Klebsiella pneumoniae clinical isolates that were positive by the imipenem-EDTA double-disk synergy test and that exhibited a single macrorestriction pattern were recovered in two distinct Greek hospitals. The isolates carried a transferable bla VIM-1 metallo--lactamase gene in a class 1 integron. Reverse transcriptase PCR showed that the gene was similarly expressed in low-and high-level carbapenem-resistant isolates, indicating the existence of additional resistance mechanisms. The clonal spread of VIM-1-producing K. pneumoniae strains in distinct regions where up to now bla VIM-2 and bla VIM-4 alleles were common is worrisome.
, nine nonrepetitive isolates of Klebsiella pneumoniae with reduced susceptibility or resistance to carbapenems were recovered from clinical specimens from separate patients hospitalized in a tertiary care hospital. The imipenem-EDTA synergy test was positive for all isolates. PCR, sequencing, and transferability experiments revealed the novel bla VIM-12 metallo--lactamase gene, which was plasmid mediated and located in a class 1 integron. Pulsed-field gel electrophoresis demonstrated a single macrorestriction pattern, indicating the clonal spread of VIM-12-producing K. pneumoniae.Acquired metallo--lactamases (MBLs) constitute a growing class of -lactamases that readily hydrolyze most -lactam antibiotics, including imipenem and meropenem (20). They are usually embedded in class 1 integron structures carrying various gene cassettes and belong to the group B -lactamases according to the classification scheme proposed by Ambler (1). Five different groups of acquired MBLs have been described (IMP, VIM, SPM, GIM, and SIM enzymes), but the first two of these groups have predominated in gram-negative organisms (8,9,13,20). VIM-type MBLs are commonly encountered among nonfermenters in the Far East and southern Europe (14,15,18,21,22), but during the last few years, the respective bla genes have also spread in members of the family Enterobacteriaceae (11,20,23). Reports of VIM-type MBL-producing K. pneumoniae isolates from Greek hospitals are increasing (5, 7). Recently, a novel VIM-type MBL variant, VIM-12, was identified from a clinical isolate of Klebsiella pneumoniae in Greece (16). In this report, we describe an outbreak caused by K. pneumoniae harboring the bla VIM-12 gene. MATERIALS AND METHODSFrom November 2006 to April 2007, nine nonrepetitive K. pneumoniae isolates exhibiting reduced susceptibility or resistance to imipenem were isolated from clinical specimens collected from separate patients hospitalized in different medical and surgical wards at Hippokration General Hospital, Thessaloniki, Greece. All patients had a long-term hospitalization and had been treated with multiple courses of antimicrobials, including carbapenems. Identification of the isolates to the species level and initial antibiotic susceptibility testing were performed by the Vitek-2 automated system (BioMérieux, Marcy l'Étoile, France), by which they were characterized as imipenem intermediate or resistant.Susceptibilities to a range of antimicrobials (amikacin, amoxicillin-clavulanate, ampicillin, aztreonam, cefepime, cefotaxime, cefoxitin, ceftazidime, ciprofloxacin, cotrimoxazole, ertapenem, imipenem, meropenem, and tetracycline) were also determined by disk diffusion (3). MICs of imipenem, meropenem, ertapenem, and tigecycline were additionally determined by Etest (AB Biodisk, Solna, Sweden) and the broth microdilution method (3). Susceptibilities were interpreted according to CLSI guidelines (3), when available. For tigecycline, the U.S.FDA (Food and Drug Administration) recommendation was used (susceptible, Յ2 g/ml; resistant, Ն8...
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