Differences in antimicrobial susceptibility testing complicating management of IMP carbapenemase-producing Enterobacterales infection
ABSTRACT: Objectives: IMP-type carbapenemases are rarely detected in Europe and limited information is available to guide the treatment of infections caused by carbapenemase-producing Enterobacterales (CPE) producing these carbapenemases. Accurate antimicrobial susceptibility testing (AST) results...
| Main Authors: | , , , , , , |
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| Format: | Article |
| Language: | English |
| Published: |
Elsevier
2021-12-01
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| Series: | Journal of Global Antimicrobial Resistance |
| Subjects: | |
| Online Access: | http://www.sciencedirect.com/science/article/pii/S2213716521002332 |
| _version_ | 1798026742894428160 |
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| author | C. Hickey S. Nguyen J. Anes D. Hurley O. Donoghue S. Fanning K. Schaffer |
| author_facet | C. Hickey S. Nguyen J. Anes D. Hurley O. Donoghue S. Fanning K. Schaffer |
| author_sort | C. Hickey |
| collection | DOAJ |
| description | ABSTRACT: Objectives: IMP-type carbapenemases are rarely detected in Europe and limited information is available to guide the treatment of infections caused by carbapenemase-producing Enterobacterales (CPE) producing these carbapenemases. Accurate antimicrobial susceptibility testing (AST) results are essential for optimal antibiotic management. Here we report discrepancies in AST of IMP-producing Enterobacterales (IMP-CPE) complicating the management of severe sepsis. Methods: Antimicrobial susceptibilities were analysed by in-house VITEK® 2, Etest and broth microdilution (BMD). Carbapenemase-encoding genes were detected by PCR. Whole-genome sequencing (WGS) was performed using an Illumina MiSeq platform. Results: Minimum inhibitory concentrations (MICs) determined by VITEK® 2 for Enterobacter hormaechei and Klebsiella oxytoca blood culture isolates were ≥16 mg/L for meropenem and ≤0.5 mg/L for ertapenem. In contrast, Etest analysis and BMD returned MICs of 2 mg/L and 1 mg/L, respectively. Both isolates tested positive for IMP carbapenemase-encoding genes by PCR. WGS revealed that both isolates carried the same blaIMP-4 gene. Based on VITEK® 2 susceptibilities, initial treatment was with tigecycline and amikacin. After subsequent deterioration, the patient was successfully treated with ertapenem and amikacin. Conclusion: This case highlights that automated AST by VITEK® 2 can over-report meropenem resistance for IMP carbapenemase-producers compared with Etest and BMD. Clinicians need to be cautious deciding against carbapenem treatment based on VITEK® 2 susceptibility testing results for IMP-positive Enterobacterales. Tigecycline was inferior to carbapenem treatment for pyelonephritis caused by isolates expressing IMP carbapenemases, however specific evidence guiding the treatment of these infections is lacking. |
| first_indexed | 2024-04-11T18:40:18Z |
| format | Article |
| id | doaj.art-fe7aa8efadc34afa9e56405cb8dd0c75 |
| institution | Directory Open Access Journal |
| issn | 2213-7165 |
| language | English |
| last_indexed | 2024-04-11T18:40:18Z |
| publishDate | 2021-12-01 |
| publisher | Elsevier |
| record_format | Article |
| series | Journal of Global Antimicrobial Resistance |
| spelling | doaj.art-fe7aa8efadc34afa9e56405cb8dd0c752022-12-22T04:09:02ZengElsevierJournal of Global Antimicrobial Resistance2213-71652021-12-0127284288Differences in antimicrobial susceptibility testing complicating management of IMP carbapenemase-producing Enterobacterales infectionC. Hickey0S. Nguyen1J. Anes2D. Hurley3O. Donoghue4S. Fanning5K. Schaffer6School of Medicine, University College Dublin, Belfield, Dublin 4, Ireland; Department of Clinical Microbiology, St Vincent's University Hospital, Elm Park, Dublin D04 T6F4, IrelandSchool of Public Health, Physiotherapy & Sports Science, University College Dublin, Belfield, Dublin D04 N2E5, IrelandSchool of Public Health, Physiotherapy & Sports Science, University College Dublin, Belfield, Dublin D04 N2E5, IrelandSchool of Public