Polyclonal multidrug-resistant Acinetobacter baumannii circulation in eight wards of the Tripoli University Hospital, Libya

Abstract

OBJECTIVE: Acinetobacter baumannii is an opportunistic pathogen infecting immunocompromised patients, including the pediatric population. Treatment options for severe infections are challenged by the dissemination of carbapenem-resistant A. baumannii (CRAB), mostly belonging to 11 international clones (ICs 1-11). We characterized gene contents, genetic elements, and phylogenetic relationships of CRAB isolates. METHODS: Unlike neighbouring countries, the characterization of CRAB from Libya is rare. In this study, 38 CRAB isolates collected during 2020-2021 from patients treated in the Tripoli University Hospital (TUH) were characterized by whole-genome sequencing for their antibiotic resistance genes content, their genetic elements, and their phylogenetic relationship to international isolates. RESULTS: gene occurred only in IC1 isolates. The phylogenetic analysis including publicly available genomes evidenced a clustering according to the continent of origin. Isolates from TUH were phylogenetically close to isolates from North Africa or the Middle East. Most of the CRAB (22 of 38, 58%) came from children, eight of whom died (36%). Circulation among adult and paediatric wards of the same clone was observed. CONCLUSIONS: At the TUH, improvement of hygiene measures is needed to lower the burden of CRAB. At the international level, surveillance of this pathogen remains crucial to prevent its further spread from endemic regions or from conflict zones where injuries are more frequent and hygiene conditions are more precarious.