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<record><TEI><teiHeader><fileDesc><titleStmt><title xml:lang="en">Prevalence of <italic>Acinetobacter baumannii</italic> bacteremia in intensive care units of Ibn Rochd University Hospital, Casablanca</title><author><name sortKey="El Kettani, Assiya" sort="El Kettani, Assiya" uniqKey="El Kettani A" first="Assiya" last="El Kettani">Assiya El Kettani</name><affiliation><nlm:aff id="AFF1">Department of Microbiology, Faculty of Medicine and Pharmacy, Hassan II University of Casablanca, Morocco</nlm:aff></affiliation><affiliation><nlm:aff id="AFF2">Bacteriology-Virology and Hospital Hygiene Laboratory, University Hospital Centre Ibn Rochd of Casablanca, Morocco</nlm:aff></affiliation></author><author><name sortKey="Maaloum, Fakhreddine" sort="Maaloum, Fakhreddine" uniqKey="Maaloum F" first="Fakhreddine" last="Maaloum">Fakhreddine Maaloum</name><affiliation><nlm:aff id="AFF1">Department of Microbiology, Faculty of Medicine and Pharmacy, Hassan II University of Casablanca, Morocco</nlm:aff></affiliation><affiliation><nlm:aff id="AFF2">Bacteriology-Virology and Hospital Hygiene Laboratory, University Hospital Centre Ibn Rochd of Casablanca, Morocco</nlm:aff></affiliation></author><author><name sortKey="Diawara, Idrissa" sort="Diawara, Idrissa" uniqKey="Diawara I" first="Idrissa" last="Diawara">Idrissa Diawara</name><affiliation><nlm:aff id="AFF1">Department of Microbiology, Faculty of Medicine and Pharmacy, Hassan II University of Casablanca, Morocco</nlm:aff></affiliation><affiliation><nlm:aff id="AFF2">Bacteriology-Virology and Hospital Hygiene Laboratory, University Hospital Centre Ibn Rochd of Casablanca, Morocco</nlm:aff></affiliation></author><author><name sortKey="Katfy, Khalid" sort="Katfy, Khalid" uniqKey="Katfy K" first="Khalid" last="Katfy">Khalid Katfy</name><affiliation><nlm:aff id="AFF1">Department of Microbiology, Faculty of Medicine and Pharmacy, Hassan II University of Casablanca, Morocco</nlm:aff></affiliation><affiliation><nlm:aff id="AFF2">Bacteriology-Virology and Hospital Hygiene Laboratory, University Hospital Centre Ibn Rochd of Casablanca, Morocco</nlm:aff></affiliation></author><author><name sortKey="Harrar, Nadia" sort="Harrar, Nadia" uniqKey="Harrar N" first="Nadia" last="Harrar">Nadia Harrar</name><affiliation><nlm:aff id="AFF2">Bacteriology-Virology and Hospital Hygiene Laboratory, University Hospital Centre Ibn Rochd of Casablanca, Morocco</nlm:aff></affiliation></author><author><name sortKey="Zerouali, Khalid" sort="Zerouali, Khalid" uniqKey="Zerouali K" first="Khalid" last="Zerouali">Khalid Zerouali</name><affiliation><nlm:aff id="AFF1">Department of Microbiology, Faculty of Medicine and Pharmacy, Hassan II University of Casablanca, Morocco</nlm:aff></affiliation><affiliation><nlm:aff id="AFF2">Bacteriology-Virology and Hospital Hygiene Laboratory, University Hospital Centre Ibn Rochd of Casablanca, Morocco</nlm:aff></affiliation></author><author><name sortKey="Belabbes, Houria" sort="Belabbes, Houria" uniqKey="Belabbes H" first="Houria" last="Belabbes">Houria Belabbes</name><affiliation><nlm:aff id="AFF1">Department of Microbiology, Faculty of Medicine and Pharmacy, Hassan II University of Casablanca, Morocco</nlm:aff></affiliation><affiliation><nlm:aff id="AFF2">Bacteriology-Virology and Hospital Hygiene Laboratory, University Hospital Centre Ibn Rochd of Casablanca, Morocco</nlm:aff></affiliation></author><author><name sortKey="Elmdaghri, Naima" sort="Elmdaghri, Naima" uniqKey="Elmdaghri N" first="Naima" last="Elmdaghri">Naima Elmdaghri</name><affiliation><nlm:aff id="AFF1">Department of Microbiology, Faculty of Medicine and Pharmacy, Hassan II University of Casablanca, Morocco</nlm:aff></affiliation><affiliation><nlm:aff id="AFF2">Bacteriology-Virology and Hospital