the high use rates of broad-spectrum cephalosporins, carbapenems, and aminoglycosides in the ICU during the study period.

* Corresponding author. Mailing address: Dipartimento di Scienze Mediche Preventive, Università di Napoli "Federico II," Via S. Pansini n. 5, 80131 Napoli, Italy. Phone: 39-081-7463026. Fax: 39-081-7703285. E-mail: rafzarri{at}unina.it.

Journal of Clinical Microbiology, March 2004, p. 946-953, Vol. 42, No. 3
0095-1137/04/$08.00+0     DOI: 10.1128/JCM.42.3.946-953.2004
Copyright © 2004, American Society for Microbiology. All Rights Reserved.



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