Characteristics and management of Enterobacteriaceae harboring IMP-4 or IMP-8 carbapenemase in a tertiary hospital

Abstract

Background: The emergence of Enterobacteriaceae harboring IMP-4 or IMP-8 carbapenemases is rare. We report an occurrence of Enterobacteriaceae harboring IMP-4 or IMP-8 carbapenemases in a Chinese tertiary care hospital from November 2010 to December 2012. Methods: The clinical characteristics of 30 patients were described. The genetic relationship of isolates was determined by pulsed-field gel electrophoresis (PFGE). Carbapenemases were detected by modified Hodge test (MHT) and polymerase chain reactions (PCRs). Amplicons were sequenced and blasted to determine the genotype. Results: Most infected patients were from intensive care unit and had complex and serious underlying illnesses requiring mechanical ventilation. PFGE revealed that Klebsiella pneumoniae showed two major PFGE types. Two Klebsiella oxytoca had an indistinguishable PFGE pattern, while four Enterobacter cloacae were different strains. The sequencing studies showed Enterobacteriaceae harboring IMP-4 or IMP-8 carbapenemase in the 23 infected patients. The majority of patients had infections with the carbapenemase-producing Enterobacteriaceae (CPE) strain, most were successfully treated with a range of antibiotics and discharged. Conclusion: It is important to maintain a high index of suspicion to screen for carbapenemase-producing Enterobacteriaceae strains. Rapid identification of these strains and implementation of stringent procedures are the key to prevent major outbreaks in a hospital setting.

Factors associated to prevalence and treatment of carbapenem-resistant Enterobacteriaceae infections: a seven years retrospective study in three tertiary care hospitals

“…Carbapenem resistance was defined according to CLSI M100S, 26th [ 11 ]. The resistance mechanisms of CRE was proved by modified Hodge test and sequencing as our previous studies [ 12 ].…”

Carbapenemase-producing Enterobacteriaceae in Mexico: report of seven non-clonal cases in a pediatric hospital

“…To date, K. oxytoca has rarely been associated with carbapenemase production [ 17 ]. In Mexico, K. oxytoca has been related to VIM-2 production [ 18 ]; in other Latin American countries, production of other carbapenemases, including KPC-2 [ 19 ], IMP-4 [ 20 ], and VIM-4, have also been reported [ 21 ].…”

Molecular Characteristics of First IMP-4-Producing Enterobacter cloacae Sequence Type 74 and 194 in Korea

“…Majority of patients were reported to be immunocompromised, similar to our patients (Qureshi et al, 2011 ). Clinical outbreaks of E. cloacae in the hematology ward, burns unit, and intensive care unit have persisted, despite of concerted infection control to prevent ongoing transmission (Leung et al, 2013 ; Chapuis et al, 2016 ; Pang et al, 2016 ). VIM-2, NDM-1, and IMP-1, frequently found in Asia, have been previously reported mechanisms of carbapenem-resistant E. cloacae in Korea (Jeong et al, 2003 ; Kim et al, 2015 ; Lee et al, 2017 ).…”

“…IMP-type E. cloacae isolates have been found in Taiwan (IMP-8), China (IMP-1 and IMP-34), Thailand (IMP-14), Japan (IMP-1 and IMP-11), Spain (IMP-13), United Kingdom (IMP-1), and South Africa (Figure 1 ; Chen et al, 2009 ; Shet et al, 2011 ; Hayakawa et al, 2014 ; Wang et al, 2015 ; Osei Sekyere, 2016 ; Matsumura et al, 2017 ). IMP-4-producing E. cloacae was particularly reported in Australia and caused clinical outbreaks, which brought greater challenges to infection control (Leung et al, 2013 ; Chapuis et al, 2016 ; Pang et al, 2016 ). The highly mobile class 1 integron facilitates global spread of the bla IMP-4 gene (Espedido et al, 2008 ; Partridge et al, 2012 ).…”