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Antimicrob Agents Chemother. 2014 Jun;58(6):3441-50. doi: 10.1128/AAC.02652-13. Epub 2014 Apr 7.

Molecular and epidemiological characterization of IMP-type metallo-β-lactamase-producing Enterobacter cloacae in a Large tertiary care hospital in Japan.

Author information

1
Disease Control and Prevention Center, National Center for Global Health and Medicine, Tokyo, Japan kayokohayakawa@gmail.com.
2
Department of Infectious Diseases, Research Institute, National Center for Global Health and Medicine, Tokyo, Japan.
3
Disease Control and Prevention Center, National Center for Global Health and Medicine, Tokyo, Japan Department of Infectious Diseases, Research Institute, National Center for Global Health and Medicine, Tokyo, Japan.
4
Microbiology Laboratory, National Center for Global Health and Medicine, Tokyo, Japan.
5
Infection Control and Prevention, National Center for Global Health and Medicine, Tokyo, Japan.
6
Disease Control and Prevention Center, National Center for Global Health and Medicine, Tokyo, Japan.

Abstract

IMP-type metallo-β-lactamase enzymes have been reported in different geographical areas and in various Gram-negative bacteria. However, the risk factors and epidemiology pertaining to IMP-type metallo-β-lactamase-producing Enterobacter cloacae (IMP-producing E. cloacae) have not been systematically evaluated. We conducted a retrospective, matched case-control study of patients from whom IMP-producing E. cloacae isolates were obtained, in addition to performing thorough molecular analyses of the clinically obtained IMP-producing E. cloacae isolates. Unique cases with IMP-producing E. cloacae isolation were included. Patients with IMP-producing E. cloacae were matched to uninfected controls at a ratio of 1 to 3. Fifteen IMP-producing E. cloacae cases were identified, with five of the isolates being obtained from blood, and they were matched to 45 uninfected controls. All (100%) patients from whom IMP-producing E. cloacae isolates were obtained had indwelling devices at the time of isolation, compared with one (2.2%) uninfected control. Independent predictors for isolation of IMP-producing E. cloacae were identified as cephalosporin exposure and invasive procedures within 3 months. Although in-hospital mortality rates were similar between cases and controls (14.3% versus 13.3%), the in-hospital mortality of patients with IMP-producing E. cloacae-caused bacteremia was significantly higher (40%) than the rate in controls. IMP-producing E. cloacae isolates were frequently positive for other resistance determinants. The MICs of meropenem and imipenem were not elevated; 10 (67%) and 12 (80%) of the 15 IMP-producing E. cloacae isolates had a MIC of ≤ 1 μg/ml. A phylogenetic tree showed a close relationship among the IMP-producing E. cloacae samples. Indwelling devices, exposure to cephalosporin, and a history of invasive procedures were associated with isolation of IMP-producing E. cloacae. Screening for carbapenemase production is important in order to apply appropriate clinical management and infection control measures.

PMID:
24709261
PMCID:
PMC4068452
DOI:
10.1128/AAC.02652-13
[Indexed for MEDLINE]
Free PMC Article

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