Skip to main content
NCBI home page
Antimicrobial Agents and Chemotherapy logoLink to Antimicrobial Agents and Chemotherapy
letter
. 2010 Dec 13;55(3):1322–1323. doi: 10.1128/AAC.01102-10

High Prevalence of Carbapenem-Resistant Acinetobacter baumannii Carrying the blaOXA-143 Gene in Brazilian Hospitals▿

Charline S Antonio 1,2,3, Patrícia R Neves 1,2,3, Micheli Medeiros 1,2,3, Elsa M Mamizuka 1,2,3, Maria R Elmor de Araújo 1,2,3, Nilton Lincopan 1,2,3,*
PMCID: PMC3067065  PMID: 21149618

A recent article by Higgins et al. reported the identification of a novel carbapenem-hydrolyzing class D β-lactamase (CHDL), defined as OXA-143, in a carbapenem-resistant Acinetobacter baumannii strain isolated in Brazil in 2004 (5). This enzyme, which has 88% identity with OXA-40, is the first representative of a novel subgroup of CHDLs whose prevalence remains to be determined (5). In an attempt to carry out this task, we have conducted a surveillance study of carbapenem-resistant A. baumannii isolates in order to determine the antimicrobial susceptibility patterns and prevalence of blaOXA-type carbapenemase genes in medical centers in both the southeastern and southern regions of Brazil. We report here a high prevalence of carbapenem-resistant A. baumannii carrying the blaOXA-143 and blaOXA-23 genes, along with the first isolation of strains carrying the blaOXA-72 (OXA-72 is a single-amino-acid variant of OXA-40) and blaOXA-58 genes in Brazilian hospitals.

From 2004 to 2008, 36 carbapenem-resistant A. baumannii isolates recovered from different patients hospitalized in eight medical centers were screened for the presence of genes encoding metallo-β-lactamases (MβLs) and OXA-type β-lactamases (6, 15). Flanking sequences of blaOXA-type genes were characterized by PCR using primers targeting ISAba-1 or -3 (12). PCR products were confirmed by sequencing, and the genetic diversity of blaOXA-positive strains was determined by enterobacterial repetitive intergenic consensus (ERIC)-PCR analysis (11).

All isolates were found to be resistant to imipenem, meropenem, ceftazidime, aztreonam, piperacillin-tazobactam, and ciprofloxacin. Tobramycin (61.1%), ampicillin-sulbactam (61.1%), gentamicin (47.2%), amikacin (27.8%), and cefepime (11.1%) susceptibility rates were determined. MβL-encoding genes were not identified, whereas a high prevalence of blaOXA genes was noticed among carbapenem-resistant isolates (Table 1). In this regard, 21 strains (58.3%) carried the blaOXA-143 gene, 15 strains (41.7%) carried the ISAba-1/blaOXA-23 gene array, one strain carried the ISAba-3/blaOXA-58/ISAba-3 gene array, and two isolates carried the blaOXA-72 gene (GenBank accession no. FJ628170, FJ492877, FJ969387, and HM804278 to HM804281). Although the presence of the blaOXA-51 and ISAba-1 genes was confirmed in all of the isolates, no colinearity of the two genes (i.e., ISAba-1 adjacent to the blaOXA-23 gene) was observed. Isolates harboring the blaOXA-143, blaOXA-72, and blaOXA-58 genes were restricted to hospitals located in São Paulo (the largest and most populous metropolitan area in southeastern Brazil), while blaOXA-23-harboring A. baumannii isolates were obtained from hospitals in São Paulo and Paraná (in southern Brazil), confirming previous reports of widespread dissemination of OXA-23-producing A. baumannii in this region (2, 9). Finally, ERIC-PCR typing revealed genetic diversity among blaOXA-143- and blaOXA-23-positive A. baumannii isolates.

TABLE 1.

Characteristics of carbapenem-resistant A. baumannii isolates carrying blaOXA-type genes encoding class D carbapenemasesa

