Figure 1.
Summary of the patient’s second hospital course with a timeline of events, fever curve, Gram-negative antibiotics and timing and location of isolates. *For isolate #7, from the kidney abscess drain (day 39), the AST profile was consistent with acquisition of the blaOXA-181-bearing ColKP3 plasmid by the hypervirulent ST23 strain. The AST profile at the time of obtaining the clinical culture was repeated due to the unusual profile (reduced susceptibility to certain extended-generation cephalosporins but resistant to the carbapenems). The AST profile was confirmed upon repeat and the isolate was found to be mCIM positive (positive for carbapenemase production). Unfortunately, by the time WGS was pursued the plasmid was lost in vitro and we were unable to demonstrate acquisition of the plasmid. AMP, ampicillin; CRO, ceftriaxone; CST, colistin; FEP, cefepime; MEM, meropenem; TOB, tobramycin; TGC, tigecycline; TZP, piperacillin/tazobactam.