TABLE 6

Studies reporting outbreaks of colistin-resistant and carbapenemase-producing isolatese

Study periodCountrySettingTest methodColistin MIC (μg/ml)Resistance mechanismTotal no. of casesBeta-lactamase(s)Sequence typeReference
2010United StatesOne single hospital (ICU and medical ward)Agar dilution>128ND5KPC-2ST258 188
2009United StatesTwo hospitals and a long-term acute care setting in Detroit, MIEtest8–64ND4KPCND 189
2012–2013MexicoOne single hospital in Mexico CityBMD4ND15KPC-2ST258 190
2013NetherlandsOne hospital and a nursing homeVitek2, EtestNDND6KPC-2, SHV-12ST258 192
2008–2009HungaryThree hospitals in MiskolcEtest16–32ND8KPC-2, SHV-12, TEM-1, SHV-11ST258 193
2008GreeceICUs of two distinct hospitalsEtest12–128ND6KPC-2, SHV-12ST258 194
2004–2005GreeceOne single hospital in Athens (ICU)Etest12–>1,024ND13 (multiclonal)NDND 195
2010ItalyTwo hospitals in Catania, SicilyBMD8–64ND8KPC-3, SHV-11, TEM-1, OXA-9ST258 196
2011ItalyOne single hospital in Palermo, SicilyEtest 28 (multiclonal)a 197
3–128ND24KPC-3, SHV-11, TEM-1, OXA-9ST258
3–32ND3KPC-3, SHV-12, TEM-1ST273
4–12ND2KPC-3, SHV-28, TEM-1, CTX-M-15ST15
2010–2013ItalyOne single hospital (22 different wards)Vitek2, Sensititre4–>16 mgrB Δnt109/119Multiclonalb 198
Unknownc50KPC-3ST512
Unknownc5KPC-3ST512
2KPC-2ST101
2010–2012SpainOne hospitalAgar dilutionNDND14VIM-1ST22 204
2014FranceHospital in PicardieBMD4–64Unknownd15OXA-48, CTX-M-15ST11 205
  • a One patient with two colistin-resistant clones (belonging to ST-258 and ST-273).

  • b There was a total of 93 bloodstream infections, but only isolates recovered in 2013 were investigated further.

  • c No mutation in the mgrB, pmrA, or pmrB gene was responsible for colistin resistance.

  • d No mutation in the mgrB gene was responsible for colistin resistance.

  • e ND, not determined.