Emergence of carbapenem resistance in Acinetobacter baumannii ...
Emergence of carbapenem resistance in Acinetobacter baumannii ...
Emergence of carbapenem resistance in Acinetobacter baumannii ...
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Nemec et al.<br />
MIC (mg/L)<br />
PCR detection <strong>of</strong> <strong>resistance</strong>-associated genes<br />
Pearson correlation<br />
45<br />
50<br />
55<br />
60<br />
65<br />
70<br />
75<br />
80<br />
85<br />
90<br />
95<br />
100<br />
Stra<strong>in</strong><br />
no.<br />
Hospital,unit,<br />
month/year<br />
<strong>of</strong> isolation<br />
PFGE<br />
pattern<br />
No. <strong>of</strong><br />
<strong>resistance</strong>s<br />
Netilmic<strong>in</strong><br />
Ceftazidime<br />
Meropenem<br />
Imipenem<br />
adeB<br />
adeS<br />
Integron VR<br />
<strong>in</strong>tI1<br />
aacC1<br />
aphA1<br />
aphA6<br />
aadB<br />
tet(B)<br />
tet(A)<br />
bla TEM-1<br />
bla oxa-58-like<br />
bla oxa-24-like<br />
ISAba1-bla oxa51-like<br />
ISAba1- ampC-like<br />
ISAba1<br />
NIPH 2668<br />
NIPH 2687<br />
NIPH 2688<br />
NIPH 2601<br />
NIPH 2635<br />
NIPH 2654<br />
NIPH 2617<br />
NIPH 2625<br />
NIPH 2592<br />
NIPH 2594<br />
NIPH 2562<br />
NIPH 2571<br />
NIPH 2895<br />
NIPH 2550<br />
NIPH 2568<br />
NIPH 2884<br />
NIPH 2518<br />
NIPH 2546<br />
NIPH 2588<br />
NIPH 2991<br />
NIPH 2519<br />
NIPH 2833<br />
NIPH 2981<br />
NIPH 2982<br />
NIPH 2996<br />
NIPH 2922<br />
NIPH 2927<br />
NIPH 2862<br />
NIPH 2867<br />
NIPH 2694<br />
NIPH 2678<br />
NIPH 2685<br />
NIPH 2698<br />
NIPH 2649<br />
NIPH 2655<br />
NIPH 2549<br />
NIPH 2650<br />
NIPH 2893<br />
NIPH 2937<br />
NIPH 2573<br />
NIPH 2737<br />
NIPH 2851<br />
NIPH 2756<br />
NIPH 2873<br />
NIPH 2902<br />
NIPH 2741<br />
NIPH 2743<br />
NIPH 2920<br />
NIPH 2992<br />
NIPH 2904<br />
NIPH 2911<br />
NIPH 2990<br />
NIPH 2580<br />
NIPH 2578<br />
NIPH 2584<br />
NIPH 2874<br />
RUH 134<br />
NIPH 2726<br />
NIPH 2733<br />
NIPH 2723<br />
NIPH 2729<br />
NIPH 2610<br />
NIPH 2751<br />
NIPH 2879<br />
NIPH 2703<br />
NIPH 2704<br />
NIPH 2700<br />
NIPH 2980<br />
NIPH 2665<br />
NIPH 2666<br />
NIPH 2605<br />
NIPH 2554<br />
NIPH 2713<br />
RUH 875<br />
NIPH 2615<br />
NIPH 2715<br />
NIPH 2620<br />
NIPH 2988<br />
NIPH 2989<br />
NIPH 2658<br />
NIPH 2660<br />
NIPH 2621<br />
NIPH 2987<br />
NIPH 2890<br />
NIPH 2714<br />
NIPH 2581<br />
NIPH 2735<br />
NIPH 2837<br />
NIPH 2693<br />
NIPH 2696<br />
NIPH 2906<br />
NIPH 2599<br />
NIPH 2602<br />
NIPH 2582<br />
NIPH 2828<br />
NIPH 2722<br />
NIPH 2885<br />
NIPH 2967<br />
NIPH 2880<br />
NIPH 2517<br />
NIPH 2986<br />
NIPH 2869<br />
NIPH 2633<br />
NIPH 2943<br />
NIPH 2598<br />
NIPH 2645<br />
NIPH 2547<br />
NIPH 2926<br />
NIPH 2968<br />
NIPH 2614<br />
Strakonice,A,07/05<br />
Kladno,B,07/05<br />
