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Panel:   Multi-Mechanism (MULTI)
AR Bank # 1158 Klebsiella pneumoniae
Study ID: MULTI-10

Biosample Accession #: SAMN34111344

mCIM Result: Positive    

Collection Year: 2018
Source: Urine
MLST: ST147(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)


MIC (μg/ml) Results and Interpretation
Drug MIC (μg/ml) INT
Amikacin >64R
Ampicillin >32R
Ampicillin/sulbactam 1>32R
Aztreonam/avibactam 10.5---
Cefepime >32R
Cefepime/zidebactam 22---
Cefiderocol 4S
Cefotaxime >64R
Cefotaxime/clavulanic acid 1>32---
Cefoxitin >16R
Ceftazidime >128R
Ceftazidime/avibactam 1>16R
Colistin 1 50.5I
Imipenem >64R
Imipenem/relebactam 1>64R
Imipenem+chelators 32---
Levofloxacin >8R
Meropenem >8R
Meropenem-vaborbactam 1>16R
Minocycline <=4S
Nitrofurantoin >128R
Omadacycline 44S
Piperacillin/tazobactam 1>128R
Plazomicin >8R
Tetracycline 8I
Tigecycline 1S
Tobramycin >16R
Trimethoprim/sulfamethoxazole 1>8R
SDD (Susceptible Dose Dependent)
S – I –R Interpretation (INT) derived from CLSI 2024 M100 S34
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
CategoryGene
Aminoglycoside aac(6')-Il, aadA1, aadA2, aph(3")-Ib, aph(6)-Id, armA, rmtB1
Beta-lactam NDM-5, OXA-232, VIM-2, CTX-M-15, OXA-1, SHV-11, TEM-1
Bleomycin ble-MBL
Efflux pumps/Other EMRD, KDEA, qacEdelta1
Macrolide-Lincosamide-Streptogramin ere(A), erm(B), mph(E), msr(E)
Phenicols/Bicyclomycins catB4, cmlA5
Quinolone aac(6')-Ib-cr, oqxA, oqxB25
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.
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.
Isolate History
Date Action Performed
11/20/23INT was updated with a new value for Colistin: from '---' to 'I'
11/20/23MIC was updated with a new value for Colistin: from '---' to '0.5'
11/20/23Drug was added: 'Colistin'
07/13/23Sequence Accession # changed: from '---' to 'SAMN34111344'
05/23/23MIC was updated with a new value for Aztreonam/avibactam: from '---' to '0.5'
05/23/23Drug was added: Aztreonam/avibactam
02/24/23Isolate Status changed: from 'Pending' to 'Active'
02/24/23Isolate was removed from panel
02/24/23Isolate Status changed: from 'Active' to 'Pending'
02/24/23Source was changed: from '---' to 'Urine'
02/24/23Collection Year was changed: from '---' to '2018'
02/24/23mCIM changed: from '---' to 'Positive'
02/22/23Isolate Status changed: from 'Pending' to 'Active'
02/06/23Gene was added to 'qacEdelta1'
02/06/23Gene was added to 'KDEA'
02/06/23Gene was added to 'EMRD'
02/06/23Gene was added to 'ble-MBL'
02/06/23Gene was added to 'dfrA12'
02/06/23Gene was added to 'sul2'
02/06/23Gene was added to 'sul1'
02/06/23Gene was added to 'ARR-2'
02/06/23Gene was added to 'cmlA5'
02/06/23Gene was added to 'catB4'
02/06/23Gene was added to 'msr(E)'
02/06/23Gene was added to 'mph(E)'
02/06/23Gene was added to 'erm(B)'
02/06/23Gene was added to 'ere(A)'
02/06/23Gene was added to 'oqxB25'
02/06/23Gene was added to 'oqxA'
02/06/23Gene was added to 'aac(6')-Ib-cr'
02/06/23Gene was added to 'rmtB1'
02/06/23Category was added: 'Efflux pumps/Other'
02/06/23Category was added: 'Bleomycin'
02/06/23Category was added: 'Trimethoprim'
02/06/23Category was added: 'Sulfonamides'
02/06/23Category was added: 'Rifampicin'
02/06/23Category was added: 'Phenicols/Bicyclomycins'
02/06/23Category was added: 'Macrolide-Lincosamide-Streptogramin'
02/06/23Category was added: 'Quinolone'
02/06/23MLST was updated: from '---' to 'ST147(Pasteur)'
02/06/23Gene was added to 'armA'
02/06/23Gene was added to 'aph(6)-Id'
