Background: Acinetobacter spp. is an opportunistic pathogen that has demonstrated increasing relevance in nosocomial infections. Carbapenem-resistant strains have been reported worldwide. Methods: Since 2014, screening for metallo-β-lactamases (MBLs) in all Acinetobacter spp. isolates using phenotypic methods and PCR has been implemented at the University Hospital Center Zagreb. Results: The bacterial strain was isolated from the drain of a child hospitalized in a paediatric intensive care unit and identified as Acinetobacter guillouiae using a MALDI TOF automated system. The strain was resistant to meropenem, ceftazidime, cefotaxime, ceftriaxone, cefepime, sulbactam/ampicillin, gentamicin and ciprofloxacin, intermediately susceptible to piperacillin/tazobactam and imipenem, and susceptible to amikacin and colistin. The Hodge test and combined disk test with EDTA were positive. The MICs of meropenem and imipenem were not reduced by cloxacillin, but a small reduction of two dilutions was observed following the addition of sodium chloride, which indicated that OXA-58 was produced. PCR and sequencing of chromosomal DNA from boiled colonies revealed blaOXA-58 and blaNDM-1 genes. Conclusion: This is the first report of NDM-1 in Acinetobacter spp. in Croatia. The early detection of these genes will aid in the prevention and in the achievement of adequate infection control by limiting the spread of these organisms.

Keywords:
Acinetobacter, Metallo-β-lactamase, Screening
1.
Bergogne-Berenzin E, Towner KJ: Acinetobacter spp. as nocomial pathogen: microbiological, clinical and epidemiologic features. Clin Microbiol Rev 1996;9:148-165.
2.
Mammina C, Palma DM, Bonura C, Aleo A, Fasciana T, Sodano C, Saporito MA, Verde MS, Calà C, Cracchiolo AN, Tetamo R: Epidemiology and clonality of carbapenem-resistant Acinetobacter baumannii from an intensive care unit in Palermo, Italy. BMC Res Notes 2012;5:365.
3.
Goić-Barišić I, Bedenić B, Tonkić M, Katić S, Kalenić S, Punda-Polić V: Molecular characterisation of carbapenem resistant Acinetobacter baumannii in different intensive care units in University Hospital Split, Croatia. J Chemother 2007;19:462-464.
4.
Goić-Barišić I, Bedenić B, Tonkić M, Novak A, Katić S, Kalenić S, Punda-Polić V, Towner KJ: Occurrence of OXA-107 and ISAba 1 in carbapenem-resistant isolates of Acinetobacter baumannii from Croatia. J Clin Microbiol 2009;47:3348-3349.
5.
Goić-Barišić I, Towner, KJ, Kovačić A, Šiško-Kraljević K, Tonkić M, Novak A, Punda-Polić V: Outbreak in Croatia caused by a new carbapenem-resistant clone of Acinetobacter baumannii producing OXA-72 carbapenemase. J Hospit Infect 2011;77:368-369.
6.
Franolić-Kukina I, Bedenić B, Budimir A, Herljević Z, Vraneš J, Higgins P: Clonal spread of carbapenem-resistant OXA-72 positive Acinetobacter baumannii in a Croatian university hospital. Int J Infect Dis 2011;15:e706-e709.
7.
Vranić-Ladavac M, Bedenić B, Minandri F, Ištok M, Frančula-Zaninović S, Ladavac R, Visca P: Carbapenem-resistance and acquired class D beta-lactamases in Acinetobacter baumannii from Croatia 2009-2010. Eur J Clin Microbiol Infect Dis 2014;33:471-478.
8.
Clinical and Laboratory Standards Institute: Performance Standards for Antimicrobial Susceptibility Testing. 23rd Informational Supplement, M100-S23. Wayne, CLSI, 2013.
9.
Bertini A,, Poirel L,, Mugnier P, Villa J, Nordmann P, Caratoli A: Characterization and PCR-based replicon typing of resistance plasmids in Acinetobacter baumannii. Antimicrob Agents Chemother 2010;54:4168-4177.
10.
