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Antimicrobial Agents and Chemotherapy, December 2006, p. 4114-4123, Vol. 50, No. 12
0066-4804/06/$08.00+0     doi:10.1128/AAC.00778-06
Copyright © 2006, American Society for Microbiology. All Rights Reserved.

Analysis of Antibiotic Resistance Genes in Multidrug-Resistant Acinetobacter sp. Isolates from Military and Civilian Patients Treated at the Walter Reed Army Medical Center{triangledown}

Kristine M. Hujer,1 Andrea M. Hujer,1 Edward A. Hulten,2 Saralee Bajaksouzian,4 Jennifer M. Adams,6 Curtis J. Donskey,1 David J. Ecker,7 Christian Massire,7 Mark W. Eshoo,7 Rangarajan Sampath,7 Jodi M. Thomson,5 Philip N. Rather,8 David W. Craft,3 Joel T. Fishbain,2 Allesa J. Ewell,3 Michael R. Jacobs,4 David L. Paterson,6 and Robert A. Bonomo1,5*

Research Service, Louis Stokes Cleveland Veterans Affairs Medical Center, Cleveland, Ohio,1 Department of Internal Medicine,2 Department of Pathology, Walter Reed Army Medical Center, Washington, D.C.,3 Department of Pathology,4 Department of Pharmacology, Case Western Reserve University School of Medicine, Cleveland, Ohio,5 Division of Infectious Diseases, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania,6 Ibis, Division of Isis Pharmaceuticals, Carlsbad, California,7 Department of Microbiology and Immunology, Emory University School of Medicine, Atlanta, Georgia8

Received 28 June 2006/ Returned for modification 20 July 2006/ Accepted 19 September 2006

Military medical facilities treating patients injured in Iraq and Afghanistan have identified a large number of multidrug-resistant (MDR) Acinetobacter baumannii isolates. In order to anticipate the impact of these pathogens on patient care, we analyzed the antibiotic resistance genes responsible for the MDR phenotype in Acinetobacter sp. isolates collected from patients at the Walter Reed Army Medical Center (WRAMC). Susceptibility testing, PCR amplification of the genetic determinants of resistance, and clonality were determined. Seventy-five unique patient isolates were included in this study: 53% were from bloodstream infections, 89% were resistant to at least three classes of antibiotics, and 15% were resistant to all nine antibiotics tested. Thirty-seven percent of the isolates were recovered from patients nosocomially infected or colonized at the WRAMC. Sixteen unique resistance genes or gene families and four mobile genetic elements were detected. In addition, this is the first report of blaOXA-58-like and blaPER-like genes in the U.S. MDR A. baumannii isolates with at least eight identified resistance determinants were recovered from 49 of the 75 patients. Molecular typing revealed multiple clones, with eight major clonal types being nosocomially acquired and with more than 60% of the isolates being related to three pan-European types. This report gives a "snapshot" of the complex genetic background responsible for antimicrobial resistance in Acinetobacter spp. from the WRAMC. Identifying genes associated with the MDR phenotype and defining patterns of transmission serve as a starting point for devising strategies to limit the clinical impact of these serious infections.

* Corresponding author. Mailing address: Infectious Diseases Section, Louis Stokes Cleveland Veterans Affairs Medical Center, 10701 East Blvd., Cleveland, OH 44106. Phone: (216) 791-3800, ext. 4399. Fax: (216) 229-8509. E-mail: robert.bonomo{at}med.va.gov.

{triangledown} Published ahead of print on 25 September 2006.

Antimicrobial Agents and Chemotherapy, December 2006, p. 4114-4123, Vol. 50, No. 12
0066-4804/06/$08.00+0     doi:10.1128/AAC.00778-06
Copyright © 2006, American Society for Microbiology. All Rights Reserved.



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