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Open Forum Infect Dis. 2018 Apr 23;5(4):ofy054. doi: 10.1093/ofid/ofy054. eCollection 2018 Apr.

Emergence of Resistance to Colistin During the Treatment of Bloodstream Infection Caused by Klebsiella pneumoniae Carbapenemase-Producing Klebsiella pneumoniae.

Author information

1
Division of Infectious Diseases and HIV Medicine, Department of Medicine, University Hospitals Cleveland Medical Center, Cleveland, Ohio.
2
Geriatric Research Education and Clinical Center, Louis Stokes Cleveland Department of Veterans Affairs Medical Center, Cleveland, Ohio.
3
Research Service.
4
Department of Medicine, Case Western Reserve University School of Medicine, Cleveland, Ohio.
5
Department of Pathology, Case Western Reserve University School of Medicine, Cleveland, Ohio.
6
Department of Molecular Biology and Microbiology, Case Western Reserve University School of Medicine, Cleveland, Ohio.
7
Public Health Research Institute Center New Jersey Medical School - Rutgers, The State University of New Jersey, Newark, New Jersey.
8
Division of Infectious Diseases, University of North Carolina, Chapel Hill, North Carolina.
9
Department of Pharmacology, Case Western Reserve University School of Medicine, Cleveland, Ohio.
10
Department of Biochemistry, Case Western Reserve University School of Medicine, Cleveland, Ohio.
11
Department of Proteomics and Bioinformatics, Case Western Reserve University School of Medicine, Cleveland, Ohio.

Abstract

We report the emergence of colistin resistance in Klebsiella pneumoniae carbapenemase (KPC)-producing Klebsiella pneumoniae after 8 days of colistin-based therapy, resulting in relapse of bloodstream infection and death. Disruption of the mgrB gene by insertion of a mobile genetic element was found to be the mechanism, which was replicated in vitro after exposure to subinhibitory concentrations of colistin and meropenem.

KEYWORDS:

Klebsiella pneumoniae; carbapenemase; colistin resistance

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