Lauretti L, Riccio ML, Mazzariol A, Cornaglia G, Amicosante G, Fontana R, Rossolini GM: Cloning and characterization of blaVIM, a new integron-borne metallo-β-lactamase gene from Pseudomonas aeruginosa clinical isolate. Antimicrob Agents Chemother 1999;43:1584-1590.
11.
Hrabak J, Stolobova M, Studentova V, Fridrichova M, Chudackova E, Zemlickova H: NDM-1 producing Acinetobacter baumannii isolated from a patient repatriated to the Czech Republic from Egypt, July 2011. Euro Surveill 2012;17:pii:20085.
12.
Rafei R, Dabbourssi F, Hamze M, Eveillard M, Lemarie C, Mallat H, Rolain HN, Guillou ML: First report of blaNDM-1 producing Acinetobacter baumannii isolated in Lebanon from civilians wounded during the Syrian war. Int J Infect Dis 2014;21:21-23.
13.
Revathi G, Siu K, Lu PL, Huang LY: First report of NDM-1 producing Acinetobacter baumannii in East Africa. Int J Infect Dis 2013;17:e1255-e1258.
14.
Fallah F, Noori M, Hashemi A, Goudarzi H, Karimi A, Erfanimanesh S, Alimer S: Prevalence of blaNDM-1, blaPER, bla VEB, blaIMP, and blaVIM genes among Acinetobacter baumannii isolated from two hospitals of Tehran, Iran. Scientifica (Cairo) 2014, Epub ahead of print.
15.
Bogaerts P, de Castro R, Roisin S, Deplano A, Huang TD, Hallin M: Emergence of NDM-1 producing Acinetobacter baumannii in Belgium. J Antimicrob Chemother 2012;67:1552-1553.
16.
Decousser JW, Jansen C, Nordmann P, Emirian A, Bonnin RA, Anais L, Merle JC, Poirel L: Outbreak of NDM-1-producing Acinetobacter baumannii in France, January to May 2013. Euro Surveill 2013;18:pii:20547.
17.
Karthikeyen K, Thirnujan MA, Krishan P: Coexistence of blaOXA-23 with blaNDM-1 and arm A in clinical isolates of Acinetobacter baumannii from India. J Antimicrob Chemother 2010;65:2253-2254.
18.
Zujić-Atalić V, Bedenić B, Kocsis E, Mazzariol A, Sardelić S, Barišić M, Plečko V, Bošnjak Z, Mijač M, Jajić I, Vranić-Ladavac M, Cornaglia G: Diversity of carbapenemases in clinical isolates of Enterobacteriaceae in Croatia - the results of a multicenter study. Clin Microbiol Infect 2014;20:O894-903.
19.
Mazzariol A, Bošnjak Z, Ballarini P, Budimir A, Bedenić B, Kalenić S, Cornaglia G: NDM-1 producing Klebsiella pneumoniae, Croatia. Emerg Infect Dis 2012;18:532-534.
20.
Dinc G, Demiraslan H, Elmali F, Ahmed SS, Metan G, Alp E, Doganay M: Efficacy of sulbactam and its combination with imipenem, colistin and tigecycline in an experimental model of carbapenem-resistant Acinetobacter baumannii sepsis. Chemotherapy 2013;59:325-329.
21.
Garnacho-Montero J, Amaya-Villar R, Gutiérrez-Pizarraya A, Espejo-Gutiérrez de Tena E, Artero-González ML, Corcia-Palomo Y, Bautista-Paloma J: Clinical efficacy and safety of the combination of colistin plus vancomycin for the treatment of severe infections caused by carbapenem-resistant Acinetobacter baumannii. Chemotherapy 2013;59:225-231.
22.
Morfín-Otero R, Alcántar-Curiel MD, Rocha MJ, Alpuche-Aranda CM, Santos-Preciado JI, Gayosso-Vázquez C, Araiza-Navarro JR, Flores-Vaca M, Esparza-Ahumada S, González-Díaz E, Pérez-Gómez HR, Rodríguez-Noriega E: Acinetobacter baumannii infections in a tertiary care hospital in Mexico over the past 13 years. Chemotherapy 2013;59:57-65.
© 2015 S. Karger AG, Basel
2015
Copyright / Drug Dosage / Disclaimer
Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher.
Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug.
Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.
You do not currently have access to this content.