Polymyxin heteroresistance in Klebsiella oxytoca

Antibiotic heteroresistance presents a growing public health concern since the phenotype is associated with treatment failure and is hard to detect using conventional diagnostic testing. In this study, we characterized polymyxin B heteroresistance in a collection of clinical and environmental isolates of Klebsiella oxytoca, an opportunistic pathogen associated with hospital-acquired infections. All six of the isolates tested exhibited heteroresistance, indicated by a 16-fold difference between the highest non-inhibitory concentration (2 µg/mL) and the minimum inhibitory concentration (32-64 µg/mL) observed in population analysis profile (PAP) assays. Heteroresistance was found to be due to the presence of a stable sub-population of resistant bacteria and was unaffected by growth phase or the presence of host antimicrobial factors present in human serum. MALDI-TOF analysis revealed L-Ara4N modifications of the lipid A of resistant sub-populations. This pilot study identifies polymyxin heteroresistance in K. oxytoca may complicate treatment of infections caused by this organism.