02/06/23Gene was added to 'aph(3")-Ib'
02/06/23Gene was added to 'aadA2'
02/06/23Gene was added to 'aadA1'
02/06/23Gene was added to 'aac(6')-Il'
02/06/23Gene was added to 'VIM-2'
02/06/23Gene was added to 'TEM-1'
02/06/23Gene was added to 'SHV-11'
02/06/23Gene was added to 'OXA-232'
02/06/23Gene was added to 'OXA-1'
02/06/23Gene was added to 'NDM-5'
02/06/23Gene was added to 'CTX-M-15'
02/06/23Category was added: 'Aminoglycoside'
02/06/23Category was added: 'Beta-lactam'
02/06/23MIC was updated with a new value for Imipenem/relebactam: from '>16' to '>64'
02/03/23INT was updated with a new value for Cefiderocol: from '---' to 'S'
02/03/23MIC was updated with a new value for Cefiderocol: from '---' to '4'
02/03/23Drug was added: Cefiderocol
02/03/23INT was updated with a new value for Nitrofurantoin: from '---' to 'R'
02/03/23INT was updated with a new value for Omadacycline: from '---' to 'S'
02/03/23INT was updated with a new value for Meropenem-vaborbactam: from '---' to 'R'
02/03/23MIC was updated with a new value for Trimethoprim/sulfamethoxazole: from '---' to '>8'
02/03/23MIC was updated with a new value for Tobramycin: from '---' to '>16'
02/03/23MIC was updated with a new value for Tigecycline: from '---' to '1'
02/03/23MIC was updated with a new value for Tetracycline: from '---' to '8'
02/03/23MIC was updated with a new value for Plazomicin: from '---' to '>8'
02/03/23MIC was updated with a new value for Piperacillin/tazobactam: from '---' to '>128'
02/03/23MIC was updated with a new value for Omadacycline: from '---' to '4'
02/03/23MIC was updated with a new value for Nitrofurantoin: from '---' to '>128'
02/03/23MIC was updated with a new value for Minocycline: from '---' to '<=4'
02/03/23MIC was updated with a new value for Meropenem-vaborbactam: from '---' to '>16'
02/03/23MIC was updated with a new value for Meropenem: from '---' to '>8'
02/03/23MIC was updated with a new value for Levofloxacin: from '---' to '>8'
02/03/23MIC was updated with a new value for Imipenem+chelators: from '---' to '2'
02/03/23MIC was updated with a new value for Imipenem: from '---' to '>64'
02/03/23MIC was updated with a new value for Imipenem/relebactam: from '---' to '>16'
02/03/23MIC was updated with a new value for Ceftazidime: from '---' to '>128'
02/03/23MIC was updated with a new value for Ceftazidime/avibactam: from '---' to '>16'
02/03/23MIC was updated with a new value for Cefoxitin: from '---' to '>16'
02/03/23MIC was updated with a new value for Cefotaxime: from '---' to '>64'
02/03/23MIC was updated with a new value for Cefotaxime/clavulanic acid: from '---' to '>32'
02/03/23MIC was updated with a new value for Cefepime: from '---' to '>32'
02/03/23MIC was updated with a new value for Cefepime/zidebactam: from '---' to '2'
02/03/23MIC was updated with a new value for Ampicillin: from '---' to '>32'
02/03/23MIC was updated with a new value for Ampicillin/sulbactam: from '---' to '>32'
02/03/23MIC was updated with a new value for Amikacin: from '---' to '>64'
02/03/23Drug was added: Nitrofurantoin
02/03/23Drug was added: Omadacycline
02/03/23Drug was added: Meropenem-vaborbactam
02/03/23INT was updated with a new value for Plazomicin: from '---' to 'R'
02/03/23INT was updated with a new value for Cefepime/zidebactam: from '---' to '---'
02/03/23INT was updated with a new value for Imipenem/relebactam: from '---' to 'R'
02/03/23INT was updated with a new value for Trimethoprim/sulfamethoxazole: from '---' to 'R'
