First outbreak of VIM-2 metallo-β-lactamase-producing in The Netherlands: microbiology, epidemiology and clinical outcomes

This study was designed to investigate the prevalence and characteristics of metallo-β-lactamase (MBL)-producing in a tertiary care centre in The Netherlands, a country that is considered to have a low prevalence of antibiotic-resistant bacteria. Imipenem-resistant isolates cultured from clinical specimens during 2008-2009 were analysed phenotypically and molecularly by polymerase chain reaction (PCR) with sequencing. Genotyping was performed by multiple-locus variable-number tandem repeat (VNTR) analysis (MLVA). Clinical information was obtained by electronic chart review for all patients infected or colonised with an imipenem-resistant isolate that was included in the study. In total, 106 imipenem-resistant isolates were included. The gene was detected in 35/106 isolates (33%) and was associated with integrons. Compared with non-MBL-producing imipenem-resistant , VIM-2 MBL-producing isolates showed higher rates of multidrug resistance. Patients with VIM-2 MBL-producing isolates were more likely to be admitted to the Intensive Care Unit (ICU) and had a higher risk of invasive infection, including development of bacteraemia. MLVA identified two separate VIM-2 MBL-producing clones, responsible for outbreaks in the ICU but also affecting 10 other departments. This is the first reported outbreak of VIM-2 MBL-producing in The Netherlands. Once introduced, VIM-2 MBL-producing cause significant infections and are easily spread within the hospital setting.