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Three cases of IMP-type metallo-β-lactamase-producing Enterobacter cloacae bloodstream infection in Japan

Yohei Hamada1, Koji Watanabe, Tatsuya Tada

  • 1Division of Infectious Diseases, Disease Control and Prevention Center, National Center for Global Health and Medicine, 1-21-1 Toyama, Shinjuku, Tokyo, 162-8655, Japan.

Journal of Infection and Chemotherapy : Official Journal of the Japan Society of Chemotherapy
|November 20, 2012
PubMed

Insights

Three cases of IMP-type metallo-β-lactamase-producing Enterobacter cloacae bloodstream infections highlight challenges in detecting carbapenem resistance. Current laboratory methods may miss these infections, leading to treatment failure and poor outcomes.

Area of Science:

  • Medical Microbiology
  • Infectious Diseases
  • Antimicrobial Resistance

Background:

  • Enterobacter cloacae is an opportunistic pathogen that can cause severe bloodstream infections.
  • Metallo-β-lactamases (MBLs) confer resistance to a broad range of β-lactam antibiotics, including carbapenems.
  • IMP-type MBLs are a significant concern due to their increasing prevalence worldwide.

Observation:

  • Three cases of IMP-type MBL-producing Enterobacter cloacae bloodstream infections were identified.
  • All isolates exhibited minimum inhibitory concentration values of 2 µg/ml for imipenem.
  • Despite empirical carbapenem treatment, two of the three patients died.

Findings:

  • The study highlights the potential for carbapenem-resistant Enterobacteriaceae (CRE) to be missed by clinical laboratories using outdated Clinical and Laboratory Standards Institute (CLSI) breakpoints.
  • The current CLSI breakpoints for carbapenems may not be sufficiently sensitive to detect all carbapenem-resistant isolates, particularly those with intermediate resistance.
  • IMP-type MBL-producing Enterobacter cloacae represents a critical challenge in bloodstream infections.

Implications:

  • Lowering carbapenem breakpoints in clinical settings is crucial for accurate detection of carbapenem resistance.
  • Implementing alternative detection methods, such as polymerase chain reaction (PCR) and immunochromatographic assays, can improve the identification of MBL-producing isolates.
  • Enhanced surveillance and rapid diagnostic strategies are necessary to combat the spread of CRE and improve patient outcomes.

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