title: Survey of metallo-β-lactamase-producing Enterobacteriaceae colonizing patients in European ICUs and rehabilitation units, 2008-11.
abstract: OBJECTIVE
  The objective of this study was to perform a multinational survey of patients' colonization by metallo-β-lactamase (MBL)-producing Enterobacteriaceae, including their molecular characterization.
  
  
  METHODS
  Patients in 18 hospital units across Europe and Israel (n = 17 945) were screened between mid-2008 and mid-2011. MBL-producing isolates were typed by PFGE and MLST. MBL genes were amplified and sequenced within their integrons. Plasmids with MBL genes were analysed by nuclease S1 plus hybridization profiling, mating and transformation assays, and by PCR-based replicon typing.
  
  
  RESULTS
  Ninety-one patients in nine centres (six countries), including 62 patients in two Greek ICUs, carried 94 non-duplicate MBL-producing organisms. Klebsiella pneumoniae isolates from Greece dominated (n = 57) and belonged mainly to ST147, ST36 and ST383. All but one of the isolates expressed VIM-1-type MBLs. Isolates of Greek origins produced five enzymes, including new VIM-39, encoded by class 1 integrons of four types. In-e541-like elements prevailed, comprising six variants located on IncR, IncFIIK, IncR + FIIK, IncR + A/C or non-typeable plasmids. The other group were new In4873 and In4863, being the first In416-like elements identified in Greece, which were present on IncA/C or non-typeable plasmids. Isolates from other countries produced only VIM-1 and the major integron was In916, identified in 16 organisms from France, Italy and Spain. In916 was carried by four plasmid types, including IncA/C, IncFIIK and IncHI2. Other integrons included a new element, In3103, in Spain and In110 identified only in Latvia.
  
  
  CONCLUSIONS
  This study provided fully comparable data on the occurrence and molecular characteristics of VIM-producing Enterobacteriaceae in a group of hospital units across Europe, documenting recent changes in their epidemiology.
authors.affiliation: National Medicines Institute, Warsaw, Poland Faculty of Medicine in Plzeň, Charles University in Prague, Plzeň, Czech Republic.
authors.forename: C C
authors.initials: CC
authors.lastname: Papagiannitsis
authors.affiliation: National Medicines Institute, Warsaw, Poland.
authors.forename: R
authors.initials: R
authors.lastname: Izdebski
authors.affiliation: National Medicines Institute, Warsaw, Poland.
authors.forename: A
authors.initials: A
authors.lastname: Baraniak
authors.affiliation: National Medicines Institute, Warsaw, Poland.
authors.forename: J
authors.initials: J
authors.lastname: Fiett
authors.affiliation: National Medicines Institute, Warsaw, Poland.
authors.forename: M
authors.initials: M
authors.lastname: Herda
authors.affiliation: Faculty of Medicine in Plzeň, Charles University in Prague, Plzeň, Czech Republic.
authors.forename: J
authors.initials: J
authors.lastname: Hrabák
authors.affiliation: University Medical Center Utrecht, Utrecht, The Netherlands.
authors.forename: L P G
authors.initials: LP
authors.lastname: Derde
authors.affiliation: University Medical Center Utrecht, Utrecht, The Netherlands.
authors.forename: M J M
authors.initials: MJ
authors.lastname: Bonten
authors.affiliation: Tel-Aviv Sourasky Medical Center, Tel-Aviv, Israel.
authors.forename: Y
authors.initials: Y
authors.lastname: Carmeli
authors.affiliation: University of Antwerp, Antwerp, Belgium.
authors.forename: H
authors.initials: H
authors.lastname: Goossens
authors.affiliation: National Medicines Institute, Warsaw, Poland.
authors.forename: W
authors.initials: W
authors.lastname: Hryniewicz
authors.affiliation: INSERM, U957 & Université Paris-Est, Créteil, France.
authors.forename: C
authors.initials: C
authors.lastname: Brun-Buisson
authors.affiliation: National Medicines Institute, Warsaw, Poland gniadkow@cls.edu.pl.
authors.forename: M
authors.initials: M
authors.lastname: Gniadkowski
mesh_terms: D002353:Carrier State / Q000453:epidemiology* / Q000382:microbiology; D004269:DNA, Bacterial / Q000737:chemistry / Q000235:genetics; D016521:Electrophoresis, Gel, Pulsed-Field; D004755:Enterobacteriaceae / Q000145:classification / Q000201:enzymology* / Q000235:genetics / Q000302:isolation & purification; D004756:Enterobacteriaceae Infections / Q000453:epidemiology* / Q000382:microbiology; D005060:Europe / Q000453:epidemiology; D005798:Genes, Bacterial; D006761:Hospitals; D006801:Humans; D007362:Intensive Care Units; D017720:Molecular Epidemiology; D058885:Multilocus Sequence Typing; D010957:Plasmids / Q000032:analysis; D016133:Polymerase Chain Reaction; D017422:Sequence Analysis, DNA; D001618:beta-Lactamases / Q000378:metabolism*
chemical_list: D004269:DNA, Bacterial; D001618:beta-Lactamases
keywords: MBLs; MLST; VIM; integrons; plasmids