Unusual accumulation of a wide array of antimicrobial resistance mechanisms in a patient with cytomegalovirus-associated hemophagocytic lymphohistiocytosis: a case report

Hasan, Mohammad Rubayet; Sundaram, Manu Somasundaram; Sundararaju, Sathyavathi; Tsui, Kin-Ming; Karim, Mohammed Yousuf; Roscoe, Diane; Imam, Omar; Janahi, Mohammad A.; Thomas, Eva; Dobson, Simon; Tan, Rusung; Tang, Patrick; Lopez, Andres Perez

doi:10.1186/s12879-020-04966-z

Table 1 Genetic mechanisms of antibiotic resistance in bacteria isolated from the patient throughout hospital course

From: Unusual accumulation of a wide array of antimicrobial resistance mechanisms in a patient with cytomegalovirus-associated hemophagocytic lymphohistiocytosis: a case report

Specimen/Organism/Date of collection	Antibiotic resistance phenotype by AST	Genotype/Resistance
Specimen/Organism/Date of collection	Antibiotic resistance phenotype by AST	Sequence type	Β-lactam antibiotics	Aminoglycosides	Quinolones	Macrolides	Glycopeptides	Other drugs
MDRO screen *Enterococcus faecium* 29/08/2018	AMP, LZD, GENS, VAN	C16; E. faecium ST unknown		aac(6′)-aph(2″) ant(6)-Ia	parC 80I gyrA 83Y	Erm (B), erm (T)	VanHax	aph(3′)-III Tet(L)
MDRO screen *Escherichia coli* 29/08/2018	AMP, AMC, TZP, AZT, CXM, FEP, FOX, CAZ, CRO, CIP, LVX, GEN, ETP, IPM, MEM, SXT	CP18; E coli ST410	CMY-2 CTX-M-15 NDM-5 OXA-1 TEM-1B	aac(3)-IId, aac(6′)-Ib-cr aadA5, aph(3″)-Ib aph(6)-Id	aac(6′)-Ib-cr gyrA 83 L gyrA 87 N parC 80I			dfrA17 sul1, sul2
MDRO screen *Klebsiella pneumoniae* 29/08/2018	AMK, AMP, AMC, TZP, AZT, CXM, FEP, FOX, CAZ, CRO, CIP, LVX, GEN, ETP, IPM, MEM, SXT	CP19; K. pneumoniae ST2096	CTX-M-15 OXA-1 OXA-232 SHV-28 TEM-1A	aac(6′)-Ib-cr aadA2 armA	aac(6′)-Ib-cr oqxAB gyrA 83Y gyrA 87G parC 80I			dfrA1, dfrA12, dfrA14 sul1 tet(L)
Urine *Enterococcus faecium* 09/09/2018	AMP, LZD, GENS, VAN, CIP, NIT, TET	C17; E. faeceum ST80		aac(6′)-aph(2″) aph(3′)-III	gyrA 83I parC 80I	erm(A), erm(B), erm(T)	VanHAX	tet(L)
Blood (PICC line) *Escherichia coli* 26/03/2019	AMK, AMP, AMC, TZP, AZT, CFZ, CFL, CXM, FEP, FOX, CAZ, CRO, CIP, LVX, GEN, ETP, IPM, MEM, SXT, CZA, C/T, FOF	CP48; E. coli ST405	blaNDM-5 blaTEM-1B	aadA2	gyrA 83 L gyrA 87 N parC 80I	erm(B)		dfrA12 sul1
Blood (peripheral) *Klebsiella pneumonaie* 06/04/2019	AMK, AMP, AMC, TZP, AZT, CXM, FEP, FOX, CAZ, CRO, CIP, LVX, GEN, ETP, IPM, MEM, SXT, FOF, TGC, CST	C12; K pneumoniae ST395	CTX-M-15 NDM-5 OXA-1 OXA-232 SHV-11 TEM-1B	aac(6′)-Ib-cr aadA2 aph(6)-Id rmtB strA	aac(6′)-Ib-cr oqxAB gyrA 83I parC 80I	erm(B)		dfrA12 dfrA7 sul1
Blood (port a cath) *Elizabethkingia meningoseptica* 06/04/2019	AMK, AZT, FEP, CAZ, CRO, GEN, IPM, MEM	C11R; E. meningoseptica	B-14 GOB-1					CME-2

AMK amikacin, AMC amoxicillin-clavulanic acid, AMP ampicillin, SAM ampicillin-sulbactam, AZM azithromycin, ATM aztreonam, CFZ cefazolin, CFL cephalexin, FEP cefepime, CTX cefotaxime, FOX cefoxitin, CAZ ceftazidime, CZA ceftazidime-avibactam, C/T ceftolozane-tazobactam, CRO ceftriaxone, CXM cefuroxime, LEX cephalexin, CEF cephalothin, CHL chloramphenicol, CIP ciprofloxacin, CLR clarithromycin, CLI clindamycin, CST colistin, DOX doxycycline, ETP ertapenem, ERY erythromycin, FOF fosfomycin, GEN gentamicin, GENS gentamicin synergy, IPM imipenem, KAN kanamycin, LVX levofloxacin, LZD linezolid, MEM meropenem, NIT nitrofurantoin, OXA oxacillin, PEN penicillin, PIP piperacillin, TZP piperacillin-tazobactam, STR streptomycin, TET tetracycline, TGC tigecycline, TMP trimethoprim, SXT trimethoprim-sulfamethoxazole, VAN vancomycin
*Bacterial whole genome sequencing (WGS) was performed as described in the supplemental methods and data were analyzed as described previously [4]

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ISSN: 1471-2334

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