Article Figures & Data
Figures
- FIG 1
Relation between genomic and phenotypic variability among 132 strains recovered from sputum samples in 9 patients chronically colonized by Achromobacter spp. (A) A. xylosoxidans; (B) A. insuavis. (Left) Genomic diversity among SpeI-generated pulsotypes at the interpatient level and at the intrasample level. Dendrogram was obtained by clustering analysis based on the Dice coefficient and unweighted pair group method with arithmetic means (UPGMA). The Dice coefficient scale is shown at the top of the dendrogram. Pulsotypes were named after the patient number (P1, P2, etc.) and a unique number for each pulsotype observed. The number of strains showing a pulsotype is indicated after the pulsotype name. (Right) Diversity of colonial morphotypes and of antibiomicrobial susceptibility patterns in relation to pulsotypes. The different colonial morphotypes and antibiotypes were defined at the intraspecimen level and were designated by m1, m2, etc. (up to 3 colonies were studied per colonial morphotype) and a1, a2, etc., respectively. The dark gray boxes represent the different morphotypes observed for strains with the opposite PFGE profile. The light gray boxes represent the different antibiotypes presented by strains with the opposite PFGE profile.
- FIG 2
Intrasample variations in antimicrobial susceptibilities toward 16 antimicrobial agents of Achromobacter spp. recovered from sputum specimens in 9 patients. (A) First-line antibiotics; (B) second-line antibiotics; (C) other antimicrobial agents. Whiskers plots illustrate the spread of zone of inhibition (ZOI) measures in millimeters for multiple strains within a sample in 9 patients chronically colonized with Achromobacter insuavis (patient 1) or Achromobacter xylosoxidans (other patients) for the 16 antimicrobial agents studied. For each patient, 8 to 27 strains were analyzed. The gray line indicates the susceptibility cutoff point edited for Acinetobacter sp. by the Antibiogram Committee of the French Society for Microbiology in 2016 or, when not available, that edited for Enterobacteriaceae. For colistin, the cutoff was that defined by Biswas et al. (26).
Tables
- TABLE 1
Summarized data for the 9 patients and samples included in the study and main results of intrasample and intramorphotype diversity study
Patient designation Age (yr) Achromobacter colonization period (yr) Sputum sample data Pulsotype diversity Antimicrobial susceptibility diversitya No. of morphotypes No. of strains studied Pulsotype no. per sample Pulsotype no. per morphotype Antibiotype diversity per sample Antibiotype diversity per morphotype Antimicrobial agents with different clinical categorization (S/R)b CV (%) No. (%) of antimicrobial agents with distinct clinical categorization (S/R) CV (%) No. (%) of antimicrobial agents with distinct clinical categorization (S/R) P1 52 18 7 16 3 1 to 2 15 7 (44) 0–10 0–3 (0–19) AMC, PIP, TPZ, CAZ, C, LEV, SXT P2 17 10 11 27 2 1 to 2 21 11 (69) 3–27 1–6 (6–37.5) AMX, AMC, TIC, TCC, CAZ, IMP, CS, C, CIP, LEV, SXT P3 20 9 4 12 2 1 to 2 9 3 (19) 6–9 0–1 (0–6) AMX, ETM, C P4 15 13 3 9 4 1 to 2 21 4 (25) 7–18 1–3 (6–19) TPZ, CS, C, SXT P5 19 9 5 15 6 1 to 3 19 6 (37.5) 2–12 0–3 (0–19) CAZ, CS, C, LEV, SXT, TET P6 13 9 6 13 8 1 to 3 20 5 (31) 7–14 0–2 (0–12.5) PIP, TPZ, CAZ, CIP, LEV P8 20 11 7 21 3 1 to 3 20 6 (37.5) 2–17 0–3 (0–19) AMC, TIC, CAZ, MEM, CS, C P11 25 6 4 11 2 1 to 2 11 3 (19) 5–11 0–2 (0–12.5) ETM, CS, SXT P12 11 5 3 8 2 1 to 2 21 7 (44) 13–27 2–5 (12.5–31) AMX, AMC, CAZ, MEM, CS, C, SXT ↵a CV, coefficient of variation of zones of inhibition measured in millimeters; S, susceptible; R, resistant (includes resistant and intermediate clinical categorizations).
↵b AMX, amoxicillin; AMC, amoxicillin-clavulanic acid; PIP, piperacillin; TPZ, piperacillin-tazobactam; TIC, ticarcillin; TCC, ticarcillin-clavulanic acid; CAZ, ceftazidime; IMP, imipenem; ETM, ertapenem; MEM, meropenem; CS, colistin; C, chloramphenicol; LEV, levofloxacin; CIP, ciprofloxacin; SXT, trimethoprim-sulfamethoxazole; TET, tetracycline. Underlined antimicrobial agent names indicate that clinical categorization varied at the intrasample level only while identical at the intramorphotype level.
- TABLE 2
Breakpoints considered in this study
Species Antibiotic breakpoint (mm)a AMX AMC TIC TCC PIP TPZ CAZ ETM IPM MEM CS C CIP LEV SXT TET Enterobacteriaceae 19 19 23 23 17–20 17–20 19–22 22–25 16–22 16–22 17 19–22 19–22 13–16 P. aeruginosa 18 18 18 18 16 17–20 18–24 22–25 17–20 Acinetobacter spp. 15–20 15–20 18–21 18–21 15–18 17–23 15–21 21 18–21 13–16 12–15 S. maltophilia 12–17 16 B. cepacia 18–21 16–20 11–16 ↵a Breakpoints are those edited by the Antibiogram Committee of the French Society for Microbiology in 2016 (CA-SFM 2016) for Enterobacteriaceae, Pseudomonas aeruginosa, Acinetobacter spp., Stenotrophomonas maltophilia, and Burkholderia cepacia. AMX, amoxicillin (25 μg); AMC, amoxicillin-clavulanic acid (20 μg/10 μg); PIP, piperacillin (75 μg); TPZ, piperacillin-tazobactam (75 μg/10 μg); TIC, ticarcillin (75 μg); TCC, ticarcillin-clavulanic acid (75 μg/10 μg); CAZ, ceftazidime (30 μg); IMP, imipenem (10 μg); ETM, ertapenem (10 μg); MEM, meropenem (10 μg); CS, colistin (50 μg); C, chloramphenicol (30 μg); LEV, levofloxacin (5 μg); CIP, ciprofloxacin (5 μg); SXT, trimethoprim-sulfamethoxazole (1.25 μg/23.75 μg); TET, tetracycline (30 μg).
- TABLE 3
Intrasample diversity of in vitro activity of 16 antimicrobial agents and impact of breakpoints used for clinical categorization
a Coefficient of variation of zones of inhibition measured in millimeters.
b Antibiotic name abbreviations are given in the footnote to Table 2.
c Susceptibility breakpoint of 12 mm was applied according to Biswas et al. (26).
