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Carbapenemase-producing Acinetobacter spp. in Cattle, France.

To the Editor: Multidrug resistance in bacteria isolated from animals is an emerging phenomenon, mirroring what is happening among humans. During the past decade, expanded-spectrum [beta]-lactamases in Enterobacteriaceae from humans (1) and animals (2) worldwide have been reported. Among humans, as a consequence of this high rate, use of carbepenems is increasing selection pressure; carbapenem-resistant gram-negative organisms are increasingly reported, including carbapenemase-producing Enterobacteriaceae and Acinetobacter spp. (3).

The most commonly acquired carbapenemases identified in Acinetobacter spp. correspond to carbapenem-hydrolyzing class D [beta]-lactamases (3). In particular, the worldwide spread of OXA-23-producing A. baumannii is considered a serious threat; those strains are frequently involved in nosocomial outbreaks for which therapeutic options are extremely limited (3,4). Our study objective was to evaluate the possible occurrence of carbapenemase-producing gram-negative bacteria in dairy cattle in France.

In August 2010, at a dairy farm 30 km from Paris, France, rectal swabs were collected from 50 cows. Samples were precultured in buffered peptone water and incubated for 18 h at 37[degrees]C. Cultures were inoculated by streaking 100 [micro]L of the suspensions onto Drigalski agar plates (bioMerieux, Balmes-les-Grottes, France) containing 1 [micro]g/mL of imipenem to select for carbapenem-resistant gram-negative isolates. Of the 50 samples, 9 produced growth on imipenem-containing plates. All colonies tested (10 colonies/sample) by using the API 20 NE (bioMerieux) system were first identified as A. lwoffii. Molecular techniques based on sequencing of the gyrA, gyrB, and rpoB genes (5) enabled more precise identification and indicated that all isolates belonged to the Acinetobacter genomospecies (DNA group) 15TU, which is known to be phylogenetically related to A. lwoffii and which has been reportedly isolated from sewage, freshwater aquaculture habitats, trout intestines, and frozen shrimp (6).

One colony per sample was retained for further investigation (isolates BY1 to BY9). Susceptibility testing and MIC determinations were performed by disk-diffusion assay (Sanofi-Diagnostic Pasteur, Marnesla-Coquette, France) and Etest (AB bioMerieux, Solna, Sweden) (Table). All isolates except 1 were resistant to penicillins, combinations of penicillins and [beta]-lactamase inhibitors, and carbapenems but susceptible to cefotaxime and of reduced susceptibility to ceftazidime. Isolate BY1 showed higher MICs for carbapenems (Table). In addition, all isolates were resistant to tetracycline, kanamycin, and fosfomycin and remained susceptible to fluoroquinolones, chloramphenicol, gentamicin, amikacin, tobramycin, and sulfonamides. Susceptibility profiles of 3 Acinetobacter genomospecies 15TU reference strains showed that they were fully susceptible to penicillins, carbapenems, tetracycline, and kanamycin.

Clonal diversity between the isolates was assessed by pulsed-field gel electrophoresis (5), which showed 6 distinct genotypes. Isolate BY1 corresponded to a single clone (data not shown), which indicated that the occurrence of Acinetobacter genomospecies 15TU strains among these animals was not the result of dissemination of a single clone.

PCR detection and sequencing of genes that encode carbapenem-hydrolyzing class D [beta]-lactamases (5) showed that the 9 Acinetobacter genomospecies 15TU isolates harbored a [bla.sub.OXA-23] gene, whereas the 3 reference strains remained negative. Sequencing confirmed that all isolates expressed [beta]-lactamase OXA-23, which is known to be widespread in A. baumannii.

Mating-out assays and plasmid electroporation assays were performed by using [bla.sub.OXA-23]-positive Acinetobacter spp. isolates as donors and rifampin-resistant A. baumannii BM4547 isolates as a recipient strain (5); however, these assays were unsuccessful. Plasmid DNA analysis (5) gave uninterpretable results, with DNA degradations.