Hygiene Laboratory, University Hospital Centre Ibn Rochd of Casablanca, Morocco</nlm:aff></affiliation></author></titleStmt><publicationStmt><idno type="wicri:source">PMC</idno><idno type="pmid">29487729</idno><idno type="pmc">5825931</idno><idno type="url">http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5825931</idno><idno type="RBID">PMC:5825931</idno><date when="2017">2017</date><idno type="wicri:Area/Pmc/Corpus">000206</idno><idno type="wicri:explorRef" wicri:stream="Pmc" wicri:step="Corpus" wicri:corpus="PMC">000206</idno></publicationStmt><sourceDesc><biblStruct><analytic><title xml:lang="en" level="a" type="main">Prevalence of <italic>Acinetobacter baumannii</italic> bacteremia in intensive care units of Ibn Rochd University Hospital, Casablanca</title><author><name sortKey="El Kettani, Assiya" sort="El Kettani, Assiya" uniqKey="El Kettani A" first="Assiya" last="El Kettani">Assiya El Kettani</name><affiliation><nlm:aff id="AFF1">Department of Microbiology, Faculty of Medicine and Pharmacy, Hassan II University of Casablanca, Morocco</nlm:aff></affiliation><affiliation><nlm:aff id="AFF2">Bacteriology-Virology and Hospital Hygiene Laboratory, University Hospital Centre Ibn Rochd of Casablanca, Morocco</nlm:aff></affiliation></author><author><name sortKey="Maaloum, Fakhreddine" sort="Maaloum, Fakhreddine" uniqKey="Maaloum F" first="Fakhreddine" last="Maaloum">Fakhreddine Maaloum</name><affiliation><nlm:aff id="AFF1">Department of Microbiology, Faculty of Medicine and Pharmacy, Hassan II University of Casablanca, Morocco</nlm:aff></affiliation><affiliation><nlm:aff id="AFF2">Bacteriology-Virology and Hospital Hygiene Laboratory, University Hospital Centre Ibn Rochd of Casablanca, Morocco</nlm:aff></affiliation></author><author><name sortKey="Diawara, Idrissa" sort="Diawara, Idrissa" uniqKey="Diawara I" first="Idrissa" last="Diawara">Idrissa Diawara</name><affiliation><nlm:aff id="AFF1">Department of Microbiology, Faculty of Medicine and Pharmacy, Hassan II University of Casablanca, Morocco</nlm:aff></affiliation><affiliation><nlm:aff id="AFF2">Bacteriology-Virology and Hospital Hygiene Laboratory, University Hospital Centre Ibn Rochd of Casablanca, Morocco</nlm:aff></affiliation></author><author><name sortKey="Katfy, Khalid" sort="Katfy, Khalid" uniqKey="Katfy K" first="Khalid" last="Katfy">Khalid Katfy</name><affiliation><nlm:aff id="AFF1">Department of Microbiology, Faculty of Medicine and Pharmacy, Hassan II University of Casablanca, Morocco</nlm:aff></affiliation><affiliation><nlm:aff id="AFF2">Bacteriology-Virology and Hospital Hygiene Laboratory, University Hospital Centre Ibn Rochd of Casablanca, Morocco</nlm:aff></affiliation></author><author><name sortKey="Harrar, Nadia" sort="Harrar, Nadia" uniqKey="Harrar N" first="Nadia" last="Harrar">Nadia Harrar</name><affiliation><nlm:aff id="AFF2">Bacteriology-Virology and Hospital Hygiene Laboratory, University Hospital Centre Ibn Rochd of Casablanca, Morocco</nlm:aff></affiliation></author><author><name sortKey="Zerouali, Khalid" sort="Zerouali, Khalid" uniqKey="Zerouali K" first="Khalid" last="Zerouali">Khalid Zerouali</name><affiliation><nlm:aff id="AFF1">Department of Microbiology, Faculty of Medicine and Pharmacy, Hassan II University of Casablanca, Morocco</nlm:aff></affiliation><affiliation><nlm:aff id="AFF2">Bacteriology-Virology and Hospital Hygiene Laboratory, University Hospital Centre Ibn Rochd of Casablanca, Morocco</nlm:aff></affiliation></author><author><name sortKey="Belabbes, Houria" sort="Belabbes, Houria" uniqKey="Belabbes H" first="Houria" last="Belabbes">Houria Belabbes</name><affiliation><nlm:aff id="AFF1">Department of Microbiology, Faculty of Medicine and Pharmacy, Hassan II University of Casablanca, Morocco</nlm:aff></affiliation><affiliation><nlm:aff