Příbram,B,07/05<br />
Most,A,03/05<br />
Příbram,E,05/05<br />
Příbram,A,06/05<br />
Kolín,A,05/05<br />
Praha 2,C,05/05<br />
Brno,A,04/05<br />
Brno,A,04/05<br />
Liberec,A,04/05<br />
Slaný,04/05<br />
Kolín,A,11/05<br />
Praha 5,B,04/05<br />
Liberec,A,04/05<br />
Praha 1,B,11/05<br />
Kolín,C,03/05<br />
Praha 2,A,03/05<br />
Praha 4,A,04/05<br />
Příbram,A,04/06<br />
Praha 2,A,03/05<br />
Praha 2,E,10/05<br />
Praha 3,A,08/05<br />
Praha 3,A,11/05<br />
Budějovice,B,01/06<br />
Budějovice,A,01/06<br />
Praha 6, 11/05<br />
Praha 1,A,10/05<br />
Most,D,09/05<br />
Strakonice,B,08/05<br />
Příbram,A,07/05<br />
Kolín,B,07/05<br />
Kladno,B,08/05<br />
Praha 2,B,06/05<br />
Kolín,B,03/05<br />
Praha 5,A,04/05<br />
Praha 2,B,06/05<br />
Praha 1,B,11/05<br />
Praha 1,A,01/06<br />
Praha 2,B,04/05<br />
Kladno,A,09/05<br />
Praha 4,A,10/05<br />
Praha 2,D,09/05<br />
Praha 1,B,10/05<br />
Praha 1,C,12/05<br />
Příbram,C,08/05<br />
Příbram,D,08/05<br />
Příbram,A,12/05<br />
Příbram,E,04/06<br />
Praha 1,A,12/05<br />
Praha 1,B,12/05<br />
Praha 3,A,03/06<br />
Praha 6,04/05<br />
Praha 6,04/05<br />
Praha 6,04/05<br />
Praha 1,B,11/05<br />
Most,C,08/05<br />
Most,D,08/05<br />
Most,C,06/05<br />
Most,B,08/05<br />
Most,A,04/05<br />
Nový Jičín,A,09/05<br />
Brno,B,11/05<br />
Kolín,A,08/05<br />
Kolín,C,08/05<br />
Kladno,B,08/05<br />
Praha 3,B,08/05<br />
Pardubice,B,06/05<br />
Pardubice,C,07/05<br />
Most,B,04/05<br />
Praha 2,A,04/05<br />
Kladno,A,08/05<br />
Praha 2,A,05/05<br />
Pardubice,B,08/05<br />
Kladno,A,05/05<br />
Praha 3,F,03/06<br />
Praha 3,B,03/06<br />
Praha 4,B,06/05<br />
Praha 4,A,06/05<br />
Kladno,A,05/05<br />
Praha 3,D,03/06<br />
Praha 1,C,11/05<br />
Pardubice,A,08/05<br />
Praha 6,03/05<br />
Plzeň,A,08/05<br />
Pardubice,C,05/05<br />
Strakonice,A,08/05<br />
Pardubice,D,08/05<br />
Plzeň,A,12/05<br />
Praha 2,F,04/05<br />
Most,A,04/05<br />
Praha 6,04/05<br />
Kolín,A,09/05<br />
Most,A,06/05<br />
Praha 1,B,11/05<br />
Ostrava,01/05<br />
Brno,A,11/05<br />
Cheb,A,03/06<br />
Praha 3,C,03/06<br />
Most,A,10/05<br />
Kladno,A,05/05<br />
Most,B,11/05<br />
Cheb,B,04/05<br />
Kladno,A,06/05<br />
Praha 2,A,03/05<br />
Praha 6,11/05<br />
Ostrava,03/05<br />
Praha 2,G,05/05<br />
A1<br />
A2<br />
A2<br />
A2<br />
A1<br />
A1<br />
A2<br />
A1<br />
A3<br />
A3<br />
A2<br />
A1<br />
A1<br />
A2<br />
A2<br />
A2<br />
A2<br />
A2<br />
A2<br />
A2<br />
A2<br />
A2<br />
A2<br />
A4<br />
A2<br />
A5<br />
A1<br />
A2<br />
A2<br />
A1<br />
A2<br />
A2<br />
A2<br />
A1<br />
A2<br />
A1<br />
A1<br />
A1<br />
A1<br />
A1<br />
A1<br />
A1<br />
A1<br />
A1<br />
A1<br />
A2<br />
A1<br />
A5<br />
A6<br />
A6<br />
A6<br />
A6<br />
A5<br />
A5<br />
A5<br />
A5<br />
A7<br />
A7<br />
A8<br />
A8<br />
A9<br />
A10<br />
A11<br />
A12<br />
A13<br />
A12<br />
unique<br />
B4<br />
