Gene duplication has been discovered for many antimicrobial resistance genes in bacterial genomes and has been considered a source of elevated antimicrobial resistance.1 The gene blaOXA-23is a major determinant in the emergence of carbapenem-resistant Acinetobacter baumannii (CRAB).2–4 We have previously reported the widespread duplication of blaOXA-23by surveying 113 clinical CRAB isolates in China.5 However, in these isolates the blaOXA-23 copy number did not correlate well with the MIC of imipenem. A similar phenomenon was also reported recently by Yoon et al.6 One reasonable explanation is that, in addition to gene duplica- tions, other mechanisms might also impact on the MIC, such as the presence of specific outer membrane proteins and/ortheover-expression of resistance–nodulation–division (RND)-type efflux pumps.7 Often, these mechanisms might vary in their performance when in different genomic contexts. Instead of making comparisons between clinical isolates, in this study we cultured A. baumannii under treatment with carbapenem, thus avoiding any interference induced in different genomic contexts. If an increase in the blaOXA-23 copy number or MIC were to occur within the same strain, the contribution of gene duplication to carbapenem resistance would be acknowledged.
Journal: The Journal of antimicrobial chemotherapy