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Introduction:
Heteroresistance (HR) describes a growing subpopulation in presence of bactericidal antibiotic concentrations that kill most of the bacterial population. We investigated HR in a clinical Enterobacter cloacae complex (ECC) strain (IMT49658).
Materials & Methods:
Population analysis profiles (PAPs) were conducted on Mueller-Hinton II agar with 0, 0.125, 0.25, 0.5, 1, 2, 4, 8 and 16 x breakpoint-concentration (16 µg/ml) of ceftazidime (CAZ) in accordance with CLSI standard to confirm a resistant subpopulation. The latter we investigated by continuous subcultivation on non-selective media without CAZ.
Results:
Subcultivation-steps revealed the increased CAZ resistant phenotype as unstable as cells reverted to a less resistant population. PAPs underlined the observation of HR with growth at up to 16-fold breakpointconcentration. WGS showed identical genomes of resistant and susceptible colonies. Nonetheless qRTPCR shed light on an increased expression of blaDHA-1 and its corresponding regulator ampR in resistant bacterial entities. Furthermore, proteomic analysis confirmed an upregulated arginin-deiminase-system (ADS) in the resistant subpopulation.
Conclusion:
Research on HR constitutes an urgent contribution to treatment-pitfall against bacterial zoonotic infections. Our results identified DHA-1/AmpR as a potential mediator of HR in the studied clinical ECCstrain. Association of the ADS with β-lactamase may provide a fitness-advantage.