Abstract
Carbapenem antibiotics are among the mainstays for treating infections caused by Acinetobacter baumannii, especially in the Northwest United States, where carbapenem-resistant A. baumannii remains relatively rare. However, between June 2012 and October 2014, an outbreak of carbapenem-resistant A. baumannii occurred in 16 patients from five health care facilities in the state of Oregon. All isolates were defined as extensively drug resistant. Multilocus sequence typing revealed that the isolates belonged to sequence type 2 (international clone 2 [IC2]) and were 95% similar as determined by repetitive-sequence-based PCR analysis. Multiplex PCR revealed the presence of a blaOXA carbapenemase gene, later identified as blaOXA-237. Whole-genome sequencing of all isolates revealed a well-supported separate branch within a global A. baumannii phylogeny. Pacific Biosciences (PacBio) SMRT sequencing was also performed on one isolate to gain insight into the genetic location of the carbapenem resistance gene. We discovered that blaOXA-237, flanked on either side by ISAba1 elements in opposite orientations, was carried on a 15,198-bp plasmid designated pORAB01-3 and was present in all 16 isolates. The plasmid also contained genes encoding a TonB-dependent receptor, septicolysin, a type IV secretory pathway (VirD4 component, TraG/TraD family) ATPase, an integrase, a RepB family plasmid DNA replication initiator protein, an alpha/beta hydrolase, and a BrnT/BrnA type II toxin-antitoxin system. This is the first reported outbreak in the northwestern United States associated with this carbapenemase. Particularly worrisome is that blaOXA-237 was carried on a plasmid and found in the most prominent worldwide clonal group IC2, potentially giving pORAB01-3 great capacity for future widespread dissemination.
| Original language | English (US) |
|---|---|
| Article number | e00797-17 |
| Journal | Antimicrobial Agents and Chemotherapy |
| Volume | 61 |
| Issue number | 11 |
| DOIs | |
| State | Published - Nov 1 2017 |
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Keywords
- Acinetobacter
- Acinetobacter baumannii
- Carbapenemase
- OXA-237
- Plasmid
ASJC Scopus subject areas
- Pharmacology
- Pharmacology (medical)
- Infectious Diseases
Cite this
Nosocomial outbreak of extensively drug-resistant acinetobacter baumannii isolates containing blaOXA-237 carried on a plasmid. / Hujer, Andrea M.; Higgins, Paul G.; Rudin, Susan D.; Buser, Genevieve L.; Marshall, Steven H.; Xanthopoulou, Kyriaki; Seifert, Harald; Rojas, Laura J.; Domitrovic, T. Nicholas; Cassidy, P. Maureen; Cunningham, Margaret C.; Vega, Robert; Furuno, Jon P.; Pfeiffer, Christopher; Beldavs, Zintars G.; Wright, Meredith S.; Jacobs, Michael R.; Adams, Mark D.; Bonomo, Robert A.
In: Antimicrobial Agents and Chemotherapy, Vol. 61, No. 11, e00797-17, 01.11.2017.Research output: Contribution to journal › Article
}
TY - JOUR
T1 - Nosocomial outbreak of extensively drug-resistant acinetobacter baumannii isolates containing blaOXA-237 carried on a plasmid
AU - Hujer, Andrea M.
AU - Higgins, Paul G.
AU - Rudin, Susan D.
AU - Buser, Genevieve L.
AU - Marshall, Steven H.
AU - Xanthopoulou, Kyriaki
AU - Seifert, Harald
AU - Rojas, Laura J.
AU - Domitrovic, T. Nicholas
AU - Cassidy, P. Maureen
AU - Cunningham, Margaret C.
AU - Vega, Robert
AU - Furuno, Jon P.
AU - Pfeiffer, Christopher
AU - Beldavs, Zintars G.
AU - Wright, Meredith S.
AU - Jacobs, Michael R.
AU - Adams, Mark D.
AU - Bonomo, Robert A.
