title: Coproduction of KPC-18 and VIM-1 Carbapenemases by Enterobacter cloacae: Implications for Newer β-Lactam-β-Lactamase Inhibitor Combinations.
abstract: Enterobacter cloacae strain G6809 with reduced susceptibility to carbapenems was identified from a patient in a long-term acute care hospital in Kentucky. G6809 belonged to sequence type (ST) 88 and carried two carbapenemase genes, bla(KPC-18) and bla(VIM-1). Whole-genome sequencing localized bla(KPC-18) to the chromosome and bla(VIM-1) to a 58-kb plasmid. The strain was highly resistant to ceftazidime-avibactam. Insidious coproduction of metallo-β-lactamase with KPC-type carbapenemase has implications for the use of next-generation β-lactam-β-lactamase inhibitor combinations.
authors.affiliation: Department of Microbiology, University of Louisville Hospital, Louisville, Kentucky, USA Department of Pathology and Laboratory Medicine, University of Louisville, Louisville, Kentucky, USA.
authors.forename: Gina K
authors.initials: GK
authors.lastname: Thomson
authors.affiliation: Department of Pathology and Laboratory Medicine, University of Louisville, Louisville, Kentucky, USA.
authors.forename: James W
authors.initials: JW
authors.lastname: Snyder
authors.affiliation: Division of Infectious Diseases, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA.
authors.forename: Christi L
authors.initials: CL
authors.lastname: McElheny
authors.affiliation: Department of Pathology and Laboratory Medicine, University of Louisville, Louisville, Kentucky, USA.
authors.forename: Kenneth S
authors.initials: KS
authors.lastname: Thomson
authors.affiliation: Division of Infectious Diseases, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA yod4@pitt.edu.
authors.forename: Yohei
authors.initials: Y
authors.lastname: Doi
mesh_terms: D000900:Anti-Bacterial Agents / Q000494:pharmacology; D001426:Bacterial Proteins / Q000096:biosynthesis*; D024881:Drug Resistance, Bacterial; D016972:Enterobacter cloacae / Q000187:drug effects / Q000201:enzymology* / Q000235:genetics; D004756:Enterobacteriaceae Infections / Q000382:microbiology*; D023061:Gene Order; D056426:Genetic Loci; D006801:Humans; D008826:Microbial Sensitivity Tests; D065093:beta-Lactamase Inhibitors / Q000494:pharmacology; D001618:beta-Lactamases / Q000096:biosynthesis*; D047090:beta-Lactams / Q000494:pharmacology
chemical_list: D000900:Anti-Bacterial Agents; D001426:Bacterial Proteins; D065093:beta-Lactamase Inhibitors; D047090:beta-Lactams; D001618:beta-Lactamases; C063912:carbapenemase