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  • 1 Hacettepe University, Turkey
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Colistin is one of the most effective alternatives for treating Acinetobacter baumannii infections. The aim of this study was to determine colistin resistance and heteroresistance rates in A. baumannii from clinical samples in Hacettepe University clinical microbiology laboratory between June 2016 and January 2017. A total of 200 isolates were included in the study. In vitro susceptibility to amikacin, gentamicin, ceftazidime, piperacillin/tazobactam, meropenem, ciprofloxacin, and tigecycline were determined by disk diffusion test. Most isolates were multiresistant as they exhibited resistance to aminoglycosides, β-lactams, and fluoroquinolones. Colistin susceptibility was determined by broth microdilution (BMD) test (EUCAST standards) and was compared with E-test (bioMérieux, France) in 120 isolates. In 14 blood isolates that were susceptible to colistin (MIC ≤ 2 mg/L), heteroresistance was investigated with the population analysis profile (PAP) method. Overall resistance (n = 200) to colistin was 28% by BMD. Among the 120 isolates where the two tests were compared, resistance to colistin was 25.8% versus 4.2% with BMD and E-test, respectively. Three blood isolates (21.4%) were heteroresistant to colistin. With E-test, a majority of the resistant isolates are overlooked and in vitro susceptibility to colistin should be determined with broth dilution method. This is the first study in Turkey reporting heteroresistance in A. baumannii isolates by the PAP method and emphasizes the need to test for heteroresistance in relation to clinical outcome in serious infections due to A. baumannii.

  • 1.

    Boucher, H. W., Talbot, G. H., Bradley, J. S., Edwards, J. E., Gilbert, D., Rice, L. B., Scheld, M., Spellberg, B., Bartlett, J.: Bad bugs, no drugs: No ESKAPE! An update from the Infectious Diseases Society of America. Clin Infect Dis 8, 112 (2009).

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 2.

    Antunes, L. C. S., Visca, P., Towner, K. J.: Acinetobacter baumannii: Evolution of a global pathogen. Pathog Dis 71, 292301 (2014).

  • 3.

    Qureshi, Z. A., Hittle, L. E., O’Hara, A. J., Rivera, J. I., Syed, A., Shields, K. R., Pasculle, A. W., Ernst, R. K., Doi, Y.: Colistin-resistant Acinetobacter baumannii: Beyond carbapenem resistance. Clin Infect Dis 60, 12951303 (2015).

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 4.

    Poirel, L., Jayol, A., Nordmann, P.: Polymyxins: Antibacterial activity, susceptibility testing, and resistance mechanisms encoded by plasmids or chromosomes. Clin Microbiol Rev 30, 557596 (2017).

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 5.

    Olaitan, A. O., Morand, S., Rolain, J. M.: Mechanisms of polymixin resistance: Acquired and intrinsic resistance in bacteria. Front Microbiol 5, 118 (2014).

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 6.

    Cai, Y., Chai, D., Wang, R., Liang, B., Bai, N.: Colistin resistance of Acinetobacter baumannii: Clinical reports, mechanisms and antimicrobial strategies. J Antimicrob Chemother 67, 16071615 (2012).

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 7.

    Li, J., Rayner, C. R., Nation, R. L., Owen, R. J., Spelman, D., Tan, K. E., Liolios, L.: Heteroresistance to colistin in multidrug-resistant Acinetobacter baumannii. Antimicrob Agents Chemother 50, 29462950 (2006).

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 8.

    Yau, W., Owen, R. J., Poudyal, A., Bell, J. M., Turnidge, J. D., Yu, H. H., Nation, R. L., Li, J.: Colistin hetero-resistance in multidrug-resistant Acinetobacter baumannii clinical isolates from the Western Pacific region in the SENTRY antimicrobial surveillance programme. J Infect 58, 138144 (2009).

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 9.

    Hawley, J. S., Murray, C. K., Jorgensen, J. H.: Colistin heteroresistance in Acinetobacter and its association with previous colistin therapy. Antimicrob Agents Chemother 52, 351352 (2008).

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 10.

    International Organization for Standardization: ISO 20776-1:2006: Clinical laboratory testing and in vitro diagnostic test systems-Susceptibility testing of infectious agents and evaluation of performance of antimicrobial susceptibility test devices – Part I: Reference method for testing the in vitro activity of antimicrobial agents against rapidly growing aerobic bacteria involved in infectious diseases. ISO, Geneva, Switzerland, 2006.

    • Search Google Scholar
    • Export Citation
  • 11.

    The European Committee on Antimicrobial Susceptibility Testing: Breakpoint Tables for Interpretation of MICs and Zone Diameters. Version 8.1, 2018.

    • Search Google Scholar
    • Export Citation
  • 12.

    Süzük Yıldız, S., Kaşkatepe, B., Şimşek, H., Sarıgüzel, F. M.: High rate of colistin and fosfomycin resistance among carbapenemase-producing Enterobacteriaceae in Turkey. Acta Microbiol Immunol Hung 66, 103112 (2019).

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 13.

    Charretier, Y., Diene, S. M., Baud, D., Chatellier, S., Santiago-Allexant, E., van Belkum, A., Guigon, G., Schrenzel, J.: Colistin heteroresistance and involvement of the PmrAB regulatory system in Acinetobacter baumannii. Antimicrob Agents Chemother 62, 128 (2018).

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 14.

