Antibiotic Resistance Is a Major Risk Factor for Epidemic Behavior ofAcinetobacter baumannii

Abstract

AbstractObjective:To study the presence of bacterial factors in clinical isolates ofAcinetobacterspecies in order to identify markers of epidemic potential.Design:Case-control study.Methods:Forty-six isolates ofAcinetobacterspecies, including 23 epidemic and 23 sporadic strains from different outbreaks in nine European countries, were compared for the presence of the following factors: hemagglutination, presence of capsules and fimbriae, binding to salivary mucins, resistance to drying, and antibiogram typing. Genotyping of all strains was performed by amplified fragment-length polymorphism (AFLP).Results:All outbreak strains except two (91%) were identified asAcinetobacter baumannii. Binding to salivary mucins and resistance to antibiotics were significantly associated with epidemic behavior. Antibiogram typing showed clustering of predominantlyA baumanniistrains within one group, and these strains were significantly more resistant to antibiotics than sporadic strains. AFLP genotyping revealed a great heterogeneity among the different EuropeanAcinetobacterstrains. Cluster analysis of AFLP fingerprints showed several small clusters of differentA baumanniioutbreak strains. AFLP genotyping could not identify a common epidemic marker within the strains studied.Conclusions:Antibiogram typing can be used in routine clinical laboratories as a screening method to recognize potentially epidemicA baumanniistrains. Several other factors were found, both in different outbreaks as well as in sporadicAcinetobacterisolates. These characteristics were unable to predict epidemic behavior and therefore cannot be used as discriminative epidemic markers. AFLP genotyping demonstrated no common clonal origin of European epidemicA baumanniistrains. This indicates that any clinicalA baumanniiisolate with resistance to multiple antibiotics can be a potential nosocomial outbreak strain.