Colistin Heteroresistance Is Largely Undetected among Carbapenem-Resistant Enterobacterales in the United States

Author:

Band Victor I.12,Satola Sarah W.345,Smith Richard D.6,Hufnagel David A.24,Bower Chris5,Conley Andrew B.7,Rishishwar Lavanya7,Dale Suzanne E.8,Hardy Dwight J.9,Vargas Roberto L.10,Dumyati Ghinwa1112,Kainer Marion A.13,Phipps Erin C.1415,Pierce Rebecca16,Wilson Lucy E.17,Sorensen Matthew18,Nilsson Erik18,Jordan I. King7ORCID,Burd Eileen M.3419ORCID,Farley Monica M.345,Jacob Jesse T.345ORCID,Ernst Robert K.6ORCID,Weiss David S.23420ORCID

Affiliation:

1. Department of Microbiology and Immunology, Emory University, Atlanta, Georgia, USA

2. Emory Vaccine Center, Atlanta, Georgia, USA

3. Emory Antibiotic Resistance Center, Atlanta, Georgia, USA

4. Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia, USA

5. Georgia Emerging Infections Program, Atlanta, Georgia, USA

6. Department of Microbial Pathogenesis, University of Maryland—Baltimore, Baltimore, Maryland, USA

7. Center for Integrated Genomics, Georgia Institute of Technology, Atlanta, Georgia, USA

8. ACM Global Laboratories, Rochester, New York, USA

9. Department of Microbiology and Immunology, University of Rochester Medical Center, Rochester, New York, USA

10. Department of Pathology and Laboratory Medicine, Rochester General Hospital, Rochester, New York, USA

11. Infectious Diseases Division, University of Rochester Medical Center, Rochester, New York, USA

12. Center for Community Health and Prevention, University of Rochester Medical Center, Rochester, New York, USA

13. Tennessee Department of Health, Nashville, Tennessee, USA

14. University of New Mexico, Albuquerque, New Mexico, USA

15. New Mexico Emerging Infections Program, Albuquerque, New Mexico, USA

16. Public Health Division, Oregon Health Authority, Salem, Oregon, USA

17. Maryland Department of Health and Mental Hygiene, Baltimore, Maryland, USA

18. Pataigin, LLC, Seattle, Washington, USA

19. Department of Pathology and Laboratory Medicine, Emory University, Atlanta, Georgia, USA

20. Research Service, Atlanta VA Medical Center, Decatur, Georgia, USA

Abstract

Heteroresistance is an underappreciated phenomenon that may be the cause of some unexplained antibiotic treatment failures. Misclassification of heteroresistant isolates as susceptible may lead to inappropriate therapy.

Funder

HHS | National Institutes of Health

U.S. Department of Veterans Affairs

Burroughs Wellcome Fund

Publisher

American Society for Microbiology

Subject

Virology,Microbiology

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