@article{uoadl:3004518,
    volume = "13",
    number = "4",
    pages = "221-225",
    journal = "Microbial Drug Resistance: Mechanism, Epidemiology, and Disease",
    issn = "1076-6294, 1931-8448",
    keywords = "amikacin;  aztreonam;  beta lactam antibiotic;  beta lactamase;  carbapenem;  cefepime;  cefpirome;  cephalosporin;  ciprofloxacin;  clavulanic acid;  colistin;  gentamicin;  imipenem;  levofloxacin;  meropenem;  metallo beta lactamase;  netilmicin;  piperacillin plus tazobactam;  protein SHV 2a;  protein VIM 4;  rifampicin;  tetracycline;  timentin;  tobramycin;  trimethoprim;  unclassified drug, aged;  antibiotic resistance;  antibiotic sensitivity;  article;  case report;  conjugation;  Enterobacter cloacae;  Enterobacter infection;  enzyme synthesis;  epididymitis;  gene identification;  gene structure;  Gram negative bacterium;  Greece;  hospital patient;  human;  integron;  male;  minimum inhibitory concentration;  nucleotide sequence;  plasmid;  polymerase chain reaction;  priority journal, beta-Lactam Resistance;  beta-Lactamases;  Carbapenems;  Conjugation, Genetic;  Enterobacter cloacae;  Integrons;  Microbial Sensitivity Tests;  Plasmids, Enterobacter cloacae;  Negibacteria",
    BIBTEX_ENTRY = "article",
    year = "2007",
    author = "Ikonomidis, A. and Spanakis, N. and Poulou, A. and Pournaras, S. and Markou, F. and Tsakris, A.",
    abstract = "Enterobacter cloacae strains are still infrequently resistant to carbapenems. A carbapenem-resistant clinical isolate of E. cloacae producing a plasmid-mediated metallo-β-lactamase (MBL), VIM-4, was recovered from a Greek hospitalized patient. The blaVIM-4 gene was located in the variable array of a class 1 integron structure repeatedly detected among blaVIM-1-bearing Gram-negative pathogens in Greece. The isolate possessed also on the same conjugative plasmid an extended-spectrum β-lactamase (ESBL), SHV-2a, which contributed to the β-lactam- resistant phenotype. This is the first report showing co-transfer of an ESBL with a VIM-type MBL. It suggests also that different VIM-type gene cassettes have been incorporated in a common integron structure, which seems indigenous of Gram-negative pathogens in our region. © 2007 Mary Ann Liebert, Inc.",
    title = "Emergence of carbapenem-resistant Enterobacter cloacae carrying VIM-4 metallo-β-lactamase and SHV-2a extended-spectrum β-lactamase in a conjugative plasmid",
    doi = "10.1089/MDR.2007.768"
}