Acinetobacter baumannii in blood-borne and central nervous system infections in intensive care unit children: molecular and genetic characteristics and clinical significance

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Abstract

Acinetobacter baumannii is a representative of the peak priority nosocomial pathogens capable of causing infections with high mortality and economic treatment costs. The purpose of our study was to determine a role of A. baumannii in blood-borne and central nervous system infections in children. We conducted a retrospective study of A. baumannii — associated cases of bacteremia and CNS infection in children. A. baumannii strains were isolated from 17 children followed up with surgical pathology (congenital heart defects — 24%, abdominal pathology — 29%, severe combined trauma — 29%) and with somatic diseases accompanied by antibacterial and/or glucocorticosteroid therapy — 18%. The minimum inhibitory concentrations of antibiotics were determined by the broth microdilution method. Carbapenemase genes were detected by real time polymerase chain reaction. Biofilm formation genes were determined by PCR. Biofilms were grown using flat-bottomed polystyrene tablets, followed by coloring, fixation, elution and detection. Population diversity was assessed by the multilocus sequence typing. About a quarter of cases of bacteremia and central nervous system infection caused by A. baumannii had an unfavorable outcome. Resistance to carbapenems, aminoglycosides, fluoroquinolones was more than 70%. Carbapenemases of the OXA-23 (24%) and OXA-40 (41%) groups were identified. The study of biofilm production showed that A. baumannii isolates formed biofilms of varying intensity: weak biofilms (59%), moderate (35%) and strong (6%). During determining the sensitivity to meropenem for biofilm and planktonic forms of cultures, it was determined that the minimum inhibitory concentrations of meropenem were significantly higher for biofilms than for planktonic forms. The minimum inhibitory concentrations of meropenem for plankton cells ranged from 0.5 to 512 mg/l. While in biofilms the same microorganisms had in vitro minimum inhibitory concentrations of meropenem within 128 to 512 mg/l and higher. All isolates bore biofilm formation regulating genes: bfmR, bap and katE. The ompA gene was found in 94% strains, and the csuA/B gene was found in 88%. The population pattern of A. baumannii isolated from blood and cerebrospinal fluid of children was represented by nine different sequence types. Most of the isolates were represented by genotypes: ST944Oxf, ST1550Oxf, ST1104Oxf belonging to the international clonal line ICL6, and ST450Oxf, ST2063Oxf and ST1102Oxf of the international clonal line ICL2. Blood-borne and central nervous system infections associated with A. baumannii have a great importance in clinical practice. This microorganism is able to persist for a long time on biotic and abiotic surfaces, has a wide natural and acquired antibiotics resistance.

About the authors

Zulfirya Z. Sadeeva

National Medical Research Center for Children’s Health, Ministry of Health of the Russian Federation

Author for correspondence.
Email: zulfiryasadeeva@yandex.ru

Junior Researcher, Laboratory of Molecular Microbiology

Russian Federation, Moscow

Irina E. Novikova

National Medical Research Center for Children’s Health, Ministry of Health of the Russian Federation

Email: zulfiryasadeeva@yandex.ru

Junior Researcher, Laboratory of Molecular Microbiology

Russian Federation, Moscow

Natalia M. Alyabyeva

National Medical Research Center for Children’s Health, Ministry of Health of the Russian Federation

Email: zulfiryasadeeva@yandex.ru

PhD (Medicine), Senior Researcher, Head of the Laboratory of Experimental Immunology and Virology

Russian Federation, Moscow

Anna V. Lazareva

National Medical Research Center for Children’s Health, Ministry of Health of the Russian Federation

Email: zulfiryasadeeva@yandex.ru

DSc (Medicine), Head Researcher, Laboratory of Molecular Microbiology, Head of the Microbiology Laboratory

Russian Federation, Moscow

Tatiana M. Komyagina

National Medical Research Center for Children’s Health, Ministry of Health of the Russian Federation

Email: zulfiryasadeeva@yandex.ru

Junior Researcher, Laboratory of Experimental Immunology and Virology

Russian Federation, Moscow

Olga V. Karaseva

National Medical Research Center for Children’s Health, Ministry of Health of the Russian Federation; Clinical and Research Institute of Emergency Pediatric Surgery and Trauma, Department of Public Health of Moscow

Email: zulfiryasadeeva@yandex.ru

DSc (Medicine), Head of the Department of Emergency Surgery and Pediatric Trauma; Deputy Director for Scientific Work, Head of the Department of Combined Trauma, Anesthesiology-Resuscitation

Russian Federation, Moscow; Moscow

Marina G. Vershinina

National Medical Research Center for Children’s Health, Ministry of Health of the Russian Federation

Email: zulfiryasadeeva@yandex.ru

PhD (Medicine), Leading Researcher, Laboratory of Medical Genomics

Russian Federation, Moscow

Andrey P. Fisenko

National Medical Research Center for Children’s Health, Ministry of Health of the Russian Federation

Email: zulfiryasadeeva@yandex.ru

DSc (Medicine), Professor, Director

Russian Federation, Moscow

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2. Figure 1. Sensitivity to antimicrobial drugs in A. baumannii isolates

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3. Figure 2. Comparison of the MIC of meropenem for planktonic and biofilm A. baumannii culturesNote. For isolate 15 and 16, the MIC of meropenem was determined to be more than 512 mg/l; in the figure, these points have values of 700 mg/l. X-axis: ordinal number of isolates. Y-axis: values of the MIC of meropenem.

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4. Figure 3. Genotypic pattern of A. baumannii isolates obtained from blood and cerebrospinal fluid of childrenNote. Dark and light color indicates isolates resistant or sensitive to carbapenems, respectively. Sectors indicate the number of isolates in the genotype.

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Copyright (c) 2023 Sadeeva Z.Z., Novikova I.E., Alyabyeva N.M., Lazareva A.V., Komyagina T.M., Karaseva O.V., Vershinina M.G., Fisenko A.P.

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