02/03/23INT was updated with a new value for Tobramycin: from '---' to 'R'
02/03/23INT was updated with a new value for Tigecycline: from '---' to 'S'
02/03/23INT was updated with a new value for Tetracycline: from '---' to 'I'
02/03/23MIC was updated with a new value for Trimethoprim/sulfamethoxazole: from '---' to '>8'
02/03/23MIC was updated with a new value for Tobramycin: from '---' to '>16'
02/03/23MIC was updated with a new value for Tigecycline: from '---' to '1'
02/03/23MIC was updated with a new value for Tetracycline: from '---' to '8'
02/03/23MIC was updated with a new value for Plazomicin: from '---' to '>8'
02/03/23MIC was updated with a new value for Piperacillin/tazobactam: from '---' to '>128'
02/03/23MIC was updated with a new value for Omadacycline: from '---' to '4'
02/03/23MIC was updated with a new value for Nitrofurantoin: from '---' to '>128'
02/03/23MIC was updated with a new value for Minocycline: from '---' to '<=4'
02/03/23MIC was updated with a new value for Meropenem-vaborbactam: from '---' to '>16'
02/03/23MIC was updated with a new value for Meropenem: from '---' to '>8'
02/03/23MIC was updated with a new value for Levofloxacin: from '---' to '>8'
02/03/23MIC was updated with a new value for Imipenem+chelators: from '---' to '2'
02/03/23MIC was updated with a new value for Imipenem: from '---' to '>64'
02/03/23MIC was updated with a new value for Imipenem/relebactam: from '---' to '>16'
02/03/23MIC was updated with a new value for Ceftazidime: from '---' to '>128'
02/03/23MIC was updated with a new value for Ceftazidime/avibactam: from '---' to '>16'
02/03/23MIC was updated with a new value for Cefoxitin: from '---' to '>16'
02/03/23MIC was updated with a new value for Cefotaxime: from '---' to '>64'
02/03/23MIC was updated with a new value for Cefotaxime/clavulanic acid: from '---' to '>32'
02/03/23MIC was updated with a new value for Cefepime: from '---' to '>32'
02/03/23MIC was updated with a new value for Cefepime/zidebactam: from '---' to '2'
02/03/23MIC was updated with a new value for Ampicillin: from '---' to '>32'
02/03/23MIC was updated with a new value for Ampicillin/sulbactam: from '---' to '>32'
02/03/23MIC was updated with a new value for Amikacin: from '---' to '>64'
02/03/23Drug was added: Plazomicin
02/03/23Drug was added: Cefepime/zidebactam
02/03/23Drug was added: Imipenem/relebactam
02/03/23Drug was added: Trimethoprim/sulfamethoxazole
02/03/23Drug was added: Tobramycin
02/03/23Drug was added: Tigecycline
02/03/23Drug was added: Tetracycline
02/03/23INT was updated with a new value for Piperacillin/tazobactam: from '---' to 'R'
02/03/23INT was updated with a new value for Minocycline: from '---' to 'S'
02/03/23INT was updated with a new value for Meropenem: from '---' to 'R'
02/03/23INT was updated with a new value for Levofloxacin: from '---' to 'R'
02/03/23INT was updated with a new value for Imipenem+chelators: from '---' to '---'
02/03/23INT was updated with a new value for Imipenem: from '---' to 'R'
02/03/23MIC was updated with a new value for Trimethoprim/sulfamethoxazole: from '---' to '>8'
02/03/23MIC was updated with a new value for Tobramycin: from '---' to '>16'
02/03/23MIC was updated with a new value for Tigecycline: from '---' to '1'
02/03/23MIC was updated with a new value for Tetracycline: from '---' to '8'
02/03/23MIC was updated with a new value for Plazomicin: from '---' to '>8'
02/03/23MIC was updated with a new value for Piperacillin/tazobactam: from '---' to '>128'
