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Background  Multidrug-resistant (MDR)  Acinetobacter baumannii  infections are considered as emerging nosocomial infections particularly in patients hospitalized in intensive care units (ICUs). Therefore, reliable detection of MDR strains is crucial for management of treatment but also for epidemiological data collections. The purpose of this study was to compare antimicrobial resistance and the clonal distribution of MDR clinical and environmental  A .  baumannii  isolates obtained from the ICUs of 10 different hospitals from five geographical regions of Turkey in the context of the demographic and clinical characteristics of the patients.    Methods  A multicenter-prospective study was conducted in 10 medical centers of Turkey over a 6 month period. A total of 164 clinical and 12 environmental MDR  A. baumannii  isolates were included in the study. Antimicrobial susceptibility testing was performed for amikacin (AN), ampicillin–sulbactam (SAM), ceftazidime (CAZ), ciprofloxacin (CIP), imipenem (IMP) and colistin (COL) by microdilution method and by antibiotic gradient test for tigecycline (TIG). Pulsed-field gel electrophoresis (PFGE) was performed to determine the clonal relationship between the isolates. The detection of the resistance genes,  bla  OXA-23 ,  bla  OXA-24 ,  bla  OXA-51,   bla  OXA-58,   bla  IMP,   bla  NDM ,  bla  KPC ,  bla  OXA-48  and  bla  PER-1  was carried out using the PCR method.    Results  The mortality rate of the 164 patients was 58.5%. The risk factors for mortality included diabetes mellitus, liv1er failure, the use of chemotherapy and previous use of quinolones. Antimicrobial resistance rates for AN, SAM, CAZ, CIP, IMP, COL and TIG were 91.8%, 99.4%, 99.4%, 100%, 99.4%, 1.2% and 1.7% respectively. Colistin showed the highest susceptibility rate. Four isolates did not grow on the culture and were excluded from the analyses. Of 172 isolates, 166 (96.5%) carried  bla  OXA-23 , 5 (2.9%)  bla  OXA-58  and one isolate (0.6%) was positive for both genes. The frequency of  bla  PER-1  was found to be 2.9%. None of the isolates had  bla  IMP ,  bla  KPC ,  bla  NDM  and  bla  OXA-48  genes. PFGE analysis showed 88 pulsotypes. Fifteen isolates were clonally unrelated. One hundred fifty-seven (91.2%) of the isolates were involved in 14 different clusters.    Conclusions  Colistin is still the most effective antibiotic for  A .  baumannii  infections. The gene  bla  OXA-23  has become the most prevalent carbapenemase in Turkey. The distribution of invasive  A .  baumannii  isolates from different regions of Turkey is not diverse so, infection control measures at medical centers should be revised to decrease the MDR  A. baumannii  infections across the country. The results of this study are expected to provide an important baseline to assess the future prophylactic and therapeutic options.

annals of clinical microbiology and antimicrobials

A prospective multicenter study on the evaluation of antimicrobial resistance and molecular epidemiology of multidrug-resistant Acinetobacter baumannii infections in intensive care units with clinical and environmental features