Prevalence and Clinical Consequences of Colistin Heteroresistance and Evolution into Full Resistance in Carbapenem-Resistant Acinetobacter baumannii
Hadas Kon, Amichay Hameir, Amir Nutman, Elizabeth Temkin, Alona Keren‐Paz, Jonathan Lellouche, David A. Schwartz, David S. Weiss, Keith S. Kaye, George L. Daikos, Anna Skiada, Emanuele Durante‐Mangoni, Yael Dishon Benattar, Dafna Yahav, Vered Daitch, Mariano Bernardo, Domenico Iossa, Lena E. Friberg, Ursula Theuretzbacher, Leonard Leibovici, Yaakov Dickstein, Dina Pollak, Sigal Mendelsohn, Mical Paul, Yehuda Carmeli, Mical Paul, Yael Dishon Benattar, Yaakov Dickstein, Roni Bitterman, Hiba Zayyad, Fidi Koppel, Yael Zak-Doron, Sergey Altunin, Nizar Andria, Ami Neuberger, Anat Stern, Neta Petersiel, Marina Raines, Amir Karban, Leonard Leibovici, Dafna Yahav, Noa Eliakim‐Raz, Oren Zusman, Michal Elbaz, Heyam Atamna, Vered Daitch, Tanya Babich, Yehuda Carmeli, Amir Nutman, Amos Adler, Inbar Levi, George L. Daikos, Anna Skiada, Ioannis Pavleas, Anastasia Antoniadou, Antigoni Kotsaki, Emanuele Durante‐Mangoni, Roberto Andini, Domenico Iossa, Mariano Bernardo, Giusi Cavezza, Lorenzo Bertolino, Giuseppe Giuffrè, Roberto Giurazza, Giuseppe Ruocco, Maria Galdo, Patrizia Murino, Adriano Cristinziano, Antonio Corcione, Rosa Zampino, Johan W. Mouton, Lena E. Friberg, Ursula Theuretzbacher
Abstract
To our knowledge, this is the first large-scale study to report on HR in Gram-negative bacteria. We described the prevalence of colistin HR in a large sample of carbapenem-resistant A. baumannii isolates, the evolution of many colistin HR isolates to a resistant phenotype following colistin exposure and withdrawal, and the clinical consequences of colistin HR. We found a high prevalence of HR among clinical carbapenem-resistant A. baumannii isolates; most evolved into a resistant phenotype following colistin exposure and withdrawal. In patients treated with colistin, evolution of HR A. baumannii into full resistance could lead to higher rates of treatment failure and contribute to the reservoir of colistin-resistant pathogens in health care settings.