Infections with VIM-1 metallo-{beta}-lactamase-producing enterobacter cloacae and their correlation with clinical outcome.

Abstract

The aim of this study was to ascertain the incidence and clinical significance of metallo-beta-lactamases among Enterobacter strains isolated from patients with nosocomial infections. We prospectively collected data on patients with Enterobacter infection during a 13-month period. All of the strains were investigated for antibiotic susceptibility, the presence and expression of metallo-beta-lactamases, and clonality. Of 29 infections (11 involving the urinary tract, 7 pneumonias, 3 skin/soft tissue infections, 3 intra-abdominal infections, 3 bacteremias, and 2 other infections), 7 (24%) were caused by Enterobacter cloacae strains harboring a bla(VIM-1) gene associated or not with a bla(SHV12) gene. Infections caused by VIM-1-producing strains were more frequently associated with a recent prior hospitalization (P = 0.006), cirrhosis (P = 0.03), relapse of infection (P < 0.001), and more prolonged duration of antibiotic therapy (P = 0.01) than were other infections. All of the isolates were susceptible to imipenem and meropenem and had bla(VIM-1) preceded by a weak P1 promoter and inactivated P2 promoters. Most VIM-1-producing Enterobacter isolates belonged to a main clone, but four different clones were found. Multiclonal VIM-1-producing E. cloacae infections are difficult to diagnose due to an apparent susceptibility to various beta-lactams, including carbapenems, and are associated with a high relapse rate and a more prolonged duration of antibiotic therapy.

• Authors: Marco Falcone, Maria Lina Mezzatesta, Mariagrazia Perilli, Chiara Forcella, Alessandra Giordano, Viviana Cafiso, Gianfranco Amicosante, Stefania Stefani, Mario Venditti
• Journal: Journal of clinical microbiology (J Clin Microbiol) Vol. 47 Issue 11 Pg. 3514-9 (Nov 2009) ISSN: 1098-660X [Electronic] United States
• PMID: 19741074 (Publication Type: Journal Article, Research Support, Non-U.S. Gov't)

Chemical References

• Anti-Bacterial Agents
• VIM-1 metallo-beta-lactamase
• beta-Lactamases

Topics

• Adult
• Aged
• Aged, 80 and over
• Anti-Bacterial Agents (pharmacology, therapeutic use)
• Bacterial Typing Techniques
• Cross Infection (drug therapy, microbiology)
• DNA Fingerprinting
• Drug Resistance, Bacterial
• Enterobacter cloacae (classification, enzymology, genetics, isolation & purification)
• Enterobacteriaceae Infections (drug therapy, microbiology)
• Female
• Genotype
• Humans
• Male
• Microbial Sensitivity Tests
• Middle Aged
• Treatment Outcome
• Young Adult
• beta-Lactamases (biosynthesis)