Clinical and Bacteriological Characteristics of IMP-Type Metallo-β-Lactamase-Producing Pseudomonas aeruginosa

Hirakata, Yoichi; Yamaguchi, Toshiyuki; Nakano, Michiko; Izumikawa, Koichi; Mine, Mariko; Aoki, Shigenobu; Kondoh, Akira; Matsuda, Junichi; Hirayama, Mitsukuni; Yanagihara, Katsunori; Miyazaki, Yoshitsugu; Tomono, Kazunori; Yamada, Yasuaki; Kamihira, Shimeru; Kohno, Shigeru

doi:10.1086/375594

Cited by 80 publications

(80 citation statements)

References 28 publications

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“…A case-controlled study from Japan showed that patients infected with MBL-producing P. aeruginosa were more likely to receive multiple antibiotics and, more importantly, that infection-related deaths due to IMP-producing P. aeruginosa were more frequent than deaths caused by bla IMPnegative P. aeruginosa (14). The occurrence of an MBL-positive isolate in a hospital setting poses a therapeutic problem, as well as a serious concern for infection control management.…”

Section: Discussionmentioning

confidence: 99%

Detection of Pseudomonas aeruginosa Producing Metallo-β-Lactamases in a Large Centralized Laboratory

et al. 2005

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Metallo-␤-lactamases (MBLs) have been increasingly recognized from clinical isolates worldwide, but the laboratory detection of these strains is not well defined. We report a study that developed an EDTA disk screen test and a molecular diagnostic assay for the detection of MBL-producing Pseudomonas aeruginosa. Using NCCLS disk methodology, inhibition zone diameters were determined in tests with imipenem (IPM) and meropenem (MEM) disks alone and in combination with 930 g of EDTA. This test was compared with the MBL Etest. The duplex PCR assay showed 100% sensitivity and specificity for detecting MBL-producing control strains. Of the 241 clinical strains of IPM-nonsusceptible P. aeruginosa from the Calgary Health Region isolated from 2002 to 2004, 110/241 (46%) were MBL positive using phenotypic methods while 107/241 (45%) were PCR positive for MBL genes: 103/241 (43%) for bla VIM and 4/241 (2%) for bla IMP . The EDTA disk screen test using MEM showed 100% sensitivity and 97% specificity for detecting MBLs in control and clinical strains. The EDTA disk screen test is simple to perform and to interpret and can easily be introduced into the workflow of a clinical laboratory. We recommend that all IPM-nonsusceptible P. aeruginosa isolates be routinely screened for MBL production using the EDTA disk screen test and that PCR confirmation be performed at a regional laboratory.Pseudomonas aeruginosa producing metallo-␤-lactamases (MBLs) was first reported from Japan in 1991 (43) and since then has been described from various parts of the world, in-

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Section: Discussionmentioning

confidence: 99%

Detection of Pseudomonas aeruginosa Producing Metallo-β-Lactamases in a Large Centralized Laboratory

et al. 2005

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“…They spread first in Japan and Korea and more recently in Europe (4,26,27) and the Americas (7,11). Large outbreaks by MBL-producing P. aeruginosa strains have been described in hospitals in Italy, Greece, and Korea (4,14,16,18,20,29), as well as in Latin America, notably, including one caused by a P. aeruginosa strain with an SPM-1 ␤-lactamase in Brazil (7). The SENTRY surveillance program for 1999 to 2002 reported MBLs in P. aeruginosa and/or Acinetobacter spp.…”

Section: Description Of Outbreakmentioning

confidence: 99%

Outbreak of Carbapenem-Resistant Pseudomonas aeruginosa Producing VIM-8, a Novel Metallo-β-Lactamase, in a Tertiary Care Center in Cali, Colombia

