title: Three cases of IMP-type metallo-β-lactamase-producing Enterobacter cloacae bloodstream infection in Japan.
abstract: We report three cases of IMP-type metallo-β-lactamase-producing Enterobacter cloacae bloodstream infection, which showed minimum inhibitory concentration values for imipenem with 2 μg/ml in all isolates. Although carbapenems were initiated empirically in all cases, two of three cases died. The Clinical and Laboratory Standards Institute lowered the breakpoints of carbapenems for Enterobacteriaceae in 2010. However, the previous breakpoints are still used in many clinical laboratories, which can result in failure to detect carbapenem-resistant Enterobacteriaceae. Therefore, lower breakpoints of carbapenems should be used in clinical settings, and alternative tests for detecting metallo-β-lactamase such as polymerase chain reaction and immunochromatographic assays may contribute to better detection of carbapenem-resistant isolates.
authors.affiliation: Division of Infectious Diseases, Disease Control and Prevention Center, National Center for Global Health and Medicine, 1-21-1 Toyama, Shinjuku, Tokyo, 162-8655, Japan.
authors.forename: Yohei
authors.initials: Y
authors.lastname: Hamada
authors.forename: Koji
authors.initials: K
authors.lastname: Watanabe
authors.forename: Tatsuya
authors.initials: T
authors.lastname: Tada
authors.forename: Tada
authors.initials: T
authors.lastname: Tatsuya
authors.forename: Kazuhisa
authors.initials: K
authors.lastname: Mezaki
authors.forename: Sosuke
authors.initials: S
authors.lastname: Takeuchi
authors.forename: Toshio
authors.initials: T
authors.lastname: Shimizu
authors.forename: Teruo
authors.initials: T
authors.lastname: Kirikae
authors.forename: Norio
authors.initials: N
authors.lastname: Ohmagari
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000494:pharmacology / Q000627:therapeutic use; D016470:Bacteremia / Q000188:drug therapy / Q000382:microbiology*; D001426:Bacterial Proteins; D016972:Enterobacter cloacae / Q000187:drug effects / Q000201:enzymology* / Q000302:isolation & purification; D004756:Enterobacteriaceae Infections / Q000188:drug therapy / Q000382:microbiology*; D006801:Humans; D007564:Japan; D008297:Male; D008826:Microbial Sensitivity Tests; D018440:beta-Lactam Resistance; D001618:beta-Lactamases / Q000096:biosynthesis*
chemical_list: D000900:Anti-Bacterial Agents; D001426:Bacterial Proteins; D001618:beta-Lactamases