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Endemicity of Acinetobacter calcoaceticus-baumannii Complex in an Intensive Care Unit in Malaysia

Amreeta Dhanoa1, Ganeswrie Rajasekaram2, Soo Sum Lean3

  • 1Jeffrey Cheah School of Medicine and Health Sciences, Monash University Malaysia, 47500 Bandar Sunway, Malaysia.

Journal of Pathogens
|January 29, 2016
PubMed

Insights

Multidrug-resistant Acinetobacter calcoaceticus-baumannii complex (ACB complex) strains are spreading in Malaysian ICUs. Genetic analysis revealed clonally related, highly resistant ACB complex, necessitating early detection and infection control to prevent further dissemination.

Area of Science:

  • Medical Microbiology
  • Infectious Diseases
  • Epidemiology

Background:

  • The Acinetobacter calcoaceticus-baumannii complex (ACB complex) is a significant opportunistic pathogen, particularly prevalent in intensive care units (ICUs).
  • Understanding the epidemiological relatedness of ACB complex is crucial for effective control and prevention of its spread in healthcare settings.

Purpose of the Study:

  • To investigate the genetic relatedness of ACB complex isolates within an ICU in Malaysia.
  • To determine the antibiotic susceptibility profiles of these ACB complex isolates.
  • To identify potential sources and transmission routes of ACB complex in the hospital environment.

Main Methods:

  • Pulsed field gel electrophoresis (PFGE) was employed for molecular typing and assessing genetic relatedness.
  • E-test and disk diffusion methods were utilized to evaluate antibiotic resistance patterns.
  • Isolates were collected from ICU patients, including blood and bronchial aspirates, over a defined study period.

Main Results:

  • A total of 44 ACB complex isolates were recovered from 38 ICU patients during the study period (December 2011 to June 2012).
  • A high prevalence of multidrug-resistant (MDR) ACB complex was observed, with 88.6% of ICU isolates exhibiting MDR patterns.
  • Significant resistance was noted against carbapenems (MIC90 >32 μg/mL) and other antibiotics like amikacin, ampicillin/sulbactam, and cefoperazone/sulbactam (MIC90 ≥256 μg/mL).
  • PFGE analysis identified a main cluster of highly resistant, clonally related isolates, indicating clonal spread.
  • Evidence of ACB complex dissemination into non-ICU wards was also observed.

Conclusions:

  • The study identified a substantial number of clonally related, multidrug-resistant ACB complex strains.
  • While the ICU serves as a likely reservoir for ACB complex transmission, importation from other hospital wards may contribute significantly.
  • Prompt identification of strain relatedness and the implementation of robust infection control strategies are essential to curb the spread of ACB complex.

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