Isolate ERIC type Hospital/stateb Date (mo/yr) Clinical sample IPMc MIC (μg/ml) blaOXA gene(s)
01 A I/SP 08/04 Tracheal secretion >64 51, 58d
1110 A1 II/SP 04/08 Urine 32 51, 23e
919 A2 II/SP 05/08 Bronchoalveolar lavage fluid 32 51, 23e
39 B III/SP 07/08 Blood >32 51, 23e
80 C IV/SP 08/08 Sternal fluid >32 51, 23e
81 C IV/SP 08/08 Wound secretion >32 51, 23,e 143
493 D II/SP 08/08 Catheter tip 32 51, 23,e 143
1031 E II/SP 09/08 Urine >64 51, 23,e 143
906 E1 II/SP 06/08 Biliary secretion 32 51, 23e
605 F II/SP 08/08 Mediastinal fluid >64 51, 143
770 F1 II/SP 07/08 Urine >64 51, 143
1089 F2 II/SP 06/08 Blood >64 51, 143
1020 F2 II/SP 09/08 Urine >32 51, 143
559 F2 II/SP 09/08 Catheter tip >64 51, 143
649 F2 II/SP 04/08 Wound secretion >64 51, 143
736 F2 II/SP 08/08 Wound secretion >64 51, 143
824 F2 II/SP 07/08 Catheter tip >64 51, 143
580 F3 II/SP 06/08 Abdominal secretion >64 51, 143
1013 F4 II/SP 05/08 Urine >64 51, 143
803 F4 II/SP 08/08 Tracheal secretion 64 51, 143
804 F4 II/SP 09/08 Catheter tip >64 51, 143
26 G V/SP 08/08 Cervical secretion >32 51, 143
28 G1 IV/SP 10/08 Tracheal secretion >64 51, 143
45 G2 VI/SP 10/08 Bronchoalveolar lavage fluid >32 51, 143
30 H III/SP 07/08 Scar secretion >32 51, 23e
659 H1 II/SP 04/08 Scar secretion >64 51, 143
33 I IV/SP 11/08 Catheter tip >32 51, 143
55 J VII/PR 01/08 Peritoneal fluid 16 51, 23e
56 J VII/PR 01/08 Sputum 16 51, 23e
52 J1 VII/PR 01/08 Drain fluid >32 51, 23e
53 J1 VII/PR 02/08 Surgical fluid 32 51, 23e
54 J1 VII/PR 12/07 Sputum 32 51, 23e
3950 K VIIISP 09/07 Burn wound fluid 32 51, 72
4347 K VIII/SP 11/07 Burn wound fluid 64 51, 72
34 L V/SP 08/08 Catheter tip >32 51, 143
46 M VII/PR 08/07 Sputum >32 51, 23e
Open in a new tab
a

All multidrug-resistant A. baumannii strains were included in this study. Multidrug resistance was defined as resistance to three or more representatives of the major antibiotic categories (i.e., quinolones, extended-spectrum cephalosporins, aminoglycosides, and carbapenems). The A. baumannii isolates were identified by using the Vitek 2 automated instrument ID system and conventional biochemical tests and by detection of the blaOXA-51-like gene (10, 13). Susceptibilities to all antimicrobial agents were determined by disk diffusion, agar dilution, and the Etest (AB Biodisk, Solna, Sweden) and interpreted according to criteria of the Clinical and Laboratory Standards Institute (3). ERIC-PCR fingerprint patterns were analyzed using the Dice similarity coefficient and the unweighted-pair group method using average linkages cluster method (BioNumeric software, Applied Maths, Kortrijk, Belgium).

b

SP, São Paulo state (southeastern Brazil); PR, Paraná state (southern Brazil).

c

IPM, imipenem.

d

Flanked by ISAba-3 (downstream) and an ISAba-3-like element (upstream).

e

ISAba-1 upstream of the blaOXA-23 gene.

In summary, the blaOXA-143 gene was commonly identified among the carbapenem-resistant A. baumannii isolates surveyed in this study. Also, we report the first isolation of blaOXA-72- and blaOXA-58-carrying strains in Brazilian hospitals. OXA-143 is a new subgroup of CHDL identified in isolates of A. baumannii from Brazil (5). We would only bring to mind that the blaOXA-72 gene was first reported from an A. baumannii strain in Thailand in 2004 (GenBank accession no. AY739646), and so far it has been restricted to Acinetobacter sp. isolates from Asian and Mediterranean countries (1, 4, 7, 8, 14).

Acknowledgments

FAPESP and CNPq research grants are gratefully acknowledged.

We thank Cefar Diagnóstica Ltda. (São Paulo, Brazil) for kindly supplying antibiotic discs for susceptibility testing and M. Miranda, L. B. Teresawa, C. S. Ito, M. Gaspar, C. R. Busato, and M. C. Noronha do Amaral for providing clinical isolates.

Footnotes

▿

Published ahead of print on 13 December 2010.

