Isolate Details | Antimicrobial Resistance Isolate Bank | Antibiotic/Antimicrobial Resistance

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Panel: Multi-Mechanism (MULTI)

AR Bank # 1163 Klebsiella pneumoniae

Study ID: MULTI-15

Biosample Accession #: SAMN34111349

mCIM Result: Positive

Collection Year: 2022
Source: Fluid - Bronchoalveolar lavage

MLST: ST231(Pasteur)

MICs obtained by broth microdilution. Modal MIC is reported.

MIC results for each antimicrobial agent for an isolate may commonly be ± 1 log2 (doubling dilution) different than what is posted on the FDA & CDC AR Bank website because this is the normal technical variability of antimicrobial susceptibility testing (see J. H. Jorgensen. 1993. J Clin Microbiol. Vol 31[11]: 2841-2844).

Note: This AR Bank panel includes isolates that are pan-resistant, meaning they are susceptible to none of the antimicrobial agents tested which may include those commonly used to treat infections with these organisms. This represents an additional risk to staff working with these organisms and should be considered as part of the receiving facility risk assessment required by the Biosafety Compliance Agreement. The increased difficulty in treatment of any infection with those isolates should also be a consideration in deciding which protocols to use and precautions to take for working with these isolates.

Panel: Multi-Mechanism (MULTI)

Drug	MIC (μg/ml)	INT
MIC (μg/ml) Results and Interpretation
Amikacin	>64	R
Ampicillin	>32	R
Ampicillin/sulbactam ¹	>32	R
Aztreonam	>32	R
Cefepime	>32	R
Cefepime/zidebactam ²	2	---
Cefiderocol	2	S
Cefotaxime	>64	R
Cefotaxime/clavulanic acid ¹	>32	---
Cefoxitin	>16	R
Ceftazidime	>128	R
Ceftazidime/avibactam ¹	>16	R
Colistin ^{1 5}	0.5	I
Imipenem	64	R
Imipenem/relebactam ¹	32	R
Imipenem+chelators ³	32	---
Levofloxacin	>8	R
Meropenem	>8	R
Meropenem-vaborbactam ¹	>16	R
Minocycline	>16	R
Nitrofurantoin	>128	R
Omadacycline ⁴	16	R
Piperacillin/tazobactam ¹	>128	R
Plazomicin ⁴	>8	R
Tetracycline	16	R
Tigecycline ⁴	4	I
Tobramycin	>16	R
Trimethoprim/sulfamethoxazole ¹	>8	R
SDD (Susceptible Dose Dependent) S – I –R Interpretation (INT) derived from CLSI 2025 M100 S35 ¹ Reflects MIC of first component ² Cefepime to zidebactam ratio (1:1) ³ Screen for metallo-beta-lactamase production [Rasheed et al. Emerging Infectious Diseases. 2013. 19(6):870-878] ⁴ Based on FDA break points ⁵ Clinical and PK/PD data demonstrate colistin has limited clinical efficacy, even if an intermediate result is obtained. Alternative agents are strongly preferred. Colistin should be used in combination with one or more active antimicrobial agents. Consultation with an infectious disease specialist is recommended.

Device manufacturers and users of FDA cleared devices shall consult the FDA’s Antibacterial Susceptibility Test Interpretive Criteria website for breakpoints recognized or recommended by FDA, and for information regarding FDA exceptions or additions to the applicable, recognized consensus standard.

Molecular Mechanisms of Resistance
Category	Gene
Aminoglycoside	aac(6')-Ib, aadA2, aph(3")-Ib, aph(3')-VI, aph(6)-Id, rmtF1
Beta-lactam	KPC-2, NDM-1, OXA-181, CMY-4, CTX-M-15, SHV-1, TEM-1
Bleomycin	ble-MBL
Efflux pumps/Other	EMRD, KDEA, qacEdelta1
Macrolide-Lincosamide-Streptogramin	erm(B), mph(A)
Phenicols/Bicyclomycins	catB
Quinolone	oqxA, oqxB11
Rifampicin	ARR-2
Sulfonamides	sul1, sul2
Trimethoprim	dfrA12

