title: Characteristics and management of Enterobacteriaceae harboring IMP-4 or IMP-8 carbapenemase in a tertiary hospital.
abstract: BACKGROUND
  The emergence of Enterobacteriaceae harboring IMP-4 or IMP-8 carbapenemases is rare. We report an occurrence of Enterobacteriaceae harboring IMP-4 or IMP-8 carbapenemases in a Chinese tertiary care hospital from November 2010 to December 2012.
  
  
  METHODS
  The clinical characteristics of 30 patients were described. The genetic relationship of isolates was determined by pulsed-field gel electrophoresis (PFGE). Carbapenemases were detected by modified Hodge test (MHT) and polymerase chain reactions (PCRs). Amplicons were sequenced and blasted to determine the genotype.
  
  
  RESULTS
  Most infected patients were from intensive care unit and had complex and serious underlying illnesses requiring mechanical ventilation. PFGE revealed that Klebsiella pneumoniae showed two major PFGE types. Two Klebsiella oxytoca had an indistinguishable PFGE pattern, while four Enterobacter cloacae were different strains. The sequencing studies showed Enterobacteriaceae harboring IMP-4 or IMP-8 carbapenemase in the 23 infected patients. The majority of patients had infections with the carbapenemase-producing Enterobacteriaceae (CPE) strain, most were successfully treated with a range of antibiotics and discharged.
  
  
  CONCLUSIONS
  It is important to maintain a high index of suspicion to screen for carbapenemase-producing Enterobacteriaceae strains. Rapid identification of these strains and implementation of stringent procedures are the key to prevent major outbreaks in a hospital setting.
authors.affiliation: Department of Clinical Laboratory, Qilu Hospital of Shandong University, Jinan, Shandong 250012, P.R. China; Department of Clinical Laboratory, Liaocheng People's Hospital, Liaocheng, Shandong 252000, P.R. China.
authors.forename: Feng
authors.initials: F
authors.lastname: Pang
authors.affiliation: Department of Clinical Pharmacy, Liaocheng People's Hospital, Liaocheng, Shandong 252000, P.R. China.
authors.forename: Xiu-Qin
authors.initials: XQ
authors.lastname: Jia
authors.affiliation: Department of Clinical Laboratory, Liaocheng People's Hospital, Liaocheng, Shandong 252000, P.R. China.
authors.forename: Zhen-Zhu
authors.initials: ZZ
authors.lastname: Song
authors.affiliation: Department of Clinical Laboratory, Liaocheng People's Hospital, Liaocheng, Shandong 252000, P.R. China.
authors.forename: Yan-Hua
authors.initials: YH
authors.lastname: Li
authors.affiliation: Department of Clinical Laboratory, Liaocheng People's Hospital, Liaocheng, Shandong 252000, P.R. China.
authors.forename: Bin
authors.initials: B
authors.lastname: Wang
authors.affiliation: Department of Clinical Laboratory, Liaocheng People's Hospital, Liaocheng, Shandong 252000, P.R. China.
authors.forename: Qi-Gang
authors.initials: QG
authors.lastname: Zhao
authors.affiliation: Department of Clinical Laboratory, Qilu Hospital of Shandong University, Jinan, Shandong 250012, P.R. China.
authors.forename: Chuan-Xin
authors.initials: CX
authors.lastname: Wang
authors.affiliation: Department of Clinical Laboratory, Qilu Hospital of Shandong University, Jinan, Shandong 250012, P.R. China.
authors.forename: Yi
authors.initials: Y
authors.lastname: Zhang
authors.affiliation: School of Biomedical Sciences, Charles Sturt University, Wagga Wagga, NSW, Australia.
authors.forename: Le-Xin
authors.initials: LX
authors.lastname: Wang
mesh_terms: D000328:Adult; D000368:Aged; D000900:Anti-Bacterial Agents / Q000494:pharmacology / Q000627:therapeutic use; D001426:Bacterial Proteins / Q000302:isolation & purification*; D002675:Child, Preschool; D002681:China / Q000453:epidemiology; D016521:Electrophoresis, Gel, Pulsed-Field; D004755:Enterobacteriaceae / Q000201:enzymology* / Q000235:genetics; D004756:Enterobacteriaceae Infections / Q000188:drug therapy / Q000201:enzymology* / Q000235:genetics; D005260:Female; D006801:Humans; D007231:Infant, Newborn; D007709:Klebsiella / Q000201:enzymology / Q000235:genetics; D008297:Male; D008826:Microbial Sensitivity Tests; D008875:Middle Aged; D016133:Polymerase Chain Reaction; D062606:Tertiary Care Centers; D001618:beta-Lactamases / Q000302:isolation & purification*
chemical_list: D000900:Anti-Bacterial Agents; D001426:Bacterial Proteins; C436760:IMP-8 enzyme; C425142:beta-lactamase IMP-4; D001618:beta-Lactamases; C063912:carbapenemase
keywords: Carbapenemase; Enterobacteriaceae; IMP-4; IMP-8; clinical outcome