Clinical epidemiology of the global expansion of Klebsiella pneumoniae carbapenemases

Abstract

Klebsiella pneumoniae carbapenemases (KPCs) were originally identified in the USA in 1996. Since then, these versatile β-lactamases have spread internationally among Gram-negative bacteria, especially K pneumoniae, although their precise epidemiology is diverse across countries and regions. The mortality described among patients infected with organisms positive for KPC is high, perhaps as a result of the limited antibiotic options remaining (often colistin, tigecycline, or aminoglycosides). Triple drug combinations using colistin, tigecycline, and imipenem have recently been associated with improved survival among patients with bacteraemia. In this Review, we summarise the epidemiology of KPCs across continents, and discuss issues around detection, present antibiotic options and those in development, treatment outcome and mortality, and infection control. In view of the limitations of present treatments and the paucity of new drugs in the pipeline, infection control must be our primary defence for now.

The combined-disk boronic acid test as an accurate strategy for the detection of KPC carbapenemase in Central America

“…These measures include informing the healthcare personnel about the outbreak, the transmission mechanism, and the need for strict adherence to hygiene protocols [6]. Also, contact precautions were undertaken, as well as rectal swab screening of inpatients with a history of hospitalization, and a protocol about control measures for the country was elaborated [24].…”

“…Carbapenemase-producing Klebsiella pneumoniae (KPC) has sparked interest due to the high antibiotic resistance that causes increased mortality compared to other strains [2,3]. Multiple outbreaks have been reported worldwide that have led to the application of several detection and control strategies [4][5][6]. Colombia was the first country in Latin America to report KPC in 2008, which caused approximately 14 deaths [7].…”

“…The diagnostic accuracy of these tests varies and these tests are sometimes used as confirmatory tests. However, molecular tests have remained the gold standard for the identification and characterization of the resistance mechanism [6,13].…”

Clinical and laboratory considerations for the rapid detection of carbapenem-resistant Enterobacteriaceae

“…In the US, the CRE epidemic is driven by the rapid expansion of CP-K. pneumoniae of sequence type 258, that express the class A KPC carbapenemase. 7,8 KPC is a particularly efficient enzyme and isolates with this resistance mechanism often display very high carbapenem minimum inhibitory concentrations (MICs). KPC is now endemic in the US, Israel, South America and some countries in Europe and Asia.…”

Identifying Patients at High Risk for Carbapenem-Resistant Enterobacteriaceae at Admission: Nurse-Led or Doctor-Led?

“…Additionally, mortality associated with CRE infections is reported to be between 40% and 50%. 1 At Tan Tock Seng Hospital (TTSH), a 1,500-bed teaching hospital in Singapore, we have been practicing a mixture of proactive infection control strategies (eg, screening patients with travel history to CRE endemic countries) and reactive infection control strategies (eg, contact tracing once CRE is identified from clinical cultures) since 2010. 2 However, these activities have not stemmed the rising trend of CP-CREs, particularly the New Delhi metallo-β-lactamase (NDM-1)-producing Enterobacteriaceae.…”