Replacement of the Dominant ST191 Clone by ST369 Among Carbapenem-Resistant Acinetobacter baumannii Bloodstream Isolates at a Tertiary Care Hospital in South Korea
The clonal dissemination of carbapenem-resistant Acinetobacter baumannii (CRAB) bacteremia is a serious clinical problem worldwide. However, the factors related to the emergence and replacement of predominant CRAB clones in nosocomial settings are unclear. By multilocus sequence typing (MLST), we ev...
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Frontiers Media S.A.
2022-07-01
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| Series: | Frontiers in Microbiology |
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| Online Access: | https://www.frontiersin.org/articles/10.3389/fmicb.2022.949060/full |
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| author | Seong Eun Kim Su-Mi Choi Yohan Yu Sung Un Shin Tae Hoon Oh Seung-Ji Kang Kyung-Hwa Park Jong Hee Shin Uh Jin Kim Sook In Jung |
| author_facet | Seong Eun Kim Su-Mi Choi Yohan Yu Sung Un Shin Tae Hoon Oh Seung-Ji Kang Kyung-Hwa Park Jong Hee Shin Uh Jin Kim Sook In Jung |
| author_sort | Seong Eun Kim |
| collection | DOAJ |
| description | The clonal dissemination of carbapenem-resistant Acinetobacter baumannii (CRAB) bacteremia is a serious clinical problem worldwide. However, the factors related to the emergence and replacement of predominant CRAB clones in nosocomial settings are unclear. By multilocus sequence typing (MLST), we evaluated the genetic relatedness of CRAB bloodstream isolates at a tertiary care hospital over a 3.5-year period and investigated the clinical and microbiologic characteristics of the predominant sequence types (STs). One hundred and seventy-nine CRAB bloodstream isolates were collected from June 2016 to December 2019, and their MLSTs according to Oxford scheme and clinical data were obtained. The predominant STs were assessed for in vitro growth, competitive growth, and virulence in a mouse model of intraperitoneal infection. Two dominant clones—ST369 (n = 98) and ST191 (n = 48)—belonging to international clone 2 (IC2) were recovered from patients admitted to intensive care units (ICUs) or wards. ST191 predominated (61%, 27/43) from June 2016 to July 2017, whereas ST369 (72%, 98/136), which was first isolated from a patient admitted to the emergency room, replaced ST191 (15%, 21/136) after August 2017. In a multivariate analysis, leukopenia (OR = 3.62, 95% CI 1.04–12.6, p = 0.04) and ST191 or 369 (OR = 5.32, 95% CI 1.25–22.65, p = 0.02) were independent risk factors for 7-day mortality. Compared with non-ST369, ST369 was associated with a shorter time to bacteremia from ICU admission (7 vs. 11 days, p = 0.01), pneumonia as an origin of bacteremia (67 vs. 52%, p = 0.04), leukopenia (28 vs. 11%, p < 0.01), and a lower 7-day survival rate (41 vs. 70%, p < 0.01). In vitro, ST 369 isolates had significantly higher growth rates and enhanced competitive growth compared to ST191. Finally, ST369 had greater virulence and a higher mortality rate than other STs in a mouse infection model. We report almost-complete replacement of the predominant ST191 clone by ST369 within an 8-month period at our hospital. ST369 had a high incidence density rate of CRAB bacteremia, a short time to bacteremia after ICU admission, and a high early mortality rate, which may be in part explained by its faster competitive growth rate and higher virulence than ST191. |
| first_indexed | 2024-04-14T04:42:26Z |
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| institution | Directory Open Access Journal |
| issn | 1664-302X |
| language | English |
| last_indexed | 2024-04-14T04:42:26Z |
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| spelling | doaj.art-16ac5f100d4b482895029624b58c3cb22022-12-22T02:11:37ZengFrontiers Media S.A.Frontiers in Microbiology1664-302X2022-07-011310.3389/fmicb.2022.949060949060Replacement of the Dominant ST191 Clone by ST369 Among Carbapenem-Resistant Acinetobacter baumannii Bloodstream Isolates at a Tertiary Care Hospital in South KoreaSeong Eun Kim0Su-Mi Choi1Yohan Yu2Sung Un Shin3Tae Hoon Oh4Seung-Ji Kang5Kyung-Hwa Park6Jong Hee Shin7Uh Jin Kim8Sook In Jung9Department of Infectious Diseases, Chonnam National University Medical School, Gwangju, South KoreaDepartment of Infectious Diseases, Chonnam National University Medical School, Gwangju, South KoreaDepartment of Infectious Diseases, Chonnam National University Medical School, Gwangju, South KoreaDepartment of Infectious Diseases, Chonnam National University Medical School, Gwangju, South KoreaDepartment of Infectious Diseases, Chonnam National University Medical School, Gwangju, South KoreaDepartment of Infectious