Yonsei Med J.  2011 Mar;52(2):351-357. 10.3349/ymj.2011.52.2.351.

The Characteristics of Metallo-beta-Lactamase-Producing Gram-Negative Bacilli Isolated from Sputum and Urine: A Single Center Experience in Korea

• Chin BS
• Han SH
• Choi SH
• Lee HS
• Jeong SJ
• Choi HK
• Choi JY
• Song YG
• Kim CK
• Yong D
• Lee K
• Kim JM

• KMID: 1779675
• DOI: http://doi.org/10.3349/ymj.2011.52.2.351

Abstract

Metallo-beta-lactamase (MBL) production usually results in high-level resistance to most beta-lactams, and a rapid spread of MBL producing major gram-negative pathogens is a matter of particular concern worldwide. However, clinical data are scarce and most studies compared MBL producer (MP) with MBL non-producer (MNP) strains which included carbapenem susceptible isolates. Therefore, we collected clinical data of patients in whom imipenem-nonsusceptible Pseudomonas aeruginosa (PA) and Acinetobacter baumannii (AB) were isolated from sputum or urine, and investigated MBL production and the risk factors related with MBL acquisition. The antimicrobial susceptibility patterns were also compared between MPs and imipenem-nonsusceptible MNPs (INMNP). Among the 176 imipenem-nonsusceptible isolates, 12 MPs (6.8%) were identified. There was no identifiable risk factor that contributed to the acquisition of MPs when compared to INMNPs, and case-fatalities were not different between the two groups. The percentage of susceptible isolates was higher among MPs for piperacilin/tazobactam and fluoroquinolones while that of ceftazidime was higher in INMNPs (p < 0.05). As regards to aztreonam, which has been known to be a uniquely stable beta-lactam against MBLs, susceptibility was preserved in only two isolates (16.7%) among MPs, and was not higher than that of INMNPs (23.2%). In conclusion, the contribution of MBLs to imipenem non-susceptibility in PA/ABs isolated from sputum and urine was relatively limited, and there was no significant risk factor associated with acquisition of MPs compared with INMNPs. However, limited susceptibility to aztreonam implies that MPs may hold additional resistance mechanisms, such as extended spectrum beta-lactamases, AmpC beta-lactamases, or other non-enzymatic mechanisms.

Keyword

Metallo-beta-lactamase; risk factor; resistance

MeSH Terms

Adult
Aged
Aged, 80 and over
Anti-Bacterial Agents/pharmacology/therapeutic use
Child
Child, Preschool
Electrophoresis, Gel, Pulsed-Field
Female
Gram-Negative Bacteria/drug effects/*enzymology/isolation & purification
Gram-Negative Bacterial Infections/drug therapy/enzymology/microbiology
Humans
Male
Microbial Sensitivity Tests
Middle Aged
Republic of Korea
Sputum/*microbiology
Urine/*microbiology
beta-Lactam Resistance
beta-Lactamases/*metabolism

Figure

• 

  Fig. 1 Pulsed field gel clectrophoresis (PFGE) analysis of metallo-β-lactamase (MBL)-producing Pseudomonas aeruginosa (A) and Acinetobacter baumannii (B). Two isolates of Pseudomonas aeruginosa (case no. 1 and no. 2) revealed identical patterns. One of them was an inpatient and the other an outpatient of the same center. The numbers on top of each figure refer to the case numbers described in Table 1. Lane M, molecular weight marker (kb).

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