Gram-Negative ESKAPE Bacteria Surveillance in COVID-19 Pandemic Exposes High-Risk Sequence Types of Acinetobacter baumannii MDR in a Tertiary Care Hospital.

Gram-Negative ESKAPE Bacteria Surveillance in COVID-19 Pandemic Exposes High-Risk Sequence Types of Acinetobacter baumannii MDR in a Tertiary Care Hospital.

Publication date: Jan 04, 2024

The interruption of bacteriological surveillance due to the COVID-19 pandemic brought serious consequences, such as the collapse of health systems and the possible increase in antimicrobial resistance. Therefore, it is necessary to know the rate of resistance and its associated mechanisms in bacteria causing hospital infections during the pandemic. The aim of this work was to show the phenotypic and molecular characteristics of antimicrobial resistance in ESKAPE bacteria in a Mexican tertiary care hospital in the second and third years of the pandemic. For this purpose, during 2021 and 2022, two hundred unduplicated strains of the ESKAPE group (Escherichia coli, Klebsiella pneumoniae, Pseudomonas aeruginosa, and Acinetobacter baumannii) were collected from various clinical sources and categorized by resistance according to the CLSI. An analysis of variance (ANOVA) complemented by the Tukey test was performed to search for changes in antimicrobial susceptibility profiles during the study period. Finally, the mechanisms of resistance involved in carbapenem resistance were analyzed, and the search for efflux pumps and high-risk sequence types in A. baumannii was performed by multilocus analysis (MLST). The results showed no changes in K. pneumoniae resistance during the period analyzed. Decreases in quinolone resistance were identified in E. coli (p = 0. 039) and P. aeruginosa (p = 0. 03). Interestingly, A. baumannii showed increases in resistance to penicillins (p = 0. 004), aminoglycosides (p < 0. 001, p = 0. 027), carbapenems (p = 0. 027), and folate inhibitors (p = 0. 001). Several genes involved in carbapenem resistance were identified (bla, bla, bla, bla, bla, and bla) with a predominance of bla and the adeABCRS efflux pump in A. baumannii. Finally, MLST analysis revealed the presence of globally distributed sequence types (ST369 and ST758) related to hospital outbreaks in other parts of the world. The results presented demonstrate that the ESKAPE group has played an important role during the COVID-19 pandemic as nosocomial antibiotic-resistant pathogens and in particular A. baumannii MDR as a potential reservoir of resistance genes. The implications of the increases in antimicrobial resistance in pathogens of the ESKAPE group and mainly in A. baumannii during the COVID-19 pandemic are analyzed and discussed.

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Concepts Keywords
Acinetobacter Acinetobacter baumannii
High antimicrobial resistance
Mexican COVID-19 pandemic
Pneumoniae ESKAPE bacteria
hospital infection
sequence type


Type Source Name
disease IDO bacteria
disease MESH COVID-19 Pandemic
disease MESH hospital infections
disease VO ANOVA
disease IDO susceptibility
drug DRUGBANK Folic Acid
drug DRUGBANK Coenzyme M
disease MESH infections
disease MESH critically ill
disease MESH pneumonia
disease MESH morbidity
drug DRUGBANK Enterococcus faecium
disease IDO pathogen
disease VO organization
drug DRUGBANK Meropenem
drug DRUGBANK Imipenem
drug DRUGBANK Piperacillin
drug DRUGBANK Tazobactam
disease MESH urinary tract infections
disease IDO blood
disease MESH sepsis
disease VO USA
disease VO protocol
disease VO frequency
disease IDO antibiotic resistance
disease IDO production
disease IDO assay
disease VO inactivation
drug DRUGBANK Methylergometrine
drug DRUGBANK Serine
disease VO GltA
drug DRUGBANK Dextrose unspecified form
pathway KEGG Homologous recombination
disease VO Cpn60
drug DRUGBANK Phosphate ion
disease IDO cell
disease VO population
disease IDO infection
disease MESH Wound infection
drug DRUGBANK Lactose
drug DRUGBANK Ademetionine
drug DRUGBANK Ceftazidime
drug DRUGBANK Ciprofloxacin
drug DRUGBANK Ampicillin
drug DRUGBANK Sulbactam
drug DRUGBANK L-Phenylalanine
drug DRUGBANK Amoxicillin
drug DRUGBANK Cefepime
drug DRUGBANK Cefoxitin
drug DRUGBANK Ceftriaxone
drug DRUGBANK Amikacin
drug DRUGBANK Gentamicin
drug DRUGBANK Ethionamide
drug DRUGBANK Ertapenem
drug DRUGBANK Colistin
drug DRUGBANK Trimethoprim
drug DRUGBANK Sulfamethoxazole
drug DRUGBANK Cefotaxime
drug DRUGBANK Levofloxacin
drug DRUGBANK Ofloxacin
drug DRUGBANK Cefadroxil
disease MESH genetic marker
disease VO gene
disease VO time
drug DRUGBANK Sodium Tetradecyl Sulfate
disease IDO country
disease MESH Coinfections
disease MESH acute respiratory distress syndrome
disease MESH Bacterial Pneumonia
disease MESH Pus
disease IDO intervention
disease IDO virulence
pathway KEGG Quorum sensing
disease MESH Emergency
drug DRUGBANK Ozone
disease MESH osteomyelitis
disease MESH leukemia

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