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Fatal Carbapenem Resistance Development in Pseudomonas Aeruginosa Under Meropenem Monotherapy, Caused by Mutations in the OprD Outer Membrane Porin

Fluit, Ad C., PhD*; Rentenaar, Rob J., MD, PhD*; Ekkelenkamp, Miquel B., MD, PhD*; Severs, Tim T., ing*; Mavinkurve-Groothuis, Annelies M. C., MD, PhD; Rogers, Malbert R. C., MSc*; Bruin, Marrie C. A., MD, PhD; Wolfs, Tom F. W., MD, PhD

The Pediatric Infectious Disease Journal: April 2019 - Volume 38 - Issue 4 - p 398–399
doi: 10.1097/INF.0000000000002244
Antimicrobial Reports

A 13-year old neutropenic boy succumbed to bacteremia and sepsis with a Pseudomonas aeruginosa strain that rapidly developed resistance to carbapenems during meropenem monotherapy. Whole genome sequencing of the susceptible and resistant blood culture isolates revealed the meropenem-resistant phenotype to be caused by truncation of the OprD gene, which added to a preexisting inactivated mexR gene.

From the *Department of Medical Microbiology, University Medical Center Utrecht, Utrecht, The Netherlands

Princess Maxima Centre for Pediatric Oncology, Utrecht, The Netherlands

Department of Pediatrics, Pediatric Immunology and Infectious Diseases, University Medical Center Utrecht, Utrecht, The Netherlands.

Accepted for publication October 23, 2018.

The authors have no funding or conflicts of interest to disclose.

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Address for correspondence: Rob J. Rentenaar, MD, PhD, Department of Medical Microbiology G04.643, University Medical Centre Utrecht, PO box 85500, 3508GA Utrecht, The Netherlands. E-mail:

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