Genomic evolution of Enterobacter hormaechei towards resistance in an osteoarticular infection under piperacillin/tazobactam treatment. Enterobacter hormaechei AMR evolution

A diabetic patient presented an osteoarticular infection with Enterobacter hormaechei, sensitive to 3rd generation cephalosporins, cefepime and piperacillin/tazobactam. Under piperacillin/tazobactam treatment, a new isolate showed resistance to 2nd and 3rd generation cephalosporins, piperacillin/tazobactam and an intermediate resistance to cefepime. The genome sequencing of two subsequent isolates of Enterobacter hormaechei allowed to identify genetic changes that could support the antimicrobial resistance profile observed.