Descriptive analysis of targeted carbapenemase genes and antibiotic susceptibility profiles among carbapenem-resistant
Acinetobacter baumannii
tested in the Antimicrobial Resistance Laboratory Network—United States, 2017–2020
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Published:2024-01-04
Issue:
Volume:
Page:
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ISSN:2165-0497
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Container-title:Microbiology Spectrum
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language:en
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Short-container-title:Microbiol Spectr
Author:
Sabour Sarah1ORCID, Bantle Katie1, Bhatnagar Amelia1ORCID, Huang Jennifer Y.1ORCID, Biggs Angela2, Bodnar Janine3, Dale Jennifer L.4, Gleason Rachel5, Klein Liore2, Lasure Megan6, Lee Rachel7, Nazarian Elizabeth3, Schneider Emily8, Smith Lori9, Snippes Vagnone Paula4, Therrien Michelle5, Tran Michael8, Valley Ann6, Wang Chun7, Young Erin L.9, Lutgring Joseph D.1ORCID, Brown Allison C.1ORCID
Affiliation:
1. Division of Healthcare Quality Promotion, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA 2. Maryland Department of Health, Baltimore, Maryland, USA 3. Wadsworth Center, Albany, New York, USA 4. Minnesota Department of Health, St. Paul, Minnesota, USA 5. Tennessee Department of Health, Nashville, Tennessee, USA 6. Wisconsin State Laboratory of Hygiene, Madison, Wisconsin, USA 7. Texas Department of State Health Services, Austin, Texas, USA 8. Washington State Department of Health Public Health Laboratories, Shoreline, Washington, USA 9. Utah Public Health Laboratory, Taylorsville, Utah, USA
Abstract
ABSTRACT
Acinetobacter baumannii
is a Gram-negative bacillus that can cause severe and difficult-to-treat healthcare-associated infections.
A. baumannii
can harbor mobile genetic elements carrying genes that produce carbapenemase enzymes, further limiting therapeutic options for infections. In the United States, the Antimicrobial Resistance Laboratory Network (AR Lab Network) conducts sentinel surveillance of carbapenem-resistant
Acinetobacter baumannii
(CRAB). Participating clinical laboratories sent CRAB isolates to the AR Lab Network for characterization, including antimicrobial susceptibility testing and molecular detection of class A (
Klebsiella pneumoniae
carbapenemase), class B (Active-on-Imipenem, New Delhi metallo-β-lactamase, and Verona integron-encoded metallo-β-lactamase), and class D (Oxacillinase,
bla
OXA-23-like
,
bla
OXA-24/40-like
,
bla
OXA-48-like
, and
bla
OXA-58-like
) carbapenemase genes. During 2017‒2020, 6,026 CRAB isolates from 45 states were tested for targeted carbapenemase genes; 1% (64 of 5,481) of CRAB tested for targeted class A and class B genes were positive, but 83% (3,351 of 4,041) of CRAB tested for targeted class D genes were positive. The number of CRAB isolates carrying a class A or B gene increased from 2 of 312 (<1%) tested in 2017 to 26 of 1,708 (2%) tested in 2020. Eighty-three percent (2,355 of 2,846) of CRAB with at least one of the targeted carbapenemase genes and 54% (271 of 500) of CRAB without were categorized as extensively drug resistant; 95% (42 of 44) of isolates carrying more than one targeted gene had difficult-to-treat susceptibility profiles. CRAB isolates carrying targeted carbapenemase genes present an emerging public health threat in the United States, and their rapid detection is crucial to improving patient safety.
IMPORTANCE
The Centers for Disease Control and Prevention has classified CRAB as an urgent public health threat. In this paper, we used a collection of >6,000 contemporary clinical isolates to evaluate the phenotypic and genotypic properties of CRAB detected in the United States. We describe the frequency of specific carbapenemase genes detected, antimicrobial susceptibility profiles, and the distribution of CRAB isolates categorized as multidrug resistant, extensively drug-resistant, or difficult to treat. We further discuss the proportion of isolates showing susceptibility to Food and Drug Administration-approved agents. Of note, 84% of CRAB tested harbored at least one class A, B, or D carbapenemase genes targeted for detection and 83% of these carbapenemase gene-positive CRAB were categorized as extensively drug resistant. Fifty-four percent of CRAB isolates without any of these carbapenemase genes detected were still extensively drug-resistant, indicating that infections caused by CRAB are highly resistant and pose a significant risk to patient safety regardless of the presence of one of these carbapenemase genes.
Funder
HHS | Centers for Disease Control and Prevention
Publisher
American Society for Microbiology
Subject
Infectious Diseases,Cell Biology,Microbiology (medical),Genetics,General Immunology and Microbiology,Ecology,Physiology
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