Nosocomial infections caused by carbapenem-resistant Acinetobacter baumannii isolates have reached epidemic levels in past decades. Currently this microorganism is responsible for outbreaks of difficult eradication and with high mortality rates worldwide. We herein report a rare case of an OXA-72-producing A. baumannii isolate colonizing a 47-year-old male patient with peritonitis due to abdominal stab wound, four years earlier than the first report of this carbapenemase in Acinetobacter pittii in Colombia. Although OXA-72 presents a low prevalence compared with OXA-23, our study demonstrated that A. baumannii isolates carrying the blaOXA-72 gene were present in the hospital environment in Colombia and could act as a reservoir for further spread to other Acinetobacter species, like A. pittii, causing carbapenem-resistance.ColcienciasUniversidad Nacional de ColombiaUniversidad Nacional de Colombia Medical School Microbiology DepartmentUniversidade Federal de São Paulo (UNIFESP) Disciplina de Infectologia Laboratório ALERTAUniversidad Nacional de Colombia Medical School Medicine DepartmentUNIFESP, Disciplina de Infectologia Laboratório ALERTAColciencias: 11010416355, Agreement 444Universidad Nacional de Colombia: 20201009713SciEL

Cayô, Rodrigo

Gales, Ana Cristina

Leal, Aura Lucia

Saavedra, Carlos Humberto

Saavedra, Sandra Yamile

The Brazilian Journal of Infectious Diseases

AbstractNosocomial infections caused by carbapenem-resistant Acinetobacter baumannii isolates have reached epidemic levels in past decades. Currently this microorganism is responsible for outbreaks of difficult eradication and with high mortality rates worldwide. We herein report a rare case of an OXA-72-producing A. baumannii isolate colonizing a 47-year-old male patient with peritonitis due to abdominal stab wound, four years earlier than the first report of this carbapenemase in Acinetobacter pittii in Colombia. Although OXA-72 presents a low prevalence compared with OXA-23, our study demonstrated that A. baumannii isolates carrying the blaOXA-72 gene were present in the hospital environment in Colombia and could act as a reservoir for further spread to other Acinetobacter species, like A. pittii, causing carbapenem-resistance

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Early dissemination of OXA-72-producing Acinetobacter baumannii strain in Colombia: a case report 