Disclaimer: Antimicrobial Resistance (AR) gene prediction was performed using a combined and deduplicated AR database (ResGANNCBI) from ResFinder, ARG-ANNOT, and NCBI AMRFinder(primary Database) accessed on 2021-05-07. AR drug classes are assigned according to these databases. This analysis does not include mutations that may result in antimicrobial resistance, or resistance determinants added to newer versions of databases used, or other antimicrobial resistance gene databases. Additional AR genes other than those listed, may be present. For resistance determinant detection, 99-100% sequence identity and 100% sequence coverage from GAMMA (primary AR gene calling tool) and SRST2 was used. GAMMA uses amino acid sequence to assign gene alleles from assemblies; SRST2 uses nucleotide sequence to assign gene alleles from sequencing reads and is used to resolve AR gene calls located on the edges of assembly scaffolds detected by GAMMA. Biosample accession numbers have been provided so that users can analyze the raw sequencing data on their own, if so desired. MLST Type (and scheme), as determined by Torsten Seemann's MLST program. For Enterobacterales the Pasteur MLST schemes are used except for E. coli for which both the Pasteur and Achtman schemes are reported. Similarly, for Acinetobacter baumannii complex, both Pasteur and Oxford MLST schemes are used and reported. SUB=novel MLST identified and "submitted". Dash (-) indicates no pubMLST scheme is available for that species. Truncated porins are defined as porin genes detected with ≥80% sequence identity and ≥80% sequence coverage and predicted to have an internal stop codon by c-SSTAR (https://github.com/chrisgulvik/c-SSTAR). * Prescence of Efflux Pump may not be associated with resistance. For additional gene information please visit the Reference Gene Catalog - Pathogen Detection - NCBI (https://www.ncbi.nlm.nih.gov/pathogens/refgene), a non-redundant database of bacterial genes related to antimicrobial resistance, biocide and stress resistance, general efflux, virulence, or antigenicity.

Propagation

MEDIUM
Medium: Trypticase Soy Agar with 5% Sheep Blood (BAP)

GROWTH CONDITIONS
Temperature: 35°C
Atmosphere: Aerobic

PROPAGATION PROCEDURE
Remove the sample vial to a container with dry ice or a freezer block. Keep vial on ice or block. (Do not let vial content thaw)

Open vial aseptically to avoid contamination.

Using a sterile loop, remove a small amount of frozen isolate from the top of the vial

Aseptically transfer the loop to BAP

Use streak plate method to isolate single colonies

Incubate inverted plate at 35°C ± 2°C for 18-24 hrs.

Storage Temperature & Biosafety

STORAGE TEMPERATURE: -70°C

BIOSAFETY LEVEL: 2
Appropriate safety procedures should always be used with this material. Laboratory safety is discussed in the current publication of 'BioSafety in Microbiological and Biomedical Laboratories' from the U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, and National Institutes of Health. This AR Bank panel includes isolates that are pan-resistant, meaning they are susceptible to none of the antimicrobial agents tested which may include those commonly used to treat infections with these organisms. This represents an additional risk to staff working with these organisms and should be considered as part of the receiving facility risk assessment required by the Biosafety Compliance Agreement. The increased difficulty in treatment of any infection with those isolates should also be a consideration in deciding which protocols to use and precautions to take for working with these isolates.

Disclaimer:
This product is sent with the condition that you are responsible for its safe storage, handling, and use. All materials are the property of the Centers for Disease Control and Prevention (CDC) and have been made available on behalf of the Food and Drug Administration (FDA). This material is not for use in human subjects and may not be redistributed. While CDC uses reasonable efforts to include accurate and up-to-date information on this product sheet, CDC makes no warranties or representations as to its accuracy. CDC is not liable for damages arising from the misidentification or misrepresentation of cultures. Please refer to the Standard Letter Agreement (SLA) for further details regarding the use of this product.

