Prevalence of carbapenemases among high-level aminoglycoside-resistant Acinetobacter baumannii isolates in a university hospital in China.

The prevalence of aminoglycoside resistant enzymes has previously been reported and extended-spectrum beta-lactamase among Acinetobacter baumannii. To track the risk of multidrug-resistant A. baumannii, the present study aimed to determine the prevalence of carbapenemases in high-level aminoglycoside resistant A. baumannii over two years. A total of 118 strains of A. baumannii were consecutively collected in the First Affiliated Hospital of Chengdu Medical College, Chengdu, China. These isolates were investigated on the genetic basis of their resistance to aminoglycosides. The results showed that 75 (63.56%) isolates were high-level resistant to aminoglycosides, including gentamicin and amikacin (minimum inhibitory concentration >= 2.56 mu g/ml). Aminoglycoside-resistant genes ant(2 ")-Ia, aac(6')-Ib, aph(3')-Ia, aac(3)-Ia, aac(3)-IIa, armA, rmtA, rmtB, rmtC, rmtD, rmtE, rmtF, rmtG, rmtH and npmA, and carbapenem-resistant genes bla(OXA-23), bla(OXA-24), bla(OXA-51), bla(OXA-58), bla(SIM), bla(IMP), bla(NDM-1), and bla(KPC), were analyzed using polymerase chain reaction. The positive rate of ant(2 ")-Ia, aac(6')-Ib, aph(3')-Ia, aac(3)-Ia and aac(3)-IIa was 66.95, 69.49, 42.37, 39.83 and 14.41%, respectively. armA was present in 72.0% (54/75) of A. baumannii isolates with high-level resistance to aminoglycosides. The remaining nine 16S ribosomal RNA methlyase genes (rmtA, rmtB, rmtC, rmtD, rmtE, rmtF, rmtG, rmtH and npmA) and aminoglycoside-modifying enzyme gene aac(6')-Ib-cr were not detected. Among the 54 armA-positive isolates, the prevalence of the carbapenem resistant bla(OXA-23) and bla(OXA-51) genes was 79.63 and 100%, respectively. armA, ant(2 ")-Ia and aac(6')-Ib were positive in 43 isolates. The results of multilocus sequence typing revealed 31 sequence types (STs) in all clinical strains. Among these STs, the high-level aminoglycoside-resistant A. baumannii ST92, which mostly harbored bla(OXA-23), was the predominant clone (29/75). In conclusion, A. baumannii harboring carbapenemases and aminoglycoside-resistant enzymes are extremely prevalent in western China, emphasizing the need to adopt surveillance programs to solve the therapeutic challenges that this presents.