Predicting Antibiotic Resistance in Gram-Negative Bacilli from Resistance Genes

• Published in: Antimicrobial agents and chemotherapy Vol. 63; no. 4
• Main Authors: Walker, G Terrance, Quan, Julia, Higgins, Stephen G, Toraskar, Nikhil, Chang, Weizhong, Saeed, Alexander, Sapiro, Vadim, Pitzer, Kelsey, Whitfield, Natalie, Lopansri, Bert K, Motyl, Mary, Sahm, Daniel
• Format: Journal Article
• Language: English
• Published: United States American Society for Microbiology 01-04-2019
• Subjects: Africa; Anti-Bacterial Agents; Anti-Bacterial Agents - pharmacology; Asia; Cross Infection - drug therapy; Cross Infection - microbiology; Drug Resistance, Microbial; Drug Resistance, Microbial - genetics; Europe; Gram-Negative Bacteria; Gram-Negative Bacteria - drug effects; Gram-Negative Bacteria - genetics; Gram-Negative Bacterial Infections; Gram-Negative Bacterial Infections - drug therapy; Gram-Negative Bacterial Infections - microbiology; Humans; Mechanisms of Resistance; North America; Polymerase Chain Reaction - methods; South America; South America; Asia; North America; Europe; Africa; antibiotic resistance; resistance genes; PCR
• ISSN: 0066-4804; 1098-6596
• DOI: 10.1128/AAC.02462-18

We developed a rapid high-throughput PCR test and evaluated highly antibiotic-resistant clinical isolates of
(
 = 2,919),
(
 = 1,974),
(
 = 1,150), and
(
 = 1,484) for several antibiotic resistance genes for comparison with phenotypic resistance across penicillins, cephalosporins, carbapenems, aminoglycosides, trimethoprim-sulfamethoxazole, fluoroquinolones, and macrolides. The isolates originated from hospitals in North America (34%), Europe (23%), Asia (13%), South America (12%), Africa (7%), or Oceania (1%) or were of unknown origin (9%). We developed statistical methods to predict phenotypic resistance from resistance genes for 49 antibiotic-organism combinations, including gentamicin, tobramycin, ciprofloxacin, levofloxacin, trimethoprim-sulfamethoxazole, ertapenem, imipenem, cefazolin, cefepime, cefotaxime, ceftazidime, ceftriaxone, ampicillin, and aztreonam. Average positive predictive values for genotypic prediction of phenotypic resistance were 91% for
, 93% for
, 87% for
, and 92% for
across the various antibiotics for this highly resistant cohort of bacterial isolates.