02/03/23MIC was updated with a new value for Omadacycline: from '---' to '4'
02/03/23MIC was updated with a new value for Nitrofurantoin: from '---' to '>128'
02/03/23MIC was updated with a new value for Minocycline: from '---' to '<=4'
02/03/23MIC was updated with a new value for Meropenem-vaborbactam: from '---' to '>16'
02/03/23MIC was updated with a new value for Meropenem: from '---' to '>8'
02/03/23MIC was updated with a new value for Levofloxacin: from '---' to '>8'
02/03/23MIC was updated with a new value for Imipenem+chelators: from '---' to '2'
02/03/23MIC was updated with a new value for Imipenem: from '---' to '>64'
02/03/23MIC was updated with a new value for Imipenem/relebactam: from '---' to '>16'
02/03/23MIC was updated with a new value for Ceftazidime: from '---' to '>128'
02/03/23MIC was updated with a new value for Ceftazidime/avibactam: from '---' to '>16'
02/03/23MIC was updated with a new value for Cefoxitin: from '---' to '>16'
02/03/23MIC was updated with a new value for Cefotaxime: from '---' to '>64'
02/03/23MIC was updated with a new value for Cefotaxime/clavulanic acid: from '---' to '>32'
02/03/23MIC was updated with a new value for Cefepime: from '---' to '>32'
02/03/23MIC was updated with a new value for Cefepime/zidebactam: from '---' to '2'
02/03/23MIC was updated with a new value for Ampicillin: from '---' to '>32'
02/03/23MIC was updated with a new value for Ampicillin/sulbactam: from '---' to '>32'
02/03/23MIC was updated with a new value for Amikacin: from '---' to '>64'
02/03/23Drug was added: Piperacillin/tazobactam
02/03/23Drug was added: Minocycline
02/03/23Drug was added: Meropenem
02/03/23Drug was added: Levofloxacin
02/03/23Drug was added: Imipenem+chelators
02/03/23INT was updated with a new value for Ceftazidime/avibactam: from '---' to 'R'
02/03/23INT was updated with a new value for Ceftazidime: from '---' to 'R'
02/03/23INT was updated with a new value for Cefoxitin: from '---' to 'R'
02/03/23INT was updated with a new value for Cefotaxime/clavulanic acid: from '---' to '---'
02/03/23INT was updated with a new value for Cefotaxime: from '---' to 'R'
02/03/23INT was updated with a new value for Cefepime: from '---' to 'R'
02/03/23INT was updated with a new value for Ampicillin/sulbactam: from '---' to 'R'
02/03/23MIC was updated with a new value for Trimethoprim/sulfamethoxazole: from '---' to '>8'
02/03/23MIC was updated with a new value for Tobramycin: from '---' to '>16'
02/03/23MIC was updated with a new value for Tigecycline: from '---' to '1'
02/03/23MIC was updated with a new value for Tetracycline: from '---' to '8'
02/03/23MIC was updated with a new value for Plazomicin: from '---' to '>8'
02/03/23MIC was updated with a new value for Piperacillin/tazobactam: from '---' to '>128'
02/03/23MIC was updated with a new value for Omadacycline: from '---' to '4'
02/03/23MIC was updated with a new value for Nitrofurantoin: from '---' to '>128'
02/03/23MIC was updated with a new value for Minocycline: from '---' to '<=4'
02/03/23MIC was updated with a new value for Meropenem-vaborbactam: from '---' to '>16'
02/03/23MIC was updated with a new value for Meropenem: from '---' to '>8'
02/03/23MIC was updated with a new value for Levofloxacin: from '---' to '>8'
02/03/23MIC was updated with a new value for Imipenem+chelators: from '---' to '2'
02/03/23MIC was updated with a new value for Imipenem: from '---' to '>64'
02/03/23MIC was updated with a new value for Imipenem/relebactam: from '---' to '>16'
