title: 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.affiliation: Nosocomial Infections Unit, Department of Infectious Diseases and Tropical Medicine, Policlinico Umberto I, University of Rome La Sapienza, Viale dell'Università 37, 00185 Rome, Italy.
authors.forename: Marco
authors.initials: M
authors.lastname: Falcone
authors.forename: Maria Lina
authors.initials: ML
authors.lastname: Mezzatesta
authors.forename: Mariagrazia
authors.initials: M
authors.lastname: Perilli
authors.forename: Chiara
authors.initials: C
authors.lastname: Forcella
authors.forename: Alessandra
authors.initials: A
authors.lastname: Giordano
authors.forename: Viviana
authors.initials: V
authors.lastname: Cafiso
authors.forename: Gianfranco
authors.initials: G
authors.lastname: Amicosante
authors.forename: Stefania
authors.initials: S
authors.lastname: Stefani
authors.forename: Mario
authors.initials: M
authors.lastname: Venditti
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000494:pharmacology / Q000627:therapeutic use*; D015373:Bacterial Typing Techniques; D003428:Cross Infection / Q000188:drug therapy* / Q000382:microbiology*; D016172:DNA Fingerprinting; D024881:Drug Resistance, Bacterial; D016972:Enterobacter cloacae / Q000145:classification / Q000201:enzymology* / Q000235:genetics / Q000302:isolation & purification; D004756:Enterobacteriaceae Infections / Q000188:drug therapy* / Q000382:microbiology*; D005260:Female; D005838:Genotype; D006801:Humans; D008297:Male; D008826:Microbial Sensitivity Tests; D008875:Middle Aged; D016896:Treatment Outcome; D055815:Young Adult; D001618:beta-Lactamases / Q000096:biosynthesis
chemical_list: D000900:Anti-Bacterial Agents; C417264:VIM-1 metallo-beta-lactamase; D001618:beta-Lactamases