Title: Worldwide proliferation of carbapenem-resistant gram-negative bacteria
Abstract: Imipenem was approved for clinical use in 1987 in Japan, followed by panipenem and meropenem in 1993 and 1995, respectively. These carbapenems have been used in clinical settings as a last resort for their broad-spectrum antibacterial activity and stability against various β-lactamases produced by gram-negative bacteria. However, carbapenem-resistant Serratia marcescens and Pseudamonas aeeruginosa emerged in Japan nearly 10 years ago.1Ito H Arakawa Y Ohsuka S et al.Plasma-mediated dissemination of the metallo-β-lactamase gene blaIMP among clinically isolated strains of.Serratia marcescens. Antimicrob Agents Chemother. 1995; 39: 824-829Crossref PubMed Scopus (209) Google Scholar, 2Senda K Akara Y Ichyama S et al.PCR detection of metallo-β-lactamase.J Clin Microbiol. 1996; 34: 2909-2913Crossref PubMed Google Scholar These strains produce a novel metallo-β-lactamase (IMP-1) that is mediated by transferable R-plasmids.3Arakawa Y Murakami M Suzuki K et al.A novel integron-like element carrying the metallo-β-lactamase gene blaIMP.Antimicrob Agents Chemother. 1996; 39: 1612-1615Crossref Scopus (269) Google Scholar IMP-1-producing gram-negative bacteria have been proliferating in Japan and have also been identified in European countries by G Cornaglia and colleagues (March 13, p 899)4Cornaglia G Riccio ML Mazzaroil A Leuretti L Fontana R Rossolini GN Appearance of IMP-1 metallo-β-lactamase in Europe.Lancet. 1999; 353: 899-900Summary Full Text Full Text PDF PubMed Scopus (135) Google Scholar and in Singapore by T H Koh and colleagues (June 19, p 2162).5Koh TH Babini GS Woodford N Sng L-H Hall LCM Livermore DM Carbapenem-hydrolising IMP-1 β-lactamase in Klebsiella pneumoniae from Singapore.Lancet. 1999; 353: 2162Summary Full Text Full Text PDF PubMed Scopus (86) Google Scholar According to our 1996–97 survey of IMP-1-producing gram-negative bacteria in Japan, 34 (1·3%) of 2533 Ps aeruginosa and 144 (4·4%) of 3222 Ser marcescens isolates produced IMP-1 through acquisition of R-plasmids that carry blaIMP gene. We also identified other IMP-1-producing gram-negative bacterial species, including Escherichia coli, Klebsiella pneumoniae, Citrobacter freundii, Enterobacter aerogenes, Ent cloacae, Proteus vulgaris, and Providencia rettgeri, as well as Ps putida, Ps fluorescens, Burkholderia cepacia, Alcaligenes xylosoxidans, and A cinetobacter spp. Conjugational transfer of wide host-range R-plasmids bearing the blaIMP gene is the mechanism of the dissemination of blaIMP gene cassette onto various gram-negative bacterial species. Gram-positive cocci such as meticillin-resistant Staphylococcus aureus, vancomycin-resistant Ent faecium, and vancomycin-resistant Ent faecalis have developed multiple antibiotic resistance, and penicillin-resistant Streptococcus pneumoniae is also developing resistance to newly developed macrolides and fluoroquinolones. These gram-positive cocci have been disseminated worldwide, causing life-threatening infections. Fortunately, carbapenems, fluoro-quinolones, and aminoglycosides are still effective against gram-negative bacteria. However, about 20% of Ps aeruginosa isolates have fluoro-quinolone resistance and nearly 5% also have amikacin resistance in Japan. International travel and transport give drug-resistant bacteria a free ride. Can we expect an explosive proliferation of IMP-1-producing gram-negative bacterial species, as seen with other resistant species? The spread of carbapenem-resistant gram-negative bacteria raises the spectre of a clinical Armageddon. To cope with bacteria that have acquired multiple antibiotic resistance, we need operational surveys and monitoring of multiple-drug-resistant gram-negative bacterial species and gram-positive cocci by WHO and national health authorities, and guidelines for prudent use of broad-spectrum antimicrobial agents in each clinical setting. This study was supported by a grant from the Ministry of Health and Welfare, Japan.
Publication Year: 1999
Publication Date: 1999-09-01
Language: en
Type: letter
Indexed In: ['crossref', 'pubmed']
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Cited By Count: 77
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