Carbapenem Heteroresistance in VIM-1-producing Klebsiella pneumoniae isolates belonging to the same clone: consequences for routine susceptibility testing.

Susceptibility results with low reproducibility by the same or different methods have been observed for metallo-beta-lactamase (MBL)-producing Enterobacteriaceae. Eighteen VIM-1-producing Klebsiella pneumoniae isolates (one per patient) belonging to a single epidemic clone in our hospital (2005 to 2008) but with different susceptibilities to carbapenems were studied. Imipenem MICs ranged from 8 to >128 mg/liter by standard CLSI microdilution, from ≤1 to >8 mg/liter by the semiautomatic Wider system, and from 0.75 to >32 mg/liter by Etest. Meropenem MICs ranged from 0.5 to 128, ≤1 to >8, and 0.38 to >32 mg/liter, respectively. Ertapenem MICs by CLSI microdilution and Etest ranged from 1 to 64 and 0.75 to >32 mg/liter, respectively. The rates of essential agreement (±1 log(2) dilution) for imipenem and meropenem MICs between the Wider system and the reference microdilution method were 45% and 49%, respectively. Those between Etest and the reference microdilution method for imipenem, meropenem, and ertapenem MICs were 33%, 67%, and 84%. The rates of very major errors for the Wider system and Etest were 33% and 28% for imipenem and 25% and 75% for meropenem, respectively. Low MIC reproducibility was observed even when the same inoculum was used (differences up to 4-fold dilutions). Heteroresistance was suspected due to the presence of colonies in the Etest inhibition zone. It was confirmed by population analysis profiles of 4 isolates displaying different imipenem MICs, with the exception of an OmpK36-porin-deficient isolate that homogeneously expressed carbapenem resistance (MIC, >128 mg/liter). Low carbapenem MIC reproducibility could be due to the presence of resistant subpopulations and variable expression of the resistance mechanisms. Since carbapenem MICs are not good markers of MBL production, reliable and reproducible phenotypic methods are needed to detect the presence of this mechanism.

[Automated method for yeast identification: ATB 32 C]. / Estudio de un método automático de identificación de levaduras: ATB 32 C.

The aim of this study was to evaluate the ATB 32 C (API system) automatic medium for identifying yeasts in clinical samples. A total of 101 yeasts strains were studied, representing 8 genera and 18 different species, identified by conventional means. All 32 microdomes of the track, including dehydrated substrates, were inoculated in a semi-solid media (C medium). After their incubation at 30 degrees C for 48 hours, the reading device ATB 1520 and the computer of ATB system the reading and automatic interpretation of the results. Using the ATB method, 85 strains were identified (84%) at species level, 9 at genus level and a non-conclusive or unacceptable profile was recorded in 7 strains. From all clinically important yeasts species, a total of 96% were identified by ATB method according to conventional methods. From all non clinically relevant species, ATB 32 C identified correctly 23 strains (78%). ATB 32 C method is a good alternative approach to conventional techniques for identifying yeasts in clinical samples.