Occurrence of carbapenem-resistant Acinetobacter baumannii clones at multiple hospitals in London and Southeast England

Abstract

From late 2003 to the end of 2005, the Health Protection Agency's national reference laboratories received approximately 1,600 referrals of Acinetobacter spp., including 419 and 58 examples, respectively, of two carbapenem-resistant Acinetobacter baumannii lineages, designated OXA-23 clones 1 and 2. Representatives of these clones were obtained from 40 and 8 hospitals, respectively, in London or elsewhere in Southeast England. Both clones had blaOXA-23-like genes, as well as the intrinsic (but downregulated) blaOXA-51-like carbapenemase genes typical of A. baumannii. Both were highly multiresistant: only colistin and tigecycline remained active versus OXA-23 clone 1 isolates; OXA-23 clone 2 isolates were also susceptible to amikacin and minocycline. These lineages increase the burden created by the southeast (SE) clone, a previously reported A. baumannii lineage with variable carbapenem resistance contingent on upregulation of the blaOXA-51-like gene. Known since 2000, the SE clone had been referred from over 40 hospitals by the end of 2005, with 627 representatives received by the reference laboratories. The OXA-23 clone 2 is now in decline, but OXA-23 clone 1 continues to be referred from new sites, as does the SE clone. Their spread is forcing the use of unorthodox therapies, principally colistin and tigecycline, although the optimal regimens remain uncertain.

FIG. 1.

PFGE profiles of ApaI-digested genomic DNA from bla_OXA-23-positive isolates and representative members of the SE clone. A bla_OXA-23-negative isolate (H26) of OXA-23 clone 1 is also included, as are some OXA-23 producers (labeled sporadic 1 to 3) with unique PFGE profiles. Isolates were from hospitals H1 to H26 (OXA-23 clone 1) and 1 to 7 (OXA-23 clone 2). Letters A to C represent isolates from different patients at the same hospital.

FIG. 2.

MIC distribution of tigecycline (a) and colistin (b) for OXA-23 clone 1 (▪), OXA-23 clone 2 (░⃞), SE clone (▧), and A. baumannii isolates from the 2000 survey (11) (mixed genotypes [□]).