    Gales, A. C., Seifert, H., Gur, D., Castanheira, M., Jones, R. N., Sader, H.: Antimicrobial susceptibility of Acinetobacter calcoaceticusAcinetobacter baumannii complex and Stenotrophomonas maltophilia clinical isolates: Results from the SENTRY Antimicrobial Surveillance Program (1997–2016). Open Forum Infect Dis 6, 3446 (2019).

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 15.

    Hernan, R. C., Bombicino, K., Granados, G., Nastro, M., Vay, C., Famiglietti, A.: Selection of colistin-resistant Acinetobacter baumannii isolates in postneurosurgical meningitis in an intensive care unit with high presence of heteroresistance to colistin. Diagn Microbiol Infect Dis 65, 188191 (2009).

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 16.

    Matuschek, E., Åhman, J., Webster, C., Kahlmeter, G.: Antimicrobial susceptibility testing of colistin-evaluation of seven commercial MIC products against standard broth microdilution for Escherichia coli, Klebsiella pneumoniae, Pseudomonas aeruginosa, and Acinetobacter spp. Clin Microbiol Infect 24, 865870 (2018).

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 17.

    Chew, K. L., La, M. V., Lin, R. T. P., Teo, J. W. P.: Colistin and polymyxin B susceptibility testing for carbapenem resistant and mcr-positive Enterobacteriaceae: Comparison of sensititre, MicroScan, Vitek 2, and Etest with broth microdilution. J Clin Microbiol 55, 26092616 (2017).

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 18.

    Bardet, L., Rolain, J. M.: Development of new tools to detect colistin-resistance among Enterobacteriaceae strains. Can J Infect Dis Med Microbiol 2018, 3095249 (2018).

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 19.

    Lai, C. C., Chen, Y. S., Lee, N. Y., Tang, H. J., Lee, S. S., Lin, C. F., Lu, P. L., Wu, J. J., Ko, W. C., Lee, W. S., Hsueh, P. R.: Susceptibility rates of clinically important bacteria collected from intensive care units against colistin, carbapenems, and other comparative agents: Results from Surveillance of Multicenter Antimicrobial Resistance in Taiwan (SMART). Infect Drug Resist 12, 627640 (2019).

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 20.

    Ko, K. S., Suh, J. Y., Kwon, K. T., Jung, S. I., Park, K. H., Kang, C. I., Chung, D. R., Peck, K. R., Song, J. H.: High rates of resistance to colistin and polymyxin B in subgroups of Acinetobacter baumannii isolates from Korea. J Antimicrob Chemother 60, 11631167 (2007).

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 21.

    Fonseca, É. L., Caldart, R. V., Freitas, F. S., Morgado, S. M., Rocha, L. T., Santos, R. C. D., Vicente, A. C. P.: Emergence of XDR International Clone IC-6 Acinetobacter baumannii carrying bla OXA-72 and bla CTX-M-115 in the Brazilian Amazon Region. J Glob Antimicrob Resist (2019). [Epub ahead of print]

    • Search Google Scholar
    • Export Citation
  • 22.

    Munoz-Price, L. S., Arheart, K., Nordmann, P., Boulanger, A. E., Cleary, T., Alvarez, R., Pizano, L., Namias, N., Kett, D. H., Poirel, L.: Eighteen years of experience with Acinetobacter baumannii in a tertiary care hospital. Crit Care Med 41, 27332742 (2013).

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 23.

    Mayanskiy, N., Chebotar, I., Alyabieva, N., Kryzhanovskaya, O., Savinova, T., Turenok, A., Bocharova, Y., Lazareva, A., Polikarpova, S., Karaseva, O.: Emergence of the uncommon clone ST944/ST78 carrying bla OXA-40-like and bla CTX-M-like genes among carbapenem-nonsusceptible Acinetobacter baumannii in Moscow, Russia. Microb Drug Resist 23, 864870 (2017).

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 24.

    Gur, D., Korten, V., Unal, S., Desphande, L. M., Castanheira, M.: Increasing carbapenem resistance due to the clonal dissemination of oxacillinase (OXA-23 and OXA-58)-producing Acinetobacter baumannii: Report from the Turkish SENTRY Program sites. J Med Microbiol 57, 15291532 (2008).

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 25.

    El-Halfawy, O. M., Valvano, M. A.: Antimicrobial heteroresistance: An emerging field in need of clarity. Clin Microbiol Rev 28, 191207 (2015).

  • 26.

    Srinivas, P., Hunt, L. N., Pouch, S. M., Thomas, K., Goff, D. A., Pancholi, P., Balada-Llasat, J. M., Bauer, K. A.: Detection of colistin heteroresistance in Acinetobacter baumannii from blood and respiratory isolates. Diagn Microbiol Infect Dis 91, 194198 (2018).

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 27.

    Gazel, D., Tatman Otkun, M.: Investigation of colistin heteroresistance and some factors affecting heteroresistance in carbapenem-resistant A. baumannii strains. Mediterr J Infect Microb Antimicrob 6, 19 (2017).

    • Search Google Scholar
    • Export Citation
  • 28.

    Rodriguez, C. H., Barberis, C., Nastro, M., Bombicino, K., Granados, G., Vay, C., Famiglietti, A.: Impact of heteroresistance to colistin in meningitis caused by Acinetobacter baumannii. J Infect 64, 119121 (2012).

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 29.

    Tan, C. H., Li, J., Nation, R. L.: Activity of colistin against heteroresistant Acinetobacter baumannii and emergence of resistance in an in vitro pharmacokinetic/pharmacodynamic model. Antimicrob Agents Chemother 51, 34133415 (2007).

    • Crossref
    • Search Google Scholar
    • Export Citation

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