Class I Integron-Borne bla VIM-1 Carbapenemase in a Strain of Enterobacter cloacae Responsible for a Case of Fatal Pneumonia

We report here a fatal case of nosocomial pneumonia due to a multidrug-resistant (MDR) strain of Enterobacter cloacae, which was also resistant to carbapenems, in a patient with a diagnosis of Churg-Strauss syndrome. The microorganism was investigated for the presence of metallo- and extended-spectrum beta-lactamases. The strain produced two class 1 integrons carrying bla(VIM-1) and aadA2 gene cassettes located on chromosomal and plasmidic DNA, respectively, and a plasmid-encoded SHV-12 extended-spectrum beta-lactamase. Our results clearly demonstrate the transfer of this kind of resistance in E. cloacae with potentially serious clinical implications.