Ceftazidime-Avibactam Resistance in Klebsiella pneumoniae Sequence Type 11 Due to a Mutation in Plasmid-Borne bla_kpc-2 to bla_kpc-33, in Henan, China

Figures & data

Table 1 Klebsiella pneumoniae Drug Susceptibility Testing and Carbapenemase Testing Results

Strain ID	Days from Admission to Culture (Source)	Ceftazidime–Avibactam Exposure at Time of Culture (Days)	MIC (μg/mL)					mCIM	Carbapenemase Inhibitor Enhancement	NG-Test CARBA 5
			Ceftazidime–Avibactam	Imipenem	Meropenem	Polymyxin B	Ceftazidime
20071257	9 (SP)	−9	4	≥32	≥32	≤0.5	≥32	POS^a	POS^a	KPC
20075334	15 (BL)	−3	4	≥32	≥32	1	≥32	POS^a	POS^a	KPC
20071561	18 (BALF)	0	4	≥32	≥32	≤0.5	≥32	POS^a	POS^a	KPC
20071685	24 (SP)	6	>256	0.25	2	≤0.5	≥32	NEG	NEG	NEG
20071741	26 (SP)	8	>256	0.25	2	1	≥32	NEG	NEG	NEG
20071764	27 (SP)	9	>256	0.25	2	1	≥32	NEG	NEG	NEG

Note: ^aPositive for Ambler class A carbapenemase.

Abbreviations: NEG, negative; POS, positive; SP, sputum; BALF, bronchoalveolar lavage fluid.

Figure 1 Infection and treatment time course of the patient infected with Klebsiella pneumoniae with the development of ceftazidime-avibactam resistance.

Abbreviation: BALF, bronchoalveolar lavage fluid.

Figure 2 Dendrogram of XbaI-digested genomic DNA from identified KPC-producing Klebsiella pneumoniae.