Crespo

Woodford²,

Sinclair³

et al. 2004

J Clin Microbiol

143

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The prevalence of imipenem resistance among Pseudomonas aeruginosa isolates at a 195-bed tertiary care medical center in Cali, Colombia, rose from 2% in 1996 to 28% in 1997 and to over 40% in 2003. Many isolates showed high-level multiresistance, and phenotypic characterization suggested the spread of a predominant strain with minor variants. Sixty-six resistant isolates collected between February 1999 and July 2003 from hospitalized patients (n ‫؍‬ 54) and environmental samples (n ‫؍‬ 12) were subjected to a fuller analysis. Genetic fingerprints were compared by pulsed-field gel electrophoresis (PFGE) of SpeI-digested genomic DNA, and bla IMP and bla VIM genes were sought by PCR. PFGE and serotyping indicated that 52 of the 66 isolates belonged to a single strain, with 82% similarity; the PFGE pattern for this organism was designated pattern A. Two further pairs of isolates represented single strains; the remaining nine isolates were unique, and in the case of one isolate, no satisfactory PFGE profile could be obtained. The pattern A isolates were mostly of serotype O12 and were highly resistant to imipenem (MICs, 32 to >256 g/ml), with this resistance decreased eightfold or more in the presence of EDTA. They yielded amplicons with bla VIM -specific primers, and sequencing of DNA from a representative isolate revealed bla VIM-8 , a novel allele with three polymorphisms compared with the sequence of bla VIM-2 . Two of these nucleotide changes were silent, but the third determined a Thr139Ala substitution. Only 4 of 13 resistant isolates (2 clinical isolates and 2 environmental isolates) assigned to other PFGE types carried bla VIM alleles, whereas the others were less multiresistant and mostly had lower levels of imipenem resistance (MICs, <32 g/ml) which was not significantly reduced by EDTA. No bla IMP alleles were detected. During 2003, when the environmental study was undertaken, serotype O12 isolates with bla VIM were recovered from sinks and stethoscopes in the most-affected units, although not from the hands of staff; the problem declined once these reservoirs were disinfected and hygienic precautions were reinforced.

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“…A particular concern is that acquired MBL genes are located on integron structures that reside on mobile genetic elements such as plasmids or transposons (23), thus enabling widespread dissemination. Clinical infections with such organisms pose serious therapeutic challenges, with increasing reports of poor patient outcomes and death (5,8,14).…”

mentioning

confidence: 99%

Phenotypic Detection of Carbapenem-Susceptible Metallo-β-Lactamase-Producing Gram-Negative Bacilli in the Clinical Laboratory

2006

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Rapid detection of metallo-␤-lactamase (MBL)-producing gram-negative pathogens is critical to prevent their widespread dissemination. Thus far, no standardized phenotypic method is available, and previously reported techniques have poor sensitivity for detecting carbapenem-susceptible MBL-carrying isolates, an increasingly described phenomenon. We developed a phenotypic detection method using both a double-disk synergy test and a combined-disk test with imipenem and 292 g EDTA on one agar plate. Genotypic confirmation was used for validation. Of the 134 clinical isolates, 84 were confirmed to carry an MBL. Of these, 51 (61%) were susceptible to at least one carbapenem, and 22 (26%) were isolated from blood. The phenotypic method correctly differentiated all MBL-producing isolates (sensitivity, 100%). Fifty-one of the 52 MBLnegative isolates were correctly differentiated (specificity, 98%). This study reports the validation of a simple and accurate MBL detection method that can be easily incorporated into the daily routine of a clinical laboratory. Early detection of MBL-carrying organisms, including those with susceptibility to carbapenems, is of paramount clinical importance, as it allows rapid initiation of strict infection control practices as well as therapeutic guidance for confirmed infection.

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Clinical and Bacteriological Characteristics of IMP-Type Metallo-β-Lactamase-Producing Pseudomonas aeruginosa

Cited by 80 publications

References 28 publications

Detection of Pseudomonas aeruginosa Producing Metallo-β-Lactamases in a Large Centralized Laboratory

Detection of Pseudomonas aeruginosa Producing Metallo-β-Lactamases in a Large Centralized Laboratory

Outbreak of Carbapenem-Resistant Pseudomonas aeruginosa Producing VIM-8, a Novel Metallo-β-Lactamase, in a Tertiary Care Center in Cali, Colombia

Phenotypic Detection of Carbapenem-Susceptible Metallo-β-Lactamase-Producing Gram-Negative Bacilli in the Clinical Laboratory

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