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Journal of Clinical Microbiology, November 2009, p. 3514-3519, Vol. 47, No. 11
0095-1137/09/$08.00+0     doi:10.1128/JCM.01193-09
Copyright © 2009, American Society for Microbiology. All Rights Reserved.

Infections with VIM-1 Metallo-β-Lactamase-Producing Enterobacter cloacae and Their Correlation with Clinical Outcome{triangledown}

Marco Falcone,1 Maria Lina Mezzatesta,2 Mariagrazia Perilli,3 Chiara Forcella,3 Alessandra Giordano,4 Viviana Cafiso,2 Gianfranco Amicosante,3 Stefania Stefani,2 and Mario Venditti1*

Nosocomial Infections Unit, Department of Infectious Diseases, Policlinico Umberto I, University of Rome La Sapienza,1 Department of Microbiology, University of Catania,2 Department of Biomedical Sciences and Technologies, University of L'Aquila,3 Department of Microbiology, Policlinico Umberto I, University of Rome La Sapienza, Rome, Italy4

Received 17 June 2009/ Returned for modification 2 August 2009/ Accepted 1 September 2009

The aim of this study was to ascertain the incidence and clinical significance of metallo-β-lactamases among Enterobacter strains isolated from patients with nosocomial infections. We prospectively collected data on patients with Enterobacter infection during a 13-month period. All of the strains were investigated for antibiotic susceptibility, the presence and expression of metallo-β-lactamases, and clonality. Of 29 infections (11 involving the urinary tract, 7 pneumonias, 3 skin/soft tissue infections, 3 intra-abdominal infections, 3 bacteremias, and 2 other infections), 7 (24%) were caused by Enterobacter cloacae strains harboring a blaVIM-1 gene associated or not with a blaSHV12 gene. Infections caused by VIM-1-producing strains were more frequently associated with a recent prior hospitalization (P = 0.006), cirrhosis (P = 0.03), relapse of infection (P < 0.001), and more prolonged duration of antibiotic therapy (P = 0.01) than were other infections. All of the isolates were susceptible to imipenem and meropenem and had blaVIM-1 preceded by a weak P1 promoter and inactivated P2 promoters. Most VIM-1-producing Enterobacter isolates belonged to a main clone, but four different clones were found. Multiclonal VIM-1-producing E. cloacae infections are difficult to diagnose due to an apparent susceptibility to various beta-lactams, including carbapenems, and are associated with a high relapse rate and a more prolonged duration of antibiotic therapy.

* Corresponding author. Mailing address: Nosocomial Infections Unit, Department of Infectious Diseases and Tropical Medicine, Policlinico Umberto I, University of Rome La Sapienza, Viale dell'Università 37, 00185 Rome, Italy. Phone: 39 0649972083. Fax: 39 064940421. E-mail: mario.venditti{at}uniroma1.it

{triangledown} Published ahead of print on 9 September 2009.

Journal of Clinical Microbiology, November 2009, p. 3514-3519, Vol. 47, No. 11
0095-1137/09/$08.00+0     doi:10.1128/JCM.01193-09
Copyright © 2009, American Society for Microbiology. All Rights Reserved.





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