FIG 5.

OprD mutation is associated with carbapenem use in the ICU and the emergence of carbapenem resistance. (A) Schematic representation of the impact of oprD mutation to predicted OprD amino acid sequence. oprD_WT is the “wild-type” unmutated gene (translates to a sequence 444 amino acids in length) and oprD_1 through to oprD_10 are mutations that emerged during the infection outbreak. Regions in green show 100% identity with oprD_WT sequence. Regions in gray are different to oprD_WT (disparate region). (B) Defined daily dose (DDD) of antibiotics from different classes used before and during the ICU infection outbreak (adapted from reference 31). (C) Distribution of meropenem MICs across tested isolates (n = 47) as determined by Etest (the highest concentration in the meropenem Etest is 32 μg/mL). The color corresponds to clinical breakpoints defined by the European Committee on Antimicrobial Susceptibility Testing (EUCAST). (D) Meropenem MIC plotted in the context of population structure. Each green number corresponds to the OprD schematic from panel A.