The aim of the study was to evaluate the dissemination of multiresistant isolates of Acinetobacter baumannii carrying resistance genes, by samples of wastewater from hospitals in Porto Alegre, Rio Grande do Sul, Brazil. We obtained 303 bacterial isolates from the wastewater of three hospitals in Porto Alegre, Rio Grande do Sul. For each isolate, we determined the profile of susceptibility to antimicrobials and the presence of the genes blaOXA-23, blaOXA-24, blaOXA-51, blaOXA-58, blaSPM-1, blaIMP, and blaVIM. The blaOXA-51 gene was found in 56% of the isolates, indicating the presence of A. baumannii in this environment. Of these, three multiresistant isolates were positive for the blaOXA-23 gene, in wastewater from two of the hospitals. The results obtained in this study indicate that isolates of A. baumannii which are multiresistant and carry resistance genes such as blaOXA-51 and blaOXA-23 are being released into the environment in the wastewater from the hospitals analyzed. Multiresistant Acinetobacter junii, the newly emerging pathogen, were also found among the multiresistant isolates. Hospital wastewater may be crucial to the development and dispersal of multiresistant bacteria, making waterbodies reservoirs of bacterial resistance.
ArakawaY., ShibataN., ShibayamaK., KurokawaH., YagiT., FujiwaraH., GotoM.2000. Convenient test for screening metallo-β-lactamase- producing Gram-negative bacteria by using thiol compounds. J. Clin. Microbiol., 38:40–43.
3.
BaqueroF., MartínezJ.L., CantónR.2008. Antibiotics and antibiotic resistance in water environments. Curr. Opin. Biotechnol., 19:260–265.
4.
Bergogne-BerezinE., TownerK.J.1996. Acinetobacter spp. as nosocomial pathogens: microbiological, clinical, and epidemiological features. Clin. Microbiol. Rev., 9:148–165.
5.
BernardsA.T., de BeaufortA.J., DijkshoornL., van BovenC.P.A.1997. Outbreak of septicaemia in neonates caused by Acinetobacter junii investigated by amplified ribosomal DNA restriction analysis (ARDRA) and four typing methods. J. Hosp. Infect., 35:129–140.
6.
BratuS., LandmanD., MartinD.A., GeorgescuC., QualeJ.2008. Correlation of antimicrobial resistance with β-lactamases, the OmpA-like porin, and efflux pumps in clinical isolates of Acinetobacter baumannii endemic to New York City. Antimicrob. Agents Chemother., 52:2999–3005.
7.
CarvalhoK.R., AssefA.P.D.A.C., PeiranoG., SantosL.C.G., PereiraM.J.F., AsensiM.D., BaqueroF.2009. Dissemination of multidrug-resistant Acinetobacter baumannii genotypes carrying blaOXA-23 collected from hospitals in Rio de Janeiro, Brazil. Int. J. Antimicrob. Agents, 34:25–28.
8.
Dalla-CostaL.M., CoelhoJ.M., SouzaA.P.H.M., CastroM.E.S., StierC.J.N., BragagnoloK.L., Rea-NetoA., Penteado-FilhoS.R., LivermoreD.M., WoodfordN.2003. Outbreak of carbapenem-resistant Acinetobacter baumannii producing the OXA-23 enzyme in Curitiba, Brazil. J. Clin. Microbiol., 41:3403–3406.
9.
EllingtonM.J., KistlerJ., LivermoreD.M., WoodfordN.2006. Multiplex PCR for rapid detection of genes encoding acquired metallo-b-lactamases. J. Antimicrob. Chemother., 21:1–2.
10.
FerreiraA.E., CunhaG.R., FuentefriaD.B., CorçãoG.2007. Perfil de suscetibilidade a antimicrobianos em cepas de Acinetobacter spp. isoladas de efluente hospitalar em Porto Alegre-RS. Caderno Farmácia, 23:9–14(In Portuguese.)
11.
GalesA.C., TognimM.C.B., ReisA.O., JonesR.N., SaderH.S.2003. Emergence of an IMP-like metallo-enzyme in Acinetobacter baumannii clinical strain from a Brazilian teaching hospital. Diagn. Microbiol. Infect. Dis., 45:77–79.
12.
GuardabassiL., PetersenA., OlsenJ.E., DalDalsgaardA.1998. Antibiotic resistance in Acinetobacter spp. isolated from sewers receiving waste effluent from a hospital and a pharmaceutical plant. Appl. Environ. Microbiol., 64:3499–3502.
13.
HungY.T., LeeY.T., HuangL.J., ChenT.L., YuK.W., FungC.P., ChoW.L., LiuC.Y.2009. Clinical characteristics of patients with Acinetobacter junii infection. J. Microbiol. Immunol. Infect., 42:47–53.
14.
JoengS.H., Kwon BaeI., ParkK.O., Jun AnY., SohnS.G., JangS.J., SungK.H., YangK.S., LeeK., YoungD., LeeS.H.2006. Outbreaks of imipenem-resistant Acinetobacter baumannii producing carbapenemases in Korea. J. Clin. Microbiol., 44:423–431.
15.
KappsteinI., GrundmannH., HauerT., NiemeyerC.2000. Aerators as a reservoir of Acinetobacter junii: an outbreak of bacteraemia in paediatric oncology patients. J. Hosp. Infect., 44:27–30.
16.
LeeK., LimY.S., YongD., YumJ.H., ChongY.2003. Evaluation of the Hodge test and the imipenem-EDTA double-disk synergy test for differentiating metallo-β-lactamase-producing isolates of Pseudomonas spp. and Acinetobacter spp. J. Clin. Microbiol., 41:4623–4629.
