A REPORT OF RARELY OBSERVED RESISTANCE PATTERN TO CARBAPENEMS IN A CLINICAL ISOLATE OF ENTEROBACTER CLOACAE

Autori:

Danijela Bejuk, Mladen Novkoski, Vlado Juranko, Davorka Prajdić-Predrijevac, Nives Todorić, Ivana Mikačić, Marija Gužvinec, Arjana Tambić Andrašević

Sažetak

Rad izvještava o pojavi soja Enterobacter cloacae u kojeg je dokazan rijetko viđen oblik otpornosti na karbapeneme posredovan enzimom IMI-1, skupine A beta-laktamaza. Soj je izoliran iz obriska rane u bolesnika koji je zbog infekcije kirurške rane prethodno liječen meropenemom. Ograničen izbor antibiotika kojima se mogu liječiti infekcije uzrokovane ovakvim uzročnicima upućuje na nužnost točne identifikacije višestruko otpornih gram-negativnih mikroorganizama i otkrivanje njihovih mehanizama otpornosti. Prepoznavanje višestruko otpornih mikroorganizama naglašava važnost kontinuiranoga mikrobiološkog nadzora bolesnika, osobito u jedinicama intenzivnog liječenja. U prikazanoj ustanovi nije bilo sekundarnog širenja ovog soja. Identifikacija novih mehanizama otpornosti pomaže kliničarima u izboru ciljane terapije, a istodobno je nužna za uspješno sprječavanje širenja infekcija izazvanih višestruko otpornim mikroorganizmima.

Summary

The paper reports on the emergence of strain in which Enterobacter cloacae has demonstrated an unusual form of resistance to carbapenems mediated by enzyme IMI-1, class A beta-lactamase. The strain was isolated from a wound swab in the patient who had a surgical wound infection previously treated with meropenem. Limited choice of antibiotics that can treat infections caused by these pathogens indicates the necessity of accurate identification of multiple resistant gram-negative microorganisms and mechanisms of their resistance. Recognition of multiresistant gram-negative microorganisms emphasizes the importance of continuous microbiological monitoring of patients, especially in intensive care units. In the investigated institution there was no secondary spread of this strain. Identifying new mechanisms of resistance will be helpful to clinicians in selection of targeted therapy, while important for efficient prevention of spreading infections caused by multiple resistant microorganisms.