Version 3: Meropenem resistant Burkholderia pseudomallei - A concerning single case in Australia with no prior meropenem exposure

We report a case of cutaneous melioidosis in a 54-year-old male with a meropenem resistant sub-population. He was empirically treated with episodic doxycycline and trimethoprim-sulfamethoxazole, however the abscess re-accumulated. The patient had no prior exposure to meropenem. A sub-population of the isolate was meropenem resistant with an MIC>32 µg/ml and the identification was re-confirmed as B. pseudomallei. Whole genome sequencing with ARDaP analysis only revealed a resistance determinant to doxycycline and it didn’t reveal a resistance determinant to meropenem. Furthermore, no carbapenemases were detected through multiple bioinformatics tools. To date this is the first reported case in Australia of a B. pseudomallei isolate resistant to meropenem without previous carbapenem exposure.