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Aim: To analyse the clinical features, laboratory data and foetal-maternal outcomes, and follow them up on a cohort of 1000 women with obstetric antiphospholipid syndrome (OAPS). Methods: The European Registry of OAPS became a registry within the framework of the European Forum on Antiphospholipid Antibody projects and was placed on a website in June 2010. Thirty hospitals throughout Europe have collaborated to carry out this registry. Cases with obstetric complaints related to antiphospholipid antibodies (aPL) who tested positive for aPL at least twice were included prospectively and retrospectively. The seven-year survey results are reported. Results: 1000 women with 3553 episodes were included of which 2553 were historical and 1000 were latest episodes. All cases fulfilled the Sydney classification criteria. According to the laboratory categories, 292 (29.2%) were in category I, 357 (35.7%) in IIa, 224 (22.4%) in IIb and 127 (12.7%) in IIc. Miscarriages were the most prevalent clinical manifestation in 386 cases (38.6%). Moreover, the presence of early preeclampsia (PE) and early foetal growth restriction (FGR) appeared in 181 (18.1%) and 161 (16.1%), respectively. In this series, 448 (44.8%) women received the recommended OAPS treatment. Patients with recommended treatment had a good live-birth rate (85%), but worse results (72.4%) were obtained in patients with any treatment (low-dose aspirin (LDA) or low-molecular-weight heparin (LMWH) not on recommended schedule, while patients with no treatment showed a poor birth rate (49.6%). Conclusion: In this series, recurrent miscarriage is the most frequent poor outcome. To avoid false-negative diagnoses, all laboratory category subsets were needed. OAPS cases have very good foetal-maternal outcomes when treated. Results suggest that we were able to improve our clinical practice to offer better treatment and outcomes to OAPS patients.

Aim: To analyse the clinical features, laboratory data and foetal-maternal outcomes, and follow them up on a cohort of 1000 women with obstetric antiphospholipid syndrome (OAPS). Methods: The European Registry of OAPS became a registry within the framework of the European Forum on Antiphospholipid Antibody projects and was placed on a website in June 2010. Thirty hospitals throughout Europe have collaborated to carry out this registry. Cases with obstetric complaints related to antiphospholipid antibodies (aPL) who tested positive for aPL at least twice were included prospectively and retrospectively. The seven-year survey results are reported. Results: 1000 women with 3553 episodes were included of which 2553 were historical and 1000 were latest episodes. All cases fulfilled the Sydney classification criteria. According to the laboratory categories, 292 (29.2%) were in category I, 357 (35.7%) in Era, 224 (22.4%) in IIb and 127 (12.7%) in IIc. Miscarriages were the most prevalent clinical manifestation in 386 cases (38.6%). Moreover, the presence of early preeclampsia (PE) and early foetal growth restriction (FGR) appeared in 181 (18.1%) and 161 (16.1%), respectively. In this series, 448 (44.8%) women received the recommended OAPS treatment. Patients with recommended treatment had a good live-birth rate (85%), but worse results (72.4%) were obtained in patients with any treatment (low-dose aspirin (LDA) or low-molecular-weight heparin (LMWH) not on recommended schedule, while patients with no treatment showed a poor birth rate (49.6%). Conclusion: In this series, recurrent miscarriage is the most frequent poor outcome. To avoid false-negative diagnoses, all laboratory category subsets were needed. OAPS cases have very good foetal-maternal outcomes when treated. Results suggest that we were able to improve our clinical practice to offer better treatment and outcomes to OAPS patients.

