{"doi":"10.1093/jac/dkab461","title":"Prevalence of colistin heteroresistance in carbapenem-resistant <i>Pseudomonas aeruginosa</i> and association with clinical outcomes in patients: an observational study","abstract":"OBJECTIVES: To describe the prevalence of colistin heteroresistance in carbapenem-resistant Pseudomonas aeruginosa (CRPA) and evaluate the association with clinical outcomes. METHODS: Colistin heteroresistance was evaluated in CRPA isolates collected from patients without cystic fibrosis in Atlanta, Georgia, USA using two definitions: HR1, growth at 4 and 8 mg/L of colistin at a frequency ≥1 × 10-6 the main population; and HR2, growth at a colistin concentration ≥8× the MIC of the main population at a frequency ≥1 × 10-7. A modified population analysis profile (mPAP) technique was compared with reference PAP for detecting heteroresistance. For adults hospitalized at the time of or within 1 week of CRPA culture, multivariable logistic regression estimated the association between heteroresistance and 90 day mortality. RESULTS: Of 143 colistin-susceptible CRPA isolates, 8 (6%) met the HR1 definition and 37 (26%) met the HR2 definition. Compared with the reference PAP, mPAP had a sensitivity and specificity of 50% and 100% for HR1 and 32% and 99% for HR2. Of 82 hospitalized patients, 45 (56%) were male and the median age was 63 years (IQR 49-73). Heteroresistance was not associated with 90 day mortality using HR1 (0% in heteroresistant versus 22% in non-heteroresistant group; P = 0.6) or HR2 (12% in heteroresistant versus 24% in non-heteroresistant group; P = 0.4; adjusted OR 0.8; 95% CI 0.2-3.4). CONCLUSIONS: Colistin heteroresistance was identified in up to 26% of patients with CRPA in our sample, although the prevalence varied depending on the definition. We did not observe an apparent association between colistin heteroresistance and 90 day mortality.","journal":"Journal of Antimicrobial Chemotherapy","year":2021,"id":167015,"datarank":0.0,"base_score":0.0,"endowment":0.0,"self_citation_contribution":0.0,"citation_network_contribution":0.0,"self_endowment_contribution":0.0,"citer_contribution":0.0,"corpus_percentile":null,"corpus_rank":null,"citation_count":33,"citer_count":0,"citers_with_citation_signal":0,"citers_with_endowment":0,"datacite_reuse_total":0,"is_dataset":false,"is_dataset_confidence":0.8919,"is_data_producer":false,"deposit_databanks":null,"is_oa":true,"file_count":0,"downloads":0,"has_version_chain":false,"published_date":"2021-01-01","fair_score":null,"fair_percentile":null,"algorithm_id":"datarank_citation_only_1hop_v6","ranking_scope":"data_only","authors":[{"id":693671,"name":"Michelle H. Davis","orcid":"0000-0001-7409-6357","position":1,"is_corresponding":false},{"id":694398,"name":"Alexander M. Page","orcid":null,"position":2,"is_corresponding":false},{"id":585459,"name":"Chris Bower","orcid":"0000-0001-7826-7846","position":3,"is_corresponding":false},{"id":693672,"name":"Gillian Smith","orcid":"0000-0001-9288-7566","position":4,"is_corresponding":false},{"id":232744,"name":"Jesse T. Jacob","orcid":"0000-0001-9811-6260","position":5,"is_corresponding":false},{"id":693673,"name":"Dan I. Andersson","orcid":"0000-0001-6640-2174","position":6,"is_corresponding":false},{"id":44709,"name":"David S. Weiss","orcid":"0000-0003-0980-7866","position":7,"is_corresponding":false},{"id":517392,"name":"Sarah W. Satola","orcid":"0000-0002-3059-0342","position":8,"is_corresponding":false},{"id":585458,"name":"Jessica Howard‐Anderson","orcid":"0000-0001-9924-0458","position":0,"is_corresponding":true}],"reference_count":21,"raw_metadata":null,"created_at":"2026-07-18T23:45:54.042727Z","pmid":"34918135","pmcid":null,"fwci":null,"citation_percentile":null,"influential_citations":0,"oa_status":null,"license":null,"views":0,"total_file_size_bytes":0,"version_count":0,"fair_f":null,"fair_a":null,"fair_i":null,"fair_r":null,"fair_zscore":null,"fair_rationale":null,"fair_model":null,"fair_agent_version":null,"fair_fulltext_source":null,"fair_has_llm":null,"fair_computed_at":null,"clinical_trials":[],"software_tools":[],"db_accessions":[],"linked_datasets":[],"topics":[]}