b r a z j i n f e c t d i s . 2 0 1 4;1  8(6):678–680
The Brazilian Journal of
INFECTIOUS  DISEASES
www.elsev ier .com/ locate /b j id
Case report
Early  dissemination  of OXA-72-producing
Acinetobacter baumannii  strain  in  Colombia:  a  case
report
Sandra Yamile Saavedraa, Rodrigo Cayôb,∗, Ana Cristina Galesb,
Aura  Lucia Leala, Carlos Humberto Saavedrac
a Microbiology Department, Medical School, Universidad Nacional de Colombia, Bogota, Colombia
b Laboratório ALERTA, Disciplina de Infectologia, Universidade Federal de São Paulo (UNIFESP), São Paulo, SP, Brazil
c Medicine Department, Medical School, Universidad Nacional de Colombia, Bogota, Colombia
a  r  t  i  c  l  e  i  n  f  o
Article history:
Received 5 May 2014
Accepted  19 May 2014
Available  online 30 August 2014
Keywords:
Acinetobacter baumannii
Carbapenem-resistance
a  b  s  t  r  a  c  t
Nosocomial infections caused by carbapenem-resistant Acinetobacter baumannii isolates
have  reached epidemic levels in past decades. Currently this microorganism is responsi-
ble  for outbreaks of difﬁcult eradication and with high mortality rates worldwide. We  herein
report  a rare case of an OXA-72-producing A. baumannii isolate colonizing a 47-year-old
male  patient with peritonitis due to abdominal stab wound, four years earlier than the ﬁrst
report  of this carbapenemase in Acinetobacter pittii in Colombia. Although OXA-72 presents
a  low prevalence compared with OXA-23, our study demonstrated that A. baumannii iso-
lates  carrying the blaOXA-72 gene were  present in the hospital environment in Colombia andOxacillinase
Colombia
could  act as a reservoir for further spread to other Acinetobacter species, like A. pittii, causing
carbapenem-resistance.
© 2014 Elsevier Editora Ltda. Este é um artigo Open Access sob a licença de CC BY-NC-NDIntroduction
Carbapenem-resistant Acinetobacter baumannii became a
1global  health concern, especially in intensive care units
(ICUs).2 In Colombia, A. baumannii was  the ﬁfth most fre-
quent  pathogen causing bloodstream infections between the
years  2001 and 2008 at ICUs, with an increased of 40% in the
∗ Corresponding author at: Laboratório ALERTA, Universidade Federal 
Clementino, 04039-032 São Paulo, SP, Brazil.
E-mail address: rodrigocayosilva@gmail.com (R. Cayô).
http://dx.doi.org/10.1016/j.bjid.2014.05.017
1413-8670/© 2014 Elsevier Editora Ltda. Este é um artigo Open Access sob a licençacarbapenem resistance.3 This fact could partially be explained
by  the spread of OXA-23-producing clones in Colombian
hospitals.4 Montealegre and colleagues5 reported, for the ﬁrst
time  in Colombia, an OXA-72-producing Acinetobacter pittii iso-
lated in 2010 from a catheter tip culture. Here, we describede São Paulo – UNIFESP, Rua Pedro de Toledo, 781, 6th ﬂoor, Vila
a  case of OXA-72-producing A. baumannii strain colonizing a
patient with peritonitis in Colombia, four years earlier than
the  ﬁrst reported case.5
 de CC BY-NC-ND
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ase  presentation
n January 20, 2006, a 47-year-old male patient was  hos-
italized  at a tertiary teaching hospital localized in Bogota,
olombia, due to an abdominal stab wound. The patient was
ubmitted  to exploratory laparotomy and a segmental small
owel  resection was  performed. Antimicrobial therapy with
lindamycin  (600 mg  iv q8 h) and amikacin (1 g iv q24 h) was
dministered for seven days, and the patient was discharged
n  good clinical conditions eight days later. On February 2,
006,  the patient was  readmitted due to severe abdominal
ain  and a new exploratory laparotomy was  carried out.
eritonitis was  diagnosed secondary to a small bowel per-
oration.  Peritoneal ﬂuid culture was  not performed at that
ime.  Antimicrobial therapy with ampicillin/sulbactam (3 g iv
6 h) was  empirically prescribed and maintained for eight days
ith clinical improvement. However, on February 9, 2006, the
atient  presented with vomit, severe abdominal pain, fever
nd  leukocytosis. Another exploratory laparotomy was car-
ied  out and the presence of multiple intestinal perforations
as  diagnosed. The antimicrobial therapy was  replaced by
eropenem  (2 g iv q8 h) and the patient was  then transferred
o  the ICU, where he remained for the next six days. The
bdominal incision had been left completely open and subse-
uently  intra-abdominal lavages were  performed. In the two
revious peritoneal lavages, the cultures were negative. On
ebruary  16, 2006, after the third peritoneal lavage, the perit-
neal  cavity was  closed and the patient was  transferred to the
nternal  medicine ward.  At this moment, a non-fermenting
ram-negative coccobacillus isolate (Acb7-31 strain) was  cul-
ured from the peritoneal ﬂuid. It was  initially identiﬁed as
 carbapenem-resistant A. baumannii by VITEK 2 automated
ystem (bioMérieux SA, Marcy  l’Etoile, France). The patient
as  discharged at 23rd day of hospitalization in good clinical
onditions.
Species  identiﬁcation by sequencing analysis of RNA poly-
erase   subunit (rpoB) gene, as previously published,6
onﬁrmed the identiﬁcation of Acb7-31 strain as A. bau-
annii.  Antimicrobial susceptibility was  evaluated by CLSI
roth  microdilution,7 except for amikacin and colistin MICs
hat  were  determined by Etest strips, according to the
anufacturer’s recommendations (AB Biodisk, Solna, Swe-
en).  According to CLSI breakpoints,8 the Acb7-31isolate was
usceptible  to minocycline (MIC, ≤0.03 mg/L), ciproﬂoxacin
MIC, ≤0.125 mg/L), colistin (MIC, 0.5 mg/L), polymyxin B
MIC,  0.5 mg/L), amikacin (MIC, 2 mg/L), gentamicin (MIC,