Date	Action Performed
Isolate History
11/20/23	INT was updated with a new value for Colistin: from '---' to 'I'
11/20/23	MIC was updated with a new value for Colistin: from '---' to '0.5'
11/20/23	Drug was added: 'Colistin'
07/13/23	Sequence Accession # changed: from '---' to 'SAMN34111349'
02/24/23	Isolate Status changed: from 'Pending' to 'Active'
02/24/23	Isolate was removed from panel
02/24/23	Isolate Status changed: from 'Active' to 'Pending'
02/24/23	Source was changed: from '---' to 'Fluid - Bronchoalveolar lavage'
02/24/23	Collection Year was changed: from '---' to '2022'
02/24/23	mCIM changed: from '---' to 'Positive'
02/22/23	Isolate Status changed: from 'Pending' to 'Active'
02/17/23	Gene was added to 'aph(3')-VI'
02/10/23	Gene was added to 'qacEdelta1'
02/10/23	Gene was added to 'KDEA'
02/10/23	Gene was added to 'EMRD'
02/10/23	Gene was added to 'ble-MBL'
02/10/23	Gene was added to 'dfrA12'
02/10/23	Gene was added to 'sul2'
02/10/23	Gene was added to 'sul1'
02/10/23	Gene was added to 'ARR-2'
02/10/23	Gene was added to 'catB'
02/10/23	Gene was added to 'mph(A)'
02/10/23	Gene was added to 'erm(B)'
02/10/23	Gene was added to 'oqxB11'
02/10/23	Gene was added to 'rmtF1'
02/10/23	Category was added: 'Efflux pumps/Other'
02/10/23	Category was added: 'Bleomycin'
02/10/23	Category was added: 'Trimethoprim'
02/10/23	Category was added: 'Sulfonamides'
02/10/23	Category was added: 'Rifampicin'
02/10/23	Category was added: 'Phenicols/Bicyclomycins'
02/10/23	Category was added: 'Macrolide-Lincosamide-Streptogramin'
02/10/23	MLST was updated: from '---' to 'ST231(Pasteur)'
02/10/23	Gene was added to 'oqxA'
02/10/23	Gene was added to 'rmtF1'
02/10/23	Gene was added to 'aph(6)-Id'
02/10/23	Gene was added to 'aph(3")-Ib'
02/10/23	Gene was added to 'aadA2'
02/10/23	Gene was added to 'aac(6')-Ib'
02/10/23	Gene was added to 'TEM-1'
02/10/23	Gene was added to 'SHV-1'
02/10/23	Gene was added to 'OXA-181'
02/10/23	Gene was added to 'NDM-1'
02/10/23	Gene was added to 'KPC-2'
02/10/23	Gene was added to 'CTX-M-15'
02/10/23	Gene was added to 'CMY-4'
02/10/23	Category was added: 'Quinolone'
02/10/23	Category was added: 'Aminoglycoside'
02/10/23	Category was added: 'Beta-lactam'
02/06/23	MIC was updated with a new value for Imipenem/relebactam: from '>16' to '32'
02/03/23	INT was updated with a new value for Cefiderocol: from '---' to 'S'
02/03/23	MIC was updated with a new value for Cefiderocol: from '---' to '2'
02/03/23	Drug was added: Cefiderocol
02/03/23	INT was updated with a new value for Nitrofurantoin: from '---' to 'R'
02/03/23	INT was updated with a new value for Omadacycline: from '---' to 'R'
02/03/23	INT was updated with a new value for Meropenem-vaborbactam: from '---' to 'R'
02/03/23	INT was updated with a new value for Plazomicin: from '---' to 'R'
02/03/23	INT was updated with a new value for Cefepime/zidebactam: from '---' to '---'
02/03/23	INT was updated with a new value for Imipenem/relebactam: from '---' to 'R'
02/03/23	INT was updated with a new value for Trimethoprim/sulfamethoxazole: from '---' to 'R'
02/03/23	MIC was updated with a new value for Trimethoprim/sulfamethoxazole: from '---' to '>8'
02/03/23	MIC was updated with a new value for Tobramycin: from '---' to '>16'
02/03/23	MIC was updated with a new value for Tigecycline: from '---' to '4'
02/03/23	MIC was updated with a new value for Tetracycline: from '---' to '16'
02/03/23	MIC was updated with a new value for Plazomicin: from '---' to '>8'
02/03/23	MIC was updated with a new value for Piperacillin/tazobactam: from '---' to '>128'
