title: Metallo-β-lactamases: a last frontier for β-lactams?
abstract: Metallo-β-lactamases are resistance determinants of increasing clinical relevance in Gram-negative bacteria. Because of their broad range, potent carbapenemase activity and resistance to inhibitors, these enzymes can confer resistance to almost all β-lactams. Since the 1990s, several metallo-β-lactamases encoded by mobile DNA have emerged in important Gram-negative pathogens (ie, in Enterobacteriaceae, Pseudomonas aeruginosa, and Acinetobacter baumannii). Some of these enzymes (eg, VIM-1 and NDM-1) have been involved in the recent crisis resulting from the international dissemination of carbapenem-resistant Klebsiella pneumoniae and other enterobacteria. Although substantial knowledge about the molecular biology and genetics of metallo-β-lactamases is available, epidemiological data are inconsistent and clinical experience is still lacking; therefore, several unsolved or debatable issues remain about the management of infections caused by producers of metallo-β-lactamase. The spread of metallo-β-lactamases presents a major challenge both for treatment of individual patients and for policies of infection control, exposing the substantial unpreparedness of public health structures in facing up to this emergency.
authors.affiliation: Department of Pathology and Diagnostics, University of Verona, Verona, Italy. giuseppe.cornaglia@univr.it
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Cornaglia
authors.forename: Helen
authors.initials: H
authors.lastname: Giamarellou
authors.forename: Gian Maria
authors.initials: GM
authors.lastname: Rossolini
mesh_terms: D000900:Anti-Bacterial Agents / Q000494:pharmacology*; D015964:Gene Expression Regulation, Bacterial / Q000502:physiology; D006090:Gram-Negative Bacteria / Q000187:drug effects* / Q000201:enzymology* / Q000235:genetics; D018440:beta-Lactam Resistance / Q000235:genetics*; D001618:beta-Lactamases / Q000145:classification*; D047090:beta-Lactams / Q000494:pharmacology*
chemical_list: D000900:Anti-Bacterial Agents; D047090:beta-Lactams; D001618:beta-Lactamases