MULTIDRUG-RESISTANT ACINETOBACTERBAUMANNII IN ADJARA REGION

Koiava T 1 , Goncalves D 2,3 , Palmeira J 2 , ArobelidzeK. 4 , TavadzeV 4 , Tediashvili M 5 , Akhvlediani L. 1 and Ferreira H 2 . 1. Batumi ShotaRustaveli State University, Faculty of Natural Sciences and Health Care-Department of Biology. 2. University of Porto – Pharmacy Faculty – Department of Microbiology. 3. Health Superior Institute of Alto Ave. 4. National Center for Disease Control and Public Healthin Adjara. 5. Eliava Institute of Bacteriophage. ...................................................................................................................... Manuscript Info Abstract ......................... ........................................................................ Manuscript History

Control of multidrug-resistant and extensively drug-resistant Acinetobacter spp. infections is an important challenge for clinical microbiologists and physicians. Its ability to survive in hospital environment and its capability to persist for long periods of time on surfaces make it a common cause of healthcare-associated infections and multiple outbreaks [PE Fournier…2006].The prevalence of A. baumanniiin healthcare centers has increased around the world (Ahmed…2010; Cisneros…2005].

Objectives:-
The current study aimed to identify Acinetobacterbaumannii by molecular method and determine its separation among different wards in hospital and determine the antimicrobial patterns of these bacteria.

Materials and Methods:-
Antimicrobial susceptibility testing:-Disk diffusion method was performed to test the susceptibility of Acinetobacterbaumanniiisolates to common antibiotics on Mueller-Hinton agar, with an inoculum equal to 0.5 McFarland turbidity according to CLSI [16]. The plates were incubated at 37°C for 18-24 hrs. And the inhibition zone diameters around the antibiotic discs were measured. There were samples of sputum and biological fluids. All isolates were examined for the antibiotic 2174 resistance of the following antibiotics: Imipenem-EDTA synergy test:-EDTA(ethylene-diamine-tetraaceticacid) is a polyaminocarboxylicacid that binds metalions like zinc and can in activate the metallo-beta-lactamases. Therefore, it is used for the phenotypic detection of MBL production in clinical isolates (Pitout, 2007)Picture 2.    Table 1)Like data of Kusradze, blaOXA-58 was not detected in any isolates in this study.  STX-Sulfonamid+timetri, CIP-ciprofloxacin,  CN-Gentamicin, , TOB-Tobramicin PIP/TAZ-Piperacilin, NET-Netilmicin, and AK-amikacin DOR-Doripenem, MRP-Meropenem, FEP-Cefepim, IMI-Imipenem,. Relativelysensitiveantibioticswas TE-Tetraciclin.

Figure 2 . Profile of Antibiotic Resistance AcinetobacterBaumannii
Acinetobacter baumannii showed a high resistance to almost all antibiotics. As the diagram shows the highest resistance was revealed towards ceftazidim, it was 100%, towards ciprofloxacin, piperacillin, tazobactam, imipenem and ticarcilin / clavulanic -90%, towards gentamicin, amikacin, tobramycin, colistin and cfepim -80%. Itshould be noted that our study was different from the research conducted in Georgia. In particular, according to the article ,,Molecular detection of OXA carbapenemase genes in multidrug-resistant Acinetobacterbaumannii isolates from Iraq and Georgia" [ Kusradze...2011] , all the samples were susceptible 2177 to colistin, but as the result of our study, 80% of the samples were resistant to colistin. In general, the resistance profile to broad spectrum antibiotics was similar. The conducted studies showed that the resistance to sulfamet+trimetrop was 70 %, and a relatively low resistance to tetracycline was 20 % ( Figure 2).

Discussion:-
Acinetobacter spp. is the second most commonly isolated non-fermenter in human specimens (after Pseudomonas aeruginosa). Acinetobacter spp. appears to be an important cause of ICU infections. Multidrug-resistant Acinetobacter spp. is alert pathogens, mostly in ICUs and is related with outbreaks of infection. Almost similar results were observed in a study by Sana Islahi in India. Most of the strains were highly resistant to the antibiotics. Therefore, treatment of these infections are complicated. Evidence has accumulated that contaminated surfaces cause the epidemic and endemic transmission of many MDR and XDR bacteria. [Hossien…2014]. ~ Our results showed that this group of antibiotics had low-level resistance tetracyclin20%, highest resistance was revealed towards ceftazidim, it was 100%, towards ciprofloxacin, piperacillin, tazobactam, imipenem and ticarcilin / clavulanic -90%, towards gentamicin, amikacin, tobramycin, colistin and cfepim -80%,The conducted studies showed that the resistance to sulfamet+trimetrop was 70 %. Also, Isolates showed specific amplification for blaOXA51, blaOXA40, families.
In summary, our results demonstrate the need for effective surveillance of antimicrobial resistance in A. baumannii in Adjara Region and suggest that it is essential to use antibiotics with the most caution to prevent the emergence of drug-resistant strains. Furthermore, these findings indicate that the prevalence of antibiotic-resistant A. baumanniiis high in Adjara Region, especially for the antibiotics of choice. This is an emerging concern to public health, particularly in the clinical management of persons with life-threatening A. baumannii infections. The results of this study confirm what some other studies have shown, that the length of hospital stay and antibiotic use prior to infection are significantly associated with increased risk of an antimicrobial resistant A. baumanniiinfection