Acquired carbapenemases in Gram-negative bacterial pathogens: detection and surveillance issues

Abstract

Acquired carbapenemases are emerging resistance determinants in Gram-negative pathogens, including Enterobacteriaceae, Pseudomonas aeruginosa and other Gram-negative non-fermenters. A consistent number of acquired carbapenemases have been identified during the past few years, belonging to either molecular class B (metallo-beta-lactamases) or molecular classes A and D (serine carbapenemases), and genes encoding these enzymes are associated with mobile genetic elements that allow their rapid dissemination in the clinical setting. Therefore, detection and surveillance of carbapenemase-producing organisms have become matters of major importance for the selection of appropriate therapeutic schemes and the implementation of infection control measures. As carbapenemase production cannot be simply inferred from the resistance profile, criteria must be established for which isolates should be suspected and screened for carbapenemase production, and for which tests (phenotypic and/or genotypic) should be adopted for confirmation of the resistance mechanism. Moreover, strategies should be devised for surveillance of carbapenemase producers in order to enable the implementation of effective surveillance programmes. The above issues are addressed in this article, as a follow-up to an expert meeting on acquired carbapenemases that was recently organized by the ESCMID Study Group for Antibiotic Resistance Surveillance.

Diseminación de Klebsiella pneumoniae productoras de KPC-3 en hospitales de Bogotá durante un periodo de tres años

“…3) Por último, la variante KPC-3 resultó ser el mecanismo de resistencia a carbapenémicos más frecuente entre los aislamientos estudiados, situación que no es usual en países de América pero sí en Europa y Asia, donde se ha asociado principalmente con pacientes que viajaron a zonas endémicas (27)(28)(29)(30).…”

Caracterización molecular de un brote de Klebsiella pneumoniae resistente a carbapenémicos en un hospital de alto nivel de complejidad de Medellín, Colombia

“…En este sentido, el apoyo a la vigilancia mediante las técnicas de biología molecular es de gran importancia para contener la diseminación de los microorganismos resistentes y evitar amenazas a la seguridad del paciente, así como el aumento de la morbilidad y la mortalidad y de los costos de la atención hospitalaria (16,17).…”

“…La caracterización molecular permite obtener información detallada sobre el comportamiento, la evolución y la diseminación de microorganismos de importancia en salud pública (16,17), con el objeto de diseñar estrategias que permitan el control de la resistencia a los antibióticos.…”

Abdominal abscess due to NDM-1-producing Klebsiella pneumoniae in Spain

“…Acquired carbapenemases are increasingly reported in Gram-negative pathogens (Miriagou et al, 2010). Metallob-lactamases belong to the class B carbapenemases and confer resistance to all b-lactams, including carbapenems, except aztreonam.…”