Colistin Heteroresistance Is Largely Undetected among Carbapenem-Resistant Enterobacterales in the United States
| Autor: | Lavanya Rishishwar, Suzanne E. Dale, Roberto L. Vargas, David S. Weiss, Ghinwa Dumyati, Jesse T. Jacob, Chris Bower, Robert K. Ernst, Eileen M. Burd, Richard D Smith, Marion A. Kainer, Lucy E. Wilson, Andrew B. Conley, I. King Jordan, Erik Nilsson, Sarah W. Satola, Victor I. Band, David A. Hufnagel, Rebecca Pierce, Matthew Sorensen, Dwight J. Hardy, Monica M. Farley, Erin C Phipps |
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| Jazyk: | angličtina |
| Rok vydání: | 2021 |
| Předmět: |
antibiotic resistance
medicine.drug_class Klebsiella pneumoniae Polymyxin Antibiotics Observation Microbial Sensitivity Tests Biology polymyxins Microbiology Clinical Science and Epidemiology 03 medical and health sciences Antibiotic resistance Enterobacterales Enterobacteriaceae Bacterial Proteins Virology Drug Resistance Multiple Bacterial polycyclic compounds medicine Humans heteroresistance 030304 developmental biology 0303 health sciences Carbapenem resistant 030306 microbiology Colistin CRE Enterobacter biochemical phenomena metabolism and nutrition bacterial infections and mycoses biology.organism_classification United States QR1-502 Anti-Bacterial Agents Carbapenems lipids (amino acids peptides and proteins) medicine.drug |
| Zdroj: | mBio, Vol 12, Iss 1 (2021) mBio |
| ISSN: | 2150-7511 2161-2129 |
| DOI: | 10.1128/mBio.02881-20 |
| Popis: | Heteroresistance is an underappreciated phenomenon that may be the cause of some unexplained antibiotic treatment failures. Misclassification of heteroresistant isolates as susceptible may lead to inappropriate therapy. Heteroresistance is a form of antibiotic resistance where a bacterial strain is comprised of a minor resistant subpopulation and a majority susceptible subpopulation. We showed previously that colistin heteroresistance can mediate the failure of colistin therapy in an in vivo infection model, even for isolates designated susceptible by clinical diagnostics. We sought to characterize the extent of colistin heteroresistance among the highly drug-resistant carbapenem-resistant Enterobacterales (CRE). We screened 408 isolates for colistin heteroresistance. These isolates were collected between 2012 and 2015 in eight U.S. states as part of active surveillance for CRE. Colistin heteroresistance was detected in 10.1% (41/408) of isolates, and it was more common than conventional homogenous resistance (7.1%, 29/408). Most (93.2%, 38/41) of these heteroresistant isolates were classified as colistin susceptible by standard clinical diagnostic testing. The frequency of colistin heteroresistance was greatest in 2015, the last year of the study. This was especially true among Enterobacter isolates, of which specific species had the highest rates of heteroresistance. Among Klebsiella pneumoniae isolates, which were the majority of isolates tested, there was a closely related cluster of colistin-heteroresistant ST-258 isolates found mostly in Georgia. However, cladistic analysis revealed that, overall, there was significant diversity in the genetic backgrounds of heteroresistant K. pneumoniae isolates. These findings suggest that due to being largely undetected in the clinic, colistin heteroresistance among CRE is underappreciated in the United States. |
| Databáze: | OpenAIRE |
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