Heteroresistance to Carbapenems in New Delhi Metallo-β-Lactamase-1–Producing Isolates: A Challenge for Detection?

Zavascki, Alexandre Prehn; Falci, Diego Rodrigues; Silva, Renato Cassol F. da; Dalarosa, Micheline Gisele; Ribeiro, Vanessa Bley; Rozales, Franciéli Pedrotti; Luz, Daniela Inocente; Magagnin, Cibele Massotti; Vieira, Fabiane Jamono; Sampaio, Jorge Luiz Mello; Barth, Afonso Luís

doi:10.1086/676442

Cited by 7 publications

(4 citation statements)

References 5 publications

(3 reference statements)

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“…This finding is similar to those reported for clinical isolates harbouring different carbapenemases and which showed heteroresistance towards various carbapenem antibiotics. [23][24][25] The addition of the efflux inhibitor, PAβN, increased the ertapenem MICs for the wild-type S. Typhimurium 14028s Rif and its AcrAB mutant strain. The fold increase was similar to that observed for the Salmonella TolC mutant carrying the plasmids (in the absence of PAβN).…”

Section: Discussionmentioning

confidence: 99%

Inactivation or inhibition of AcrAB-TolC increases resistance of carbapenemase-producing Enterobacteriaceae to carbapenems

Saw

Webber

Mushtaq

et al. 2016

J. Antimicrob. Chemother.

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Section: Discussionmentioning

confidence: 99%

Inactivation or inhibition of AcrAB-TolC increases resistance of carbapenemase-producing Enterobacteriaceae to carbapenems

Saw

Webber

Mushtaq

et al. 2016

J. Antimicrob. Chemother.

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“…Increased cephalothinase activity of the more resistant subpopulation was reported for Enterobacter cloacae, Citrobacter freundii, Proteus vulgaris, and Morganella morganii (28). The New Delhi ␤-lactamase (NDM-1) conferred heteroresistance in Providencia rettgeri (134). Similarly, elevated expression of the ␤-lactamase gene in resistant subpopulations compared to native populations was detected in Klebsiella pneumoniae isolates heteroresistant to meropenem (40) and in imipenem-heteroresistant A. baumannii (91).…”

Section: Heteroresistance To ␤-Lactamsmentioning

confidence: 93%

Antimicrobial Heteroresistance: an Emerging Field in Need of Clarity

2015

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SUMMARY “Heteroresistance” describes a phenomenon where subpopulations of seemingly isogenic bacteria exhibit a range of susceptibilities to a particular antibiotic. Unfortunately, a lack of standard methods to determine heteroresistance has led to inappropriate use of this term. Heteroresistance has been recognized since at least 1947 and occurs in Gram-positive and Gram-negative bacteria. Its clinical relevance may be considerable, since more resistant subpopulations may be selected during antimicrobial therapy. However, the use of nonstandard methods to define heteroresistance, which are costly and involve considerable labor and resources, precludes evaluating the clinical magnitude and severity of this phenomenon. We review the available literature on antibiotic heteroresistance and propose recommendations for definitions and determination criteria for heteroresistant bacteria. This will help in assessing the global clinical impact of heteroresistance and developing uniform guidelines for improved therapeutic outcomes.

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“…Compared to what happened with KPC, which was detected in Brazil 10 years after the initial description, NDM-1-producing strains were detected much earlier, which indicates a great potential for more efficient dissemination in Brazil. This P. rettgeri strain was later shown to have heterogeneous carbapenem resistance, which could make its detection a challenging task 88 . Subsequently, expression of NDM-1 was reported in E. hormaechei from the same city where the first case had been detected 89 …”

Section: The Rise Of Carbapenemases In Brazilmentioning

confidence: 99%

Antimicrobial resistance in Enterobacteriaceae in Brazil: focus on β-lactams and polymyxins

Sampaio

Gales

2016

Brazilian Journal of Microbiology

101

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During the last 30 years there has been a dissemination of plasmid-mediated β-lactamases in Enterobacteriaceae in Brazil. Extended spectrum β-lactamases (ESBL) are widely disseminated in the hospital setting and are detected in a lower frequency in the community setting. Cefotaximases are the most frequently detected ESBL type and Klebsiella pneumoniae is the predominant species among ESBL producers. Klebsiella pneumoniae carbapenemase-producing Enterobacteriaceae became widely disseminated in Brazil during the last decade and KPC production is currently the most frequent resistance mechanism (96.2%) in carbapenem resistant K. pneumoniae. To date KPC-2 is the only variant reported in Brazil. Polymyxin B resistance in KPC-2-producing K. pneumoniae has come to an alarming rate of 27.1% in 2015 in São Paulo, the largest city in Brazil. New Delhi metallo-β-lactamase was detected in Brazil in 2013, has been reported in different Brazilian states but are not widely disseminated. Antimicrobial resistance in Enterobacteriaceae in Brazil is a very serious problem that needs urgent actions which includes both more strict adherence to infection control measures and more judicious use of antimicrobials.

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Heteroresistance to Carbapenems in New Delhi Metallo-β-Lactamase-1–Producing Isolates: A Challenge for Detection?

Cited by 7 publications

References 5 publications

Inactivation or inhibition of AcrAB-TolC increases resistance of carbapenemase-producing Enterobacteriaceae to carbapenems

Inactivation or inhibition of AcrAB-TolC increases resistance of carbapenemase-producing Enterobacteriaceae to carbapenems

Antimicrobial Heteroresistance: an Emerging Field in Need of Clarity

Antimicrobial resistance in Enterobacteriaceae in Brazil: focus on β-lactams and polymyxins

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