A Novel Insertion Sequence, ISAba10, Inserted into ISAba1 Adjacent to the bla(OXA-23) Gene and Disrupting the Outer Membrane Protein Gene carO in Acinetobacter baumannii

We investigated an outbreak caused by carbapenem-resistant Acinetobacter baumannii carrying the bla(OXA-23) gene. A novel insertion sequence (IS), named ISAba10, was found to be inserted into the ISAba1 element preceding the bla(OXA-23) gene in a group of isolates showing higher carbapenem MICs. The presence of ISAba10 was associated with increased OXA-23 expression, likely by providing additional promoter sequences. ISAba10 was also inserted into the carO outer membrane protein gene in most of these isolates.