{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,5,14]],"date-time":"2025-05-14T05:09:50Z","timestamp":1747199390504,"version":"3.40.5"},"reference-count":25,"publisher":"Akademiai Kiado Zrt.","issue":"3","funder":[{"name":"University of Sofia \u201cSt. Kliment Ohridski\u201d","award":["80-10-148\/26.03.2021"],"award-info":[{"award-number":["80-10-148\/26.03.2021"]}]}],"content-domain":{"domain":["akjournals.com"],"crossmark-restriction":true},"short-container-title":["AMicr"],"published-print":{"date-parts":[[2022,9,16]]},"abstract":"Abstract<\/jats:title>\n Colistin is considered as the last-line antibiotic for the treatment of infections caused by extensively drug-resistant Gram-negative pathogens belonging to the ESKAPE (\n E<\/jats:underline>nterococcus faecium<\/jats:italic>, \n S<\/jats:underline>taphylococcus aureus<\/jats:italic>, \n K<\/jats:underline>lebsiella pneumoniae<\/jats:italic>, \n A<\/jats:underline>cinetobacter baumannii<\/jats:italic>, \n P<\/jats:underline>seudomonas aeruginosa<\/jats:italic>, and \n E<\/jats:underline>nterobacter<\/jats:italic> species) group. The present study aimed to explore the colistin resistance mechanisms of a Klebsiella aerogenes<\/jats:italic> (formerly Enterobacter aerogenes<\/jats:italic>) isolate (Kae1177-1bg) obtained from a Bulgarian critically ill patient with septic shock in 2020. Antimicrobial susceptibility testing and whole-genome sequencing using DNA nanoball technology were performed. The resulting read pairs were used for draft genome assembly, MLST analysis and mutation screening in the pmrA<\/jats:italic>\/B<\/jats:italic>, phoP<\/jats:italic>\/Q<\/jats:italic>, and mgrB<\/jats:italic> genes. Kae1177-1bg demonstrated high-level resistance to colistin, resistance to 3rd<\/jats:sup> generation cephalosporins and susceptibility to all other antibiotics tested. In our strain a CMY-2-type class C cephalosporinase was the only \u03b2-lactamase identified. No mobile colistin resistance (mcr<\/jats:italic>) genes were detected. A total of three missense variants in the genes for the two-component PmrA\/PmrB system were identified. Two of them were located in the pmrB<\/jats:italic> (pR57K and pN275K) and one in the pmrA<\/jats:italic> gene (pL162M). The pN275K variant emerged as the most likely cause for colistin resistance because it affected a highly conservative position and was the only nonconservative amino acid substitution. In conclusion, to the best of our knowledge, this is the first documented clinical case of a high-level colistin-resistant K. aerogenes<\/jats:italic> in Bulgaria and the first identification of the nonconservative amino acid substitution pN275K worldwide. Colistin-resistant Gram-negative pathogens of ESKAPE group are serious threat to public health and should be subjected to infection control stewardship practices.<\/jats:p>","DOI":"10.1556\/030.2022.01833","type":"journal-article","created":{"date-parts":[[2022,8,29]],"date-time":"2022-08-29T08:53:13Z","timestamp":1661763193000},"page":"209-214","update-policy":"https:\/\/doi.org\/10.1556\/policypage.crossmark.crossref.1","source":"Crossref","is-referenced-by-count":2,"title":["First detection of a colistin-resistant Klebsiella aerogenes isolate from a critically ill patient with septic shock in Bulgaria"],"prefix":"10.1556","volume":"69","author":[{"given":"Slavil","family":"Peykov","sequence":"first","affiliation":[{"name":"Department of Genetics, Faculty of Biology, Sofia University \u201cSt. Kliment Ohridski\u201d, Sofia, Bulgaria"},{"name":"BioInfoTech Laboratory, Sofia Tech Park, Sofia, Bulgaria"},{"name":"Department of Medical Microbiology, Faculty of Medicine, Medical University of Sofia, Sofia, Bulgaria"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Alexander","family":"Stratev","sequence":"additional","affiliation":[{"name":"Intensive Care Unit, UMHAT \u201cSt. Ivan Rilski\u201d, Sofia, Bulgaria"},{"name":"Department of Anaesthesiology and Intensive Care, Faculty of Medicine, Medical University of Sofia, Sofia, Bulgaria"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Boris","family":"Kirov","sequence":"additional","affiliation":[{"name":"BioInfoTech Laboratory, Sofia Tech Park, Sofia, Bulgaria"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Raina","family":"Gergova","sequence":"additional","affiliation":[{"name":"Department of Medical Microbiology, Faculty of Medicine, Medical University of Sofia, Sofia, Bulgaria"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5197-1849","authenticated-orcid":true,"given":"Tanya","family":"Strateva","sequence":"additional","affiliation":[{"name":"Department of Medical Microbiology, Faculty of Medicine, Medical University of Sofia, Sofia, Bulgaria"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"425","reference":[{"key":"B1","series-title":"Clin Microbiol Rev","doi-asserted-by":"publisher","DOI":"10.1128\/CMR.00181-19","article-title":"Antimicrobial resistance in ESKAPE pathogens","volume":"33","author":"De Oliveira \n DMP","year":"2020","unstructured":"De Oliveira \n DMP\n , \n Forde \n BM\n , \n Kidd \n TJ\n , \n Harris \n PNA\n , \n Schembri \n MA\n , \n Beatson \n SA\n , et\u00a0al\n . 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Acta Microbiol Immunol Hung \n 2022; 69: 27\u201334. https:\/\/doi.org\/10.1556\/030.2022.01640.10.1556\/030.2022.01640"},{"key":"B3","series-title":"Lancet Infect Dis","doi-asserted-by":"publisher","first-page":"318","DOI":"10.1016\/S1473-3099(17)30753-3","article-title":"WHO Pathogens Priority List Working Group. Discovery, research, and development of new antibiotics: the WHO priority list of antibiotic-resistant bacteria and tuberculosis","volume":"18","author":"Tacconelli \n E","year":"2018","unstructured":"Tacconelli \n E\n , \n Carrara \n E\n , \n Savoldi \n A\n , \n Harbarth \n S\n , \n Mendelson \n M\n , \n Monnet \n DL\n , et\u00a0al\n . WHO Pathogens Priority List Working Group. Discovery, research, and development of new antibiotics: the WHO priority list of antibiotic-resistant bacteria and tuberculosis. 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