id="AFF2">Bacteriology-Virology and Hospital Hygiene Laboratory, University Hospital Centre Ibn Rochd of Casablanca, Morocco</nlm:aff></affiliation></author><author><name sortKey="Elmdaghri, Naima" sort="Elmdaghri, Naima" uniqKey="Elmdaghri N" first="Naima" last="Elmdaghri">Naima Elmdaghri</name><affiliation><nlm:aff id="AFF1">Department of Microbiology, Faculty of Medicine and Pharmacy, Hassan II University of Casablanca, Morocco</nlm:aff></affiliation><affiliation><nlm:aff id="AFF2">Bacteriology-Virology and Hospital Hygiene Laboratory, University Hospital Centre Ibn Rochd of Casablanca, Morocco</nlm:aff></affiliation></author></analytic><series><title level="j">Iranian Journal of Microbiology</title><idno type="ISSN">2008-3289</idno><idno type="eISSN">2008-4447</idno><imprint><date when="2017">2017</date></imprint></series></biblStruct></sourceDesc></fileDesc><profileDesc><textClass></textClass></profileDesc></teiHeader><front><div type="abstract" xml:lang="en"><sec><title>Background and Objectives:</title><p><italic>Acinetobacter baumannii</italic> bacteremia are grave because of the multi-resistance of the organism to antibiotics. This study aimed to determine the prevalence of <italic>A. baumannii</italic> isolated from blood cultures and to describe their antibiotic resistance patterns.</p></sec><sec><title>Materials and Methods:</title><p>A retrospective longitudinal study was conducted on blood cultures between 2010 and 2014 from all Ibn Rochd University Hospital intensive care units; it was based on the exploitation of microbiology laboratory database (duplicates were excluded). Isolation and identification of <italic>A. baumannii</italic> were performed according to standard techniques of bacteriology and susceptibility testing as recommended by the CLSI. PCR was used to detect β-Lactamase genes, <italic>bla</italic><sub>OXA-51</sub>, <italic>bla</italic><sub>OXA-23</sub>.</p></sec><sec><title>Results:</title><p>Among the 4232 samples received at the laboratory, 2402 (56.8%) were positive. Negative coagulase <italic>Staphylococcus</italic> was isolated in 21.6% of cases followed by <italic>A. baumannii</italic> (9.2%), and <italic>K. pneumoniae</italic> (9.1%). <italic>A. baumannii</italic> strains were resistant to most antibiotics tested: imipenem (75.7%), ceftazidim (85.4%), cefotaxim (98.6%), gentamicin (78.1%), amikacin (63.5%) and ciprofloxacin (88.2%). All <italic>A. baumannii</italic> strains, resistant to carbapenem, tested were positive for <italic>bla</italic><sub>OXA-51</sub> genes and 87.5% expressed the <italic>bla</italic><sub>OXA-23</sub> genes.</p></sec><sec><title>Conclusion:</title><p><italic>A. baumannii</italic> was the second germ frequently isolated from blood cultures in intensive care units. It was multi-resistant to antibiotics. The strengthening of hospital hygiene measures and surveillance of antibiotic resistance is needed to limit the spread of germs and to optimize the management of antibiotics.</p></sec></div></front><back><div1 type="bibliography"><listBibl><biblStruct><analytic><author><name sortKey="Boucher, Hw" uniqKey="Boucher H">HW Boucher</name></author><author><name sortKey="Talbot, Gh" uniqKey="Talbot G">GH Talbot</name></author><author><name sortKey="Bradley, Js" uniqKey="Bradley J">JS Bradley</name></author><author><name sortKey="Edwards, Je" uniqKey="Edwards J">JE Edwards</name></author><author><name sortKey="Gilbert, D" uniqKey="Gilbert D">D Gilbert</name></author><author><name sortKey="Rice, Lb" uniqKey="Rice L">LB Rice</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Lee, Hy" uniqKey="Lee H">HY Lee</name></author><author><name sortKey="Chen, Cl" uniqKey="Chen C">CL Chen</name></author><author><name sortKey="Wu, Sr" uniqKey="Wu S">SR Wu</name></author><author><name sortKey="Huang, Cw" uniqKey="Huang C">CW Huang</name></author><author><name sortKey="Chiu, Ch" uniqKey="Chiu C">CH. 