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Macrolide, lincosamide and streptogramin B resistance in a dominant clone of Australian community methicillin-resistant Staphylococcus aureus.

producing strains were tested in this study. Such a breakpoint would more closely resemble the 22–23 mm values for imipenem and meropenem, although these are matched against MIC breakpoints of £4 mg/L rather than £2 mg/L. Nevertheless, it is notable that a few of the isolates were genuinely resistant to ertapenem, with MICs of 4–16 mg/L, whilst none required an imipenem or meropenem MIC above 1 mg/L, as determined by agar dilution. Although combined resistance mechanisms were not investigated in the present isolates, these results are in accord with the view that ertapenem is more vulnerable to combinations of ESBLs (or AmpC) and impermeability than other carbapenems and that such combined mechanisms largely arise in Klebsiella spp. or Enterobacter spp., not E. coli. They are also compatible with a recent international survey which found that the resistance rate to ertapenem among ESBL-producing Enterobacteriaceae was 6%, compared with 2–2.5% for imipenem and meropenem.