Metallo-β-lactamases (MBLs).
The little-known big problem

We believe that by better understanding how the production of MBLs impacts patient care and outcomes, we can strive to take control of the rising threat of MBL-producing bacteria. Together.

This educational resource is here to help you and the infectious diseases community.

Did you know MBLs account for the majority of the ‘Big Five’ carbapenemases?1,2

Discover more about 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.

Putting MBLs under the spotlight

MBLs are spreading globally and alarmingly fast.1,3,4 There is an urgent need to tackle problematic carbapenemases and slow their spread in difficult-to-treat organisms,1,5,6 with the ultimate aim of helping to prevent avoidable morbidity and mortality.

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Carbapenem-resistant Enterobacterales infection mortality rate, of up to 40%
The mortality rate associated with infections caused by carbapenem-resistant Enterobacterales (CRE)7*
metallo β lactamase MBL Enterobacterales infection mortality rate, of up to 67%
The mortality rate associated with infections caused by MBL-producing Enterobacterales8†
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Why are MBLs an urgent problem?

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They can hydrolyse and provide resistance to almost all β-lactam antibiotics9,10
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There is a scarcity of clinically useful antimicrobial options for infections caused by MBLs9,10
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MBL encoding genes are easily transferable between bacteria and new bacterial isolates harbouring MBLs are being detected at a rapid pace9–13
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Isolates have been discovered around the world in healthcare-associated and environmental settings3,9
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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

Understanding MBLs and carbapenemases.png

Understanding MBLs

Do you want to discover and understand more about MBLs?

Hear Dr Luke Moore explain what MBLs are and learn about the ‘Big Five’ carbapenemases

Understanding MBLs

metallo β lactamase MBL infection burden Enterobacterales

The Burden

Infections caused by MBL-producing Enterobacterales cause higher mortality rates compared to non-carbapenemase producing CRE14–17

Explore in detail the burden of MBL-producing Enterobacterales on patient outcomes.

Understand the burden

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

Footnotes

*Based on the all-cause 28-day mortality of carbapenemase-producing Klebsiella pneumoniae strains found through a retrospective observational study.7

†The mortality rate associated with infections caused by MBL-producing organisms has been found to range from 18–67%.8

Abbreviations
CRE, carbapenem-resistant Enterobacterales; MBL, metallo-β-lactamase; NDM, New Delhi metallo-β-lactamase.
References
  1. Henderson J, et al. J Hosp Infect 2020;104:12–19.
  2. Bonnin RA, et al. Front Med (Lausanne) 2021;7:616490.
  3. Boyd SE, et al. Antimicrob Agents Chemother 2020;64:e00397-20.
  4. Wu W, et al. Clin Microbiol Rev 2019;32:e00115-18.
  5. Nordmann P, et al. Emerg Infect Dis 2011;17:1791–8.
  6. Bonomo RA, et al. Clin Infect Dis 2018;66:1290–7.
  7. Daikos GL, et al. Antimicrob Agents Chemother 2014;58:2322-8.
  8. Adam MA, et al. BMC Infect Dis 2018;18:668.
  9. Mojica MF, et al. Lancet Infect Dis 2022;22(1):e28–e34.
  10. Tan X, et al. Infect Drug Resist 2021;14:125–42.
  11. Yu H, et al. Antibiotics (Basel) 2022;11(7):942.
  12. Logan LK, et al. Open Forum Infect Dis 2016;3(2):ofw090.
  13. Hammoudi Halat D, et al. Antibiotics (Basel) 2020;9(4):186.
  14. Tamma PD, et al. Clin Infect Dis 2017;64:257–64.
  15. de Jager P, et al. PLoS One 2015;10:e0123337;
  16. Daikos GL, et al. Antimicrob Agents Chemother 2009;53:1868–73;
  17. Hayakawa K, et al. J Antimicrob Chemother 2020;75:697–708.