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<front><journal-meta><journal-id journal-id-type="nlm-ta">Iran J Microbiol</journal-id><journal-id journal-id-type="iso-abbrev">Iran J Microbiol</journal-id><journal-id journal-id-type="publisher-id">IJM</journal-id><journal-id journal-id-type="pmc">IJM</journal-id><journal-title-group><journal-title>Iranian Journal of Microbiology</journal-title></journal-title-group><issn pub-type="ppub">2008-3289</issn><issn pub-type="epub">2008-4447</issn><publisher><publisher-name>Tehran University of Medical Sciences</publisher-name></publisher></journal-meta><article-meta><article-id pub-id-type="pmid">29487729</article-id><article-id pub-id-type="pmc">5825931</article-id><article-id pub-id-type="publisher-id">ijm-9-318</article-id><article-categories><subj-group subj-group-type="heading"><subject>Original Article</subject></subj-group></article-categories><title-group><article-title>Prevalence of <italic>Acinetobacter baumannii</italic> bacteremia in intensive care units of Ibn Rochd University Hospital, Casablanca</article-title></title-group><contrib-group><contrib contrib-type="author"><name><surname>El Kettani</surname><given-names>Assiya</given-names></name><xref ref-type="aff" rid="AFF1"><sup>1</sup></xref><xref ref-type="aff" rid="AFF2"><sup>2</sup></xref><xref ref-type="corresp" rid="C1"><sup>*</sup></xref></contrib><contrib contrib-type="author"><name><surname>Maaloum</surname><given-names>Fakhreddine</given-names></name><xref ref-type="aff" rid="AFF1"><sup>1</sup></xref><xref ref-type="aff" rid="AFF2"><sup>2</sup></xref></contrib><contrib contrib-type="author"><name><surname>Diawara</surname><given-names>Idrissa</given-names></name><xref ref-type="aff" rid="AFF1"><sup>1</sup></xref><xref ref-type="aff" rid="AFF2"><sup>2</sup></xref></contrib><contrib contrib-type="author"><name><surname>Katfy</surname><given-names>Khalid</given-names></name><xref ref-type="aff" rid="AFF1"><sup>1</sup></xref><xref ref-type="aff" rid="AFF2"><sup>2</sup></xref></contrib><contrib contrib-type="author"><name><surname>Harrar</surname><given-names>Nadia</given-names></name><xref ref-type="aff" rid="AFF2"><sup>2</sup></xref></contrib><contrib contrib-type="author"><name><surname>Zerouali</surname><given-names>Khalid</given-names></name><xref ref-type="aff" rid="AFF1"><sup>1</sup></xref><xref ref-type="aff" rid="AFF2"><sup>2</sup></xref></contrib><contrib contrib-type="author"><name><surname>Belabbes</surname><given-names>Houria</given-names></name><xref ref-type="aff" rid="AFF1"><sup>1</sup></xref><xref ref-type="aff" rid="AFF2"><sup>2</sup></xref></contrib><contrib contrib-type="author"><name><surname>Elmdaghri</surname><given-names>Naima</given-names></name><xref ref-type="aff" rid="AFF1"><sup>1</sup></xref><xref ref-type="aff" rid="AFF2"><sup>2</sup></xref></contrib><aff id="AFF1"><label>1</label>Department of Microbiology, Faculty of Medicine and Pharmacy, Hassan II University of Casablanca, Morocco</aff><aff id="AFF2"><label>2</label>Bacteriology-Virology and Hospital Hygiene Laboratory, University Hospital Centre Ibn Rochd of Casablanca, Morocco</aff></contrib-group><author-notes><corresp id="C1"><label>*</label>Corresponding author: Dr. Assiya El Kettani, Department of Microbiology, Faculty of Medicine and Pharmacy, Hassan II University of Casablanca, Morocco; Bacteriology-Virology and Hospital Hygiene Laboratory, University Hospital Centre Ibn Rochd of Casablanca, Morocco. Tel: +212619094322, Email: <email>assiyaelkettani@gmail.com</email></corresp></author-notes><pub-date pub-type="ppub"><month>12</month><year>2017</year></pub-date><volume>9</volume><issue>6</issue><fpage>318</fpage><lpage>323</lpage><history><date date-type="received"><month>7</month><year>2017</year></date><date date-type="accepted"><month>11</month><year>2017</year></date></history><permissions><copyright-statement>Copyright© 2017 Iranian Neuroscience Society</copyright-statement><copyright-year>2017</copyright-year><license license-type="open-access" xlink:href="http://creativecommons.org/licenses/by/3.0/"><license-p>This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.