Phenotypic antimicrobial resistance associated with different bla genotypes and their combinations in...

Varying combinations of β-lactamase genes (bla) in Enterobacterales manifest different resistant phenotypes.

This study aimed to identify bla gene types and combinations resulting in variations in phenotypic antimicrobial resistance.

Minimum inhibitory concentrations (MICs) of 75 extended spectrum β-lactamase (ESBL), AmpC β-lactamase and carbapenemase-producing Entero-bacterales isolates from a variety of clinical specimens were determined by Vitek micro-broth dilution. Bla genes were detected by 16-plex tandem PCR panel and Xpert Carba-R assay. BlaCTX-M group-1 and blaOXA-48 were the most common ESBL and carbapenemase genes, respectively.

Majority of the isolates (92%, 69/75) had bla gene combinations. Thirty-eight isolates (51%) carried ESBL, AmpC genes and/or narrow spectrum bla genes without any carbapenemase genes. The common bla gene combination in these isolates was blaCTX-M group-1 + blaOXA1 which is known to confer decreased susce-ptibility to piperacillin-tazobactam. Antibiotics with potential activity against ESBL-producing bacteria such as fourth generation cephalosporins, β-lactam/β-lactam-inhibitor combinations, quinolones and gentamicin also showed low rates of susceptibility. Highest susceptibility rates were to meropenem (92%) and amikacin (92%). Thirty-seven isolates (49%) carried carbapenemase genes as well. These isolates showed even higher resistance rates to all antibiotics, except amikacin (92%susceptible). Significantly higher MIC values for cefoxitin, ceftazidime, ceftriaxone, cefepime, meropenem, amikacin, tobramycin and trimethoprim-sulfamethoxazole were seen in isolates carrying blaNDM than blaOXA-48. However, a higher MIC for norfloxacin was seen in isolates with blaOXA-48.

In conclusion, this study showed that Enterobacterales with different bla gene combinations manifest variations in phenotypic resistance to both β-lactam and non-β-lactam antibiotics.