Laboratoire Microbiologie Santé et Environnement (LMSE), Doctoral School of Science & Technology, Faculty of Public Health, Lebanese University, Tripoli, Lebanon (firstname.lastname@example.org; email@example.com)
Reviewer: Ziad Daoud
College of Medicine, Central Michigan University, Mount Pleasant, MI, United States (firstname.lastname@example.org)
Hospital epidemiology of Acinetobacter baumannii in Lebanon
OXA-58 was the unique carbapenemase described in the earliest epidemiological studies (published in or before 2011) and was harbored by the global clones 1 (sequence type 20 “ST20”IP, a single locus variant of ST1IP), 2 (ST2IP), and 3 (ST3IP) (Zarrilli et al., 2008; Di Popolo et al., 2011). In global clone 1 strains incriminated in an outbreak that occurred between 2004 and 2005 in a university hospital in Beirut, blaOXA-58 was carried by a pABIR plasmid and bounded by 2 insertion sequences (IS18 and ISAba3) explaining thus its dissemination (Zarrilli et al., 2008). However, in agreement with worldwide observations, a marked shift from OXA-58 to OXA-23 was witnessed in the following studies with ST2IP (a main ST in the global clone 2) being the main OXA-23 producing clone (Nawfal Dagher et al., 2019; Rafei et al., 2015; Dahdouh et al., 2016; Al Atrouni et al., 2016; Hajjar Soudeiha et al., 2018; Osman et al., 2020; Rafei et al., 2014). Despite the predominance of OXA-23-producing ST2 strains, other mechanisms and clones were also detected but to a lesser degree. Isolates belonging to ST636IP and carrying blaOXA-72 (blaOXA-24 variant) on pMAL-1 plasmid were responsible for a nosocomial outbreak along with other ST2IP and ST2-likeIP carrying blaOXA-23 on Tn2006 (Makke et al., 2020). NDM-1, produced by ST85IP strains, was firstly detected in Syrian refugees and then in Lebanese patients (Al Atrouni et al., 2016; Rafei et al., 2014). Other STs positive for blaNDM-1 were also identified as ST25IP and ST708IP (Rafei et al., 2015; Al Atrouni et al., 2016). In another multi-regional study, the beta-lactamase gene blaGES-11 was associated with blaOXA-23 isolates in 90% of CRAB collected in 2012 (Hammoudi et al., 2015). Generally, the genomic context of resistance genes was sparingly addressed in Lebanon. In one of the sequenced blaNDM-1 carrying ST85IP isolates, blaNDM-1 along with 14 copies of the aphA6 amikacin resistance genes were enclosed within a novel transposon Tn7 named Tn6924 (Mann et al., 2022). In another ST2IP strain, each of the four blaOXA-23 copies was located in an AbaR4 copy, and blaTEM and aphA1 genes were present in a novel variant of AbGRI2 known as AbGRI2-15 (Liepa et al., 2022).
IP: sequence types (ST) defined according to the MLST scheme of the Pasteur Institute.
Extra-hospital epidemiology of Acinetobacter baumannii in Lebanon
Concerning clonality, they were so diverse belonging to different STs, generally, novel ones, which were different from the STs found among hospital isolates. However, some identified STs are common in health care settings as ST1IP, ST2IP, and ST10IP (Rafei et al., 2015; Al Atrouni et al., 2016; Al Bayssari et al., 2015). Studying two susceptible environmental isolates belonging to global clone 1 helped to better redraw the population structure of this clone, which now encompasses 2 major clades including 5 main antibiotic-resistant lineages and 4 single-isolate antibiotic-susceptible lineages outside of the 2 clades (Koong et al., 2021).
IP: sequence types (ST) defined according to the MLST scheme of the Pasteur Institute.
Screenshot of the PubMed website while searching for articles on Acinetobacter baumannii in Lebanon as of 30.01.2023
Dandachi I, Azar E, Hamouch R, Maliha P, Abdallah S, Kanaan E, Badawi R, Khairallah T, Matar GM, Daoud Z. Acinetobacter spp in a third world country with socio-economic and immigrants challenges. J Infect Dev Ctries. 2019 Nov 30;13(11):948-955.
Kanafani ZA, El Zakhem A, Zahreddine N, Ahmadieh R, Kanj SS. Ten-year surveillance study of ventilator-associated pneumonia at a tertiary care center in Lebanon. J Infect Public Health. 2019 Jul-Aug;12(4):492-495.
