ArticleAntimicrobial agents and chemotherapy2016
Genomic Characterization of Colistin Heteroresistance in Klebsiella pneumoniae during a Nosocomial Outbreak.
Article in Antimicrobial agents and chemotherapy, 2016. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 57 papers, 2 of them syntheses that pooled it.
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Who cites it
57 citing papers in PubMed, 2 syntheses or guidelines pooled it.
- Systematic review and meta-analysis of colistin heteroresistance in Klebsiella pneumoniae isolates.BMC infectious diseases · 2025Pooled it
- Global prevalence of mutation in theFrontiers in microbiology · 2024Pooled it
- Rapid Adaptive Evolution under Combination Therapy inACS infectious diseases · 2026Article
- Peptoid-based antimicrobial strategies against polymyxin-resistant Gram-negative bacteria.Journal of applied microbiology · 2026Article
- Polymyxin heteroresistance inJournal of medical microbiology · 2026Article
- Emergence of Polymyxin Resistance Driven by a PhoQ Mutation in KPC-2-ProducingAntibiotics (Basel, Switzerland) · 2026Article
- An Investigation of Colistin Heteroresistance inBioMed research international · 2026Article
- Regional Genomic and Phylogenomic Insights into Multidrug and Colistin-Resistant Klebsiella pneumoniae Strains from Tanzania, Kenya, Uganda, and Ethiopia.Current microbiology · 2025Article
- Evaluation of Six Commercial and Noncommercial Colistin Resistance Diagnostics.MicrobiologyOpen · 2025Article
- Colistin heteroresistance, mechanisms, diagnostic methods, and therapeutic options: A review.Germs · 2025Review
- Article
- Detection of Colistin Heteroresistance in Carbapenem-ResistantInternational journal of microbiology · 2025Article
- Genome analyses of colistin-resistant high-risk blaBMC microbiology · 2024Article
- Theoretical considerations and empirical predictions of the pharmaco- and population dynamics of heteroresistance.Proceedings of the National Academy of Sciences of the United States of America · 2024Article
- Theoretical Considerations and Empirical Predictions of the Pharmaco- and Population Dynamics of Heteroresistance.bioRxiv : the preprint server for biology · 2023Article
- Multicenter Study of Colistin Heteroresistance in Carbapenem-Resistant Klebsiella pneumoniae Strains in China.Microbiology spectrum · 2023Article
- Article
- Heteroresistance to Colistin in Clinical Isolates ofAntibiotics (Basel, Switzerland) · 2023Article
- Review
- Characterization of Carbapenemase-ProducingAntibiotics (Basel, Switzerland) · 2022Article
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9 authors.
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Abstract
Klebsiella pneumoniae is emerging as an important nosocomial pathogen due to its rapidly increasing multidrug resistance, which has led to a renewed interest in polymyxin antibiotics, such as colistin, as antibiotics of last resort. However, heteroresistance (i.e., the presence of a subpopulation of resistant bacteria in an otherwise susceptible culture) may hamper the effectiveness of colistin treatment in patients. In a previous study, we showed that colistin resistance among extended-spectrum-beta-lactamase (ESBL)-producing K. pneumoniae isolates emerged after the introduction of selective digestive tract decontamination (SDD) in an intensive care unit (ICU). In this study, we investigated heteroresistance to colistin among ESBL-producing K. pneumoniae isolates by using population analysis profiles (PAPs). We used whole-genome sequencing (WGS) to identify the mutations that were associated with the emergence of colistin resistance in these K. pneumoniae isolates. We found five heteroresistant subpopulations, with colistin MICs ranging from 8 to 64 mg/liter, which were derived from five clonally related, colistin-susceptible clinical isolates. WGS revealed the presence of mutations in the lpxM, mgrB, phoQ, and yciM genes in colistin-resistant K. pneumoniae isolates. In two strains, mgrB was inactivated by an IS3-like or ISKpn14 insertion sequence element. Complementation in trans with the wild-type mgrB gene resulted in these strains reverting to colistin susceptibility. The MICs for colistin-susceptible strains increased 2- to 4-fold in the presence of the mutated phoQ, lpxM, and yciM alleles. In conclusion, the present study indicates that heteroresistant K. pneumoniae subpopulations may be selected for upon exposure to colistin. Mutations in mgrB and phoQ have previously been associated with colistin resistance, but we provide experimental evidence for roles of mutations in the yciM and lpxM genes in the emergence of colistin resistance in K. pneumoniae.
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