Investigation of the Virulence Factors of Multidrug-Resistant Acinetobacter baumannii Isolates

Acinetobacter baumannii is an opportunistic human pathogen which causes life-threatening nosocomial infections such as ventilator-associated pneumonia, bacteremia, meningitis, urinary tract and wound infections. Treatment options are very limited for infections caused by multi-drug resistant (MDR) A.baumannii strains. Until recently, the majority of studies related to A.baumannii have focused on antibiotic resistance, treatment protocols and epidemiological data, however, there have been few studies addressing the virulence factors of this organism. The features such as biofilm formation, serum resistance, motility, efflux pumps and iron acquisition mechanisms help the bacterium to survive in adverse environmental conditions and facilitate the development of an infection. The aim of the present study was to investigate the basic characteristics that contribute to the virulence of clinically important MDR A.baumannii isolates. Sixty-five ciprofloxacin-imipenem-trimethoprim/sulfamethoxazole-resistant A.baumannii strains isolated from various clinical specimens between December 2011 and March 2012 at Ege University Faculty of Medicine, Department of Medical Microbiology were included in the study. The clonal relationship of the isolates was analyzed by PCR using Enterobacterial repetitive intergenic consensus (ERIC)-2 primer. Biofilm formation, serum resistance, twitching and swarming motility efflux pump and siderophore production were sought in representatives of each clone. Investigated MDR A.baumannii isolates were classified into seven main clusters, and the largest cluster included 86% of the strains. The virulence-associated features were investigated in 16 representative strains, including sub-groups. Twelve, three and one of the examined strains were determined to be strong, intermediate and weak biofilm producers, respectively. Siderophore production was not encountered in any of the isolates. Of the sixteen strains, two, one and thirteen isolates were found to be resistant, moderately susceptible and susceptible to bactericidal effect of serum, respectively. In our study, swarming motility was observed in seven strains while twitching motility was observed in only one strain. Swarming was simultaneously detected with twitching in one isolate. The presence of an efflux pump was investigated with ciprofloxacin in 16 representative strains but none of them were positive. However, eflux pump was determined in two of the five doxycycline resistant strains. Biofilm production was the most commonly observed characteristic among the examined strains. In addition, serum resistance, swarming and an efflux pump which has a spectrum including tetracyclines, were also determined among features associated with virulence. While the biofilm production was encountered at the members of all clones, serum resistance was found only in the representatives of the most dominant clone. Motility and the presence of an efflux pump were not associated with a particular clone. MDR A.baumannii strains are among the most important agents of nosocomial infections in our hospital and all over the world. Revealing the characteristics that play a role in the pathogenesis of these isolates, will contribute to infection control measures and to the investigation of new treatment options.