PY - 2017/11/1
Y1 - 2017/11/1
N2 - Carbapenem antibiotics are among the mainstays for treating infections caused by Acinetobacter baumannii, especially in the Northwest United States, where carbapenem-resistant A. baumannii remains relatively rare. However, between June 2012 and October 2014, an outbreak of carbapenem-resistant A. baumannii occurred in 16 patients from five health care facilities in the state of Oregon. All isolates were defined as extensively drug resistant. Multilocus sequence typing revealed that the isolates belonged to sequence type 2 (international clone 2 [IC2]) and were 95% similar as determined by repetitive-sequence-based PCR analysis. Multiplex PCR revealed the presence of a blaOXA carbapenemase gene, later identified as blaOXA-237. Whole-genome sequencing of all isolates revealed a well-supported separate branch within a global A. baumannii phylogeny. Pacific Biosciences (PacBio) SMRT sequencing was also performed on one isolate to gain insight into the genetic location of the carbapenem resistance gene. We discovered that blaOXA-237, flanked on either side by ISAba1 elements in opposite orientations, was carried on a 15,198-bp plasmid designated pORAB01-3 and was present in all 16 isolates. The plasmid also contained genes encoding a TonB-dependent receptor, septicolysin, a type IV secretory pathway (VirD4 component, TraG/TraD family) ATPase, an integrase, a RepB family plasmid DNA replication initiator protein, an alpha/beta hydrolase, and a BrnT/BrnA type II toxin-antitoxin system. This is the first reported outbreak in the northwestern United States associated with this carbapenemase. Particularly worrisome is that blaOXA-237 was carried on a plasmid and found in the most prominent worldwide clonal group IC2, potentially giving pORAB01-3 great capacity for future widespread dissemination.
AB - Carbapenem antibiotics are among the mainstays for treating infections caused by Acinetobacter baumannii, especially in the Northwest United States, where carbapenem-resistant A. baumannii remains relatively rare. However, between June 2012 and October 2014, an outbreak of carbapenem-resistant A. baumannii occurred in 16 patients from five health care facilities in the state of Oregon. All isolates were defined as extensively drug resistant. Multilocus sequence typing revealed that the isolates belonged to sequence type 2 (international clone 2 [IC2]) and were 95% similar as determined by repetitive-sequence-based PCR analysis. Multiplex PCR revealed the presence of a blaOXA carbapenemase gene, later identified as blaOXA-237. Whole-genome sequencing of all isolates revealed a well-supported separate branch within a global A. baumannii phylogeny. Pacific Biosciences (PacBio) SMRT sequencing was also performed on one isolate to gain insight into the genetic location of the carbapenem resistance gene. We discovered that blaOXA-237, flanked on either side by ISAba1 elements in opposite orientations, was carried on a 15,198-bp plasmid designated pORAB01-3 and was present in all 16 isolates. The plasmid also contained genes encoding a TonB-dependent receptor, septicolysin, a type IV secretory pathway (VirD4 component, TraG/TraD family) ATPase, an integrase, a RepB family plasmid DNA replication initiator protein, an alpha/beta hydrolase, and a BrnT/BrnA type II toxin-antitoxin system. This is the first reported outbreak in the northwestern United States associated with this carbapenemase. Particularly worrisome is that blaOXA-237 was carried on a plasmid and found in the most prominent worldwide clonal group IC2, potentially giving pORAB01-3 great capacity for future widespread dissemination.
KW - Acinetobacter
KW - Acinetobacter baumannii
KW - Carbapenemase
KW - OXA-237
KW - Plasmid
UR - http://www.scopus.com/inward/record.url?scp=85032503131&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85032503131&partnerID=8YFLogxK
U2 - 10.1128/AAC.00797-17
DO - 10.1128/AAC.00797-17
M3 - Article
C2 - 28893775
AN - SCOPUS:85032503131
VL - 61
JO - Antimicrobial Agents and Chemotherapy
JF - Antimicrobial Agents and Chemotherapy
SN - 0066-4804
IS - 11
M1 - e00797-17
ER -