Diseases, Chonnam National University Medical School, Gwangju, South KoreaDepartment of Infectious Diseases, Chonnam National University Medical School, Gwangju, South KoreaDepartment of Laboratory Medicine, Chonnam National University Medical School, Gwangju, South KoreaDepartment of Infectious Diseases, Chonnam National University Medical School, Gwangju, South KoreaDepartment of Infectious Diseases, Chonnam National University Medical School, Gwangju, South KoreaThe clonal dissemination of carbapenem-resistant Acinetobacter baumannii (CRAB) bacteremia is a serious clinical problem worldwide. However, the factors related to the emergence and replacement of predominant CRAB clones in nosocomial settings are unclear. By multilocus sequence typing (MLST), we evaluated the genetic relatedness of CRAB bloodstream isolates at a tertiary care hospital over a 3.5-year period and investigated the clinical and microbiologic characteristics of the predominant sequence types (STs). One hundred and seventy-nine CRAB bloodstream isolates were collected from June 2016 to December 2019, and their MLSTs according to Oxford scheme and clinical data were obtained. The predominant STs were assessed for in vitro growth, competitive growth, and virulence in a mouse model of intraperitoneal infection. Two dominant clones—ST369 (n = 98) and ST191 (n = 48)—belonging to international clone 2 (IC2) were recovered from patients admitted to intensive care units (ICUs) or wards. ST191 predominated (61%, 27/43) from June 2016 to July 2017, whereas ST369 (72%, 98/136), which was first isolated from a patient admitted to the emergency room, replaced ST191 (15%, 21/136) after August 2017. In a multivariate analysis, leukopenia (OR = 3.62, 95% CI 1.04–12.6, p = 0.04) and ST191 or 369 (OR = 5.32, 95% CI 1.25–22.65, p = 0.02) were independent risk factors for 7-day mortality. Compared with non-ST369, ST369 was associated with a shorter time to bacteremia from ICU admission (7 vs. 11 days, p = 0.01), pneumonia as an origin of bacteremia (67 vs. 52%, p = 0.04), leukopenia (28 vs. 11%, p < 0.01), and a lower 7-day survival rate (41 vs. 70%, p < 0.01). In vitro, ST 369 isolates had significantly higher growth rates and enhanced competitive growth compared to ST191. Finally, ST369 had greater virulence and a higher mortality rate than other STs in a mouse infection model. We report almost-complete replacement of the predominant ST191 clone by ST369 within an 8-month period at our hospital. ST369 had a high incidence density rate of CRAB bacteremia, a short time to bacteremia after ICU admission, and a high early mortality rate, which may be in part explained by its faster competitive growth rate and higher virulence than ST191.https://www.frontiersin.org/articles/10.3389/fmicb.2022.949060/fullCarbapenem-resistant Acinetobacter baumanniimultilocus sequence typing (MLST)ST369replacementcompetitionvirulence |
| spellingShingle | Seong Eun Kim Su-Mi Choi Yohan Yu Sung Un Shin Tae Hoon Oh Seung-Ji Kang Kyung-Hwa Park Jong Hee Shin Uh Jin Kim Sook In Jung Replacement of the Dominant ST191 Clone by ST369 Among Carbapenem-Resistant Acinetobacter baumannii Bloodstream Isolates at a Tertiary Care Hospital in South Korea Frontiers in Microbiology Carbapenem-resistant Acinetobacter baumannii multilocus sequence typing (MLST) ST369 replacement competition virulence |
| title | Replacement of the Dominant ST191 Clone by ST369 Among Carbapenem-Resistant Acinetobacter baumannii Bloodstream Isolates at a Tertiary Care Hospital in South Korea |
| title_full | Replacement of the Dominant ST191 Clone by ST369 Among Carbapenem-Resistant Acinetobacter baumannii Bloodstream Isolates at a Tertiary Care Hospital in South Korea |
| title_fullStr | Replacement of the Dominant ST191 Clone by ST369 Among Carbapenem-Resistant Acinetobacter baumannii Bloodstream Isolates at a Tertiary Care Hospital in South Korea |
| title_full_unstemmed | Replacement of the Dominant ST191 Clone by ST369 Among Carbapenem-Resistant Acinetobacter baumannii Bloodstream Isolates at a Tertiary Care Hospital in South Korea |
| title_short | Replacement of the Dominant ST191 Clone by ST369 Among Carbapenem-Resistant Acinetobacter baumannii Bloodstream Isolates at a Tertiary Care Hospital in South Korea |
| title_sort | replacement of the dominant st191 clone by st369 among carbapenem resistant acinetobacter baumannii bloodstream isolates at a tertiary care hospital in south korea |
| topic | Carbapenem-resistant Acinetobacter baumannii multilocus sequence typing (MLST) ST369 replacement competition virulence |
| url | https://www.frontiersin.org/articles/10.3389/fmicb.2022.949060/full |
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