Meropenem-resistant Burkholderia pseudomallei: a concerning single case in Australia with no prior meropenem exposure

We report a case of cutaneous melioidosis in a 54-year-old male with a meropenem-resistant sub-population. He was empirically treated with episodic doxycycline and trimethoprim-sulfamethoxazole; however, the abscess re-accumulated. The patient had no prior exposure to meropenem. A sub-population of the isolate was meropenem resistant with an MIC >32 µg ml^-1 and the identification was re-confirmed as Burkholderia pseudomallei. Whole-genome sequencing with ARDaP analysis only revealed a resistance determinant to doxycycline and did not reveal a resistance determinant to meropenem. Furthermore, no carbapenemases were detected through multiple bioinformatics tools. To date, this is the first reported case in Australia of a B. pseudomallei isolate resistant to meropenem without previous carbapenem exposure.