Clinical relevance, mechanisms, and evolution of polymyxin B heteroresistance carbapenem-resistant Klebsiella pneumoniae: A genomic, retrospective cohort study

Luo, Qixia; Xu, Linna; Wang, Yuan; Fu, Hao; Xiao, Tingting; Yu, Wei; Zhou, Wangxiao; Zhang, Kanghui; Shen, Jiaying; Ji, Jinru; Ying, Chaoqun; Xiao, Yonghong

doi:10.1016/j.cmi.2024.01.014

Cited by 6 publications

(2 citation statements)

References 25 publications

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“…In this study, we uncovered a widespread occurrence of the PB-HR phenomenon among clinical strains of CRKP, which exhibited a higher PB-HR rate, surpassing the previously reported figure of 76.62% [ 34 ]. In another multicenter study conducted in China focusing on the PB-HR phenomenon in CRKP strains, the observed frequency of colistin heteroresistance exhibited a range spanning from 2.9% to 13.9%, among which Guangzhou demonstrated the highest rate (13.9%)[ 35 ].…”

Section: Discussionmentioning

confidence: 56%

A novel small RNA PhaS contributes to polymyxin B-heteroresistance in carbapenem-resistant Klebsiella pneumoniae

Zhao,

Yang,

Xiang

et al. 2024

Emerging Microbes & Infections

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Section: Discussionmentioning

confidence: 56%

A novel small RNA PhaS contributes to polymyxin B-heteroresistance in carbapenem-resistant Klebsiella pneumoniae

Zhao,

Yang,

Xiang

et al. 2024

Emerging Microbes & Infections

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“…Luo et al also reported in their study that there was a high rate of mgrB insertional mutations and no mutations in pmrAB or phoPQ and stated that this was consistent with previous findings which showed that those genes had a significantly lower mutation rate compared to mgrB . However, they also stated that the high amount of mgrB disruptions may be related to the high prevalence of ST11 since this ST showed a significantly higher rate of mgrB disruptions compared to other STs in their study [ 31 ].…”

Section: Discussionmentioning

confidence: 99%

Assessment of Colistin Heteroresistance among Multidrug-Resistant Klebsiella pneumoniae Isolated from Intensive Care Patients in Europe

Braspenning,

Rajakani,

Sey

et al. 2024

Antibiotics

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Heteroresistance (HR) to colistin is especially concerning in settings where multi-drug-resistant (MDR) K. pneumoniae are prevalent and empiric use of colistin might lead to treatment failures. This study aimed to assess the frequency of occurrence of colistin HR (CHR) among (MDR) K. pneumoniae (n = 676) isolated from patients hospitalized in 13 intensive care units (ICUs) in six European countries in a clinical trial assessing the impact of decolonization strategies. All isolates were whole-genome-sequenced and studied for in vitro colistin susceptibility. The majority were colistin-susceptible (CS) (n = 597, MIC ≤ 2 µg/mL), and 79 were fully colistin-resistant (CR) (MIC > 2 µg/mL). A total of 288 CS isolates were randomly selected for population analysis profiling (PAP) to assess CHR prevalence. CHR was detected in 108/288 CS K. pneumoniae. No significant association was found between the occurrence of CHR and country, MIC-value, K-antigen type, and O-antigen type. Overall, 92% (617/671) of the K. pneumoniae were MDR with high prevalence among CS (91%, 539/592) and CR (98.7%, 78/79) isolates. In contrast, the proportion of carbapenemase-producing K. pneumoniae (CP-Kpn) was higher among CR (72.2%, 57/79) than CS isolates (29.3%, 174/594). The proportions of MDR and CP-Kpn were similar among CHR (MDR: 85%, 91/107; CP-Kpn: 29.9%, 32/107) and selected CS isolates (MDR: 84.7%, 244/288; CP-Kpn: 28.1%, 80/285). WGS analysis of PAP isolates showed diverse insertion elements in mgrB or even among technical replicates underscoring the stochasticity of the CHR phenotype. CHR isolates showed high sequence type (ST) diversity (Simpson’s diversity index, SDI: 0.97, in 52 of the 85 STs tested). CR (SDI: 0.85) isolates were highly associated with specific STs (ST101, ST147, ST258/ST512, p ≤ 0.003). The widespread nature of CHR among MDR K. pneumoniae in our study urge the development of rapid HR detection methods to inform on the need for combination regimens.

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Rapid colorimetric polymyxin B microelution directly from positive blood bottles: because patients with serious infections should not have to wait for results of culture-based methodologies

Collar,

Becker,

Moreira

et al. 2024

Eur J Clin Microbiol Infect Dis

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Clinical relevance, mechanisms, and evolution of polymyxin B heteroresistance carbapenem-resistant Klebsiella pneumoniae: A genomic, retrospective cohort study

Cited by 6 publications

References 25 publications

A novel small RNA PhaS contributes to polymyxin B-heteroresistance in carbapenem-resistant Klebsiella pneumoniae

A novel small RNA PhaS contributes to polymyxin B-heteroresistance in carbapenem-resistant Klebsiella pneumoniae

Assessment of Colistin Heteroresistance among Multidrug-Resistant Klebsiella pneumoniae Isolated from Intensive Care Patients in Europe

Rapid colorimetric polymyxin B microelution directly from positive blood bottles: because patients with serious infections should not have to wait for results of culture-based methodologies

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