ArticleJournal of clinical microbiology2010
Carbapenem Heteroresistance in VIM-1-producing Klebsiella pneumoniae isolates belonging to the same clone: consequences for routine susceptibility testing.
Article in Journal of clinical microbiology, 2010. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 34 papers.
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Who cites it
34 citing papers in PubMed, 63 citations in OpenAlex.
- Beyond susceptibility results: understanding the clinical and diagnostic burden of bacterial heteroresistance.Molecular biology reports · 2026Review
- Recurrent infections caused by ESBL-producing enterobacterales with or without subsequent development of distinct carbapenem-resistant phenotypes: differential driving factors and impact on outcome.JAC-antimicrobial resistance · 2026Article
- Epidemiology, mechanisms, and clinical impact of bacterial heteroresistance.npj antimicrobials and resistance · 2025Review
- Reporting antimicrobial susceptibility and detection of carbapenemase production in single and double carbapenemase-producing Gram-negative clinical isolates: a nationwide proficiency study.Frontiers in microbiology · 2025Article
- Rapid AST: Possibility of inferring resistance mechanisms with complex phenotypes.Revista espanola de quimioterapia : publicacion oficial de la Sociedad Espanola de Quimioterapia · 2024Article
- Whole-Genome Sequence Analysis of Carbapenem-Heteroresistant Klebsiella pneumoniae and Escherichia coli Isolates.Current microbiology · 2022Article
- Antibiotic Heteroresistance inInternational journal of molecular sciences · 2021Review
- Article
- Risk factors and outcome associated with infection or colonization due to carbapenem-heteroresistantJAC-antimicrobial resistance · 2021Article
- Heteroresistance to Amikacin in Carbapenem-ResistantFrontiers in microbiology · 2021Article
- Impact of Carbapenem Heteroresistance Among Multidrug-Resistant ESBL/AmpC-ProducingInfection and drug resistance · 2021Article
- Unstable Mechanisms of Resistance to Inhibitors of Escherichia coli Lipoprotein Signal Peptidase.mBio · 2020Article
- Mechanisms of Heteroresistance and Resistance to Imipenem inInfection and drug resistance · 2020Article
- Mechanisms and clinical relevance of bacterial heteroresistance.Nature reviews. Microbiology · 2019Review
- Antimicrobial Susceptibility Testing for Polymyxins: Challenges, Issues, and Recommendations.Journal of clinical microbiology · 2019Review
- Single-cell electro-phenotyping for rapid assessment ofSensors and actuators. B, Chemical · 2018Article
- Multicenter Evaluation of the Xpert Carba-R Assay for Detection of Carbapenemase Genes in Gram-Negative Isolates.Journal of clinical microbiology · 2018Article
- Rapid Phenotypic Antibiotic Susceptibility Testing of Uropathogens Using Optical Signal Analysis on the Nanowell Slide.Frontiers in microbiology · 2018Article
- Carbapenem-heteroresistance among isolates of the Enterobacter cloacae complex: is it a real concern?European journal of clinical microbiology & infectious diseases : official publication of the European Society of Clinical Microbiology · 2018Article
- Rapid phenotypic stress-based microfluidic antibiotic susceptibility testing of Gram-negative clinical isolates.Scientific reports · 2017Article
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Authors and funding
6 authors at 3 institutions in 1 country.
Funding
No grant is acknowledged in the PubMed record.
Abstract
Susceptibility results with low reproducibility by the same or different methods have been observed for metallo-beta-lactamase (MBL)-producing Enterobacteriaceae. Eighteen VIM-1-producing Klebsiella pneumoniae isolates (one per patient) belonging to a single epidemic clone in our hospital (2005 to 2008) but with different susceptibilities to carbapenems were studied. Imipenem MICs ranged from 8 to >128 mg/liter by standard CLSI microdilution, from ≤1 to >8 mg/liter by the semiautomatic Wider system, and from 0.75 to >32 mg/liter by Etest. Meropenem MICs ranged from 0.5 to 128, ≤1 to >8, and 0.38 to >32 mg/liter, respectively. Ertapenem MICs by CLSI microdilution and Etest ranged from 1 to 64 and 0.75 to >32 mg/liter, respectively. The rates of essential agreement (±1 log(2) dilution) for imipenem and meropenem MICs between the Wider system and the reference microdilution method were 45% and 49%, respectively. Those between Etest and the reference microdilution method for imipenem, meropenem, and ertapenem MICs were 33%, 67%, and 84%. The rates of very major errors for the Wider system and Etest were 33% and 28% for imipenem and 25% and 75% for meropenem, respectively. Low MIC reproducibility was observed even when the same inoculum was used (differences up to 4-fold dilutions). Heteroresistance was suspected due to the presence of colonies in the Etest inhibition zone. It was confirmed by population analysis profiles of 4 isolates displaying different imipenem MICs, with the exception of an OmpK36-porin-deficient isolate that homogeneously expressed carbapenem resistance (MIC, >128 mg/liter). Low carbapenem MIC reproducibility could be due to the presence of resistant subpopulations and variable expression of the resistance mechanisms. Since carbapenem MICs are not good markers of MBL production, reliable and reproducible phenotypic methods are needed to detect the presence of this mechanism.
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