Abstract
Colistin is the last resort for the treatment of infections with carbapenem-resistant (CR) Gram-negative bacteria particularly Acinetobacter baumannii (CRAB). Currently, both colistin-resistant and -heteroresistant A. baumannii isolates have been reported globally. We therefore investigated the colistin heteroresistance rate in 75 non-duplicate colistin-susceptible CRAB clinical isolates from a Thai university collected in 2016. Minimum inhibitory concentrations (MICs) of colistin for all isolates were determined by broth microdilution method and carbapenemase genes were detected by PCR methods. All isolates were genotyped by ERIC-PCR method and screened for colistin heteroresistance by modified population analysis profile (PAP) method. The colistin MIC range for the 75 isolates was 0.5–2 µg/mL, with MIC50 and MIC90 of 1 and 2 µg/mL, respectively. Thirty-three isolates (44%) were considered colistin-heteroresistant with subpopulations growing at 3–8 μg/mL of colistin. After three daily passages of the subpopulations on antibiotic-free medium, their colistin MICs ranged from 4 to > 32 µg/mL, with MIC50 and MIC90 of 32 and > 32 µg/mL, respectively. Eight different ERIC-PCR profiles were obtained among the 33 isolates and all carried blaOXA-23-like. The high rate of colistin heteroresistance in the CRAB isolates highlights the possibility of treatment failure of CRAB infections by colistin due to the selection of colistin-resistant subpopulations.
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Acknowledgements
This work was supported by Khon Kaen University Research Grant (Project Numbers 600011 and 6100017). We thank Faculty of Associated Medical Sciences, Khon Kaen University and the CMDL, Khon Kaen University for providing a scholarship for Khin Thet Thet. We are grateful to the staff of Clinical Microbiology Unit, Srinagarind Hospital for collecting the clinical isolates.
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The present study was conducted under the protocol approved by the Khon Kaen University Ethics Committee for Human Research based on the Declaration of Helsinki and the ICH Good Clinical Practice Guidelines (Project ID: HE581434).
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Thet, K.T., Lunha, K., Srisrattakarn, A. et al. Colistin heteroresistance in carbapenem-resistant Acinetobacter baumannii clinical isolates from a Thai university hospital. World J Microbiol Biotechnol 36, 102 (2020). https://doi.org/10.1007/s11274-020-02873-8
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DOI: https://doi.org/10.1007/s11274-020-02873-8