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Volume 12, Number 8—August 2006
Research

Carbapenem Resistance in Klebsiella pneumoniae Not Detected by Automated Susceptibility Testing

Fred C. Tenover*Comments to Author , Rajinder K. Kalsi†, Portia P. Williams‡, Roberta B. Carey*, Sheila Stocker*, David R. Lonsway*, J. Kamile Rasheed*, James W. Biddle*, John E. McGowan‡, and Bruce Hanna†
Author affiliations: *Centers for Disease Control and Prevention, Atlanta, Georgia, USA; †Bellevue Hospital, New York, New York, USA; ‡Rollins School of Public Heath, Emory University, Atlanta, Georgia, USA

Main Article

Table 1

Carbapenem susceptibility and strain typing results for isolates tested in the study*

Organism Imipenem broth microdilution MIC† (μg/mL) and CLSI interpretation Meropenem broth microdilution MIC (μg/mL) and CLSI interpretation PFGE profile Hospital identification no.
1 Klebsiella pneumoniae 8 I 16 R A 1
2 K. pneumoniae 16 R >16 R A 1
3 K. pneumoniae 16 R 16 R A 2
4 K. pneumoniae 8 I 8 I A 2
5 K. pneumoniae 16 R >16 R A 2
6 K. pneumoniae 16 R 16 R A 2
7 K. pneumoniae 16 R 16 R A 3
8 K. pneumoniae 32 R 16 R A 4
9 K. pneumoniae 16 R >16 R B 1
10 K. pneumoniae 16 R >16 R B 1
11 K. pneumoniae 16 R 16 R C 4
12 K. pneumoniae 16 R 16 R D 1
13 K. pneumoniae 16 R 16 R E 4
14 K. pneumoniae 16 R >16 R F 1
15 K. pneumoniae 16 R >16 R F1 4
K. pneumoniae
1534 (control) 16 R >16 R NA NA
Serratia marcescens
525 (control) >16 R >16 R NA NA

*CLSI, Clinical and Laboratory Standards Institute; PFGE, pulsed-field gel electrophoresis; NA, not applicable.†Interpretations of MIC results used CLSI criteria (18); I, intermediate; R, resistant.