The genetic structures surrounding the [bla.sub.OXA-23] gene were investigated by PCR mapping (7), which identified transposon Tn2008 in isolate BY2 only. Tn2008 is a major vehicle for the spread of the [bla.sub.OXA-23] gene in A. baumannii in the People's Republic of China (8) and the United States (9). In the other isolates, the ISAba1 element of Tn2008 had been truncated by a novel insertion sequence termed ISAcsp2 (www-is.biotoul.fr).

The dairy farmer indicated that most animals from which OXA-23 producers had been identified had received antimicrobial drugs in the previous weeks. Although 1 animal had received amoxicillin-clavulanate, most of the others had been given oxytetracycline and neomycin to treat mastitis.

[beta]-lactamase OXA-23 is a common source of carbapenem resistance in A. baumannii (5). Infections with multidrug-resistant OXA-23-producing A. baumannii or A. junii have been reported from hospitals but not from the community. Our study showed that OXA-23-producers in particular, and carbapenemase producers in general, may be isolated from animals. Among the hypotheses that could explain the selection of this carbapenemase, use of penicillins or penicillin-[beta]-lactamase inhibitor combinations could create selective pressure for [beta]-lactamases because OXA-23 does confer, in addition to decreased susceptibility to carbapenems, a high level of resistance to those compounds. We have previously shown that A. radioresistens, an environmental species, was the progenitor of the [bla.sub.OXA-23] gene (10). Studies are needed to determine to what extent and at which locations Acinetobacter genomospecies 15TU and A. radioresistens might co-reside and therefore where the [bla.sub.OXA-23] gene exchange might have occurred.

Acknowledgments

We thankA. Nemec and L. Dijkshoorn for the Acinetobacter genomospecies 15TU reference strains.

This work was partially funded by a grant from the Institut National de la Sante et de la Recherche Medicale (INSERM) (U914), the Ministere de l'Education Nationale et de la Recherche (UPRES-EA3539), Universite Paris XI, and mostly by grants from the European Community (TROCAR, HEALTH-F3-2008-223031 and TEMPOtest-QC, HEALTH-2009-241742) and from INSERM (U914). L.P. was funded by a grant-in-aid from the Ecole Nationale Veterinaire de Maisons-Alfort through an INSERM-Ecole Nationale Veterinaire de Maisons-Alfort contract.

References

(1.) Livermore DM, Canton R, Gniadkowski M, Nordmann P, Rossolini GM, Arlet G, et al. CTX-M: changing the face of ESBLs in Europe. J Antimicrob Che mother. 2007;59:165-74. http://dx.doi. org/10.1093/jac/dkl483

(2.) Carattoli A. Animal reservoirs for extended-spectrum [beta]-lactamase producers. Clin Microbiol Infect. 2008;14(Suppl 1):117 23. http://dx.doi.org/10.1111/j.1469-0691. 2007.01851.x

(3.) Poirel L, Nordmann P. Carbapenem resistance in Acinetobacter baumannii: mechanisms and epidemiology. Clin Microbiol Infect. 2006;12:826-36. http://dx.doi. org/10.1111/j.1469-0691.2006.01456.x

(4.) Mugnier PD, Poirel L, Naas T, Nordmann P. Worldwide dissemination of the blaOXA-23 carbapenemase gene of Acinetobacter baumannii. Emerg Infect Dis. 2010;16:35-40. http://dx.doi.org/10.3201/ eid1601.090852

(5.) Gundi VA, Dijkshoorn L, Burignat S, Raoult D, La Scola B. Validation of partial rpoB gene sequence analysis for the identification of clinically important and emerging Acinetobacter species. Microbiology. 2009;155:2333-41. http://dx.doi. org/10.1099/mic.0.026054-0

(6.) Guardabassi L, Dalsgaard A, Olsen JE. Phenotypic characterization and antibiotic resistance of Acinetobacter spp. isolated from aquatic sources. J Appl Mi crobiol. 1999;87:659-67. http://dx.doi. org/10.1046/j.1365-2672.1999.00905.x

(7.) Corvec S, Poirel L, Naas T, Drugeon H, Nordmann P. Genetics and expression of the carbapenem-hydrolyzing oxacillinase gene blaOXA-23 in Acinetobacter baumannii. Antimicrob Agents Che mother. 2007;51:1530-3. http://dx.doi. org/10.1128/AAC.01132-06