Haddad S, Jabbour JF, Hindy JR, Makki M, Sabbagh A, Nayfeh M, Boustany M, El-Zein S, Tamim H, Zakhem AE, El Cheikh J, Bazarbachi A, Kanj SS. Bacterial bloodstream infections and patterns of resistance in patients with haematological malignancies at a tertiary centre in Lebanon over 10 years. J Glob Antimicrob Resist. 2021 Dec;27:228-235.
Bourgi J, Said JM, Yaakoub C, Atallah B, Al Akkary N, Sleiman Z, Ghanimé G. Bacterial infection profile and predictors among patients admitted to a burn care center: A retrospective study. Burns. 2020 Dec;46(8):1968-1976.
Nawfal Dagher T, Al-Bayssari C, Chabou S, Antar N, Diene SM, Azar E, Rolain JM. Investigation of multidrug-resistant ST2 Acinetobacter baumannii isolated from Saint George hospital in Lebanon. BMC Microbiol. 2019 Feb 2;19(1):29.
Chamoun K, Farah M, Araj G, Daoud Z, Moghnieh R, Salameh P, Saade D, Mokhbat J, Abboud E, Hamze M, Abboud E, Jisr T, Haddad A, Feghali R, Azar N, El-Zaatari M, Chedid M, Haddad C, Zouain Dib Nehme M, Barakat A, Husni R; Lebanese Society of Infectious Diseases Study Group (LSID study group). Surveillance of antimicrobial resistance in Lebanese hospitals: retrospective nationwide compiled data. Int J Infect Dis. 2016 May;46:64-70.
Rafei R, Pailhoriès H, Hamze M, Eveillard M, Mallat H, Dabboussi F, Joly-Guillou ML, Kempf M. Molecular epidemiology of Acinetobacter baumannii in different hospitals in Tripoli, Lebanon using blaOXA-51-like sequence based typing. BMC Microbiol. 2015 May 16;15:103.
Dahdouh E, Hajjar M, Suarez M, Daoud Z. Acinetobacter baumannii isolated from Lebanese patients: Phenotypes and genotypes of resistance, clonality, and determinants of pathogenicity. Front Cell Infect Microbiol. 2016 Nov 25;6:163.
Al Atrouni A, Hamze M, Jisr T, Lemarié C, Eveillard M, Joly-Guillou ML, Kempf M. Wide spread of OXA-23-producing carbapenem-resistant Acinetobacter baumannii belonging to clonal complex II in different hospitals in Lebanon. Int J Infect Dis. 2016 Nov;52:29-36.
Hammoudi D, Moubareck CA, Hakime N, Houmani M, Barakat A, Najjar Z, Suleiman M, Fayad N, Sarraf R, Sarkis DK. Spread of imipenem-resistant Acinetobacter baumannii co-expressing OXA-23 and GES-11 carbapenemases in Lebanon. Int J Infect Dis. 2015 Jul;36:56-61.
Hajjar Soudeiha M, Dahdouh E, Daoud Z, Sarkis DK. Phenotypic and genotypic detection of β-lactamases in Acinetobacter spp. isolates recovered from Lebanese patients over a 1-year period. J Glob Antimicrob Resist. 2018 Mar;12:107-112.
Moghnieh R, Araj GF, Awad L, Daoud Z, Mokhbat JE, Jisr T, Abdallah D, Azar N, Irani-Hakimeh N, Balkis MM, Youssef M, Karayakoupoglou G, Hamze M, Matar M, Atoui R, Abboud E, Feghali R, Yared N, Husni R. A compilation of antimicrobial susceptibility data from a network of 13 Lebanese hospitals reflecting the national situation during 2015-2016. Antimicrob Resist Infect Control. 2019 Feb 20;8:41.
Chamieh A, Nawfal TD, Ballouz T, Afif C, Juvelekian G, Hlais S, Rolain JM, Azar E. Control and elimination of extensively drug-resistant Acinetobacter baumanii in an intensive care unit. Emerg Infect Dis. 2019 Oct;25(10):1928-1931.
Osman M, B Halimeh F, Rafei R, Mallat H, Tom JE, Raad EB, M Diene S, Jamal S, Atrouni AA, Dabboussi F, Moudani W, Madec JY, Saras E, Lupo A, Haenni M, Rolain JM, Hamze M. Investigation of an XDR-Acinetobacter baumannii ST2 outbreak in an intensive care unit of a Lebanese tertiary care hospital. Future Microbiol. 2020 Oct;15:1535-1542.
Chamieh A, Zgheib R, El-Sawalhi S, Yammine L, El-Hajj G, Zmerli O, Afif C, Rolain JM, Azar E. Trends of multidrug-resistant pathogens, difficult to treat bloodstream infections, and antimicrobial consumption at a tertiary care center in Lebanon from 2015-2020: COVID-19 Aftermath. Antibiotics (Basel). 2021 Aug 21;10(8):1016.