</license-p></license></permissions><abstract><sec><title>Background and Objectives:</title><p><italic>Acinetobacter baumannii</italic> bacteremia are grave because of the multi-resistance of the organism to antibiotics. This study aimed to determine the prevalence of <italic>A. baumannii</italic> isolated from blood cultures and to describe their antibiotic resistance patterns.</p></sec><sec><title>Materials and Methods:</title><p>A retrospective longitudinal study was conducted on blood cultures between 2010 and 2014 from all Ibn Rochd University Hospital intensive care units; it was based on the exploitation of microbiology laboratory database (duplicates were excluded). Isolation and identification of <italic>A. baumannii</italic> were performed according to standard techniques of bacteriology and susceptibility testing as recommended by the CLSI. PCR was used to detect β-Lactamase genes, <italic>bla</italic><sub>OXA-51</sub>, <italic>bla</italic><sub>OXA-23</sub>.</p></sec><sec><title>Results:</title><p>Among the 4232 samples received at the laboratory, 2402 (56.8%) were positive. Negative coagulase <italic>Staphylococcus</italic> was isolated in 21.6% of cases followed by <italic>A. baumannii</italic> (9.2%), and <italic>K. pneumoniae</italic> (9.1%). <italic>A. baumannii</italic> strains were resistant to most antibiotics tested: imipenem (75.7%), ceftazidim (85.4%), cefotaxim (98.6%), gentamicin (78.1%), amikacin (63.5%) and ciprofloxacin (88.2%). All <italic>A. baumannii</italic> strains, resistant to carbapenem, tested were positive for <italic>bla</italic><sub>OXA-51</sub> genes and 87.5% expressed the <italic>bla</italic><sub>OXA-23</sub> genes.</p></sec><sec><title>Conclusion:</title><p><italic>A. baumannii</italic> was the second germ frequently isolated from blood cultures in intensive care units. It was multi-resistant to antibiotics. The strengthening of hospital hygiene measures and surveillance of antibiotic resistance is needed to limit the spread of germs and to optimize the management of antibiotics.</p></sec></abstract><kwd-group><kwd><italic>Acinetobacter baumannii</italic></kwd><kwd>Bacteremi</kwd><kwd>Antibiotic resistance</kwd><kwd><italic>bla</italic><sub>OXA-51</sub></kwd><kwd><italic>bla</italic><sub>OXA-23</sub></kwd></kwd-group></article-meta></front><body><sec sec-type="intro"><title>INTRODUCTION</title><p><italic>Acinetobacter baumannii</italic> is a Gram-negative pathogen. It is frequently associated with nosocomial infections (bacteremia, pneumonia, meningitis and urinary tract infections). It was also recognized worldwide as an emerging cause of nosocomial outbreaks and listed by the American Society of Infectious Diseases (IDSA) as one of the six most hazardous microorganisms (<xref rid="B1" ref-type="bibr">1</xref>). <italic>A. baumannii</italic> bacteremia in intensive care units (ICUs) are responsible of a significant morbidity and mortality and create a therapeutic problem due to the multidrug resistance of the organism to antibiotics (<xref rid="B2" ref-type="bibr">2</xref>, <xref rid="B3" ref-type="bibr">3</xref>). <italic>A. baumannii</italic> have a natural resistance to antibiotics, but also an acquired resistance by production of enzymes: the β-lactamases and especially metallo-β-lactamase and oxacillinases and by efflux pumps and changing porins (<xref rid="B4" ref-type="bibr">4</xref>). Carbapenem hydrolyzing β-lactamases belonging to oxacilinases enzymes are the main enzymes contributing to the inactivation of imipenem in <italic>A. baumannii</italic> (<xref rid="B5" ref-type="bibr">5</xref>, <xref rid="B6" ref-type="bibr">6</xref>).