Emergence of metallo-β-lactamases GIM-1 and VIM in multidrug-resistant Pseudomonas aeruginosa in North Rhine-Westphalia, Germany.

stay, Patient A received successively piperacillin/tazobactam with vancomycin, cefepime with ciprofloxacin, and imipenem with ciprofloxacin, but Patient B only received amoxicillin/clavulanate (Figure 1). It is well established that K. pneumoniae isolates are an important reservoir of b-lactamases. Thus, the dissemination of the KPC carbapenemase has been linked to the dispersion of a clonal ST258-type K. pneumoniae strain. Nevertheless, it appears that the rapid emergence of blaOXA-48 in K. pneumoniae would be explained by the horizontal transmission of an OXA-48-encoding plasmid within strains belonging to different STs. Our experience raises concern about a possible rapid rise in carbapenem resistance in enteric bacteria through the spread of blaOXA-48-positive plasmids and/or strains. Outbreaks involving different OXA-48-producing species have already been described. Early detection by sensitive screening methods is needed, with targeted surveillance and consideration given to infection control measures, to prevent this spread.