Emergence of VIM-12 in Enterobacter cloacae.

Detection of the bla(VIM-12) gene within the originally described Inh12 integron in a clinical isolate of Enterobacter cloacae is reported for the first time worldwide. Integron Inh12 was carried on a conjugative plasmid of approximately 85 kb which also conferred resistance to aztreonam, likely due to AmpC production.

De-escalation therapy rates are significantly higher by bronchoalveolar lavage than by tracheal aspirate.

Objective: To assess outcomes with de-escalation therapy in ventilator-associated pneumonia (VAP).

Design: Prospective observational study.

Setting: Multidisciplinary intensive care unit.

Both early-onset and late-onset ventilator-associated pneumonia are caused mainly by potentially multiresistant bacteria.

Objective: To compare the causative pathogens of early-onset and late-onset ventilator-associated pneumonia (VAP) diagnosed by bronchoalveolar lavage quantitative cultures. Most previous reports have been based on endotracheal aspirate cultures and gave uncertain findings.

Design: Prospective evaluation of consecutive patients with clinical suspicion for VAP.