02/03/23	MIC was updated with a new value for Omadacycline: from '---' to '16'
02/03/23	MIC was updated with a new value for Nitrofurantoin: from '---' to '>128'
02/03/23	MIC was updated with a new value for Minocycline: from '---' to '>16'
02/03/23	MIC was updated with a new value for Meropenem-vaborbactam: from '---' to '>16'
02/03/23	MIC was updated with a new value for Meropenem: from '---' to '>8'
02/03/23	MIC was updated with a new value for Levofloxacin: from '---' to '>8'
02/03/23	MIC was updated with a new value for Imipenem+chelators: from '---' to '32'
02/03/23	MIC was updated with a new value for Imipenem: from '---' to '64'
02/03/23	MIC was updated with a new value for Imipenem/relebactam: from '---' to '>16'
02/03/23	MIC was updated with a new value for Ceftazidime: from '---' to '>128'
02/03/23	MIC was updated with a new value for Ceftazidime/avibactam: from '---' to '>16'
02/03/23	MIC was updated with a new value for Cefoxitin: from '---' to '>16'
02/03/23	MIC was updated with a new value for Cefotaxime: from '---' to '>64'
02/03/23	MIC was updated with a new value for Cefotaxime/clavulanic acid: from '---' to '>32'
02/03/23	MIC was updated with a new value for Cefepime: from '---' to '>32'
02/03/23	MIC was updated with a new value for Cefepime/zidebactam: from '---' to '2'
02/03/23	MIC was updated with a new value for Aztreonam: from '---' to '>32'
02/03/23	MIC was updated with a new value for Ampicillin: from '---' to '>32'
02/03/23	MIC was updated with a new value for Ampicillin/sulbactam: from '---' to '>32'
02/03/23	MIC was updated with a new value for Amikacin: from '---' to '>64'
02/03/23	INT was updated with a new value for Tobramycin: from '---' to 'R'
02/03/23	Drug was added: Nitrofurantoin
02/03/23	Drug was added: Omadacycline
02/03/23	Drug was added: Meropenem-vaborbactam
02/03/23	Drug was added: Plazomicin
02/03/23	Drug was added: Cefepime/zidebactam
02/03/23	Drug was added: Imipenem/relebactam
02/03/23	Drug was added: Trimethoprim/sulfamethoxazole
02/03/23	INT was updated with a new value for Tigecycline: from '---' to 'I'
02/03/23	INT was updated with a new value for Tetracycline: from '---' to 'R'
02/03/23	INT was updated with a new value for Piperacillin/tazobactam: from '---' to 'R'
02/03/23	INT was updated with a new value for Minocycline: from '---' to 'R'
02/03/23	INT was updated with a new value for Meropenem: from '---' to 'R'
02/03/23	INT was updated with a new value for Levofloxacin: from '---' to 'R'
02/03/23	INT was updated with a new value for Imipenem+chelators: from '---' to '---'
02/03/23	INT was updated with a new value for Imipenem: from '---' to 'R'
02/03/23	MIC was updated with a new value for Trimethoprim/sulfamethoxazole: from '---' to '>8'
02/03/23	MIC was updated with a new value for Tobramycin: from '---' to '>16'
02/03/23	MIC was updated with a new value for Tigecycline: from '---' to '4'
02/03/23	MIC was updated with a new value for Tetracycline: from '---' to '16'
02/03/23	MIC was updated with a new value for Plazomicin: from '---' to '>8'
02/03/23	MIC was updated with a new value for Piperacillin/tazobactam: from '---' to '>128'
02/03/23	MIC was updated with a new value for Omadacycline: from '---' to '16'
02/03/23	MIC was updated with a new value for Nitrofurantoin: from '---' to '>128'
02/03/23	MIC was updated with a new value for Minocycline: from '---' to '>16'
02/03/23	MIC was updated with a new value for Meropenem-vaborbactam: from '---' to '>16'
02/03/23	MIC was updated with a new value for Meropenem: from '---' to '>8'
