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1 November 2007

Volume 45, Number 9
Clinical Infectious Diseases 2007;45:1171–1178
© 2007 by the Infectious Diseases Society of America. All rights reserved.
1058-4838/2007/4509-0007$15.00
DOI: 10.1086/522288
MAJOR ARTICLE

Complex Clonal and Plasmid Epidemiology in the First Outbreak of Enterobacteriaceae Infection Involving VIM‐1 Metallo‐β‐Lactamase in Spain: Toward Endemicity?

M. Tato,1

T. M. Coque,1

P. Ruíz‐Garbajosa,1

V. Pintado,2

J. Cobo,2

H. S. Sader,3

R. N. Jones,3

F. Baquero,1 and

R. Cantón1

1Servicio de Microbiología and 2Servicio de Enfermedades Infecciosas, Hospital Universitario Ramón y Cajal, Madrid, Spain; and 3JMI Laboratories, North Liberty, Iowa

Background.We report the emergence and spread of metallo‐β‐lactamases (MBLs) among enterobacterial isolates at Ramón y Cajal University Hospital (Madrid, Spain).

Methods and results.During the period from March 2005 through September 2006, 25 patients (52% of whom were in the intensive care unit) were infected and/or colonized with single or different MBL‐producing Enterobacteriaceae isolates (Klebsiella pneumoniae, 14 patients; Enterobacter cloacae, 12 patients; Escherichia coli, 1 patient; and/or Klebsiella oxytoca, 1 patient). Clonal analysis (XbaI pulsed‐field gel electrophoresis) revealed that all K. pneumoniae isolates belonged to the same clone, but 6 patterns were found among the E. cloacae isolates. Carbapenems were affected to different degrees (minimum inhibitory concentration, 1 to >8 μg/mL), as were aminoglycosides and ciprofloxacin. The blaVIM‐1 MBL gene was present in all isolates; in addition, the blaSHV‐12 extended‐spectrum β‐lactamase gene was detected in K. pneumoniae and E. coli isolates. The blaVIM‐1 gene was detected within a 4.0‐kb class 1 integron (blaVIM‐1‐aacA4‐dfrII‐aadA1‐catB2) in K. pneumoniae and E. coli and in a 2.5‐kb class 1 integron (blaVIM‐1‐aacA4‐aadA1) in E. cloacae and K. oxytoca isolates. The blaVIM‐1 gene was transferable (filter‐mating) in 14 of 14 K. pneumoniae isolates, 4 of 11 E. cloacae isolates, and 1 of 1 E. coli isolate. A 60‐kb plasmid belonging to the IncI1 group was detected in the epidemic VIM‐1‐K. pneumoniae clone. Plasmids of 300‐ or 435‐kb belonging to IncH12 group were found among E. cloacae isolates.

Conclusions.K. pneumoniae‐MBL monoclonal epidemics coexisted with E. cloacae‐MBL multiclonal epidemics in our hospital. The spread of the blaVIM‐1 gene among Enterobacteriaceae was driven by clonal spread associated with intergeneric plasmid transfer with different class I integron platforms. Such complex epidemiology might anticipate endemicity and should be considered for the design of containment epidemiology strategies.

Received 28 March 2007; accepted 12 June 2007; electronically published 27 September 2007.

Reprints or correspondence: Dr. Rafael Cantón, Servicio de Microbiología, Hospital Universitario Ramón y Cajal, 28034‐Madrid, Spain ().

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M. Treviño, L. Moldes, L. Martínez-Lamas, C. Varón, B. J. Regueiro. (2009) Carbapenem-resistant Enterobacter cloacae and the emergence of metallo-β-lactamase-producing strains in a third-level hospital (Santiago de Compostela, NW Spain). European Journal of Clinical Microbiology & Infectious Diseases
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