MBL Producing Gram-Negative Bacilli from Sputum and Urine During the study period, 432 PA (340 from - ; , fo ge FT e l † l e a C sputum and 92 from urine) and 199 AB (159 l l l l l l l l c h ; a a a a a a a a a a m , rr in v v v v v v v v v v o i i i i i i h i i i h i FS o cy . t t from sputum and 40 from urine) non-repeti- c t v v v v v v v v v a rv r r r r r r a r r r C m D S ;tcaam ilanahe lirtrahom irtedaem u e e u u u u u u u u u u O S S S S S S D S S S tive isolates were identified. Among them, 187 (29.6%) were imipenem non-susceptible ob rc ,c te Z A I R I R R tza tra LA i,n R R S R R R R (130 PA and 57 AB). Eleven isolates were ex- C / n C I lilicn ,iCH ;iem ;ttna cluded from the analysis because of inade- G R I S R ra ;I p is R R S S S R R S A epe iren fcee ,rse quate availability of their medical records. Fi- ,pP ,u ,PE ;R nally, 176 isolates consisting of 123 PA (102 y t i Q R I S S Z R C le l R R R R R S S S i F T U ; ib b from sputum and 21 from urine) and 53 AB ; ; t i t e m p R IIrcoS tspuum ltcbaau ,scsue p e (48 from sputum and 5 from urine) were ana- T c s I R I R I I R I Z S S R u A E ,T /s S lyzed. The proportion of sources (sputum and S H P n ; CA ;S lili icn S urine) was not different between PA and AB S S PA iin icp ika I F R R R R R R R S S C n , a m m (p = 0.19, data not shown). A a a P m , , A u S K P MBL production was identified in 12 iso- a / R I I ;s M Z S R R S S R R S S b P T n r A -1 -1 -2 iissodm ttceoba i;canAM il;fznao lates by PCR (6.8%)(Table 1). The bla was VIM-2 the most common MBL type (75%, 6 of 7 PA 2 2 2 2 1 2 2 2 2 L e - - - - - - - - - P a e x e B p P M M M M M M M M M IM IVM liep icnA lfroo ,LcZ y I I I I I I I I I and 3 of 5 AB); two bla and one bla se- t M M IMP-1 SIM-1 V V V V I V V V V S lt , ip C quences were identified in MPs. The propor- u B c ; liicundngm ;Airsgunoea li;I,rtfuaePC ilI,itceopann li.rvcsvaae S / tions of susceptible strains among MPs were P N M d A 41.7% for piperacillin/tazobactam, fluoroqui- e A V s s , , u c i N E nolones, and aminoglycosides while few iso- y t IET ,VK iltona saan raeh ;tTEe ssua l S o A I s i V , u b i , lates proved to be susceptible to aztreonam o t P R i I ,/C AM isoo oom itvse lana aed n I v E E a L e C S r (16.7%) and ceftazidime (8.3%). In PFGE , I M C eon OM ,ZL irrto seud noge lcvau irsde P e e , e e , , R n n P n A n T P E o o E o L o F Z analysis, 5 AB isolates revealed different pat- N A C p P c / .r n N N M C N C N C T tshno ;,PeA ;,FCH iililcnn tcnee scao terns (Fig. 1). However, 2 isolates among the 7 A 0 6 6 3 1 1 4 8 8 4 7 7 a x e w MBL-producing PA revealed identical PFGE P 1 m im i o 1 1 iithn6 iftzead lkeuem ,/aCm tsheam i,onand A patterns. They were obtained 14 days apart s e n t o x w ,c itc O fo lta from an inpatient of a rehabilitation center and a s l l e r o d 1 1 1 6 2 0 6 2 2 2 0 1 y Z y M t o a s n 4 1 iltsspoaa i;sdoeCA lycephom i;ycanAm ittuopane irtftsehe I h i an outpatient who was regularly visiting OPD g C n i of the same center. This last patient was the c y u a 8 0 0 0 1 4 4 0 3 9 t M 1 1 ,6HM licygon ,tcLua il,IcLdn tdnan tsahno d s 8 2 5 2 7 2 only one whose culture study was referred from o 6 1 r H P OPD among the 176 imipenem nonsusceptible L L e s sae tsya ,aGm ;reA i;cnC itpna isxm B i r t i PA and AB isolates in our study. The propor- e t M . c s c r se H A liu y i o n y h b e t a a c iid ;ne ;se lfa com ree tpu t r tion of MPs among imipenem non-susceptible i i c c e e a l g y n w i c c s e r a o n ti saaakw FH ,iccepeSm ilrqounono irrcohnena ;,vanVAN tynadhew rttpeaenm i l n a c h s s isolates was not different according to the spe- p o a a t n c c o i e c n r o i m r n r e d t e t u c g i g lm s F L cies (PA 5.7%/AB 9.4%). However, urine had a u t a H e n n i u u a R n u c L a a C D I Q P G C P P L A A K C P higher proportion of MP among imipenem p o c in s d e T RU i;rsnagoSm ;l,fFaunQm il;,ssFouCR i,iscepaEm trtFpEaneG itttpuoane v l non-susceptible isolates than sputum (26.9% e c w e T T T T T T R P R P R R P R P vs. 3.3%, p < 0.001). p P P e S S U S U S U U S S U S h t B B ,;rsgeaO ,rtzeoaTZ rtrcyebua ;IeenpSm liitcaPnde iittsvheed With regard to the risk factors associated f g r A A A A A A A B B B o P P P P P P P O A A A A A s with MP acquisition, we compared baseline c i t s characteristics, underlying morbidity and use i x M am ;A on reo led lry r e M F M F F F M M M M F e t S tc m lm m a la of antibiotics within 28 days prior to isolation c 7 55 lll--aoβ ltcaabu ,.tcpub ,;ERM rtvseee .rgeu2 a r ) a e between MPs and INMNPs (Table 2). ICU s h g r 2 5 5 2 0 3 8 6 4 2 y 4 6 4 5 6 8 6 7 1 C A ( 11 12 ,tLeaBm rz/sneoa lrynaom iftrxoaen ilsoaow ittnneoa . stay (70.1% vs. 25%, p = 0.003) and mechan- 1 e . * * l ical ventilator care prior to PA/AB isolation o 1 2 3 4 5 6 7 8 9 0 b 1 N a e u e T M p P c * † P T Yonsei Med J http://www.eymj.org Volume 52 Number 2 March 2011 353