Investigation of colistin heteroresistance and the colistin resistance genes mcr-1 to mcr-5 in Escherichia coli and Klebsiella pneumoniae isolates in a tertiary hospital in Turkey

Heteroresistance is not detected by traditional antimicrobial susceptibility testing methods and may lead to treatment failures. Investigating the presence of plasmid-mediated colistin resistance genes is important because of the horizontal transmission of the relevant genes between bacterial species. This study aimed to investigate the presence of colistin heteroresistance and the colistin resistance genes mcr-1 to mcr-5 in Escherichia coli and Klebsiella pneumoniae isolates. A total of 254 isolates, including 100 E. coli and 154 K. pneumoniae strains isolated from clinical samples, were included in the study. Colistin susceptibility was evaluated using the broth microdilution method for all strains. Heteroresistance screening was performed using the gradient strip test. Eight strains were evaluated for heteroresistance by population analysis profiling (PAP). The colistin resistance genes mcr-1 to mcr-5 were investigated by multiplex polymerase chain reaction (PCR) in colistin-resistant K. pneumoniae isolates. Multilocus sequence typing (MLST) analysis was performed on two K. pneumoniae strains. Colistin resistance was not detected in the E. coli isolates and was detected in 16.23% (25/154) of the K. pneumoniae isolates. No heteroresistant bacteria were detected by the gradient strip test or by PAP. All colistin-resistant isolates were negative for the mcr genes. The two isolates analyzed by MLST were ST14 and ST2096. Periodic follow-up of colistin heteroresistance is useful for administering appropriate antibiotic therapy. In addition, the investigation of colistin resistance genes is important for infection control measures.