Molecular and Epidemiological Characterization of IMP-Type Metallo-β-Lactamase-Producing Enterobacter cloacae in a Large Tertiary Care Hospital in Japan
| Autor: | Kayo Shimada, Kayoko Hayakawa, Kazuhisa Mezaki, Masayoshi Tojo, Shiho Kubota, Teruo Kirikae, Norio Ohmagari, Maki Nagamatsu, Emi Kuroda, Satoshi Kutsuna, Yuko Sugiki, Tohru Miyoshi-Akiyama, Nozomi Takeshita |
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| Jazyk: | angličtina |
| Rok vydání: | 2014 |
| Předmět: |
Male
Imipenem Cephalosporin Bacteremia Japan Risk Factors Epidemiology polycyclic compounds Infection control Pharmacology (medical) Hospital Mortality Phylogeny Aged 80 and over biology Enterobacteriaceae Infections Middle Aged Infectious Diseases Female medicine.drug Inosine monophosphate medicine.medical_specialty animal structures medicine.drug_class R Factors Meropenem beta-Lactamases Microbiology Epidemiology and Surveillance Bacterial Proteins Inosine Monophosphate Enterobacter cloacae medicine Humans Aged Retrospective Studies Pharmacology Infection Control business.industry Tertiary Healthcare biochemical phenomena metabolism and nutrition biology.organism_classification medicine.disease bacterial infections and mycoses Cephalosporins bacteria Thienamycins business |
| Popis: | 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. |
| Databáze: | OpenAIRE |
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