B3<br />
B1<br />
B1<br />
B2<br />
NT<br />
NT<br />
NT<br />
unique<br />
NT<br />
NT<br />
NT<br />
NT<br />
NT<br />
NT<br />
NT<br />
NT<br />
NT<br />
NT<br />
NT<br />
NT<br />
NT<br />
NT<br />
NT<br />
unique<br />
NT<br />
NT<br />
NT<br />
unique<br />
unique<br />
NT<br />
NT<br />
NT<br />
NT<br />
NT<br />
NT<br />
NT<br />
NT<br />
NT<br />
NT<br />
NT<br />
9<br />
9<br />
10<br />
8<br />
9<br />
9<br />
7<br />
8<br />
8<br />
6<br />
9<br />
11<br />
8<br />
9<br />
8<br />
7<br />
7<br />
9<br />
7<br />
8<br />
12<br />
9<br />
10<br />
10<br />
7<br />
6<br />
10<br />
11<br />
6<br />
8<br />
11<br />
7<br />
7<br />
9<br />
8<br />
7<br />
12<br />
9<br />
9<br />
7<br />
7<br />
9<br />
10<br />
7<br />
9<br />
9<br />
8<br />
8<br />
8<br />
7<br />
5<br />
4<br />
7<br />
6<br />
7<br />
6<br />
7<br />
7<br />
8<br />
8<br />
7<br />
7<br />
5<br />
5<br />
5<br />
5<br />
3<br />
5<br />
6<br />
7<br />
3<br />
9<br />
0<br />
0<br />
0<br />
0<br />
0<br />
0<br />
0<br />
0<br />
0<br />
0<br />
0<br />
0<br />
0<br />
0<br />
0<br />
0<br />
0<br />
0<br />
0<br />
3<br />
0<br />
0<br />
0<br />
4<br />
6<br />
0<br />
0<br />
0<br />
0<br />
0<br />
0<br />
0<br />
0<br />
0<br />
0<br />
0<br />
64 >64 4 4<br />
>64 >64 2 2<br />
16 >64 16 8<br />
>64 >64 4 2<br />
64 >64 4 2<br />
64 >64 4 2<br />
32 >64 1 1<br />
1 >64 1 1<br />
64 64 1 1<br />
0.5 64 1 1<br />
>64 >64 2 1<br />
>64 >64 >16 16<br />
>64 >64 4 4<br />
>64 >64 2 1<br />
32 >64 1 1<br />
16 >64 1 1<br />
32 >64 1 1<br />
>64 >64 2 1<br />
8 >64 1 1<br />
32 >64 2 2<br />
>64 >64 >16 16<br />
>64 >64 1 1<br />
32 >64 >16 8<br />
64 >64 8 4<br />
16 >64 2 1<br />
1 >64 4 4<br />
8 >64 >16 16<br />
>64 >64 16 8<br />
1 >64 2 2<br />
32 >64 2 2<br />
32 >64 >16 8<br />
32 >64 1 1<br />
32 >64 2 2<br />
32 >64 16 8<br />
32 >64 1 1<br />
16 >64 1 1<br />
>64 >64 16 8<br />
32 >64 16 8<br />
16 >64 16 8<br />
64 >64 4 2<br />
32 64 2 2<br />
16 >64 16 4<br />
16 >64 16 4<br />
16 >64 1 1<br />
32 >64 >16 16<br />
16 64 8 4<br />
32 >64 4 2<br />
16 >64 >16 8<br />
16 >64 16 8<br />
>64 >64 4 2<br />
16 >64 1 1<br />
4 >64 1 1<br />
>64 >64 2 1<br />
16 >64 8 8<br />
16 >64 8 8<br />
16 >64 1 1<br />
>64 >64 2 2<br />
>64 >64 2 2<br />
>64 >64 2 2<br />
>64 >64 2 2<br />
32 >64 4 2<br />
16 64 1 1<br />
16 32 0.5 0.5<br />
8 8 0.5 0.25<br />
16 2 0.5 0.25<br />
16 8 0.5 0.25<br />
0.5 8 16 8<br />
8 64 0.5 1<br />
8 64 0.5 1<br />
4 8 0.25 0.25<br />
8 8 0.25 0.25<br />
32 >64 8 4<br />
1 2 0.125 0.25<br />
1 4 0.25 0.25<br />
1 4 0.25 0.25<br />
1 1 0.125 0.25<br />
1 2 0.25 0.25<br />
1 4 0.125 0.25<br />
1 4 0.25 0.25<br />
0.5 8 0.25 0.25<br />
0.5 2 0.125 0.25<br />
1 8 0.5 0.25<br />
1 4 0.25 0.25<br />
0.5 4 0.125 0.125<br />
1 4 0.25 0.25<br />
1 8 0.25 0.25<br />
0.5 4 0.25 0.25<br />
1 4 0.25 0.25<br />
0.5 4 0.125 0.125<br />
