Molecular Epidemiology of Extensively-Drug Resistant Acinetobacter baumannii Sequence Type 2 Co-Harboring bla_NDM and bla_OXA From Clinical Origin

Figures & data

Table 1 Clinical Information for the Sources of A. baumannii Isolates (n = 174)

Clinical Information	n (%)
Sex
Male	113 (64.9)
Female	61 (35)
Age (years)
Range	1–70
Mean	35.8
Clinical samples
Sputum	81 (46.5)
Pus swabs	42 (24.1)
Blood	19 (10.9)
Urine	18 (10.3)
Throat swabs	7 (4)
Cerebrospinal fluid	3 (1.7)
Nasal swabs	2 (1.1)
Seminal fluid	1 (0.6)
High vaginal swabs	1 (0.6)
Hospital wards
Intensive care unit	131 (75.2)
Male surgical ward	13 (7.4)
Female medical ward	11 (6.3)
Operation theater	8 (4.6)
Male medical ward	6 (3.4)
Female surgical ward	5 (2.8)

Figure 1 The hierarchical clustering of carbapenem-resistant Acinetobacter baumannii. The antibiotics are shown on the x-axis, aligned with the bacterial strains on the y-axis. The scale on the y-axis shows bacterial resistance, intermediate resistance, and sensitivity from 1 to 3, respectively. The dendrogram shows the relationship among the different antibacterial drugs.

Abbreviations: CT, colistin; MEM, meropenem; IPM, imipenem; CAZ, ceftazidime; CTX, cefotaxime; FEP, cefepime; SAM, ampicillin/sulbactam; PIP, piperacillin; MEZ, mezlocillin; TZP, piperacillin/tazobactam; TOB, tobramycin; SXT, trimethoprim/sulfamethoxazole; LEV, levofloxacin; TET, tetracycline; CIP, ciprofloxacin; CN, gentamicin; AK, amikacin.

Figure 2 Carbapenem-resistant A. baumannii shows simultaneous resistance to multiple classes of antibiotics.

Figure 3 Carbapenem-resistant phenotypes. The left photograph shows the DDST for MBL production, and the right photograph displays the MHT for carbapenemase production.

Abbreviations: ETP, ertapenem; MEM, meropenem; EDTA, ethylenediaminetetraacetic acid; MHT, modified Hodge's test; DDST, double disk susceptibility test; +ve, positive control; -ve, negative control; T-70, 71, tested organisms.

Table 2 Prevalence of Carbapenem-Resistant Acinetobacter baumannii Sequence Types in Different Clinical Wards

ST (n = 113)	CC	Allelic Profile	Clinical Infections and Hospital Wards
			Sputum (n = 60)	Pus (n = 29)	Blood (n = 7)	Throat (n = 5)	Urine (n = 9)	CSF (n = 1)	Nasal (n = 1)	HVS (n = 1)
2 (n = 53, 46.9%)	2	2,2,2,2,2,2,2	27 (ICU:21, MMW:3, FMW:2, OT:1)	13 (ICU:7, MSW:3, FSW:1, OT:2)	4 (ICU:3, MMW: 1)	3 (ICU)	5 (FMW:2, ICU:3)	0	0	1 (FMW)
1 (n = 18, 15.9%)	1	1, 1, 1, 1, 5, 1, 1	13 (ICU:12, FMW:1)	3 (FSW:1, ICU:1, OT:1)	0	1 (ICU)	0	1 (OT)	0	0
589 (n = 14, 12.3%)	1	1,1,2,1,9,1,1	5 (ICU:3, FMW:1, OT:1)	4 (ICU:2, MSW:2)	1 (ICU)	1 (ICU)	2 (ICU)	0	1 (MSW)	0
7 (n = 11, 9.7%)	1	1,1,1,2,5,1,1	5 (ICU)	4 (MSW:2, FMW:1, ICU:1)	1 (ICU)	0	1 (ICU)	0	0	0
158 (n = 10, 8.8%)	158	41, 42, 13, 1, 5, 4, 14	6 (ICU)	2 (ICU:1, MSW:1)	1 (ICU)	0	1 (ICU)	0	0	0
23 (n = 5, 4.4%)	23	1, 3, 10, 1, 4, 4, 4	3 (ICU:2, FMW:1)	2 (ICU)	0	0	0	0	0	0
25 (n = 2, 1.7%)	25	3, 3, 2, 4, 7, 2, 4	1 (FMW)	1 (FSW)	0	0	0	0	0	0

Note: The ST profiles consist of 7 allele numbers, corresponding to cpn60, fusA, gltA, pyrG, recA, rplB, and rpoB, respectively (https://pubmlst.org/abaumannii/).

Abbreviations: ST, sequence type; CC, clonal complex; CSF, cerebral spinal fluid; HVS, high vaginal swab; ICU, intensive care unit; MMW, male medical ward; FMW, female medical ward; MSW, male surgical ward; FSW, female surgical ward; OT, operation theater.

Table 3 The Co-Detection and Distribution of Carbapenem-Resistant Genes in Different CR-AB Alleles

ST of CR-AB (n = 113)	blaOXA-23 (n = 56)	blaOXA-24 (n = 10)	blaOXA-58 (n = 22)	blaOXA-143 (n = 3)	blaNDM-1 (n = 28)
1 (n = 18)	6 (10.5%)	1 (10%)	2 (9%)	1 (33.4%)	2 (7.1%)
2 (n = 53)	28 (50%)	8 (80%)	12 (54.5%)	2 (66.6%)	14 (50%)
7 (n = 11)	4 (7.1%)	1 (10%)	2 (9%)	0	4 (14.2%)
23 (n = 5)	3 (5.3%)	0	2 (9%)	0	1 (3.5%)
25 (n = 2)	2 (3.57%)	0	0	0	1 (3.5%)
158 (n = 10)	4 (7.1%)	0	0	0	2 (7%)
589 (n = 14)	9 (16%)	0	4 (18%)	0	4 (14.2%)

Abbreviations: ST, sequence type; CR-AB, carbapenem-resistant Acinetobacter baumannii.