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. 2006 Aug;12(8):1209-13.
doi: 10.3201/eid1208.060291.

Carbapenem resistance in Klebsiella pneumoniae not detected by automated susceptibility testing

Fred C Tenover  1 , Rajinder K Kalsi, Portia P Williams, Roberta B Carey, Sheila Stocker, David Lonsway, J Kamile Rasheed, James W Biddle, John E McGowan Jr, Bruce Hanna
Affiliations

Carbapenem resistance in Klebsiella pneumoniae not detected by automated susceptibility testing

Fred C Tenover et al. Emerg Infect Dis. 2006 Aug.

Abstract

Detecting beta-lactamase-mediated carbapenem resistance among Klebsiella pneumoniae isolates and other Enterobacteriaceae is an emerging problem. In this study, 15 blaKPC-positive Klebsiella pneumoniae that showed discrepant results for imipenem and meropenem from 4 New York City hospitals were characterized by isoelectric focusing; broth microdilution (BMD); disk diffusion (DD); and MicroScan, Phoenix, Sensititre, VITEK, and VITEK 2 automated systems. All 15 isolates were either intermediate or resistant to imipenem and meropenem by BMD; 1 was susceptible to imipenem by DD. MicroScan and Phoenix reported 1 (6.7%) and 2 (13.3%) isolates, respectively, as imipenem susceptible. VITEK and VITEK 2 reported 10 (67%) and 5 (33%) isolates, respectively, as imipenem susceptible. By Sensititre, 13 (87%) isolates were susceptible to imipenem, and 12 (80%) were susceptible to meropenem. The VITEK 2 Advanced Expert System changed 2 imipenem MIC results from >16 ?g/mL to <2 ?g/mL but kept the interpretation as resistant. The recognition of carbapenem-resistant K. pneumoniae continues to challenge automated susceptibility systems.

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Figures

Figure
Figure
Klebsiella pneumoniae isolate tested with imipenem Etest strip (AB Biodisk, Solna, Sweden) on Mueller-Hinton agar. Inner colonies made determination of the imipenem MIC difficult.
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