Rizk NA, Zahreddine N, Haddad N, Ahmadieh R, Hannun A, Bou Harb S, Haddad SF, Zeenny RM, Kanj SS. The impact of antimicrobial stewardship and infection control interventions on Acinetobacter baumannii resistance rates in the ICU of a tertiary care center in Lebanon. Antibiotics (Basel). 2022 Jul 7;11(7):911.
Moussally M, Zahreddine N, Kazma J, Ahmadieh R, Kan SS, Kanafan ZA. Prevalence of antibiotic-resistant organisms among hospitalized patients at a tertiary care center in Lebanon, 2010-2018. J Infect Public Health. 2021 Jan;14(1):12-16.
Moghnieh R, Tamim H, Jadayel M, Abdallah D, Al-Kassem R, Kadiri H, Hafez H, Al-Hassan S, Ajjour L, Lakkis R, Jisr T, Samaha NL, Haddad N. The effect of temporary closure and enhanced terminal disinfection using aerosolized hydrogen peroxide of an open-bay intensive care unit on the acquisition of extensively drug-resistant Acinetobacter baumannii. Antimicrob Resist Infect Control. 2020 Jul 14;9(1):108.
Zarrilli R, Vitale D, Di Popolo A, Bagattini M, Daoud Z, Khan AU, Afif C, Triassi M. A plasmid-borne blaOXA-58 gene confers imipenem resistance to Acinetobacter baumannii isolates from a Lebanese hospital. Antimicrob Agents Chemother. 2008 Nov;52(11):4115-20.
Di Popolo A, Giannouli M, Triassi M, Brisse S, Zarrilli R. Molecular epidemiological investigation of multidrug-resistant Acinetobacter baumannii strains in four Mediterranean countries with a multilocus sequence typing scheme. Clin Microbiol Infect. 2011 Feb;17(2):197-201.
Rafei R, Dabboussi F, Hamze M, Eveillard M, Lemarié C, Gaultier MP, Mallat H, Moghnieh R, Husni-Samaha R, Joly-Guillou ML, Kempf M. Molecular analysis of Acinetobacter baumannii strains isolated in Lebanon using four different typing methods. PLoS One. 2014 Dec 26;9(12):e115969.
Rafei R, Dabboussi F, Hamze M, Eveillard M, Lemarié C, Mallat H, Rolain JM, Joly-Guillou ML, Kempf M. First report of blaNDM-1-producing Acinetobacter baumannii isolated in Lebanon from civilians wounded during the Syrian war. Int J Infect Dis. 2014 Apr;21:21-3.
Mann R, Rafei R, Gunawan C, Harmer CJ, Hamidian M. Variants of Tn6924, a novel Tn7 family transposon carrying the blaNDM metallo-β-Lactamase and 14 copies of the aphA6 amikacin resistance genes found in Acinetobacter baumannii. Microbiol Spectr. 2022 Feb 23;10(1):e0174521.
Liepa R, Mann R, Osman M, Hamze M, Gunawan C, Hamidian M. Cl415, a carbapenem-resistant Acinetobacter baumannii isolate containing four AbaR4 and a new variant of AbGRI2, represents a novel global clone 2 strain. J Antimicrob Chemother. 2022 Feb 2;77(2):345-350.
Rafei R, Hamze M, Pailhoriès H, Eveillard M, Marsollier L, Joly-Guillou ML, Dabboussi F, Kempf M. Extrahuman epidemiology of Acinetobacter baumannii in Lebanon. Appl Environ Microbiol. 2015 Apr;81(7):2359-67.
Al Atrouni A, Hamze M, Rafei R, Eveillard M, Joly-Guillou ML, Kempf M. Diversity of Acinetobacter species isolated from different environments in Lebanon: a nationwide study. Future Microbiol. 2016 Sep;11:1147-56.
Al Bayssari C, Dabboussi F, Hamze M, Rolain JM. Emergence of carbapenemase-producing Pseudomonas aeruginosa and Acinetobacter baumannii in livestock animals in Lebanon. J Antimicrob Chemother. 2015 Mar;70(3):950-1.
Koong J, Johnson C, Rafei R, Hamze M, Myers GSA, Kenyon JJ, Lopatkin AJ, Hamidian M. Phylogenomics of two ST1 antibiotic-susceptible non-clinical Acinetobacter baumannii strains reveals multiple lineages and complex evolutionary history in global clone 1. Microb Genom. 2021 Dec;7(12):000705.