Coproduction of KPC-18 and VIM-1 carbapenemases by Enterobacter cloacae: Implications for newer ß-lactam-ß-lactamase inhibitor combinations.
Enterobacter cloacae strain G6809 with reduced susceptibility to carbapenems was identified from a patient in a long-term acute care hospital in Kentucky. G6809 belonged to sequence type (ST) 88 and carried two carbapenemase genes, blaKPC-18 and blaVIM-1. Whole-genome sequencing localized blaKPC-18 to the chromosome and blaVIM-1 to a 58-kb plasmid. The strain was highly resistant to ceftazidime-avibactam. Insidious coproduction of metallo-ß-lactamase with KPC-type carbapenemase has implications for the use of next-generation ß-lactam-ß-lactamase inhibitor combinations. Copyright © 2016, American Society for Microbiology. All Rights Reserved.