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Capsule Thickness, Not Biofilm Formation, Gives Rise to Mucoid Acinetobacter baumannii Phenotypes That are More Prevalent in Long-Term Infections: A Study of Clinical Isolates from a Hospital in China

Authors Hu L, Shi Y, Xu Q, Zhang L, He J, Jiang Y, Liu L, Leptihn S, Yu Y, Hua X, Zhou Z

Received 7 September 2019

Accepted for publication 17 December 2019

Published 9 January 2020 Volume 2020:13 Pages 99—109

DOI https://doi.org/10.2147/IDR.S230178

Checked for plagiarism Yes

Review by Single anonymous peer review

Peer reviewer comments 3

Editor who approved publication: Dr Sahil Khanna


Lihua Hu,1,* Yue Shi,2,3,* Qingye Xu,2,3 Linghong Zhang,2,3 Jintao He,2,3 Yan Jiang,2,3 Lilin Liu,2,3 Sebastian Leptihn,4 Yunsong Yu,2,3 Xiaoting Hua,2,3 Zhihui Zhou2,3

1Department of Critical Care Medicine, Hangzhou General Hospital of Chinese People’s Armed Police, Hangzhou, People’s Republic of China; 2Department of Infectious Diseases, Sir Run Run Shaw Hospital, College of Medicine, Zhejiang University, Hangzhou, People’s Republic of China; 3Key Laboratory of Microbial Technology and Bioinformatics of Zhejiang Province, Hangzhou, People’s Republic of China; 4Zhejiang-University-University of Edinburgh Institute, School of Medicine, Zhejiang University, Haining, People’s Republic of China

*These authors contributed equally to this work

Correspondence: Zhihui Zhou Email zhouzhihui@zju.edu.cn
Xiaoting Hua Tel/Fax +86-571-86006142
Email xiaotinghua@zju.edu.cn

Background: Acinetobacter baumannii is a nosocomial pathogen of critical importance due to the increasing numbers of antibiotic-resistant isolates. Colonies can have a smooth or matt appearance, but also exhibit slimy, mucoid growth, with the latter being increasingly isolated in patients in recent years.
Methods: We isolated 60 A. baumannii strains from altogether 56 patients and found that all patients were infected by mucoid strains, with four patients having also matt phenotypes in addition to the mucoid ones. The morphology of the colonies and capsules was observed. The antibiotics susceptibilities were tested, and the biofilm formation ability was determined by crystal violet staining. The whole-genome sequencing (WGS) was performed on all the strains, and then the core genome multilocus sequence typing (cgMLST) and drug resistance gene analysis were performed. Finally, a part of isolates were selected to test virulence in a Galleria mellonella model.
Results: We observed much larger capsules in the mucoid strains compared to the matt isolates. But the mucoid phenotype did not correlate with the amount of biofilm produced by the strain. Almost all mucus-type A. baumannii were multi-drug resistant isolates, containing various antibiotic resistance genes. The main ST types of mucoid-type A.baumannii were ST191 and ST195, of which ST191 isolates were more virulence, while ST195 isolates were weaker.
Conclusion: The mucoid A. baumannii had resistance to most antibiotics and some strains had high virulence, which should be paid attention in clinical.

Keywords: Acinetobacter baumannii, capsule, biofilm formation, mucoid phenotype


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