REFERENCES

  • 1.Candel, F. J., et al. 2010. A combination of tigecycline, colistin, and meropenem against multidrug-resistant Acinetobacter baumannii bacteremia in a renal transplant recipient: pharmacodynamic and microbiological aspects. Rev. Esp. Quimioter. 23:103-108. [PubMed] [Google Scholar]
  • 2.Carvalho, K. R., et al. 2009. Dissemination of multidrug-resistant Acinetobacter baumannii genotypes carrying blaOXA-23 collected from hospitals in Rio de Janeiro, Brazil. Int. J. Antimicrob. Agents 34:25-28. [DOI] [PubMed] [Google Scholar]
  • 3.Clinical and Laboratory Standards Institute. 2009. Performance standards for antimicrobial susceptibility testing; 19th informational supplement. M100-S19. Clinical and Laboratory Standards Institute, Wayne, PA.
  • 4.Di Popolo, A., M. Giannouli, M. Triassi, S. Brisse, and R. Zarrilli. 28 April 2010, posting date. Molecular epidemiological investigation of multidrug-resistant Acinetobacter baumannii strains in four Mediterranean countries with a multilocus sequence typing scheme. Clin. Microbiol. Infect. doi: 10.1111/j.1469-0691.2010.03254.x. [DOI] [PubMed]
  • 5.Higgins, P. G., L. Poirel, M. Lehmann, P. Nordmann, and H. Seifert. 2009. OXA-143, a novel carbapenem-hydrolyzing class D beta-lactamase in Acinetobacter baumannii. Antimicrob. Agents Chemother. 53:5035-5038. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 6.Higgins, P. G., M. Lehmann, and H. Seifert. 2010. Inclusion of OXA-143 primers in a multiplex polymerase chain reaction (PCR) for genes encoding prevalent OXA carbapenemases in Acinetobacter spp. Int. J. Antimicrob. Agents 35:305. [DOI] [PubMed] [Google Scholar]
  • 7.Lee, K., et al. 2009. Wide dissemination of OXA-type carbapenemases in clinical Acinetobacter spp. isolates from South Korea. Int. J. Antimicrob. Agents 33:520-524. [DOI] [PubMed] [Google Scholar]
  • 8.Lu, P. L., M. Doumith, D. M. Livermore, T. L. Chen, and N. Woodford. 2009. Diversity of carbapenem resistance mechanisms in Acinetobacter baumannii from a Taiwan hospital: spread of plasmid-borne OXA-72 carbapenemase. J. Antimicrob. Chemother. 63:641-647. [DOI] [PubMed] [Google Scholar]
  • 9.Schimith Bier, K. E., et al. 2010. Temporal evolution of carbapenem-resistant Acinetobacter baumannii in Curitiba, southern Brazil. Am. J. Infect. Control 38:308-314. [DOI] [PubMed] [Google Scholar]
  • 10.Schreckenberger, P. C., M. I. Daneshvar, R. S. Weyant, and D. G. Hollis. 2003. Acinetobacter, Achromobacter, Chryseobacerium, Moraxella and other nonfermentative Gram-negative rods, p. 749-779. In P. R. Murray, E. J. Baron, J. H. Jorgensen, M. A. Pfaller, and R. H. Yolken (ed.), Manual of clinical microbiology, 8th ed. ASM Press, Washington, DC.
  • 11.Silbert, S., M. A. Pfaller, R. J. Hollis, A. L. Barth, and H. S. Sader. 2004. Evaluation of three molecular typing techniques for nonfermentative Gram-negative bacilli. Infect. Control Hosp. Epidemiol. 25:847-851. [DOI] [PubMed] [Google Scholar]
  • 12.Turton, J. F., et al. 2006. The role of ISAba1 in expression of OXA carbapenemase genes in Acinetobacter baumannii. FEMS Microbiol. Lett. 258:72-77. [DOI] [PubMed] [Google Scholar]
  • 13.Turton, J. F., et al. 2006. Identification of Acinetobacter baumannii by detection of the blaOXA-51-like carbapenemase gene intrinsic to this species. J. Clin. Microbiol. 44:2974-2976. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 14.Wang, H., et al. 2007. Molecular epidemiology of clinical isolates of carbapenem-resistant Acinetobacter spp. from Chinese hospitals. Antimicrob. Agents Chemother. 51:4022-4028. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 15.Woodford, N. 2010. Rapid characterization of beta-lactamases by multiplex PCR. Methods Mol. Biol. 642:181-192. [DOI] [PubMed] [Google Scholar]

Articles from Antimicrobial Agents and Chemotherapy are provided here courtesy of American Society for Microbiology (ASM)

RESOURCES