Clonality, virulence determinants, and profiles of resistance of clinical Acinetobacter baumannii isolates obtained from a Spanish hospital

INTRODUCTION: Acinetobacter baumannii is a nosocomial pathogen that is showing increasing rates of carbapenem resistance. Multi-Drug Resistant (MDR) International Clones (ICs), associated with certain oxacillinases, are being reported globally. This organism also harbors numerous virulence determinants. In this study, we aim at characterizing A. baumannii isolated from a Spanish hospital in terms of antimicrobial susceptibility, clonality, carbapenemase genes harbored, and virulence determinants expressed. MATERIALS AND METHODS: Fifty nine clinical bloodstream isolates were obtained from 2009 until 2013. Antimicrobial Susceptibility Testing was performed according to the CLSI guidelines. PFGE and tri-locus PCR typing were then performed in order to determine local and international clonality. PCRs for the detection of common carbapenemases were also performed. Production of hemolysis, biofilms, siderophores, surface motility, and proteolysis were determined phenotypically. Doubling times for selected strains were also calculated. Finally, statistical analysis for detecting associations between these factors was conducted. RESULTS AND DISCUSSION: Carbapenem non-susceptibility was 84.75%, suggesting the immediate need for intervention. PFGE showed the distribution of the majority of the isolates among 7 clusters. Although all three ICs were detected, IC II was predominant at 71.19%. bla(OXA-24-like) was the most prevalent carbapenemase (62.71%), followed by bla(OXA-58-like) (13.56%), and bla(OXA-23-like) (11.86%). Strains pertaining to IC II, and those harboring bla(OXA-24-like), were positively associated with α-hemolysis, production of strong biofilms, and siderophore production. Harboring bla(OXA-23-like) and bla(OXA-58-like) was associated with attenuated virulence. These associations suggest that an interplay exists between these factors that could be locally exploited. CONCLUSIONS: An alarmingly high rate of carbapenem non-susceptibility has been detected in this study. There was a predominance of IC II and bla(OXA-24-like), and those factors were associated with heightened expression of virulence determinants. This association could be exploited for modifying treatment regimens and for improving on infection control protocols in this hospital.