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JAC Advance Access originally published online on May 13, 2008
Journal of Antimicrobial Chemotherapy 2008 62(3):484-489; doi:10.1093/jac/dkn205
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© The Author 2008. Published by Oxford University Press on behalf of the British Society for Antimicrobial Chemotherapy. All rights reserved. For Permissions, please e-mail: journals.permissions@oxfordjournals.org

Original research

Emergence of carbapenem resistance in Acinetobacter baumannii in the Czech Republic is associated with the spread of multidrug-resistant strains of European clone II

Alexandr Nemec1,2,*, Lenka Krízová1, Martina Maixnerová1, Laure Diancourt3, Tanny J. K. van der Reijden4, Sylvain Brisse3, Peterhans van den Broek4 and Lenie Dijkshoorn4

1 Centre of Epidemiology and Microbiology, National Institute of Public Health, Prague, Czech Republic 2 3rd Faculty of Medicine, Charles University in Prague, Prague, Czech Republic 3 Genotyping of Pathogens and Public Health, Institut Pasteur, Paris, France 4 Department of Infectious Diseases, Leiden University Medical Center, Leiden, The Netherlands

Received 11 February 2008; returned 25 March 2008; revised 11 April 2008; accepted 16 April 2008

* Correspondence address. Centre of Epidemiology and Microbiology, National Institute of Public Health, Srobárova 48, 100 42 Prague 10, Czech Republic. Tel: +420-267082266; Fax: +420-267082538; E-mail: anemec{at}szu.cz

Objectives: The aim of this study was to analyse the emergence of carbapenem resistance among hospital strains of Acinetobacter in the Czech Republic.

Methods: Acinetobacter isolates were collected prospectively in 2005–06 from 19 diagnostic laboratories. They were identified to species level by AFLP, typed using AFLP, pulsed-field gel electrophoresis (PFGE) and multilocus sequence typing, and tested for susceptibility to 14 antimicrobials and for the presence of 20 genes associated with antimicrobial resistance.

Results: A total of 150 Acinetobacter isolates were obtained from 56 intensive care units of 20 hospitals in 15 cities. They were identified as Acinetobacter baumannii (n = 108) or other species. A. baumannii isolates were allocated to EU clone I (n = 5), EU clone II (n = 66) or other, mostly unique genotypes. Two-thirds of the clone II isolates had nearly identical AFLP and PFGE fingerprints. As many as 85% and 88% isolates were susceptible to meropenem and imipenem (≤4 mg/L), respectively. Carbapenem MICs of ≥8 mg/L were found in 23 A. baumannii isolates, of which 20 belonged to clone II. Isolates with blaOXA-58-like (n = 3), blaOXA-24-like (n = 1) or ISAba1 adjacent to blaOXA-51-like (n = 34) had carbapenem MICs of 2 to >16 mg/L, while those without these elements showed MICs of ≤0.5–4 mg/L. Clone II isolates varied in susceptibility to some antibiotics including carbapenems and carried 6–12 resistance genes in 17 combinations.

Conclusions: The emergence of Acinetobacter carbapenem resistance in the Czech Republic is associated with the spread of A. baumannii strains of EU clone II. The variation in susceptibility in these strains is likely to result from both the horizontal spread of resistance genes and differential expression of intrinsic genes.

Keywords: European clonal lineages , AFLP , PCR gene detection , OXA-type carbapenemases


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