02/03/23	MIC was updated with a new value for Levofloxacin: from '---' to '>8'
02/03/23	MIC was updated with a new value for Imipenem+chelators: from '---' to '32'
02/03/23	MIC was updated with a new value for Imipenem: from '---' to '64'
02/03/23	MIC was updated with a new value for Imipenem/relebactam: from '---' to '>16'
02/03/23	MIC was updated with a new value for Ceftazidime: from '---' to '>128'
02/03/23	MIC was updated with a new value for Ceftazidime/avibactam: from '---' to '>16'
02/03/23	MIC was updated with a new value for Cefoxitin: from '---' to '>16'
02/03/23	MIC was updated with a new value for Cefotaxime: from '---' to '>64'
02/03/23	MIC was updated with a new value for Cefotaxime/clavulanic acid: from '---' to '>32'
02/03/23	MIC was updated with a new value for Cefepime: from '---' to '>32'
02/03/23	MIC was updated with a new value for Cefepime/zidebactam: from '---' to '2'
02/03/23	MIC was updated with a new value for Aztreonam: from '---' to '>32'
02/03/23	MIC was updated with a new value for Ampicillin: from '---' to '>32'
02/03/23	MIC was updated with a new value for Ampicillin/sulbactam: from '---' to '>32'
02/03/23	MIC was updated with a new value for Amikacin: from '---' to '>64'
02/03/23	INT was updated with a new value for Ceftazidime/avibactam: from '---' to 'R'
02/03/23	Drug was added: Tobramycin
02/03/23	Drug was added: Tigecycline
02/03/23	Drug was added: Tetracycline
02/03/23	Drug was added: Piperacillin/tazobactam
02/03/23	Drug was added: Minocycline
02/03/23	Drug was added: Meropenem
02/03/23	Drug was added: Levofloxacin
02/03/23	Drug was added: Imipenem+chelators
02/03/23	Drug was added: Imipenem
02/03/23	INT was updated with a new value for Ceftazidime: from '---' to 'R'
02/03/23	INT was updated with a new value for Cefoxitin: from '---' to 'R'
02/03/23	INT was updated with a new value for Cefotaxime/clavulanic acid: from '---' to '---'
02/03/23	INT was updated with a new value for Cefotaxime: from '---' to 'R'
02/03/23	INT was updated with a new value for Cefepime: from '---' to 'R'
02/03/23	INT was updated with a new value for Aztreonam: from '---' to 'R'
02/03/23	INT was updated with a new value for Ampicillin/sulbactam: from '---' to 'R'
02/03/23	INT was updated with a new value for Ampicillin: from '---' to 'R'
02/03/23	MIC was updated with a new value for Trimethoprim/sulfamethoxazole: from '---' to '>8'
02/03/23	MIC was updated with a new value for Tobramycin: from '---' to '>16'
02/03/23	MIC was updated with a new value for Tigecycline: from '---' to '4'
02/03/23	MIC was updated with a new value for Tetracycline: from '---' to '16'
02/03/23	MIC was updated with a new value for Plazomicin: from '---' to '>8'
02/03/23	MIC was updated with a new value for Piperacillin/tazobactam: from '---' to '>128'
02/03/23	MIC was updated with a new value for Omadacycline: from '---' to '16'
02/03/23	MIC was updated with a new value for Nitrofurantoin: from '---' to '>128'
02/03/23	MIC was updated with a new value for Minocycline: from '---' to '>16'
02/03/23	MIC was updated with a new value for Meropenem-vaborbactam: from '---' to '>16'
02/03/23	MIC was updated with a new value for Meropenem: from '---' to '>8'
02/03/23	MIC was updated with a new value for Levofloxacin: from '---' to '>8'
02/03/23	MIC was updated with a new value for Imipenem+chelators: from '---' to '32'
02/03/23	MIC was updated with a new value for Imipenem: from '---' to '64'
02/03/23	MIC was updated with a new value for Imipenem/relebactam: from '---' to '>16'
