Research Article
Dissemination and Genetic Relatedness of Multidrug-Resistant
and Extensively Drug-Resistant Acinetobacter baumannii
Isolates from a Burn Hospital in Iraq
Aras A. K Shali , Paywast J Jalal , and Sehand K Arif
Dept of Biology, College of Science, University of Sulaimani, Al Sulaymaniyah, Iraq
Correspondence should be addressed to Aras A. K Shali; aras.kamal@univsul.edu.iq
Received 14 February 2022; Revised 14 March 2022; Accepted 20 May 2022; Published 27 May 2022
Academic Editor: Abdelaziz Ed-dra
Copyright © 2022 Aras A. K Shali et al. is is an open access article distributed under the Creative Commons Attribution License,
which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
Acinetobacter baumannii is an aggressive opportunistic bacterial pathogen that causes severe nosocomial infections, especially
among burn patients. An increasing number of hospitals-acquired infections have been reported all over the world. However, little
attention has been paid to the relatedness between A. baumannii isolates from different hospital environments and patients. In this
study, 27 isolates were collected from the Burn and Plastic Surgery Hospital of Al Sulaymaniyah City, Iraq, from January through
December 2019 (11 from patients and 16 from the wards environment), identified to species level as A. baumannii using Vitek 2
system and molecular detection of 16S rRNA gene, and then confirmed by targeting the bla
OXA-51
gene. Moreover, the isolates
were characterized by means of automated antimicrobial susceptibility assay, antimicrobial-resistant patterns, a phenotypic
method using a combined disk test, and molecular methods for the detection of class A and C β-lactamase genes, and finally, the
genetic relatedness was classified. Antimicrobial susceptibility testing showed that 63% (17/27) of the retrieved A. baumannii
isolates were extensively drug-resistant to 8/9 antimicrobial classes. Furthermore, 37% (10/27) of the isolates were classified as
multidrug-resistant; 8 isolates exhibited similar resistant patterns and the other two isolates showed 2 different patterns, while
resistance was greater in isolates from patients than from the ward environment. Combined disk test showed that two isolates
contained extended-spectrum β-lactamase. All isolates carried bla
TEM-1
, and two copies of the bla
CTX-1
gene were indicated in one
isolate, while bla
SHV
was absent in all isolates. Twenty-four isolates carried the bla
AmpC
gene; among them, 3 isolates harbored the
insertion sequence ISAba-1 upstream to the gene. Using Enterobacterial Repetitive Intergenic Consensus PCR, the isolates were
clustered into 6 distinct types; among them, two clusters, each of four strains, were classified to contain isolates from both patients
and environments. e clusters of similar genotypes were found in inpatients as well as the environments of different wards during
time periods, suggesting transmission within the hospital. Identification of possible infection sources and controlling the
transmission of these aggressive resistance strains should be strictly conducted.
1. Introduction
Multiantibiotic resistance to bacterial pathogens has increased
worldwide which is considered a public health hazard. e
development of multidrug-resistant MDR and extensively drug-
resistant XDR bacteria is reported in several recent studies
which require urgencies to upgrade the currently in-use anti-
microbial agents or to create new alternatives [1]. Besides, there
should be frequent monitoring of the antimicrobial suscepti-
bility testing to indicate the antibiotic of choice and to identify
the resistance patterns [2].
A. baumannii has over the last several years gained
recognition as being an opportunistic pathogen. While
usually a benign component for inpatients, it causes about
10% of nosocomial infections in intensive care units (ICUs),
leading to a wide range of infections such as bacteremia,
secondary meningitis, pneumonia, burns, wounds, and
urinary tract infections [3]. Clinically, its significance has
been forced by its capacity to acquire resistance determi-
nants which makes it a highly threatening organism within
the field of antibiotics. A. baumannii has high intrinsic
resistance to several antibiotics and a tendency to acquire
Hindawi
Canadian Journal of Infectious Diseases and Medical Microbiology
Volume 2022, Article ID 8243192, 10 pages
https://doi.org/10.1155/2022/8243192