(8.) Wang X, Zong Z, Lu X. Tn2008 is a major vehicle carrying blaOXA-23 in Acinetobacter baumannii from China. Diagn Microbiol Infect Dis. 2011;69:218-22. http://dx.doi. org/10.1016/j.diagmicrobio.2010.10.018

(9.) Adams-Haduch JM, Paterson DL, Sidjabat HE, Pasculle AW, Potoski BA, Muto CA, et al. Genetic basis of multidrug resistance in Acinetobacter baumannii clinical isolates at a tertiary medical center in Pennsylvania. Antimicrob Agents Che mother. 2008;52:3837-43. http://dx.doi. org/10.1128/AAC.00570-08

(10.) Poirel L, Figueiredo S, Cattoir V, Carattoli A, Nordmann P. Acinetobacter radioresistens as a silent source of carbapenem resistance for Acinetobacter spp. Antimi crob Agents Chemother. 2008;52:1252-6. http://dx.doi.org/10.1128/AAC.01304-07

Laurent Poirel, Beatrice Bercot, Yves Millemann, Remy A. Bonnin, Glenn Pannaux, and Patrice Nordmann

Author affiliations: Hopital de Bicetre, Le Kremlin-Bicetre, France (L. Poirel, B. Bercot, R.A. Bonnin, P. Nordmann); Hopital Lariboisiere, Paris, France (B. Bercot); and Universite Paris-Est, Maisons-Alfort, France (Y. Millemann, G. Pannaux)

DOI: http://dx.doi.org/10.3201/eid1803.111330

Address for correspondence: Laurent Poirel, Virologie, Hopital de Bicetre, 76 Rue du General Leclerc, 94275 Le Kremlin-Bicetre, Cedex, France; email: laurent.poirel@bct.aphp. fr
Table. Antimicrobial drug MICs for Acinetobacter genomospecies 15TU
isolates from cows and reference strains, France, August 2010 *

 MIC, [micro]g/mL

 Acinetobacter
 genomospecies 15TU

Drug class BY1 BY2-BY9

Penicillins and combinations
 Amoxicillin >256 128-256
 Amoxicillin + CLA >256 128-256
Cephalosporins
 Cefoxitin 32 16-32
 Cefotaxime 32 16-32
 Ceftazidime 32 16-32
 Cefepime 16 4-16
Monobactam (aztreonam) 64 32
Carbapenems
 Meropenem 16 2-4
 Imipenem >32 4-6
 Doripenem 8 2-4
Cyclines
 Tetracycline >256 >256
 Tigecycline 0.064 0.047-0.064
Quinolones (ciprofloxacin) 0.5 0.5
Aminoglycosides
 Gentamicin 0.5 0.25-0.5
 Kanamycin >256 >256
Sulfonamides 4 4

 MIC, [micro]g/mL

 Reference strain

Drug class NIPH 2171 NIPH 899

Penicillins and combinations
 Amoxicillin 4 4
 Amoxicillin + CLA 4 4
Cephalosporins
 Cefoxitin 16 16
 Cefotaxime 8 6
 Ceftazidime 16 16
 Cefepime 4 4
Monobactam (aztreonam) 32 16
Carbapenems
 Meropenem 0.5 0.5
 Imipenem 0.25 0.25
 Doripenem 0.5 0.5
Cyclines
 Tetracycline 0.5 0.5
 Tigecycline 0.047 0.125
Quinolones (ciprofloxacin) 0.25 0.25
Aminoglycosides
 Gentamicin 0.25 0.25
 Kanamycin 0.5 0.5
Sulfonamides 4 >256

* CLA, clavulanic acid (4 ng/mL).
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Author:Poirel, Laurent; Bercot, Beatrice; Millemann, Yves; Bonnin, Remy A.; Pannaux, Glenn; Nordmann, Patri
Publication:Emerging Infectious Diseases
Article Type:Letter to the editor
Geographic Code:4EUFR
Date:Mar 1, 2012
Words:1535
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