MBL Summary

Understanding metallo-β-lactamases (MBLs) is critical

The world is running out of antimicrobial options:1 MBLs can hydrolyse almost all β-lactam antibiotics. In addition, available treatments are made even less effective through the frequent co-production of MBLs with serine β-lactamases (SBLs) and extended spectrum β-lactamases (ESBLs).1–4

The outcome?

A mortality rate from MBL-producing Enterobacterales as high as 67%.5*

What has happened over the last 20 years?

Dr Luke Moore describes the mechanism of resistance behind MBLs, the importance of utilising surveillance data to understand local epidemiology and the methods of testing and diagnostics for infections caused by MBLs.

Watch the videos below to understand more about MBLs:

What are MBLs?

Importance of surveillance data

Testing and diagnostics

Video_id
6340801162112
Account_id
1852113022001
Player_id
g2OtgoAoBs

Dr Luke Moore: What are MBLs?

Dr Moore gives a definition of MBLs and explains their mechanism of resistance.
The most concerning class of antimicrobial resistance is that of Ambler Class B or the MBLs.”
id
button-1
Video_id
6340802727112
Account_id
1852113022001
Player_id
g2OtgoAoBs

Dr Luke Moore: The importance of surveillance data

Dr Moore interrogates why it’s so important to maintain up-to-date local and global MBL surveillance data.
We’re seeing these metallo-β-lactamases in all areas of clinical practice.”
id
button-2
Video_id
6340802048112
Account_id
1852113022001
Player_id
g2OtgoAoBs

Dr Luke Moore: Methods of testing and diagnostics for these infections

Dr Moore examines the importance of rapid tests for detecting MBLs and the challenges that exist with current testing methods.
There are several different phenotypic and molecular diagnostics to help us identify MBLs.”
id
button-3

Examining carbapenem-resistant Enterobacterales (CRE)

The 'Big Five' carbapenemases

Globally there are five main carbapenemases of clinical relevance; familiarly known as the ‘Big Five’:1,2

IMP Imipenemase metallo-β-lactamase

NDM New Delhi metallo-β-lactamase

VIM Verona Integron-encoded metallo-β-lactamase

KPC Klebsiella pneumoniae carbapenemase

OXA-48-like Oxacillinase-48-like carbapenemases

Classification of the most relevant carbapenemases produced by Enterobacterales.3

Ambler-Bush class Carbapenemase type Common examples Most frequently identified in
A Serine-β-lactamases KPC, SME, IMI K. pneumoniae, S. marcescens and other Enterobacterales
B Metallo-β-lactamases NDM, VIM, IMP, GIM, and SPM E. coli, K. pneumoniae, Enterobacter and other Enterobacterales
C Serine-β-lactamases OXA-48-like K. pneumoniae, E. coli and other Enterobacterales

Adapted from: Villegas MV, et al. 2019.3

The production of the five main carbapenemases is of high clinical, therapeutic and epidemiological relevance:3,4

  • They cause hospital outbreaks associated with clones and plasmid dissemination
  • Infections caused by carbapenemase-producing bacteria are associated with higher mortality rates and increased patient and healthcare associated burden
  • They can lead to multi-resistance and pan-resistance, further complicating treatment decision-making

Abbreviations

IMI, imipenemase; SME, Serratia marcescens enzymes; GIM, Germany imipenemase; SPM, Sao Paulo metallo-β-lactamase.

References

  1. Henderson J, et al. J Hosp Infect 2020;104(1):12–19.
  2. Bonnin RA, et al. Front Med (Lausanne) 2021;7:616490.
  3. Villegas MV, et al. Infection 2019;23:358–68.
  4. Tamma PD, et al. Clin Infect Dis 2017;64:257–64.

The emergence of CRE has become a major public health crisis worldwide8

The widespread dissemination of CRE and their ability to mediate carbapenem resistance represents one of the most challenging problems of antimicrobial resistance that we face today.9

Increased awareness and understanding of carbapenemase-producing (CP)-CRE, including MBL-producing CRE, and the administration of timely, appropriate treatment to treat infections caused by these pathogens can improve patient outcomes.10–13

style
background-hairy-pathogen-with-tail

Act now to slow the spread of CRE and rising mortality rates.

style
Background-grey, centered

metallo β lactamase MBL epidemiology carbapenemases

Epidemiology

Are you under threat from MBLs in your country?

Explore MBL epidemiology and learn about the incidence and prevalence of carbapenemases in your region

Explore epidemiology

metallo β lactamase MBL patient profiles key risk factors

Patient profiles

Are you aware of the risk factors for MBL-producing pathogens?

Learn about key patient risk factors associated with infections caused by MBL-producing Enterobacterales

View patient profiles

Abbreviations
AMR, antimicrobial resistance; CP, carbapenemase-producing; CRE, carbapenem-resistant Enterobacterales; ESBLs, extended spectrum β-lactamases; MBL, metallo-β-lactamase; SBL, serine β-lactamases.
References
  1. Sader HS, et al. Eur J Clin Microbiol Infect Dis 2022;41:477–87.
  2. Mojica MF, et al. Curr Drug Targets 2016:17:1029–50.
  3. Boyd SE, et al. Antimicrob Agents Chemother 2020;64:e00397-20.
  4. Tan X, et al. Infect Drug Resist 2021;14:125–42.
  5. Adam MA, et al. BMC Infect Dis 2018;18:668
  6. Henderson J, et al. J Hosp Infect 2020;104(1):12–19.
  7. Bahr G, et al. Chem Rev 2021;121(13):7957–8094.
  8. Pudpong K, et al. Infect Drug Resist 2022;15:3025–37.
  9. Sader HS, et al. J Antimicrob Chemother 2021;76:659–66.
  10. Zavascki AP, et al. J Antimicrob Chemother 2006;58:387–92.
  11. Willmann M et al. BMC Infect Dis 2013;13:515.
  12. Papadimitriou-Olivgeris M, et al. Eur J Clin Microbiol Infect Dis 2017;36:1125–31.
  13. Daikos GL, et al. Antimicrob Agents Chemothe r 2009;53:1868–73.