 mg/L), ceftazidime (MIC, 8 mg/L), cefotaxime (MIC, 8 mg/L),
ntermediate to levoﬂoxacin (MIC, 4 mg/L) and resistant
o  imipenem (MIC, 32 mg/L), meropenem (MIC, 32 mg/L),
mpicillin-sulbactam (MIC, 32/16 mg/L) and cefepime (MIC,
4  mg/L). In order to evaluate the contribution of overex-
ression of efﬂux pumps in the resistance to carbapenems,
he MICs for imipenem and meropenem were  also deter-
ined  in the presence of 15 mg/L of the efﬂux pump
nhibitor, Phe-Arg--naphthylamide (PAN). Although a 4-
old  decrease in the MICs for meropenem was  observed
n  the presence of PAN (MICs, 32 to 8 mg/L), the MICs
or  imipenem did not change signiﬁcantly (MICs, 32 to
6  mg/L).4;1 8(6):678–680  679
Multiplex-PCR assays targeting carbapenem-hydrolyzing
class D -lactamases (CHDLs) and metallo--lactamase (MLs)
encoding  genes were performed, as previously published.9,10
The presence of blaOXA-51-like and blaOXA-24/40-like was  con-
ﬁrmed by PCR. DNA sequencing identiﬁed the blaOXA-24/40-like
amplicon as blaOXA-72 and revealed that it was ﬂanked
by XerC/XerD-binding sites, a structure implicated with its
mobilization.11 Genomic DNA digested with the endonuclease
I-Ceu-I and plasmid DNA from Acb7-31 strain were  separated
by  PFGE, and subsequent Southern blot and hybridization
with blaOXA-72-speciﬁc probe showed that the blaOXA-72 gene
was located on a plasmid of ∼20 kb. It seems that this is a
non-conjugative plasmid since it was  not successfully trans-
ferred  by conjugation. Similar results were observed by Bonnin
and  colleagues12 who described three French A. pittii isolates
carrying  the blaOXA-72 gene mediated by a non conjugative
20-kb plasmid. Interesting, the sizes of plasmids carrying the
blaOXA-72 gene in Acinetobacter spp. isolates varies considerably
in South America, ranging from 83 kb to 163 kb, as previously
reported.5,13,14
Conclusion
Despite its lower prevalence, OXA-72 had been present in
Colombia  longer than we thought, since the Acb7-31 strain
was  isolated in 2006 in Bogota, located 462.4 km from Cali,
where  an OXA-72-producing A. pittii strain was  isolated in
2010.  Although the Acb7-31 strain was considered as a colo-
nizer  strain, our study documented that blaOXA-72 was  present
in  the hospital environment and could act as a reservoir
for  further spread to other Acinetobacter species, like A. pit-
tii.  In addition, the overexpression of efﬂux pumps seems to
contribute  for increasing meropenem MICs for inhibiting the
Acb7-31  strain.
Funding
This study was  ﬁnanced by Colciencias CODE: 11010416355,
Agreement 444 and Universidad Nacional de Colombia CODE:
20201009713.
Conﬂicts  of  interests
A.C.G. recently received research funding and/or consultation
fees  from AstraZeneca and Thermo Fisher Scientiﬁc. Other
authors  have nothing to declare.
Acknowledgements
GREBO (Andrés González), Clínica de Occidente (Elkin Lemus,
Norma  Montoya, Marta Salinas, Francelina González, Edgar
Sánchez),  Clínica Jorge Pin˜eros  Corpas (Geny Díaz, Carlos
Barrios), Clínica Reina Sofía (Edilma Torrado, Diego Garzón),
Clínica  San Pedro Claver (Carlos Alquichire, Marta Ruiz, Gladis
Ceballos,  Pilar Hurtado, Jose Guillermo Ruiz Rodríguez), Fun-
dación  Cardioinfantil (Álvaro Arango, Patricia Bravo), Hospital
Occidente  de Kennedy (Romelia Villa, Nubia Escobar, Piedad
Giraldo,  Álvaro Jiménez), Hospital El Tunal (Marta Isabel
i s . 2 0
r
1
1
1
1
1680  b r a z j i n f e c t d 
Garzón, Julia Quijano, Rafael Pérez Yepes), Hospital Militar
Central  (Carlos Pérez, Matilde Méndez, María Nilse González,
Diana  Ferrucho, Juan Pablo Velásquez), Hospital Universitario
San  Ignacio (Carlos Álvarez, Beatriz Ariza), Hospital Simón
Bolívar  (Constanza Correa, Luz Janeth Márquez, William Clav-
ijo),  Hospital Santa Clara (José Roberto Tamara, Gloria Inés
Gallo,  Guillermo Ortiz), Hospital Universitario Clínica San
Rafael  (Marta Pulido, Rabel Lobelo), Hospital Universitario La
Samaritana (Johana Osorio, Elsa Marina Zubieta, Emilio Rey),
Instituto  Nacional de Cancerología (Jorge Cortes, Claudia Patri-
cia Arroyo, Luz Marina Martínez, Elizabeth Rodríguez, Clara
Inés  Gómez), Policlínico del Olaya (Johana Carol Estrada, Ana
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Nosocomial infections caused by carbapenem-resistant Acinetobacter baumannii isolates have reached epidemic levels in past decades. Currently this microorganism is responsible for outbreaks of difficult eradication and with high mortality rates worldwide. We herein report a rare case of an OXA-72-producing A. baumannii isolate colonizing a 47-year-old male patient with peritonitis due to abdominal stab wound, four years earlier than the first report of this carbapenemase in Acinetobacter pittii in Colombia. Although OXA-72 presents a low prevalence compared with OXA-23, our study demonstrated that A. baumannii isolates carrying the blaOXA-72 gene were present in the hospital environment in Colombia and could act as a reservoir for further spread to other Acinetobacter species, like A. pittii, causing carbapenem-resistance. Keywords: Acinetobacter baumannii, Carbapenem-resistance, Oxacillinase, Colombi

Sandra Yamile Saavedra

Rodrigo Cayô

Ana Cristina Gales

Aura Lucia Leal

Carlos Humberto Saavedra

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Early dissemination of OXA-72-producing Acinetobacter baumannii strain in Colombia: a case report

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Early dissemination of OXA-72-producing Acinetobacter baumannii strain in Colombia: a case report

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