The online version of this article (https://doi.org/10.1186/s13756-017-0296-7) contains supplementary material, which is available to authorized users.
Carbapenem-nonsusceptible A. baumannii-calcoaceticus complex have emerged worldwide, but the epidemiology in Indonesian hospitals has not been studied.
A prospective observational study was performed on the intensive care units (ICUs) of the national referral hospital in Jakarta-Indonesia, in 2013 and 2014. All consecutive adult patients admitted and hospitalized for >48 h in ICUs were included. Basic and clinical data at admission were recorded. Carbapenem-nonsusceptible A. baumannii-calcoaceticus complex from clinical cultures and standardized screening were included. Environmental niches and healthcare workers (HCWs) were also screened. PCR was used to detect carbapenemase genes, and Raman spectroscopy as well as multilocus sequence typing (MLST) for typing.
Of 412 included patients, 69 (16.7%) carried carbapenem-nonsusceptible A. baumannii-calcoaceticus complex on admission, and 89 (25.9%) became positive during ICU stay. The acquisition rate was 43 per 1000 patient-days at risk. Six isolates were cultured from environment and one from a HCW. Acquisition of carbapenem-nonsusceptible A. baumannii-calcoaceticus complex was associated with longer ICU stay (median interquartile range [IQR]: 11 days [5–18], adjusted hazard ratio [aHR]: 2.56 [99% confidence interval (CI):1.76–3.70]), but not with mortality (adjusted odds ratio: 1.59 [99%CI: 0.74–3.40] at the chosen level of significance). The blaOXA-23-like gene was detected in 292/318 (91.8%) isolates, including isolates from the environment and HCW. Typing revealed five major clusters. Sequence types (ST)195, ST208, ST218, ST642 as well as new STs were found. The dominant clone consisted of isolates from patients and environment throughout the study period.
Carbapenem-nonsusceptible A. baumannii-calcoaceticus complex are endemic in this setting. Prevention requires source control and limiting transmission of strains.
The study was retrospectively registered at www.trialregister.nl (No:5541). Candidate number: 23,527, NTR number: NTR5541, Date registered NTR: 22nd December 2015.
Additional file 1: Table S1. List of environmental samples. Table S2. Baseline characteristics of patients admitted to the adult and Emergency Room (ER) ICUs. Table S3. Variables associated with mortality among patients with and without carbapenem-nonsusceptible A. baumannii-calcoaceticus complex. Table S4. Variables associated with length of stay among patients with and without carbapenem-nonsusceptible A. baumannii-calcoaceticus complex. Table S5. Source of detection of the carbapenem-nonsusceptible A. baumannii-calcoaceticus complex isolates collected in the study. Table S6. Sources of the five major Raman clusters of carbapenem-nonsusceptible A. baumannii-calcoaceticus complex in adult ICU and ER-ICUs. (DOC 288 kb)
Additional file 2: Figure S1. Carbapenem-nonsusceptible Acinetobacter baumannii-calcoaceticus complex carriage of included patients admitted to adult and ER-ICUs of Dr. Cipto Mangunkusomo General Hospital, Jakarta, Indonesia. (TIFF 1522 kb)
Additional file 3: Figure S2. Raman spectroscopy-based cluster analysis of Acinetobacter baumannii-calcoaceticus complex isolates from adult and ER-ICUs. Note: Raman spectra correlation matrix of carbapenem-nonsusceptible A. baumannii-calcoaceticus complex isolates. Isolates are shown in a color-scale (red-orange-yellow-grey) based on their similarity of correlation coefficient value. Red clusters (91–100%) indicate isolates that are indistinguishable according to the cut-off value. Grey areas (≤70%) indicate isolates that are not related. The potentially related isolates are shown by yellow areas (lower similarities (71–80%)) and orange areas (higher similarities (81–90%)). (JPEG 761 kb)
Additional file 4: Figure S3. The bed-clone analysis of cluster CIPTO-31 carbapenem-nonsusceptible Acinetobacter baumannii-calcoaceticus complex. Note: The bed-clone analysis from cluster CIPTO-31 carbapenem-nonsusceptible A. baumannii-calcoaceticus complex showed spreading of 115 isolates in both ICUs. The isolates were found in patients from almost all the beds. A red diamond represents an environmental isolate. (TIFF 1930 kb)
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- Endemic carbapenem-nonsusceptible Acinetobacter baumannii-calcoaceticus complex in intensive care units of the national referral hospital in Jakarta, Indonesia
Yulia Rosa Saharman
Wil H. F. Goessens
Corné H. W. Klaassen
Henri A. Verbrugh
Juliëtte A. Severin
- BioMed Central
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