Acinetobacter baumannii in Southern Croatia: clonal lineages, biofilm formation, and resistance patterns

Abstract

Background: Acinetobacter baumannii is one of the most prevalent causes of severe hospital-acquired infections and is responsible for the dramatic increase in carbapenem resistance in Croatia in the last 5 years. Such data have encouraged multicenter research focused on the organism's ability to form biofilm, susceptibility to antibiotics, and particular genotype lineage. Methods: Biofilm formation in 109 unrelated clinical isolates of A. baumannii recovered in six cities of Southern Croatia was investigated. Genotyping was performed by pulsed-field gel electrophoresis and antibiotic profile was tested by applying the disc diffusion method and confirmed by determining the minimum inhibitory concentrations. The ability to form biofilm in vitro was determined from overnight cultures of the collected isolates on microtiter plates, after staining with crystal violet, and quantified at 570 nm after solubilization with ethanol. The statistical relevance was calculated in an appropriate program with level of statistical confidence. Results: There was no significant difference in biofilm formation due to the genotype lineage. Isolates collected from intensive care units (ICUs) and isolated from respiratory samples were more likely to create a biofilm compared with isolates from other departments and other samples. There was a significant difference in the ability to produce biofilm in relation to antibiotic resistance pattern. A large proportion of A. baumannii isolates that were resistant to ampicillin/sulbactam, carbapenems, and amikacin were found to be biofilm-negative. In contrast, isolates susceptible and intermediately susceptible to ampicillin/sulbactam, carbapenems, and amikacin were biofilm producers. Conclusion: Clinical isolates of A. baumannii from respiratory samples in ICUs with a particular susceptibility pattern are more prone to form biofilm.

Keywords::

• Acinetobacter baumannii
• genotyping
• biofilm formation
• resistance to antibiotics
• Southern Croatia

Acknowledgments

We thank all the Croatian collaborative centers of the CAMS for providing clinical isolates of A. baumannii for this multicenter investigation. We would also like to thank Dr Kevin Towner (Nottingham, UK) for help and suggestions in preparing this manuscript.

Declaration of interest: This work was supported by the University of Zagreb (project no. 202649-202710) and in part by the Croatian Science Foundation (project no. 5656). The authors report no conflicts of interest.