Diminished Susceptibility to Cefoperazone/Sulbactam and Piperacillin/Tazobactam in  Due to Narrow-Spectrum β-Lactamases as Well as Omp Mutation

Antibiotics	Breakpoint, (μg/ml)	Klebsiella pneumoniae							Escherichia cou		Klebriehd axyoca
Antibiotics	Breakpoint, (μg/ml)	E1	E3	E4	E7	E9	E10	E11	E6	E8	E2	E5
CRO	≤1≥4	≤0.5	≤0.5	≤0.5	≤0.5 1		≤0.5	1	≤0.5	≤0.5	1	1
CAZ	4 ≥16	1	2	1	4	4	4	4	2	4	1 1
FEP	≤2 216 1	1		0.25	1	2	2	2	0.5	2	1 1
AMC	≤8 ≥32	≥128	≥128	≥128	≥128	≥128	≥128	≥128	≥128	≥128	≥128	≥128
CSL	≤16 ≥64	64	64	64	64	≥128	128	≥128	64	128	128	≥128
TZP	≤16 ≥128	≥256	≥256	≥256	≥256	2256	2256	≥256	≥256	≥256	≥256	≥256
FPT	≤2 ≥16	1	0.5	0.06	0.125	2	1	2	0.25	1	0.125	0.25
FPZ	≤2 216	0.25	0.25	0.06	0.125	0.25	0.25 1		0.125	0.25	0.125	0.125
CZA	≤8 216 1		0.5	0.25	0.25	1	0.25	1	0.5	0.5	0.5	0.25
CZT	≤2 28	2	1	0.5 1		2	2	2 1		1	2	2

Gene sequencing results.

Number	Accession	Strain	ST	β-Lactamase gene	Promoter sequence mutation	Omp mutation
E1	JAKQYI000000000	Kpn	45	bla_SHV-1, bla_TEM-1B	none	OmpK36, OmpK37
E3	JAKOEX000000000	Kpn	45	bla_SHV-1, bla_TEM-1B	none	OmpK36, OmpK37
E4	JAKOEY000000000	Kpn	2854	bla_SHV-1	none	OmpK36, OmpK37
E7	JAKOGA000000000	Kpn	2358	bla_SHV-1, bla_TEM-1B	none	OmpK36, OmpK37
E9	JAKOGC000000000	Kpn	2358	bla_SHV-1, bla_TEM-1B	none	OmpK36, OmpK37
E10	JAKOGD000000000	Kpn	189	bla_SHV-1	none	OmpK36, OmpK37
E11	JAKOPO000000000	Kpn	45	bla_SHV-1	none	OmpK36, OmpK37
E6	JAKOEZ000000000	Eco	88	bla_TEM-1B	none	none
E8	JAKOGB000000000	Eco	409	bla_TEM-1B	none	none
E2	JAKPCC000000000	Kox	194	bla_OXY-1-3	none	OmpK36 mutations, OmpK35 and OmpK37 deficiency
E5	JAKPCD000000000	Kox	11	bla_OXY-1-1	none	no OmpK (OmpK35, OmpK36 and OmpK37) gene found

Antibiotics	Breakpoints (μg/ml)	Klebsiella pneumoniae							Escherichia coli		Klebsiella oxytoca
Antibiotics	Breakpoints (μg/ml)	E1	E3	E4	E7	E9	E10	E11	E6	E8	E2	E5
CRO	≤ 1 ≥ 4	≤ 0.5	≤ 0.5	≤ 0.5	≤ 0.5	1	≤ 0.5	1	≤ 0.5	≤ 0.5	1	1
CAZ	≤ 4 ≥ 16	1	2	1	4	4	4	4	2	4	1	1
FEP	≤ 2 ≥ 16	1	1	0.25	1	2	2	2	0.5	2	1	1
AMC	≤ 8 ≥ 32	≥ 128	≥ 128	≥ 128	≥ 128	≥ 128	≥ 128	≥ 128	≥ 128	≥ 128	≥ 128	≥ 128
CSL	≤ 16 ≥ 64	64	64	64	64	≥ 128	128	≥ 128	64	128	128	≥ 128
TZP	≤ 16 ≥ 128	≥ 256	≥ 256	≥ 256	≥ 256	≥ 256	≥ 256	≥ 256	≥ 256	≥ 256	≥ 256	≥ 256
FPT	≤ 2 ≥ 16	1	0.5	0.06	0.125	2	1	2	0.25	1	0.125	0.25
FPZ	≤ 2 ≥ 16	0.25	0.25	0.06	0.125	0.25	0.25	1	0.125	0.25	0.125	0.125
CZA	≤ 8 ≥ 16	1	0.5	0.25	0.25	1	0.25	1	0.5	0.5	0.5	0.25
CZT	≤ 2 ≥ 8	2	1	0.5	1	2	2	2	1	1	2	2

Number	Strain	ST	p-Lactamase gene	Promoter sequence mutation	Omp mutation
El	Kpn	45	blaSHV-1, blaTEM-lB	none	OmpK36, OmpK3 7
E3	Kpn	45	blaSHV-1, blaTEM-lB	none	OmpK36. OmpK3 7
E4	Kpn	2854	blaSHV-1	none	OmpK36, OmpK3 7
E7	Kpn	2358	blaSHV-1 - blaTEM-lB	none	OmpK36, OmpK3 7
E9	Kpn	2358	blaSHV-1. blaTEM-lB	none	OmpK36. OmpK3 7
E10	Kpn 18	9	blaSHV-1	none	OmpK36. OmpK3 7
Ell	Kpn	45	blaSHV-1	none	OmpK36, OmpK3 7
E6	Eco	88	blaTEM-lB	none	none
ES	Eco	409	blaTEM-1B	none	none
E2	Kox	194	blaOXY-1-3	none	OmpK36 mutations. OmpK35 and OmpK 37 deficiency
E5	Kox 11		blaOXY-1-1	none	no OmpK (OmpK3 5, OmpK36 and OmpK37) gene found

Diminished Susceptibility to Cefoperazone/Sulbactam and Piperacillin/Tazobactam in Enterobacteriaceae Due to Narrow-Spectrum β-Lactamases as Well as Omp Mutation