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http://dx.doi.org/10.3343/alm.2018.38.6.545

Differences in Colistin-resistant Acinetobacter baumannii Clinical Isolates Between Patients With and Without Prior Colistin Treatment  

Park, Yu Jin (Department of Laboratory Medicine, Yonsei University College of Medicine)
Hong, Duck Jin (Department of Laboratory Medicine, Sheikh Khalifa Specialty Hospital)
Yoon, Eun-Jeong (Department of Laboratory Medicine and Research Institute of Bacterial Resistance, Yonsei University)
Kim, Dokyun (Department of Laboratory Medicine and Research Institute of Bacterial Resistance, Yonsei University)
Choi, Min Hyuk (Department of Laboratory Medicine, Yonsei University College of Medicine)
Hong, Jun Sung (Department of Laboratory Medicine and Research Institute of Bacterial Resistance, Yonsei University)
Lee, Hyukmin (Department of Laboratory Medicine and Research Institute of Bacterial Resistance, Yonsei University)
Yong, Dongeun (Department of Laboratory Medicine and Research Institute of Bacterial Resistance, Yonsei University)
Jeong, Seok Hoon (Department of Laboratory Medicine and Research Institute of Bacterial Resistance, Yonsei University)
Publication Information
Annals of Laboratory Medicine / v.38, no.6, 2018 , pp. 545-554 More about this Journal
Abstract
Background: The increasing morbidity and mortality rates associated with Acinetobacter baumannii are due to the emergence of drug resistance and the limited treatment options. We compared characteristics of colistin-resistant Acinetobacter baumannii (CR-AB) clinical isolates recovered from patients with and without prior colistin treatment. We assessed whether prior colistin treatment affects the resistance mechanism of CR-AB isolates, mortality rates, and clinical characteristics. Additionally, a proper method for identifying CR-AB was determined. Methods: We collected 36 non-duplicate CR-AB clinical isolates resistant to colistin. Antimicrobial susceptibility testing, Sanger sequencing analysis, molecular typing, lipid A structure analysis, and in vitro synergy testing were performed. Eleven colistin-susceptible AB isolates were used as controls. Results: Despite no differences in clinical characteristics between patients with and without prior colistin treatment, resistance-causing genetic mutations were more frequent in isolates from colistin-treated patients. Distinct mutations were overlooked via the Sanger sequencing method, perhaps because of a masking effect by the colistin-susceptible AB subpopulation of CR-AB isolates lacking genetic mutations. However, modified lipid A analysis revealed colistin resistance peaks, despite the population heterogeneity, and peak levels were significantly different between the groups. Conclusions: Although prior colistin use did not induce clinical or susceptibility differences, we demonstrated that identification of CR-AB by sequencing is insufficient. We propose that population heterogeneity has a masking effect, especially in colistin non-treated patients; therefore, accurate testing methods reflecting physiological alterations of the bacteria, such as phosphoethanolamine-modified lipid A identification by matrix-assisted laser desorption ionization-time of flight, should be employed.
Keywords
Colistin; Population heterogeneity; Acinetobacter baumannii; Resistance; Lipid A analysis; Pathogenesis;
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