Volume 23, Issue 1 (Apr - May 2019)                   J Qazvin Univ Med Sci 2019, 23(1): 2-13 | Back to browse issues page

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Keshavarz-Hedayati S, Shapouri R, Habibollah-Pourzereshki N, Bigverdi R, Peymani A. Molecular Investigation of Resistance to Disinfectants in Acinetobacter Baumannii Isolates Collected From Qazvin Hospitals, Iran (2017). J Qazvin Univ Med Sci. 2019; 23 (1) :2-13
URL: http://journal.qums.ac.ir/article-1-2854-en.html
1- Department of Microbiology, Faculty of Basic Sciences, Zanjan Branch, Islamic Azad University, Zanjan, Iran.
2- Medical Microbiology Research Center, Qazvin University of Medical Sciences, Qazvin, Iran.
3- Department of Medical Microbiology, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran.
4- Medical Microbiology Research Center, Qazvin University of Medical Sciences, Qazvin, Iran. , a.peymani@gmail.com
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1. Introduction
Acinetobacter baumannii is one of the major causes of hospital infections. The important feature of this organism is its intrinsic drug resistance or high tendency to obtain various resistance factors against the antibiotics used in the hospital [4]. According to studies, the resistance of this organism to antimicrobials and antiseptic agents is increasing as we see the emergence of A. cinetobacter species with multidrug resistance (MDR) patterns in health care centers which simultaneously exhibit resistance to at least three important antibiotic classes of β-lactam, aminoglycoside, and fluoroquinolone [2, 3].
The effective use of disinfectants, such as the quaternary ammonium compounds is a major contributor to the prevention of hospital infections. These compounds are salts containing nitrogen atom and four free radicals with antimicrobial activity and can lose their activity in pH<3 [5]. In recent years, there have been numerous reports of the presence of A. baumannii isolates resistant to common disinfectants in treatment centers, which is determined by qacE and qacEΔ1 genes. The qacEΔ1 gene is a mutant version of the qacE gene that is widely distributed throughout Gram-negative bacteria as it is located on 3’-conserved area of the class 1 integrons and acts as one of the genes that cause multiple drug resistance [9, 10].
About half of the class 1 integrons contain a gene resistant to quaternary ammonium compounds as a factor involved in resistance to disinfectants [7, 8]. This study, while analyzing the antibiotic susceptibility pattern, investigates the frequency of qacE and qacEΔ1 genes as disinfectant resistance genes in A. baumannii isolates collected from hospitalized patients in different departments of hospitals in Qazvin, Iran.
2. Materials and Methods
This descriptive study with the cross-sectional design was conducted during 2016-2017. A total of 141 A. baumannii isolates were collected from patients hospitalized in different hospitals in Qazvin. All isolates were identified by standard biochemical and microbiological tests. Identification of A. baumannii was confirmed by amplification of the blaOXA-51-like gene using polymerase chain reaction (PCR).
The antibiotic susceptibility patterns of all isolates were analyzed by using Kirby-Bauer test based on the instructions of Clinical Laboratory Standards Institute (CLSI) and using the antibiotics of amoxicillin-clavulanic acid, ceftazidime, gentamicin, amikacin, imipenem, cefotaxime, ciprofloxacin, and tetracycline antibiotics [13]. We used A. baumannii strain ATCC 19606 to control the susceptibility test.
For examining the presence of qacE and qacEΔ1 genes using PCR method, first, the DNA was extracted using the relevant kits based on instructions in a final volume of 20 mL. To identify sequences of isolated genes to confirm their presence, PCR products were sent to Macrogen, Inc. (Seoul, Korea). Then, a possible relationship between the presence of resistance genes and MDR patterns was evaluated using the Chi-squared test at a significance level of 0.05.
3. Results
The antibiotic susceptibility test results showed that most of the isolates were resistant to amoxicillin-clavulanic acid (n=127, 89.2%) followed by gentamicin and cefotaxime (n=126, 88.3%). Moreover, most of them were susceptible to amikacin (n=17, 12.6%) and ceftazidime (n=11, 8.3%). In total, 133 (94.32%) isolates were resistant simultaneously to the three antibiotic classes. Also, their MDR pattern showed that out of 133 isolates, 84 (59%) harbored qacEΔ1 and 24 (17%) qacE genes, while 49 (40%) and 109 (82%) isolates did not harbor qacEΔ1 and qacE genes, respectively. There was a significant association between the presence of resistance genes and MDR patterns (P=0.001).
4. Conclusion
Based on the results, 94.32% of A. baumannii isolates showed MDR patterns. It seems that the inappropriate and excessive use of broad-spectrum antibiotics and the lack of proper infection control strategy are the main reasons for the emergence of MDR isolates in different healthcare centers [15]. The highest drug resistance was reported for amoxicillin-clavulanic acid, cefotaxime, and gentamicin antibiotics, respectively, while amikacin and ceftazidime were the most effective drugs against A. baumannii isolates. Moreover, qacE and qacEΔ1 genes were highly present in A. baumannii isolates of the studied treatment centers. Obviously, these microorganisms contribute to the development of various infections and the increase in mortality rates, especially in hospitalized patients. Therefore, the identification of these isolates is of particular importance.
To control the resistance of this bacterium to the antiseptic compounds, we recommend the proper use of these disinfectants in the standard concentrations by the authorities and manufacturing companies.
Ethical Considerations
Compliance with ethical guidelines

In all stages of the study, ethical guidelines and confidentiality of the received information were observed. The Research Ethics Committee of Qazvin University of Medical Sciences approved this study (Ethical Code: 10371).
This paper was extracted from an MS of Samaneh Keshavarz-Hedayati, Department of Microbiology, School of Basic Science, Zanjan Branch, Islamic Azad University.
Authors' contributions
Formal analysis and project administration: Amir Peymani; Data collection, microbiology and molecular tests, and draft preparation: Samaneh Keshavarz-Hedayati; Data curation and writing: Narges Habibollah-Pourzereshki; Project management consultancy: Reza Shapouri and Reza Bigverdi; Final draft preparation: all authors.
Conflicts of interest
The authors declare no conflict of interest.
The authors would like to thank the management and staff of Medical Microbiology Research Center of Qazvin University of Medical Sciences for their valuable cooperation.
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Type of Study: Research | Subject: Microbiology

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