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Peleg AY, Franklin C, Bell JM, et al. Dissemination of the metallo-beta-lactamase gene blaIMP-4 among gram-negative pathogens in a clinical setting in Australia. Clin Infect Dis. 2005;41(11):1549-56doi: 10.1086/497831.
Peleg, A. Y., Franklin, C., Bell, J. M., & Spelman, D. W. (2005). Dissemination of the metallo-beta-lactamase gene blaIMP-4 among gram-negative pathogens in a clinical setting in Australia. Clinical infectious diseases : an official publication of the Infectious Diseases Society of America, 41(11), 1549-56. https://doi.org/10.1086/497831
Peleg, Anton Y, et al. "Dissemination of the metallo-beta-lactamase gene blaIMP-4 among gram-negative pathogens in a clinical setting in Australia." Clinical infectious diseases : an official publication of the Infectious Diseases Society of America vol. 41,11 (2005): 1549-56. doi: https://doi.org/10.1086/497831
Peleg AY, Franklin C, Bell JM, Spelman DW. Dissemination of the metallo-beta-lactamase gene blaIMP-4 among gram-negative pathogens in a clinical setting in Australia. Clin Infect Dis. 2005 Dec 01;41(11):1549-56. doi: 10.1086/497831. Epub 2005 Oct 31. PMID: 16267725.
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Clin Infect Dis. 2005 Dec 01;41(11):1549-56. doi: 10.1086/497831. Epub 2005 Oct 31.

Dissemination of the metallo-beta-lactamase gene blaIMP-4 among gram-negative pathogens in a clinical setting in Australia.

Clinical infectious diseases : an official publication of the Infectious Diseases Society of America

Anton Y Peleg, Clare Franklin, Jan M Bell, Denis W Spelman

Affiliations

  1. Infectious Diseases and Microbiology Department, The Alfred Hospital, Melbourne, Australia. [email protected]

PMID: 16267725 DOI: 10.1086/497831

Abstract

BACKGROUND: The clinical utility of carbapenems is under threat because of the emergence of acquired metallo-beta-lactamase (MBL) genes. We describe the first outbreak in Australia of infection and/or colonization with gram-negative pathogens carrying the MBL gene blaIMP-4.

METHODS: MBL-producing organisms were identified using susceptibility data in conjunction with MBL screening methods. PCR and sequence analysis were performed to characterize the resistance gene and identify the presence of integrons. DNA profiles were determined by ribotyping. Clinical and epidemiological data were prospectively collected from January-July 2004.

RESULTS: A total of 19 isolates were recovered from 16 patients: Serratia marcescens (10 isolates), Klebsiella pneumoniae (4 isolates), Pseudomonas aeruginosa (3 isolates), Escherichia coli (1 isolate), and Enterobacter cloacae (1 isolate). Isolates were resistant to most beta-lactams except aztreonam, and variable resistance to carbapenems was observed (MIC range, 2 to >8 mg/L). PCR and sequence analysis identified the blaIMP-4 gene and a class 1 integrase (IntI1) in all isolates. Of the 16 patients, 12 (75%) had infection; 5 had septicemia, 5 had ventilator-associated pneumonia, 1 had a urinary tract infection, and 1 had a superficial central venous line infection. Six (38%) of the 16 patients died, and 5 of those 6 (31% of the group of 16) had clinical infection with an MBL-producing organism. All except 2 patients had spatio-temporal epidemiological links in the intensive care unit. All K. pneumoniae isolates were of different ribogroups, whereas the S. marcescens and P. aeruginosa isolates were predominately of the same ribogroup.

CONCLUSIONS: MBL-producing gram-negative organisms have now emerged in Australia. The resistance gene, blaIMP-4, appears highly mobile; this outbreak involved 5 different gram-negative genera from patients with close epidemiological links.

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