Objectives: To analyse the evolution and genetic relatedness of Acinetobacter baumannii clonal lineages in Greece during a 10 year period. Methods: The study included 94 randomly selected A. baumannii clinical isolates recovered from 2000 to 2009 in eight tertiary Greek hospitals. Carbapenem MICs were determined by agar dilution. PCR was applied for carbapenemase genes. Isolates were typed by PFGE and tri-locus sequence typing (3LST), and 25 were also typed by multilocus sequence typing (MLST) developed by the Institut Pasteur, followed by e-Burst analysis. Results: All isolates were multidrug-resistant (MDR); 54 (57.4%) were non-susceptible to imipenem and/or meropenem. The blaOXA-58 gene was identified in 51 (94.4%) carbapenem-non-susceptible and 15 (37.5%) carbapenem- susceptible isolates; other carbapenemase genes were not detected. Eight different PFGE types were identified. Sequence typing revealed previously characterized 3LST groups (1, 2, 4 and 5) and MLST types (STs) (1, 2, 15, 45 and 54) and the novel STs 85 (in two distant hospitals) and 86. Eight novel 3LST alleles were identified. Fifty-two (55.3%) isolates were assigned to 3LST group 1 and ST2 or ST45, both corresponding to international clonal complex 2 (CC2). Thirty-one (33.0%) isolates were assigned to 3LST group 2 and ST1 (CC1). From 2000 to 2004 63% of isolates belonged to 3LST group 2, but from 2005 to 2009 87.5% of isolates belonged to 3LST group 1; this shift was accompanied by an increase in carbapenem resistance from 43.5% to 64.6% of isolates. Conclusions: The emergence of MDR A. baumannii in Greece was associated with CC1 and CC2, which are disseminated worldwide, often harbouring the blaOXA-58 gene. Novel 3LST alleles and STs were also detected, underlining an evolutionary divergence in Greece.

Single-locus blaOXA-51-like sequence-based typing (SBT) was evaluated for its ability to determine correctly sequence types (STs) in Acinetobacter baumannii clinical isolates, in comparison with the Pasteur's multilocus sequence typing (MLST) reference method and 3-locus sequence typing (3-LST). The comparative study was performed in 585 multidrug-resistant (MDR) A. baumannii clinical isolates recovered from 21 hospitals located throughout Greece, Italy, Lebanon, and Turkey. The isolates belonged to nine clonal complexes (CCs) that correspond to 12 distinct sequence types (STs) and to one singleton ST. These clonal lineages predominate worldwide among nosocomial MDR A. baumannii strains. The most common clone was CC2 (ST2 and ST45; n = 278 isolates) followed by CC1 (ST1 and ST20; n = 155), CC25 (n = 65), ST78 (n = 62), CC15 (ST15 and ST84; n = 9), CC10 (n = 4), CC3 (n = 4), CC6 (n = 3), CC54 (n = 3), and CC83 (n = 2). Using the bla OXA-51-like SBT method, all 585 isolates of the study were typed and assigned correctly to the nine CCs and the singleton ST78. The 3-LST method was not able to classify isolates belonging to CC6, CC10, CC54, and CC83, which are not yet characterized in its database. The low-cost and convenient blaOXA-51-like SBT method, compared with 3-LST and MLST, discriminated all epidemic and sporadic lineages of our collection and could be effectively applied to type rapidly A. baumannii strains. © 2014, American Society for Microbiology. All Rights Reserved.