02/03/23	MIC was updated with a new value for Ceftazidime: from '---' to '>128'
02/03/23	MIC was updated with a new value for Ceftazidime/avibactam: from '---' to '>16'
02/03/23	MIC was updated with a new value for Cefoxitin: from '---' to '>16'
02/03/23	MIC was updated with a new value for Cefotaxime: from '---' to '>64'
02/03/23	MIC was updated with a new value for Cefotaxime/clavulanic acid: from '---' to '>32'
02/03/23	MIC was updated with a new value for Cefepime: from '---' to '>32'
02/03/23	MIC was updated with a new value for Cefepime/zidebactam: from '---' to '2'
02/03/23	MIC was updated with a new value for Aztreonam: from '---' to '>32'
02/03/23	MIC was updated with a new value for Ampicillin: from '---' to '>32'
02/03/23	MIC was updated with a new value for Ampicillin/sulbactam: from '---' to '>32'
02/03/23	MIC was updated with a new value for Amikacin: from '---' to '>64'
02/03/23	Drug was added: Ceftazidime/avibactam
02/03/23	Drug was added: Ceftazidime
02/03/23	Drug was added: Cefoxitin
02/03/23	Drug was added: Cefotaxime/clavulanic acid
02/03/23	Drug was added: Cefotaxime
02/03/23	Drug was added: Cefepime
02/03/23	Drug was added: Aztreonam
02/03/23	Drug was added: Ampicillin/sulbactam
02/03/23	INT was updated with a new value for Amikacin: from '---' to 'R'
02/03/23	MIC was updated with a new value for Trimethoprim/sulfamethoxazole: from '---' to '>8'
02/03/23	MIC was updated with a new value for Tobramycin: from '---' to '>16'
02/03/23	MIC was updated with a new value for Tigecycline: from '---' to '4'
02/03/23	MIC was updated with a new value for Tetracycline: from '---' to '16'
02/03/23	MIC was updated with a new value for Plazomicin: from '---' to '>8'
02/03/23	MIC was updated with a new value for Piperacillin/tazobactam: from '---' to '>128'
02/03/23	MIC was updated with a new value for Omadacycline: from '---' to '16'
02/03/23	MIC was updated with a new value for Nitrofurantoin: from '---' to '>128'
02/03/23	MIC was updated with a new value for Minocycline: from '---' to '>16'
02/03/23	MIC was updated with a new value for Meropenem-vaborbactam: from '---' to '>16'
02/03/23	MIC was updated with a new value for Meropenem: from '---' to '>8'
02/03/23	MIC was updated with a new value for Levofloxacin: from '---' to '>8'
02/03/23	MIC was updated with a new value for Imipenem+chelators: from '---' to '32'
02/03/23	MIC was updated with a new value for Imipenem: from '---' to '64'
02/03/23	MIC was updated with a new value for Imipenem/relebactam: from '---' to '>16'
02/03/23	MIC was updated with a new value for Ceftazidime: from '---' to '>128'
02/03/23	MIC was updated with a new value for Ceftazidime/avibactam: from '---' to '>16'
02/03/23	MIC was updated with a new value for Cefoxitin: from '---' to '>16'
02/03/23	MIC was updated with a new value for Cefotaxime: from '---' to '>64'
02/03/23	MIC was updated with a new value for Cefotaxime/clavulanic acid: from '---' to '>32'
02/03/23	MIC was updated with a new value for Cefepime: from '---' to '>32'
02/03/23	MIC was updated with a new value for Cefepime/zidebactam: from '---' to '2'
02/03/23	MIC was updated with a new value for Aztreonam: from '---' to '>32'
02/03/23	MIC was updated with a new value for Ampicillin: from '---' to '>32'
02/03/23	MIC was updated with a new value for Ampicillin/sulbactam: from '---' to '>32'
02/03/23	MIC was updated with a new value for Amikacin: from '---' to '>64'
02/03/23	Drug was added: Ampicillin
02/03/23	Drug was added: Amikacin
08/01/22	Isolate Created

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