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...

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Autores principales:	C. Hickey, S. Nguyen, J. Anes, D. Hurley, O. Donoghue, S. Fanning, K. Schaffer
Formato:	article
Lenguaje:	EN
Publicado:	Elsevier 2021
Materias:	IMP carbapenemase Carbapenemase-producing Enterobacterales CPE Antimicrobial susceptibility testing Microbiology QR1-502
Acceso en línea:	https://doaj.org/article/fe7aa8efadc34afa9e56405cb8dd0c75
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spelling	oai:doaj.org-article:fe7aa8efadc34afa9e56405cb8dd0c752021-11-26T04:29:12ZDifferences in antimicrobial susceptibility testing complicating management of IMP carbapenemase-producing Enterobacterales infection2213-716510.1016/j.jgar.2021.09.010https://doaj.org/article/fe7aa8efadc34afa9e56405cb8dd0c752021-12-01T00:00:00Zhttp://www.sciencedirect.com/science/article/pii/S2213716521002332https://doaj.org/toc/2213-7165ABSTRACT: 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.C. HickeyS. NguyenJ. AnesD. HurleyO. DonoghueS. FanningK. SchafferElsevierarticleIMP carbapenemaseCarbapenemase-producing EnterobacteralesCPEAntimicrobial susceptibility testingMicrobiologyQR1-502ENJournal of Global Antimicrobial Resistance, Vol 27, Iss , Pp 284-288 (2021)
institution	DOAJ
collection	DOAJ
language	EN
topic	IMP carbapenemase Carbapenemase-producing Enterobacterales CPE Antimicrobial susceptibility testing Microbiology QR1-502
spellingShingle	IMP carbapenemase Carbapenemase-producing Enterobacterales CPE Antimicrobial susceptibility testing Microbiology QR1-502 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
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.
format	article
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
title	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_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_sort	differences in antimicrobial susceptibility testing complicating management of imp carbapenemase-producing enterobacterales infection
publisher	Elsevier
publishDate	2021
url	https://doaj.org/article/fe7aa8efadc34afa9e56405cb8dd0c75
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Differences in antimicrobial susceptibility testing complicating management of IMP carbapenemase-producing Enterobacterales infection

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