Objectives: To analyse the evolution and genetic relatedness of Acinetobacter baumannii clonal lineages in Greece during a 10 year period. Methods: The study included 94 randomly selected A. baumannii clinical isolates recovered from 2000 to 2009 in eight tertiary Greek hospitals. Carbapenem MICs were determined by agar dilution. PCR was applied for carbapenemase genes. Isolates were typed by PFGE and tri-locus sequence typing (3LST), and 25 were also typed by multilocus sequence typing (MLST) developed by the Institut Pasteur, followed by e-Burst analysis. Results: All isolates were multidrug-resistant (MDR); 54 (57.4%) were non-susceptible to imipenem and/or meropenem. The blaOXA-58 gene was identified in 51 (94.4%) carbapenem-non-susceptible and 15 (37.5%) carbapenem-susceptible isolates; other carbapenemase genes were not detected. Eight different PFGE types were identified. Sequence typing revealed previously characterized 3LST groups (1, 2, 4 and 5) and MLST types (STs) (1, 2, 15, 45 and 54) and the novel STs 85 (in two distant hospitals) and 86. Eight novel 3LST alleles were identified. Fifty-two (55.3%) isolates were assigned to 3LST group 1 and ST2 or ST45, both corresponding to international clonal complex 2 (CC2). Thirty-one (33.0%) isolates were assigned to 3LST group 2 and ST1 (CC1). From 2000 to 2004 63% of isolates belonged to 3LST group 2, but from 2005 to 2009 87.5% of isolates belonged to 3LST group 1; this shift was accompanied by an increase in carbapenem resistance from 43.5% to 64.6% of isolates. Conclusions: The emergence of MDR A. baumannii in Greece was associated with CC1 and CC2, which are disseminated worldwide, often harbouring the blaOXA-58 gene. Novel 3LST alleles and STs were also detected, underlining an evolutionary divergence in Greece. © The Author 2011. Published by Oxford University Press on behalf of the British Society for Antimicrobial Chemotherapy. All rights reserved.

The characteristics of carbapenem heteroresistance were studied in 14 apparently carbapenem-susceptible Acinetobacter baumannii isolates. The MICs for carbapenems were determined, and the isolates were genotyped by pulsed-field gel electrophoresis (PFGE) and sequence typing (ST). Population analysis, testing of the stability of the heteroresistant subpopulations, and time-killing assays were performed. The agar dilution MICs of both imipenem and meropenem for the native isolates ranged from 0.25 to 4 mg/liter. The isolates belonged to nine PFGE types and exhibited seven ST allelic profiles. Population analysis revealed subpopulations that grew in the presence of imipenem at concentrations of up to 8 mg/liter and meropenem at concentrations of up to 32 mg/liter. The meropenem-heteroresistant subpopulations of 11 isolates exhibited stable resistance with MICs that ranged from 16 to >32 mg/liter; their PFGE profiles were identical to those of the native isolates. Time-kill assays with meropenem revealed less pronounced killing for 10 isolates. These findings indicate that meropenem pressure can produce meropenem-heteroresistant subpopulations that might subsequently select for highly resistant strains. Copyright © 2009, American Society for Microbiology. All Rights Reserved.

Single-locus bla OXA-51-like sequence-based typing (SBT) was evaluated for its ability to determine correctly sequence types (STs) in Acinetobacter baumannii clinical isolates, in comparison with the Pasteur's multilocus sequence typing (MLST) reference method and 3-locus sequence typing (3-LST). The comparative study was performed in 585 multidrug-resistant (MDR) A. baumannii clinical isolates recovered from 21 hospitals located throughout Greece, Italy, Lebanon, and Turkey. The isolates belonged to nine clonal complexes (CCs) that correspond to 12 distinct sequence types (STs) and to one singleton ST. These clonal lineages predominate worldwide among nosocomial MDR A. baumannii strains. The most common clone was CC2 (ST2 and ST45; n = 278 isolates) followed by CC1 (ST1 and ST20; n = 155), CC25 ( n = 65), ST78 ( n = 62), CC15 (ST15 and ST84; n = 9), CC10 ( n = 4), CC3 ( n = 4), CC6 ( n = 3), CC54 ( n = 3), and CC83 ( n = 2). Using the bla OXA-51-like SBT method, all 585 isolates of the study were typed and assigned correctly to the nine CCs and the singleton ST78. The 3-LST method was not able to classify isolates belonging to CC6, CC10, CC54, and CC83, which are not yet characterized in its database. The low-cost and convenient bla OXA-51-like SBT method, compared with 3-LST and MLST, discriminated all epidemic and sporadic lineages of our collection and could be effectively applied to type rapidly A. baumannii strains.