0.5 4 0.125 0.125<br />
0.5 4 0.125 0.125<br />
0.5 4 4 8<br />
0.5 4 0.25 0.25<br />
0.5 4 0.125 0.125<br />
0.5 2 0.25 0.25<br />
2 64 1 0.5<br />
4 >64 0.5 0.5<br />
0.5 2 0.125 0.125<br />
0.25 1 0.125 0.125<br />
0.5 1 0.125 0.125<br />
0.5 4 0.125 0.25<br />
0.5 4 0.125 0.125<br />
0.5 1 0.125 0.125<br />
1 2 0.125 0.25<br />
0.125 1 0.125 0.125<br />
0.5 1 0.125 0.125<br />
0.5 4 0.125 0.125<br />
1 2 0.25 0.25<br />
3.0<br />
3.0<br />
3.0<br />
3.0<br />
3.0<br />
3.0<br />
3.0<br />
3.0<br />
2.5<br />
2.5<br />
3.0<br />
3.0<br />
3.0<br />
3.0<br />
3.0<br />
3.0<br />
3.0<br />
3.0<br />
3.0<br />
3.0<br />
3.0<br />
3.0<br />
3.0<br />
3.0<br />
3.0<br />
3.0<br />
3.0<br />
3.0<br />
3.0<br />
3.0<br />
2.5<br />
3.0<br />
3.0<br />
3.0<br />
3.0<br />
3.0<br />
3.0<br />
3.0<br />
2.5<br />
3.0<br />
3.0<br />
3.0<br />
3.0<br />
3.0<br />
3.0<br />
3.0<br />
3.0<br />
3.0<br />
3.0<br />
3.0<br />
2.5<br />
2.5<br />
2.5<br />
3.5<br />
2.5<br />
2.5<br />
2.5<br />
3.0<br />
3.0<br />
2.5<br />
EU clone I EU clone II<br />
Figure 1. Dendrogram <strong>of</strong> cluster analysis <strong>of</strong> AFLP f<strong>in</strong>gerpr<strong>in</strong>ts <strong>of</strong> 108 A. <strong>baumannii</strong> isolates <strong>in</strong> the present study. Clusters <strong>of</strong> more than two isolates def<strong>in</strong>ed<br />
at 80% are marked by vertical l<strong>in</strong>es. Numbers follow<strong>in</strong>g the city name <strong>in</strong>dicate different hospitals <strong>in</strong> the city; capitals denote different ICUs <strong>in</strong> the same<br />
hospital. Indicated are the numbers <strong>of</strong> antimicrobial agents to which an isolate was resistant us<strong>in</strong>g disc diffusion with 12 antimicrobial agents. Positive PCR<br />
results are presented by black boxes. All stra<strong>in</strong>s were positive both for ampC-like and bla OXA-51-like , and negative for bla IMP-like , bla VIM-like , bla SIM-1 , aacC2<br />
and aacA4. All stra<strong>in</strong>s positive for aacC1 were also positive for aadA1. VR 2.5, 3.0 and 3.5 denote three respective variable class 1 <strong>in</strong>tegron regions. Positive<br />
PCR results for primer comb<strong>in</strong>ations ISAba1-bla OXA-51-like and ISAba1-ampC-like <strong>in</strong>dicate the location <strong>of</strong> ISAba1 <strong>in</strong> the promotor regions <strong>of</strong> bla OXA-51-like<br />
and ampC-like, respectively. The designations <strong>of</strong> isolates studied by MLST are underl<strong>in</strong>ed. RUH 134 and RUH 875 are the reference stra<strong>in</strong>s <strong>of</strong> EU clones II<br />
and I, respectively. 2 NT, not tested; blank, negative (except for RUH 134 and RUH 875 for which no data are shown).<br />
486
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