{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,12]],"date-time":"2026-10-12T17:13:07Z","timestamp":1791825187234,"version":"4.3.4"},"reference-count":46,"publisher":"American Society for Microbiology","issue":"5","license":[{"start":{"date-parts":[[2024,5,2]],"date-time":"2024-05-02T00:00:00Z","timestamp":1714608000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/doi.org\/10.1128\/ASMCopyrightv2"},{"start":{"date-parts":[[2024,5,2]],"date-time":"2024-05-02T00:00:00Z","timestamp":1714608000000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.asm.org\/non-commercial-tdm-license"}],"content-domain":{"domain":["journals.asm.org"],"crossmark-restriction":true},"short-container-title":["Antimicrob Agents Chemother"],"published-print":{"date-parts":[[2024,5,2]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title\/>\n                    <jats:p>\n                      <jats:italic>Pseudomonas aeruginosa<\/jats:italic>\n                      harboring Verona Integron-encoded metallo-\u03b2-lactamase enzymes (VIM-CRPA) have been associated with infection outbreaks in several parts of the world. In the US, however, VIM-CRPA remain rare. Starting in December 2018, we identified a cluster of cases in our institution. Herein, we present our epidemiological investigation and strategies to control\/manage these challenging infections. This study was conducted in a large academic healthcare system in Miami, FL, between December 2018 and January 2022. Patients were prospectively identified via rapid molecular diagnostics when cultures revealed carbapenem-resistant\n                      <jats:italic>P. aeruginosa<\/jats:italic>\n                      . Alerts were received in real time by the antimicrobial stewardship program and infection prevention teams. Upon alert recognition, a series of interventions were performed as a coordinated effort. A retrospective chart review was conducted to collect patient demographics, antimicrobial therapy, and clinical outcomes. Thirty-nine VIM-CRPA isolates led to infection in 21 patients. The majority were male (76.2%); the median age was 52 years. The majority were mechanically ventilated (\n                      <jats:italic>n<\/jats:italic>\n                      = 15\/21; 71.4%); 47.6% (\n                      <jats:italic>n<\/jats:italic>\n                      = 10\/21) received renal replacement therapy at the time of index culture. Respiratory (\n                      <jats:italic>n<\/jats:italic>\n                      = 20\/39; 51.3%) or bloodstream (\n                      <jats:italic>n<\/jats:italic>\n                      = 13\/39; 33.3%) were the most common sources. Most infections (\n                      <jats:italic>n<\/jats:italic>\n                      = 23\/37; 62.2%) were treated with an aztreonam\u2013avibactam regimen. Six patients (28.6%) expired within 30 days of index VIM-CRPA infection. Fourteen isolates were selected for whole genome sequencing. Most of them belonged to ST111 (12\/14), and they all carried bla\n                      <jats:sub>VIM-2<\/jats:sub>\n                      chromosomally. This report describes the clinical experience treating serious VIM-CRPA infections with either aztreonam\u2013ceftazidime\/avibactam or cefiderocol in combination with other agents. The importance of implementing infection prevention strategies to curb VIM-CRPA outbreaks is also demonstrated.\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.1128\/aac.01474-23","type":"journal-article","created":{"date-parts":[[2024,4,11]],"date-time":"2024-04-11T09:06:49Z","timestamp":1712826409000},"update-policy":"https:\/\/doi.org\/10.1128\/asmj-crossmark-policy-page","source":"Crossref","is-referenced-by-count":15,"title":["Difficult-to-treat (DTR)\n                    <i>Pseudomonas aeruginosa<\/i>\n                    harboring Verona-Integron metallo-\u03b2-lactamase (\n                    <i>bla<\/i>\n                    <sub>VIM<\/sub>\n                    ): infection management and molecular analysis"],"prefix":"10.1128","volume":"68","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-1974-4547","authenticated-orcid":false,"given":"Ana D.","family":"Vega","sequence":"first","affiliation":[{"name":"Department of Pharmacy, Jackson Health System, Miami, Florida, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kailynn","family":"DeRonde","sequence":"additional","affiliation":[{"name":"Department of Pharmacy, Jackson Health System, Miami, Florida, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8542-4870","authenticated-orcid":true,"given":"Adriana","family":"Jimenez","sequence":"additional","affiliation":[{"name":"Department of Pharmacy, Jackson Health System, Miami, Florida, USA"},{"name":"Department of Epidemiology, Florida International University, Miami, Florida, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael","family":"Piazza","sequence":"additional","affiliation":[{"name":"Department of Medicine, Virtua Medical Group, Medford, New Jersey, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christine","family":"Vu","sequence":"additional","affiliation":[{"name":"Department of Pharmacy, Jackson Health System, Miami, Florida, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Octavio","family":"Martinez","sequence":"additional","affiliation":[{"name":"Department of Pharmacy, Jackson Health System, Miami, Florida, USA"},{"name":"Department of Medicine, University of Miami Miller School of Medicine, Miami, Florida, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Laura J.","family":"Rojas","sequence":"additional","affiliation":[{"name":"Department of Molecular Biology and Microbiology, Case Western Reserve University School of Medicine, Cleveland, Ohio, USA"},{"name":"CWRU-Cleveland VAMC Center for Antimicrobial Resistance and Epidemiology (Case VA CARES), Cleveland, Ohio, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Steven","family":"Marshall","sequence":"additional","affiliation":[{"name":"Department of Medicine, Louis Stokes Cleveland Department of Veterans Affairs Medical Center, Cleveland, Ohio, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5859-1769","authenticated-orcid":true,"given":"Mohamad","family":"Yasmin","sequence":"additional","affiliation":[{"name":"Department of Medicine, Louis Stokes Cleveland Department of Veterans Affairs Medical Center, Cleveland, Ohio, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3299-894X","authenticated-orcid":true,"given":"Robert A.","family":"Bonomo","sequence":"additional","affiliation":[{"name":"Department of Molecular Biology and Microbiology, Case Western Reserve University School of Medicine, Cleveland, Ohio, USA"},{"name":"CWRU-Cleveland VAMC Center for Antimicrobial Resistance and Epidemiology (Case VA CARES), Cleveland, Ohio, USA"},{"name":"Department of Medicine, Louis Stokes Cleveland Department of Veterans Affairs Medical Center, Cleveland, Ohio, USA"},{"name":"Departments of Proteomics, Case Western Reserve University School of Medicine, Cleveland, Ohio, USA"},{"name":"Department of Pharmacology, Case Western Reserve University School of Medicine, Cleveland, Ohio, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2364-8358","authenticated-orcid":false,"given":"Lilian M.","family":"Abbo","sequence":"additional","affiliation":[{"name":"Department of Pharmacy, Jackson Health System, Miami, Florida, USA"},{"name":"Department of Medicine, University of Miami Miller School of Medicine, Miami, Florida, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"235","reference":[{"key":"e_1_3_2_2_2","first-page":"2686","volume-title":"Mandell, Douglass and Bennett\u2019s principles and practice of infectious diseases","author":"Araos R","unstructured":"Araos R, D\u2019Agata E. 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