Main Article

References
  1. Yigit  H, Queenan  AM, Anderson  GJ, Sanchez-Sanchez  AD, Biddle  JW, Steward  CD, Novel carbapenem-hydrolyzing β-lactamase, KPC-1, from a carbapenem-resistant strain of Klebsiella pneumoniae. Antimicrob Agents Chemother. 2001;45:1151–61. DOIPubMedGoogle Scholar
  2. Yigit  H, Queenan  AM, Anderson  GA, Biddle  JW, Steward  CD, Domenech-Sanchez  A, Carbapenem-resistant strain of Klebsiella oxytoca harboring carbapenem-hydrolyzing beta-lactamase KPC-2. Antimicrob Agents Chemother. 2003;47:3881–9. DOIPubMedGoogle Scholar
  3. Bradford  PA, Bratu  S, Urban  C, Visalli  M, Mariano  N, Landman  D, Emergence of carbapenem-resistant Klebsiella spp. possessing the class A carbapenem-hydrolyzing KPC-2 and inhibitor resistant TEM-30 beta-lactamases in New York City. Clin Infect Dis. 2004;39:55–60. DOIPubMedGoogle Scholar
  4. Smith Moland  E, Hanson  ND, Herrera  VL, Black  JA, Lockhart  TJ, Hossain  A, Plasmid-mediated, carbapenem-hydrolysing β-lactamase, KPC-2, in Klebsiella pneumoniae isolates. J Antimicrob Chemother. 2003;51:711–4. DOIPubMedGoogle Scholar
  5. Bratu  S, Landman  D, Alam  M, Tolentino  E, Quale  J. Detection of KPC carbapenem-hydrolyzing enzymes in Enterobacter spp. from Brooklyn, New York. Antimicrob Agents Chemother. 2005;49:776–8. DOIPubMedGoogle Scholar
  6. Woodford  N, Tierno  PM Jr, Young  K, Tysall  L, Palepou  MF, Ward  E, Outbreak of Klebsiella pneumoniae producing a new carbapenem-hydrolyzing class A beta-lactamase, KPC-3, in a New York Medical Center. Antimicrob Agents Chemother. 2004;48:4793–9. DOIPubMedGoogle Scholar
  7. Yigit  H, Anderson  GJ, Biddle  JW, Steward  CD, Rasheed  JK, Valera  LL, Carbapenem resistance in a clinical isolate of Enterobacter aerogenes is associated with decreased expression of OmpF and OmpC analogs. Antimicrob Agents Chemother. 2002;46:3817–22. DOIPubMedGoogle Scholar
  8. Villar  HE, Danel  F, Livermore  DM. Permeability to carbapenems of Proteus mirabilis mutants selected for resistance to imipenem or other beta-lactams. J Antimicrob Chemother. 1997;40:365–70. DOIPubMedGoogle Scholar
  9. White  RL, Kays  MB, Friedrich  LV, Brown  EW, Koonce  JR. Pseudoresistance of Pseudomonas aeruginosa resulting from degradation of imipenem in an automated susceptibility testing system with pre-dried panels. J Clin Microbiol. 1991;29:398–400.PubMedGoogle Scholar
  10. Doern  GV, Brueggemann  AB, Perla  R, Daly  J, Halkias  D, Jones  RN, Multicenter laboratory evaluation of the bioMérieux VITEK antimicrobial susceptibility testing system with 11 antimicrobial agents versus members of the Family Enterobacteriaceae and Pseudomonas aeruginosa. J Clin Microbiol. 1997;35:2115–9.PubMedGoogle Scholar
  11. Steward  CD, Wallace  D, Hubert  SK, Lawton  R, Fridkin  SK, Gaynes  RP, Ability of laboratories to detect emerging antimicrobial resistance in nosocomial pathogens: a survey of Project ICARE laboratories. Diagn Microbiol Infect Dis. 2000;38:59–67. DOIPubMedGoogle Scholar
  12. Steward  CD, Mohammed  JM, Swenson  JM, Stocker  SA, Williams  PP, Gaynes  RP, Antimicrobial susceptibility testing of carbapenems: multicenter validity testing and accuracy levels of five antimicrobial test methods for detecting resistance in Enterobacteriaceae and Pseudomonas aeruginosa isolates. J Clin Microbiol. 2003;41:351–8. DOIPubMedGoogle Scholar
  13. Carmeli  Y, Eichelberger  K, Soja  D, Dakos  J, Venkataraman  L, deGirolami  P, Failure of quality control measures to prevent reporting of false resistance to imipenem, resulting in a pseudo-outbreak of imipenem-resistant Pseudomonas aeruginosa. J Clin Microbiol. 1998;36:595–7.PubMedGoogle Scholar
  14. Bratu  S, Mooty  M, Nichani  S, Landman  D, Gullans  C, Pettinato  B, Emergence of KPC-possessing Klebsiella pneumoniae in Brooklyn, New York: epidemiology and recommendations for detection. Antimicrob Agents Chemother. 2005;49:3018–20. DOIPubMedGoogle Scholar
  15. Bratu  S, Landman  D, Haag  R, Recco  R, Eramo  A, Alam  M, Rapid spread of carbapenem-resistant Klebsiella pneumoniae in New York City: a new threat to our antibiotic armamentarium. Arch Intern Med. 2005;165:1430–5. DOIPubMedGoogle Scholar
  16. National Committee for Clinical Laboratory Standards (NCCLS). Methods for dilution antimicrobial susceptibility tests for bacteria that grow aerobically; approved standard–sixth edition. NCCLS document M7–A6. Wayne (PA): The Committee; 2003.
  17. National Committee for Clinical Laboratory Standards (NCCLS). Performance standards for antimicrobial disk susceptibility tests; approved standard–eighth edition. NCCLS document M2–A8. Wayne (PA): The Committee; 2003.
  18. Clinical and Laboratory Standards Institute. Performance standards for antimicrobial susceptibility testing; Fifteenth informational supplement M100–S15. Wayne (PA): The Institute; 2005.

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