</p><p>The aim of this study was to determine the prevalence of <italic>A. baumannii</italic> isolated from blood cultures performed in intensive care units of Ibn Rochd University hospital at Casablanca-Morocco during the last five years (2010–2014) and to describe the evolution of the organism’s resistance to antibiotics. Then, to detect the presence of Oxacillinases: OXA-23 and OXA-51 among the isolates showing resistance to imipenem.</p></sec><sec sec-type="materials|methods"><title>MATERIALS AND METHODS</title><sec sec-type="subjects"><title>Samples collection (Patients samples).</title><p>A retrospective longitudinal study was carried out on blood cultures from all ICUs in Ibn Rochd University Hospital between 2010 and 2014. It was based on the exploitation of the Microbiology laboratory database (duplicates of the same patient were excluded). All bacteria including <italic>A. baumannii</italic> identified by the standard bacteriological methods in the routine diagnosis of bacteremia from all ICUs were examined. PCR was used to target the <italic>bla</italic><sub>OXA-23</sub> and <italic>bla</italic><sub>OXA-51</sub> among the imipenem resistant isolates <italic>A. baumannii</italic>.</p></sec><sec><title>Antimicrobial susceptibility testing.</title><p>Antimicrobial susceptibility testing was done for all <italic>A. baumannii</italic>. Disk diffusion test was used to determine the susceptibity of isolates to ceftazidim (30 μg), 30 μg cefotaxim (30 μg), 30 μg amikacin (30 μg), 10 μg gentamicin (10 μg), ciprofloxacin (5 μg), ampicillin/sulbactam (10 μg), piperacillin/tazobactam (85 μg), netilmicin (10 μg), Tobramycin (10 μg), trimethoprim/sulfametoxazol (25 μg), tetracycline (30 μg), imipenem (10 μg). E-test was used to determine the MICs for colistin (Biomérieux Marcy l’Etoile France). <italic>E. coli</italic> ATCC 25922 was used as a quality control strain. Results were interpreted according to the breakpoints recommended by the Clinical and Laboratory Standards Institute (CLSI, 2014).</p></sec><sec><title>Preparation of DNA and PCR.</title><p>All <italic>A. baumannii</italic> resistant to imipenem were grown on Mueller–Hinton (MH) agar plates (Bio-Rad, Marnes-la-Coquette, France) for 18–24 hours at 37°C, bacterial cells were suspended in 500 μl of ultrapure water. Suspension was heated at 100°C for 10 min and immediately frozen at 0°C for 5 min. 300 μl of supernatant were then recovered after centrifugation of 14000 g for 10 min. Supernatant containing DNA was stored at −20°C until further use (<xref rid="B5" ref-type="bibr">5</xref>).</p><p>PCR protocol described by Sandle et al. (<xref rid="B6" ref-type="bibr">6</xref>) was used for detection of <italic>bla</italic><sub>OXA-23</sub> and <italic>bla</italic><sub>OXA-51</sub> among the imipenem resisrant isolates.</p></sec><sec sec-type="methods"><title>Statistical analysis.</title><p>Data were analyzed with Epi-Info 7 (Centers for Disease Control, Atlanta, Georgia, USA) and Microsoft Excel. The chi square test or Fisher’s exact test was performed to compare proportions. Differences were considered significant if the p-value is <0.05.</p></sec></sec><sec sec-type="results"><title>RESULTS</title><p>During the study period, a total of 4232 non-duplicate blood cultures from 4232 patients were received at the laboratory. Of these, 2402 blood cultures (56.8%) were positive. Negative coagulase Staphylococcus was isolated in 21.6% of cases followed by <italic>A. baumannii</italic> (9.2%) and <italic>K. pneumoniae</italic> (9.1%) (<xref ref-type="fig" rid="F1">Fig. 1</xref>).