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

 Yu Jin Park  ;  Duck Jin Hong  ;  Eun-Jeong Yoon  ;  Dokyun Kim  ;  Min Hyuk Choi  ;  Jun Sung Hong  ;  Hyukmin Lee  ;  Dongeun Yong  ;  Seok Hoon Jeong 
 Annals of Laboratory Medicine, Vol.38(6) : 545-554, 2018 
Journal Title
 Annals of Laboratory Medicine 
Issue Date
Acinetobacter Infections/drug therapy* ; Acinetobacter Infections/microbiology ; Acinetobacter baumannii/drug effects ; Acinetobacter baumannii/isolation & purification* ; Adolescent ; Adult ; Aged ; Anti-Bacterial Agents/therapeutic use* ; Anti-Infective Agents/pharmacology ; Colistin/therapeutic use* ; DNA, Bacterial/genetics ; DNA, Bacterial/metabolism ; Drug Resistance, Bacterial/genetics ; Electrophoresis, Gel, Pulsed-Field ; Female ; Humans ; Lipid A/analysis ; Lipid A/chemistry ; Male ; Microbial Sensitivity Tests ; Middle Aged ; Multilocus Sequence Typing ; Spectrometry, Mass, Matrix-Assisted Laser Desorption-Ionization ; Young Adult
Acinetobacter baumannii ; Colistin ; Lipid A analysis ; Pathogenesis ; Population heterogeneity ; Resistance
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.
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1. College of Medicine (의과대학) > Dept. of Laboratory Medicine (진단검사의학교실) > 1. Journal Papers
Yonsei Authors
김도균(Kim, Dokyun) ORCID logo https://orcid.org/0000-0002-0348-5440
용동은(Yong, Dong Eun) ORCID logo https://orcid.org/0000-0002-1225-8477
이혁민(Lee, Hyuk Min) ORCID logo https://orcid.org/0000-0002-8523-4126
정석훈(Jeong, Seok Hoon) ORCID logo https://orcid.org/0000-0001-9290-897X
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