{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,22]],"date-time":"2026-07-22T10:19:13Z","timestamp":1784715553132,"version":"3.55.0"},"reference-count":50,"publisher":"MDPI AG","issue":"9","license":[{"start":{"date-parts":[[2020,8,21]],"date-time":"2020-08-21T00:00:00Z","timestamp":1597968000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"VRID - Universidad de Concepcion","award":["218.074.061-1.0"],"award-info":[{"award-number":["218.074.061-1.0"]}]},{"name":"National Agency for Research and Development (ANID)","award":["21160336"],"award-info":[{"award-number":["21160336"]}]},{"DOI":"10.13039\/501100002850","name":"Fondo Nacional de Desarrollo Cient\u00edfico y Tecnol\u00f3gico","doi-asserted-by":"publisher","award":["11190602"],"award-info":[{"award-number":["11190602"]}],"id":[{"id":"10.13039\/501100002850","id-type":"DOI","asserted-by":"publisher"}]},{"name":"ANID Millennium Science Initiative\/ Millennium Initiative for Collaborative Research on Bacterial Resistance, MICROB-R","award":["NCN17_081"],"award-info":[{"award-number":["NCN17_081"]}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Microorganisms"],"abstract":"<jats:p>Colistin-heteroresistant (CST-HR) Enterobacterales isolates have been identified recently, challenging the clinical laboratories since routine susceptibility tests fail to detect this phenotype. In this work we describe the first CST-HR phenotype in extended-spectrum \u03b2-lactamase (ESBL)-producing Klebsiella pneumoniae isolates in South America. Additionally, we determine the genomic mechanisms of colistin heteroresistance in these strains. The CST-HR phenotype was analyzed by the population analysis profile (PAP) method, and mutations associated with this phenotype were determined by whole-genome sequencing (WGS) and the local BLAST+ DB tool. As a result, 8\/60 isolates were classified as CST-HR according to the PAP method. From WGS, we determined that the CST-HR isolates belong to three different Sequence Types (STs) and four K-loci: ST11 (KL15 and KL81), ST25 (KL2), and ST1161 (KL19). We identified diverse mutations in the two-component regulatory systems PmrAB and PhoPQ, as well as a disruption of the mgrB global regulator mediated by IS1-like and IS-5-like elements, which could confer resistance to CST in CST-HR and ESBL-producing isolates. These are the first descriptions in Chile of CST-HR in ESBL-producing K. pneumoniae isolates. The emergence of these isolates could have a major impact on the effectiveness of colistin as a \u201clast resort\u201d against these isolates, thus jeopardizing current antibiotic alternatives; therefore, it is important to consider the epidemiology of the CST-HR phenotype.<\/jats:p>","DOI":"10.3390\/microorganisms8091279","type":"journal-article","created":{"date-parts":[[2020,8,23]],"date-time":"2020-08-23T21:28:06Z","timestamp":1598218086000},"page":"1279","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":18,"title":["Colistin Heteroresistance among Extended Spectrum \u03b2-lactamases-Producing Klebsiella pneumoniae"],"prefix":"10.3390","volume":"8","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-7889-2844","authenticated-orcid":false,"given":"Felipe","family":"Morales-Le\u00f3n","sequence":"first","affiliation":[{"name":"Facultad de Farmacia, Departamento de Farmacia, Universidad de Concepci\u00f3n, Concepci\u00f3n 4030000, Chile"},{"name":"Laboratorio de Investigaci\u00f3n en Agentes Antibacterianos (LIAA), Departamento de Microbiolog\u00eda, Facultad de Ciencias Biol\u00f3gicas, Universidad de Concepci\u00f3n, Concepci\u00f3n 4070386, Chile"},{"name":"Millennium Nucleus for Collaborative Research on Bacterial Resistance, MICROB-R, Concepci\u00f3n 4070386, Chile"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4697-034X","authenticated-orcid":false,"given":"Celia A.","family":"Lima","sequence":"additional","affiliation":[{"name":"Laboratorio de Investigaci\u00f3n en Agentes Antibacterianos (LIAA), Departamento de Microbiolog\u00eda, Facultad de Ciencias Biol\u00f3gicas, Universidad de Concepci\u00f3n, Concepci\u00f3n 4070386, Chile"},{"name":"Millennium Nucleus for Collaborative Research on Bacterial Resistance, MICROB-R, Concepci\u00f3n 4070386, Chile"},{"name":"Departamento de Prevenci\u00f3n y Salud P\u00fablica, Facultad de Odontolog\u00eda, Universidad de Concepci\u00f3n, Concepci\u00f3n 4070386, Chile"},{"name":"Departamento de Medicina Interna, Facultad de Medicina, Universidad de Concepci\u00f3n, Concepci\u00f3n 4070386, Chile"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2351-1236","authenticated-orcid":false,"given":"Gerardo","family":"Gonz\u00e1lez-Rocha","sequence":"additional","affiliation":[{"name":"Laboratorio de Investigaci\u00f3n en Agentes Antibacterianos (LIAA), Departamento de Microbiolog\u00eda, Facultad de Ciencias Biol\u00f3gicas, Universidad de Concepci\u00f3n, Concepci\u00f3n 4070386, Chile"},{"name":"Millennium Nucleus for Collaborative Research on Bacterial Resistance, MICROB-R, Concepci\u00f3n 4070386, Chile"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6382-7625","authenticated-orcid":false,"given":"Andr\u00e9s","family":"Opazo-Capurro","sequence":"additional","affiliation":[{"name":"Laboratorio de Investigaci\u00f3n en Agentes Antibacterianos (LIAA), Departamento de Microbiolog\u00eda, Facultad de Ciencias Biol\u00f3gicas, Universidad de Concepci\u00f3n, Concepci\u00f3n 4070386, Chile"},{"name":"Millennium Nucleus for Collaborative Research on Bacterial Resistance, MICROB-R, Concepci\u00f3n 4070386, Chile"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9277-4681","authenticated-orcid":false,"given":"Helia","family":"Bello-Toledo","sequence":"additional","affiliation":[{"name":"Laboratorio de Investigaci\u00f3n en Agentes Antibacterianos (LIAA), Departamento de Microbiolog\u00eda, Facultad de Ciencias Biol\u00f3gicas, Universidad de Concepci\u00f3n, Concepci\u00f3n 4070386, Chile"},{"name":"Millennium Nucleus for Collaborative Research on Bacterial Resistance, MICROB-R, Concepci\u00f3n 4070386, Chile"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2020,8,21]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","unstructured":"Petrosillo, N., Taglietti, F., and Granata, G. 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