Nursing Home as a Reservoir of Carbapenem-Resistant Acinetobacter baumannii

Acinetobacter baumannii is an increasingly common pathogen in healthcare settings globally. It is frequently resistant to multiple antimicrobial agents and there are recent reports on strains that are pandrug resistant. The aim of the study was to characterize the mechanisms of carbapenem resistance of A. baumannii strains from a nursing home in Zagreb and to genotype the strains. Antimicrobial susceptibility testing was performed by the broth microdilution method according to the Clinical and Laboratory Standards Institute (CLSI). PCR was used to detect genes encoding carbapenemases of groups A, B, and D and extended-spectrum -lactamases. Genotyping of the strains was performed by rep-PCR. All strains were found to be resistant to ceftazidime, cefotaxime, ceftriaxone, cefepime, piperacillin/tazobactam, imipenem, meropenem, and ciprofloxacin. All, but one strain, were resistant to gentamicin. PCR revealed bla(OXA-23) genes in 14, bla(OXA-24) in 5, and bla(VIM) in 11 strains. All strains positive for bla(VIM) genes coharbored bla(OXA-23) genes. The 14 strains with OXA-23 belonged to ICL II, whereas the 5 strains positive for bla(OXA-24) belonged to ICL I. In contrast to hospitals where OXA-24/40-like -lactamases and OXA-58 were the most prevalent, OXA-23-like -lactamases are the dominant group in the nursing home. OXA-58-like -lactamase, which is the most widespread group, was not found. Acquisition of bla(MBL) genes in A. baumannii strains was observed. Rep-PCR identified two clones. Two strains A10 and A13 were alocated to a novel sequence type ST 637. Nursing homes can act as a source of dissemination of bla(OXA) and bla(MBL) genes in the environment and the possible influx to the hospital environment.