</p><fig id="F1" orientation="portrait" position="float"><label>Fig. 1.</label><caption><p>Distribution of bacteria isolated from intensive care units blood cultures</p></caption><graphic xlink:href="IJM-9-318-g001"></graphic></fig><p>The prevalence of <italic>A. baumannii</italic> strains increased from 7% in 2010 to 10% in 2011, 2012 and 2013, and then decreased slightly in 2014 (9%).</p><p><italic>A. baumannii</italic> strains were resistant to: imipenem (75.7%), ceftazidime (85.4%), cefotaxime (98.6%), gentamicin (78.1%), ciprofloxacin (88.2 %), the netilmicin (14%) and colistin (1%) (<xref ref-type="fig" rid="F2">Fig. 2</xref>).</p><fig id="F2" orientation="portrait" position="float"><label>Fig. 2.</label><caption><p>Antibiotic resistance of <italic>A. baumannii</italic> in Intensive care units</p></caption><graphic xlink:href="IJM-9-318-g002"></graphic></fig><p>The evolution of antibiotic resistance was determined for ceftazidim, cefotaxim, imipenem and ciprofloxacin. It was relatively stable for the third generation cephalosporins and fluoroquinolones. However, it increased for imipenem, from 50% in 2010 to 86% in 2013 (<italic>p</italic>=0.0003) and then decreased slightly in 2014 (75%) (<italic>p</italic>=0.35) (<xref ref-type="fig" rid="F3">Fig. 3</xref>).</p><fig id="F3" orientation="portrait" position="float"><label>Fig. 3.</label><caption><p>Evolution of <italic>A. baumannii</italic> resistance to antibiotics during the study period</p></caption><graphic xlink:href="IJM-9-318-g003"></graphic></fig><p>As for the genotypic characterization of <italic>A. baumannii</italic> strains resistant to imipenem, determined by PCR, all <italic>A. baumannii</italic> strains were positive for <italic>bla</italic><sub>OXA-51</sub> genes and 87.5% (n=147) expressed the <italic>bla</italic><sub>OXA-23</sub> genes (<xref ref-type="fig" rid="F4">Fig. 4</xref>).</p><fig id="F4" orientation="portrait" position="float"><label>Fig. 4.</label><caption><p>PCR for <italic>bla</italic><sub>OXA-51</sub> and <italic>bla</italic><sub>OXA-23</sub> genes of <italic>A. baumannii</italic> isolated from ICU blood cultures</p></caption><graphic xlink:href="IJM-9-318-g004"></graphic></fig></sec><sec sec-type="discussion"><title>DISCUSSION</title><p>In our study, <italic>A. baumannii</italic> was the second germ frequently isolated from blood cultures in ICUs between 2010 and 2014 (9.2%). It was characterized by a multi-resistance to the antibiotics tested (C3G, aminoglycosides, fluoroquinonolones and imipenem). It was however, sensitive to colistin in 99% of cases.</p><p>The evolution of antibiotic resistance during the study period was increasing especially for imipenem (from 50% in 2010 to 75% in 2014). All isolates of <italic>A. baumannii</italic>, resistant to carbapenem, were positive for <italic>bla</italic><sub>OXA-51</sub> genes and 87.5% were positive for <italic>bla</italic><sub>OXA-23</sub>.</p><p><italic>A. baumannii</italic> is considered as an opportunistic pathogen that can survive in austere conditions. It is responsible of an increasing rate of severe nosocomial infections. They affect especially immunocompromised patients, exposed to prolonged stays in ICUs and having a previous exposure to antibiotics; carbapenems and 3<sup>rd</sup> generation cephalosporins are the most involved, followed by fluoroquinolones, aminoglyco-sides and metronidazole (<xref rid="B2" ref-type="bibr">2</xref>, <xref rid="B7" ref-type="bibr">7</xref>). Other factors that are associated with the occurrence of <italic>A. baumannii</italic> bacteremia are: assisted ventilation, central catheterization, urinary catheters, and nasogastric probes (<xref rid="B8" ref-type="bibr">8</xref>).