1Global and Tropical Health Division, Menzies School of Health Research, Darwin 0810, Australia.
2Department of Infectious Diseases, Royal Darwin Hospital, Darwin 0810, Australia.
Microb Genom. 2019 Mar;5(3). doi: 10.1099/mgen.0.000258. Epub 2019 Feb 26.
Acinetobacter baumannii causes severe, fulminant, community-acquired pneumonia (CAP) in tropical and subtropical regions. We compared the population structure, virulence and antimicrobial resistance determinants of northern Australian community-onset A. baumannii strains with local and global strains. We performed whole-genome sequencing on 55 clinical and five throat colonization A. baumannii isolates collected in northern Australia between 1994 and 2016. Clinical isolates included CAP (n=41), healthcare-associated pneumonia (n=7) and nosocomial bloodstream (n=7) isolates. We also included 93 publicly available international A. baumannii genome sequences in the analyses. Patients with A. baumannii CAP were almost all critically unwell; 82 % required intensive care unit admission and 18 % died during their inpatient stay. Whole-genome phylogenetic analysis demonstrated that community-onset strains were not phylogenetically distinct from nosocomial strains. Some non-multidrug-resistant local strains were closely related to multidrug-resistant strains from geographically distant locations. Pasteur sequence type (ST)10 was the dominant ST and accounted for 31/60 (52 %) northern Australian strains; the remainder belonged to a diverse range of STs. The most recent common ancestor for ST10 was estimated to have occurred in 1738 (95 % highest posterior density, 1626-1826), with evidence of multiple introduction events between Australia and Southeast Asia between then and the present day. Virulence genes associated with biofilm formation and the type 6 secretion system (T6SS) were absent in many strains, and were not associated with in-hospital mortality. All strains were susceptible to gentamicin and meropenem; none carried an AbaR resistance island. Our results suggest that international dissemination of A. baumannii is occurring in the community on a contemporary timescale. Genes associated with biofilm formation and the T6SS may not be required for survival in community niches. The relative contributions of host and bacterial factors to the clinical severity of community-onset A. baumannii infection require further investigation.
鲍曼不动杆菌在热带和亚热带地区引起严重的暴发性社区获得性肺炎(CAP)。我们比较了 1994 年至 2016 年间在澳大利亚北部采集的 55 例临床和 5 例咽喉定植鲍曼不动杆菌分离株的群体结构、毒力和抗微生物药物耐药决定因素与当地和全球菌株的差异。我们对澳大利亚北部采集的 55 例临床和 5 例咽喉定植鲍曼不动杆菌分离株进行了全基因组测序,其中包括 CAP(n=41)、与医疗保健相关的肺炎(n=7)和医院获得性血流感染(n=7)分离株。我们还在分析中纳入了 93 个公开的国际鲍曼不动杆菌基因组序列。患有鲍曼不动杆菌 CAP 的患者几乎都病情严重,82%需要入住重症监护病房,18%在住院期间死亡。全基因组系统发育分析表明,社区获得性菌株与医院获得性菌株在系统发育上没有明显区别。一些非多药耐药的本地菌株与来自地理位置遥远的地区的多药耐药菌株密切相关。巴斯德序列型(ST)10 是主要的 ST,占 60 例(52%)澳大利亚北部菌株中的 31/60;其余菌株属于多种 ST。ST10 的最近共同祖先估计发生在 1738 年(95%最高后验密度,1626-1826),从那时到现在,有证据表明澳大利亚和东南亚之间发生了多次传入事件。许多菌株中不存在与生物膜形成和 6 型分泌系统(T6SS)相关的毒力基因,且这些基因与院内死亡率无关。所有菌株均对庆大霉素和美罗培南敏感;没有菌株携带 AbaR 耐药岛。我们的研究结果表明,在当代,鲍曼不动杆菌正在社区中进行国际传播。与生物膜形成和 T6SS 相关的基因可能不是在社区环境中生存所必需的。宿主和细菌因素对社区获得性鲍曼不动杆菌感染临床严重程度的相对贡献需要进一步研究。
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