We investigated the colistin resistance rate among 356 Enterobacter
spp. clinical isolates from eight hospitals in Korea.
Antibiotic susceptibility testing was performed by broth microdilution.
While 51 of 213 (23.9%) Enterobacter cloacae isolates
were colistin-resistant, only six of 143 (4.2%) E. aerogenes
isolates showed resistance. We also identified the skip
well phenotype in eight E. cloacae and three E. aerogenes
isolates. Multilocus sequence typing for E. cloacae and randomly
amplified polymorphic DNA analysis and enterobacterial
repetitive intergenic consensus PCR for E. aerogenes
revealed that clonal spreading of colistin-resistant and skip
well Enterobacter spp. isolates had not occurred. In vitro
time-kill assays were performed with three colistin-resistant,
three skip well, and two colistin-susceptible isolates of E. cloacae
and E. aerogenes. Inconsistent results were observed
among isolates with skip well phenotypes; while some were
eradicated by 2 mg/L colistin, others were not. This suggests
that skip well isolates have differentiated into different categories.
As the high rates of colistin resistance in E. cloacae
detected are of clinical concern, continuous monitoring is
warranted. In addition, the clinical implications and mechanisms
of the skip well phenotype should be investigated to
ensure the appropriate use of colistin against Enterobacter
infections.
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