02/03/23MIC was updated with a new value for Ceftazidime: from '---' to '>128'
02/03/23MIC was updated with a new value for Ceftazidime/avibactam: from '---' to '>16'
02/03/23MIC was updated with a new value for Cefoxitin: from '---' to '>16'
02/03/23MIC was updated with a new value for Cefotaxime: from '---' to '>64'
02/03/23MIC was updated with a new value for Cefotaxime/clavulanic acid: from '---' to '>32'
02/03/23MIC was updated with a new value for Cefepime: from '---' to '>32'
02/03/23MIC was updated with a new value for Cefepime/zidebactam: from '---' to '2'
02/03/23MIC was updated with a new value for Ampicillin: from '---' to '>32'
02/03/23MIC was updated with a new value for Ampicillin/sulbactam: from '---' to '>32'
02/03/23MIC was updated with a new value for Amikacin: from '---' to '>64'
02/03/23Drug was added: Imipenem
02/03/23Drug was added: Ceftazidime/avibactam
02/03/23Drug was added: Ceftazidime
02/03/23Drug was added: Cefoxitin
02/03/23Drug was added: Cefotaxime/clavulanic acid
02/03/23Drug was added: Cefotaxime
02/03/23Drug was added: Cefepime
02/03/23Drug was added: Ampicillin/sulbactam
02/03/23INT was updated with a new value for Ampicillin: from '---' to 'R'
02/03/23INT was updated with a new value for Amikacin: from '---' to 'R'
02/03/23MIC was updated with a new value for Trimethoprim/sulfamethoxazole: from '---' to '>8'
02/03/23MIC was updated with a new value for Tobramycin: from '---' to '>16'
02/03/23MIC was updated with a new value for Tigecycline: from '---' to '1'
02/03/23MIC was updated with a new value for Tetracycline: from '---' to '8'
02/03/23MIC was updated with a new value for Plazomicin: from '---' to '>8'
02/03/23MIC was updated with a new value for Piperacillin/tazobactam: from '---' to '>128'
02/03/23MIC was updated with a new value for Omadacycline: from '---' to '4'
02/03/23MIC was updated with a new value for Nitrofurantoin: from '---' to '>128'
02/03/23MIC was updated with a new value for Minocycline: from '---' to '<=4'
02/03/23MIC was updated with a new value for Meropenem-vaborbactam: from '---' to '>16'
02/03/23MIC was updated with a new value for Meropenem: from '---' to '>8'
02/03/23MIC was updated with a new value for Levofloxacin: from '---' to '>8'
02/03/23MIC was updated with a new value for Imipenem+chelators: from '---' to '2'
02/03/23MIC was updated with a new value for Imipenem: from '---' to '>64'
02/03/23MIC was updated with a new value for Imipenem/relebactam: from '---' to '>16'
02/03/23MIC was updated with a new value for Ceftazidime: from '---' to '>128'
02/03/23MIC was updated with a new value for Ceftazidime/avibactam: from '---' to '>16'
02/03/23MIC was updated with a new value for Cefoxitin: from '---' to '>16'
02/03/23MIC was updated with a new value for Cefotaxime: from '---' to '>64'
02/03/23MIC was updated with a new value for Cefotaxime/clavulanic acid: from '---' to '>32'
02/03/23MIC was updated with a new value for Cefepime: from '---' to '>32'
02/03/23MIC was updated with a new value for Cefepime/zidebactam: from '---' to '2'
02/03/23MIC was updated with a new value for Ampicillin: from '---' to '>32'
02/03/23MIC was updated with a new value for Ampicillin/sulbactam: from '---' to '>32'
02/03/23MIC was updated with a new value for Amikacin: from '---' to '>64'
02/03/23Drug was added: Ampicillin
02/03/23Drug was added: Amikacin
08/01/22Isolate Created
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