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Table 3 Comparison of CMg-identified genotypic resistance with phenotypic culture results and the impact on guideline-recommended beta-lactam antibiotic treatment

From: Evaluating the potential for respiratory metagenomics to improve treatment of secondary infection and detection of nosocomial transmission on expanded COVID-19 intensive care units

Sample ID

Bacteria reported by culture and metagenomics

Culture-reported resistance

CMg predicted resistance

Relevant genes identified

Genotype/phenotype match?

CMg-based treatment recommendationa

S1

K. aerogenes

No

–

–

Y

Meropenem

S10

K. pneumoniae

No

–

–

Y

Co-amoxiclav

S11

K. pneumoniae

No

–

–

Y

Co-amoxiclav

S20

S. aureus

Erythromycin

Erythromycin

erm

Y

Co-amoxiclav

S21

E. cloacae

No

No

–

Y

Meropenem

S31

K. pneumoniae

ESBL

Co-trimoxazole

ESBL

Co-trimoxazole

blaTEM,

blaSHV

blaCTX-M,

sul

Y

Y

Meropenem

S34

K. pneumoniae

No

ESBL

blaTEM, blaSHV

N

Meropenemb

S35

A. baumannii

ESBL

–

 

N

Meropenem

S36

S. aureus

Erythromycin

Trimethoprim

Erythromycin

Trimethoprim

erm

dfrG

Y

Co-amoxiclav

S37

P. mirabilis

No

Amoxicillin

Trimethoprim

blaOXA

dfrA

N

N

Meropenem

M. morganni

Co-trimoxazole

Fosfomycin

Nitrofurantoin

Co-trimoxazole

–

–

dfrA

Y

N

N

S39

C. koseri

Amoxicillin

Amoxicillin

blaCKO

Y

Co-amoxiclav

S44

S. marcescens

No

–

–

Y

Meropenem

S49

K. pneumoniae

ESBL

ESBL

blaTEM

Y

Meropenem

S51

S. aureus

Erythromycin

Erythromycin

erm

Y

Co-amoxiclav

C. koseri

Amoxicillin

Amoxicillin

blaCKO

Y

S52

K. aerogenes

Gentamicin

–

–

N

Meropenem

S56

P. mirabilis

Amoxicillin

Co-trimoxazole

Amoxicillin

–

blaTEM

–

Y

N

Co-amoxiclav

S59

K. pneumoniae

ESBL

Co-trimoxazole

ESBL

Co-trimoxazole

blaTEM,

blaSHV,

sul

Y

Y

Meropenem

S61

P. mirabilis

No

–

–

Y

Co-amoxiclav

K. pneumoniae

No

–

–

Y

S62

K. aerogenes

ESBL

–

–

N

Meropenem

S63

K. pneumoniae

ESBL

ESBL

blaSHV

Y

Meropenem

  1. aRecommended antibiotics are those defined in the Guy’s and St Thomas’ Guideline for empiric and targeted first-line treatment for ITU-acquired ventilator-associated pneumonia (VAP). Piperacillin-tazobactam is the first line empiric choice with recommendation to change therapy based on culture results and discussion with microbiology and infectious diseases. Meropenem is used for ESBL-Enterobacterales and E. cloacae, K. aerogenes (formally E. aerogenes), M. morganii and S. marcescens that have inducible β-lactam resistance. Co-amoxiclav is recommended for susceptible organisms
  2. bDetection of ESBL by metagenomics for K. pneumoniae in this sample was not confirmed by culture