title: Emergence of carbapenem-resistant Enterobacter cloacae carrying VIM-4 metallo-beta-lactamase and SHV-2a extended-spectrum beta-lactamase in a conjugative plasmid.
abstract: Enterobacter cloacae strains are still infrequently resistant to carbapenems. A carbapenem-resistant clinical isolate of E. cloacae producing a plasmid-mediated metallo-beta-lactamase (MBL), VIM-4, was recovered from a Greek hospitalized patient. The bla(VIM-4) gene was located in the variable array of a class 1 integron structure repeatedly detected among bla(VIM-1)-bearing Gram-negative pathogens in Greece. The isolate possessed also on the same conjugative plasmid an extended-spectrum beta-lactamase (ESBL), SHV-2a, which contributed to the beta-lactam-resistant phenotype. This is the first report showing co-transfer of an ESBL with a VIM-type MBL. It suggests also that different VIM-type gene cassettes have been incorporated in a common integron structure, which seems indigenous of Gram-negative pathogens in our region.
authors.affiliation: Department of Medical Microbiology, University of Thessalia, 412 22 Larissa, Greece.
authors.forename: Alexandros
authors.initials: A
authors.lastname: Ikonomidis
authors.forename: Nicholas
authors.initials: N
authors.lastname: Spanakis
authors.forename: Aggeliki
authors.initials: A
authors.lastname: Poulou
authors.forename: Spyros
authors.initials: S
authors.lastname: Pournaras
authors.forename: Fani
authors.initials: F
authors.lastname: Markou
authors.forename: Athanassios
authors.initials: A
authors.lastname: Tsakris
mesh_terms: D015780:Carbapenems / Q000494:pharmacology*; D003227:Conjugation, Genetic; D016972:Enterobacter cloacae / Q000187:drug effects* / Q000201:enzymology / Q000235:genetics; D032023:Integrons; D008826:Microbial Sensitivity Tests; D010957:Plasmids; D018440:beta-Lactam Resistance; D001618:beta-Lactamases / Q000235:genetics*
chemical_list: D015780:Carbapenems; C490029:beta-lactamase SHV-2a; D001618:beta-Lactamases; C482459:metallo-beta-lactamase VIM-4, Enterobacter cloacae