ABSTRACT
Carbapenem-resistant Acinetobacter baumannii is becoming increasingly prevalent in patients with diabetes mellitus in the Middle East. We examined the relationship of these bacteria and their resistance mechanisms to the diabetic disease status of patients in Saudi Arabia. Susceptibilities of 271 isolates to carbapenems, tigecycline and colistin were determined, followed by detection of carbapenemase genes. A blaVIM gene was detected in ~95â% of isolates; blaOXA-23 and blaOXA-40 genes were also prevalent. Diabetic patients were significantly more likely to carry carbapenem-resistant isolates. Carbapenem-resistant A. baumannii is a serious problem in diabetic patients, and molecular detection of resistance mechanisms in these isolates is required.
Subject(s)
Acinetobacter Infections/complications , Acinetobacter baumannii/drug effects , Carbapenems/pharmacology , Diabetes Complications/epidemiology , Diabetes Mellitus/epidemiology , Drug Resistance, Bacterial , Acinetobacter Infections/microbiology , Acinetobacter baumannii/classification , Acinetobacter baumannii/genetics , Acinetobacter baumannii/isolation & purification , Anti-Bacterial Agents/pharmacology , Bacterial Proteins/genetics , Diabetes Complications/microbiology , Drug Resistance, Bacterial/genetics , Humans , Microbial Sensitivity Tests , Prevalence , Saudi Arabia/epidemiology , beta-Lactamases/geneticsABSTRACT
We aimed to characterize the vancomycin genotype/phenotype, carriage of putative virulence genes, and genetic relatedness of Enterococcus faecium isolates in Saudi Arabia. E. faecium isolated from inpatients at our medical center were studied. Sensitivity to ampicillin, linezolid, teicoplanin, quinupristin/dalfopristin, tetracycline, and ciprofloxacin was determined. The presence of van genes and virulence genes for aggregation substance (Asa-1), enterococcal surface proteins (esp), cytolysin (cylA, cylL, cylM), gelatinase (gelE), E. faecium endocarditis antigen (EfaA( fm )), hyaluronidase (hyl), and collagen adhesion (Ace) was assessed. Genetic relatedness was determined by pulsed-field gel electrophoresis (PFGE). Twenty-nine E. faecium isolates were obtained and the majority of isolates (n/N = 22/29) were from stool specimens. PFGE analysis identified eight pulsotypes (A-H) based on 80 % similarities. Isolates were represented in five major pulsotypes: type A (n = 5), type B (n = 3), type D (n = 6), type E (n = 5), and type F (n = 7). All isolates were vanA gene-positive. Thirteen isolates had vanA(+)/vanB(+) genotype. Of these, ten exhibited a vanB phenotype and three had a vanA phenotype. Eight isolates with vanA(+)/vanB(-) genotype exhibited vanB phenotype. Six of these eight isolates belonged to the same pulsotype. All isolates were positive for gelE, esp, and EfaA( fm ) genes. Five were CylA-positive and 24 had the hyl genes. Of the eight isolates harboring a combination of gelE, esp, EfaA( fm ), and hyl genes, five showed vanB phenotype-vanA genotype incongruence. This is the first report of vanB phenotype-vanA genotype incongruent E. faecium in the Middle East region. Molecular typing indicates clonal spread and high occurrence of virulence genes, especially esp genes, associated with epidemic clones.
Subject(s)
Bacterial Proteins/genetics , Carbon-Oxygen Ligases/genetics , Enterococcus faecium/drug effects , Enterococcus faecium/isolation & purification , Vancomycin Resistance , Academic Medical Centers , Bacterial Proteins/metabolism , Carbon-Oxygen Ligases/metabolism , Cluster Analysis , DNA, Bacterial/genetics , Electrophoresis, Gel, Pulsed-Field , Enterococcus faecium/classification , Enterococcus faecium/genetics , Feces/microbiology , Genotype , Gram-Positive Bacterial Infections/microbiology , Humans , Molecular Typing , Phenotype , Saudi Arabia , Virulence Factors/geneticsABSTRACT
BACKGROUND: Information on strain types of human cytomegalovirus (HCMV) isolates from Saudi Arabian patients is lacking. MATERIALS AND METHODS: 80 clinical isolates of HCMV from Saudi Arabian patients were analyzed by PCR amplification of three regions (DNA polymerase, glycoprotein B, and glycoprotein H) of the virus genome. The resultant amplicons (2.0-2.7 kb) were further studied by restriction fragment length polymorphism (RFLP) using four enzymes (HaeIII, HhaI, MspI, and RsaI). RESULTS: Combined analysis of the cleavage patterns generated by the enzymes identified five strains, S1-S5, and several mixed and unique strains. 18 isolates belonged to S1 strain and were similar to laboratory strain AD169. Eight isolates were present in each of S2 and S3 strains. Six isolates and four isolates were found in S4 and S5 strains, respectively. 12 isolates contained a mixture of S3 and S5, which may have resulted from a dual infection. Each of the 24 remaining isolates had a different strain pattern. CONCLUSION: Our findings show that 80 HCMV clinical isolates were distributed into 30 different strains using PCRRFLP analysis of multiple viral subgenomic regions. However, the number of isolates is not uniformly distributed among strains (p < 0.02).