Health, Physiotherapy & Sports Science, University College Dublin, Belfield, Dublin D04 N2E5, IrelandDepartment of Clinical Microbiology, St Vincent's University Hospital, Elm Park, Dublin D04 T6F4, IrelandSchool of Public Health, Physiotherapy & Sports Science, University College Dublin, Belfield, Dublin D04 N2E5, IrelandSchool of Medicine, University College Dublin, Belfield, Dublin 4, Ireland; Department of Clinical Microbiology, St Vincent's University Hospital, Elm Park, Dublin D04 T6F4, Ireland; Corresponding author. Mailing address: Department of Microbiology, St Vincent's University Hospital, Elm Park, Dublin D04 T6F4, Ireland.ABSTRACT: Objectives: IMP-type carbapenemases are rarely detected in Europe and limited information is available to guide the treatment of infections caused by carbapenemase-producing Enterobacterales (CPE) producing these carbapenemases. Accurate antimicrobial susceptibility testing (AST) results are essential for optimal antibiotic management. Here we report discrepancies in AST of IMP-producing Enterobacterales (IMP-CPE) complicating the management of severe sepsis. Methods: Antimicrobial susceptibilities were analysed by in-house VITEK® 2, Etest and broth microdilution (BMD). Carbapenemase-encoding genes were detected by PCR. Whole-genome sequencing (WGS) was performed using an Illumina MiSeq platform. Results: Minimum inhibitory concentrations (MICs) determined by VITEK® 2 for Enterobacter hormaechei and Klebsiella oxytoca blood culture isolates were ≥16 mg/L for meropenem and ≤0.5 mg/L for ertapenem. In contrast, Etest analysis and BMD returned MICs of 2 mg/L and 1 mg/L, respectively. Both isolates tested positive for IMP carbapenemase-encoding genes by PCR. WGS revealed that both isolates carried the same blaIMP-4 gene. Based on VITEK® 2 susceptibilities, initial treatment was with tigecycline and amikacin. After subsequent deterioration, the patient was successfully treated with ertapenem and amikacin. Conclusion: This case highlights that automated AST by VITEK® 2 can over-report meropenem resistance for IMP carbapenemase-producers compared with Etest and BMD. Clinicians need to be cautious deciding against carbapenem treatment based on VITEK® 2 susceptibility testing results for IMP-positive Enterobacterales. Tigecycline was inferior to carbapenem treatment for pyelonephritis caused by isolates expressing IMP carbapenemases, however specific evidence guiding the treatment of these infections is lacking.http://www.sciencedirect.com/science/article/pii/S2213716521002332IMP carbapenemaseCarbapenemase-producing EnterobacteralesCPEAntimicrobial susceptibility testing |
| spellingShingle | C. Hickey S. Nguyen J. Anes D. Hurley O. Donoghue S. Fanning K. Schaffer Differences in antimicrobial susceptibility testing complicating management of IMP carbapenemase-producing Enterobacterales infection Journal of Global Antimicrobial Resistance IMP carbapenemase Carbapenemase-producing Enterobacterales CPE Antimicrobial susceptibility testing |
| title | Differences in antimicrobial susceptibility testing complicating management of IMP carbapenemase-producing Enterobacterales infection |
| title_full | Differences in antimicrobial susceptibility testing complicating management of IMP carbapenemase-producing Enterobacterales infection |
| title_fullStr | Differences in antimicrobial susceptibility testing complicating management of IMP carbapenemase-producing Enterobacterales infection |
| title_full_unstemmed | Differences in antimicrobial susceptibility testing complicating management of IMP carbapenemase-producing Enterobacterales infection |
| title_short | Differences in antimicrobial susceptibility testing complicating management of IMP carbapenemase-producing Enterobacterales infection |
| title_sort | differences in antimicrobial susceptibility testing complicating management of imp carbapenemase producing enterobacterales infection |
| topic | IMP carbapenemase Carbapenemase-producing Enterobacterales CPE Antimicrobial susceptibility testing |
| url | http://www.sciencedirect.com/science/article/pii/S2213716521002332 |
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