</p><p>The distribution of bacteria in our study is consistent with a previous study in the same hospital in which <italic>A. baumannii</italic> represented 13% of the bacteria isolated from blood cultures (<xref rid="B9" ref-type="bibr">9</xref>). It should be noted that the negative coagulase staphylococci are contaminants in the majority of cases and only 10% to 30% were clinically significant (<xref rid="B10" ref-type="bibr">10</xref>). Nevertheless, this distribution contrasts with data from a French study where <italic>S. aureus</italic> (18.4%), <italic>E. coli</italic> (15.4%) and <italic>S. epidermidis</italic> (14.4%) accounted for almost a half (48.3%) of blood cultures isolated microorganisms; <italic>Candida albicans</italic> represented 2.5%. <italic>A. baumannii</italic> was rarely isolated (0.6% of microorganisms responsible of nosocomial infections in all sites) (<xref rid="B11" ref-type="bibr">11</xref>).</p><p>Resistance to the 3<sup>rd</sup> generation cephalosporins and ciprofloxacin, in Algeria, Tunisia and France, is over than 50% (<xref rid="B11" ref-type="bibr">11</xref>–<xref rid="B14" ref-type="bibr">14</xref>) as it was in our study.</p><p>Resistance to imipenem (treatment of choice for <italic>A. baumannii</italic> infections) is variable: 3.3% in France, 60% to 89.9% in Tunisia and 48% in Algeria (<xref rid="B11" ref-type="bibr">11</xref>–<xref rid="B14" ref-type="bibr">14</xref>). Our study objectified an increased resistance from 50% in 2010 to 86% in 2013 with a slight decrease in 2014 (75%). This could be due to pressure selection exerted by excessive prescription of imipenem.</p><p>The acquired carbapenem resistance in <italic>A. baumannii</italic> is often associated with carbapenemase production; IMP, VIM and SIM-type metallo-β-lactamase production or the OXA-24, OXA-23 and OXA-58 type class D carbapenemases. But also with the over production of natural oxacillinase (OXA-51) (<xref rid="B15" ref-type="bibr">15</xref>). OXA-23 and OXA-51 are considered as the most prevalent among <italic>A. baumannii</italic> carbapenem resistance (<xref rid="B16" ref-type="bibr">16</xref>). In our study, all <italic>A. baumannii</italic> strains were positive for <italic>bla</italic><sub>OXA-51</sub> genes and 87.5% (n=147) for <italic>bla</italic><sub>OXA-23</sub>.</p><p>Strains of <italic>A. baumannii</italic> harbouring OXA-23 enzymes have been identified in Brazil, Argentina and Colombia (<xref rid="B17" ref-type="bibr">17</xref>–<xref rid="B21" ref-type="bibr">21</xref>). Moreover, carbapenemases belonging to OXA-23 subgroup have been detected in Europe, Australia, Tahiti, China, Korea, Singapore, Vietnam, USA, Libya and Pakistan (<xref rid="B22" ref-type="bibr">22</xref>) Mobilization of the <italic>bla</italic><sub>OXA</sub> genes is determined by the presence of insertion sequences and transposons, and therefore has a high potential to spread (<xref rid="B23" ref-type="bibr">23</xref>). That is why it is essential to conduct molecular genotyping studies as well as characterizing the carbapenemases found in specific geographic areas, to highlight molecular evolution of both genes and resistant clones.</p><p>The multi-drug resistance of this germ has led to a renewed interest in colistin, to the association of antibiotics (rifampicin-colistin, colistin-imipenem) and the use of new antibiotics such as tigecycline to overcome therapeutic impasses (<xref rid="B24" ref-type="bibr">24</xref>).</p></sec><sec sec-type="conclusion"><title>CONCLUSION</title><p><italic>A. baumannii</italic> was the second germ that was frequently isolated in blood cultures of intensive care units in the last five years in Ibn Rochd University Hospital. It was multi-resistant to antibiotics with a particular increasing resistance to imipenem. 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