17.
LintonK.B., RichmondM.B., BevanR., GillespieW.A.1974. Antibiotic resistance and R factors in coliform bacilli isolated from hospital and domestic sewage. J. Med. Microbiol., 7:91–103.
18.
MendesR.E., BellJ.M., TurnidgeJ.D., CastanheiraM., JonesR.N.2009. Emergence and widespread dissemination of OXA-23, -24/40 and -58 carbapenemases among Acinetobacter spp. in Asia-Pacific nations: report from the SENTRY Surveillance Program. J. Antimicrob. Chemother., 63:55–59.
19.
MerkierA.K., CentrónD.2006. bla (OXA-51)-type beta-lactamase genes are ubiquitous and vary within a strain in Acinetobacter baumannii. Int. J. Antimicrob. Agents, 28:110–113.
20.
MisbahS., HassanH., YusofM.Y., HanifahY.A., AbuBakarS.2005. Genomic species identification of Acinetobacter of clinical isolates by 16S rDNA sequencing. Singapore Med. J., 46:461–464.
PelegA.Y., PatersonD.L.2006. Multidrug-resistant Acinetobacter: a threat to the antibiotic era. Intern. Med. J., 36:479–482.
23.
SaderH.S., CastanheiraM., MendesR.E., TolemanM., WalshT.R., JonesR.N.2005. Dissemination and diversity of metallo-b-lactamases in Latin America: report from the SENTRY Antimicrobial Surveillance Program. Intern. J. Antimicrob. Agents, 25:57–61.
24.
StoevaT., HigginsP.G., SavovE., MarkovskaR., MitovI., SeifertH.2009. Nosocomial spread of OXA-23 and OXA-58 b-lactamase-producing Acinetobacter baumannii in a Bulgarian hospital. J. Antimicrob. Chemother., 15:1–2.
25.
TakagiE.H., LincopanN., CassettariV.C., PassadoreL.F., MamizukaE.M., MartinezM.B.2009. Carbapenem-resistant Acinetobacter baumannii outbreak at University hospital. Braz. J. Microbiol., 40:339–341.
26.
TognimM.C.B., GalesA.C., PenteadoA.P., SilbertS., SaderH.2006. Dissemination of IMP-1 metallo-beta-lactamase-producing Acinetobacter species in a Brazilian teaching hospital. Infect. Control Hosp. Epidemiol., 27:742–747.
27.
TurtonJ.F., WoodfordN., GloverJ., YardeS., KaufmannM.E., PittT.L.2006. Identification of Acinetobacter baumannii by detection of the blaOXA-51-like carbapenemase gene intrinsic to this species. J. Clin. Microbiol., 44:2974–2976.
28.
VahabogluH., BudakF., KasapM., GacarG., TorolS., KaradenizliA., KolayliF., ErogluC.2006. High prevalence of OXA-51-type class D beta-lactamases among ceftazidime-resistant clinical isolates of Acinetobacter spp.: co-existence with OXA-58 in multiple centres. J. Antimicrob. Chemother., 58:537–542.
29.
VillegasM.V., HartsteinA.I.2003. Acinetobacter outbreaks, 1977–2000. Infect. Control Hosp. Epidemiol., 24:284–295.
30.
WalshT.R., BolmströmA., QwärnströmA., GalesA.2002. Evaluation of a new Etest for detecting metallo-beta-lactamases in routine clinical testing. J. Clin. Microbiol., 40:2755–2759.
31.
WoodfordN., EllingtonM.J., CoelhoJ.M., TurtonJ.F., WardM.E., BrownS., AmyesS.G., LivermoreD.M.2006. Multiplex PCR for genes encoding prevalent OXA carbapenemases in Acinetobacter spp. Int. J. Antimicrob. Agents, 27:351–353.
32.
YanJ.J., WuJ.J., TsaiS.H., ChuangC.L.2004. Comparison of the double-disk, combined disk, and Etest methods for detecting metallo-beta-lactamases in gram-negative bacilli. Diagn. Microbiol. Infect. Dis., 49:5–11.
33.
YangC.M., LinM.F., LiaoP.C., YenH.W., ChangB.V., TangT.K., ChemC., SungC.H., LiouM.L.2009. Comparison of antimicrobial resistance patterns between clinical and sewage isolates in a regional hospital in Taiwan. Lett. Appl. Microbiol., 48:560–565.
34.
YongD., LeeK., YumJ.H., ShinH.B., RossoliniG.M., ChongY.2002. Imipenem-EDTA disk method for differentiation of metallo-β-lactamase-producing clinical isolates of Pseudomonas spp. and Acinetobacter spp. J. Clin. Microbiol., 40:3798–3801.
35.
ZarrilliR., CasilloR., Di PopoloA., TripodiM.F., BagattiniM., CuccurulloS., CrivaroV., RagoneE., MatteiA., GaldieriN., TriassiM., UtiliR.2007. Molecular epidemiology of a clonal outbreak of multidrug-resistant Acinetobacter baumannii in a university hospital in Italy. Clin. Microbiol. Infect., 13:481–489.
Supplementary Material
Please find the following supplemental material available below.
For Open Access articles published under a Creative Commons License, all supplemental material carries the same license as the article it is associated with.
For non-Open Access articles published, all supplemental material carries a non-exclusive license, and permission requests for re-use of supplemental material or any part of supplemental material shall be sent directly to the copyright owner as specified in the copyright notice associated with the article.
