Klebsiella pneumoniae Carbapenemases in Enterobacteriaceae: History, Evolution, and Microbiology Concerns

Abstract

Since the discovery of penicillin 80 years ago, gram-negative bacteria have become proficient at evading the lethal activity of β-lactam antibiotics, principally through the production of β-lactamases. The rapid emergence of penicillinases in both gram-positive and gram-negative bacteria led to the development of cephalosporin β-lactam antibiotics, but production of plasmid-mediated extended-spectrum cephalosporinases (or extended-spectrum β-lactamases) and AmpC enzymes resulted in resistance to this drug class. Because carbapenems were the only β-lactam agents active against such extended-spectrum β-lactamase-producing strains, appropriate and inappropriate use soon resulted in Enterobacteriaceae resistance. As a result, two distinct types of carbapenemases-the metallo-β-lactamases and Klebsiella pneumoniae carbapenemases (KPCs)-were soon identified. The KPCs comprise 10 variants that differ from one another by one to three amino acid substitutions (KPC-2 to KPC-11). The KPC-producing Enterobacteriaceae are not only multidrug resistant but are also difficult to detect routinely in the clinical microbiology laboratory. Tigecycline, polymyxins (colistin and polymyxin B), and aminoglycosides are possible candidate therapies for infections caused by KPC-producing organisms, although well-conducted clinical trials are required to fully define their roles in patient management. The shortage of new antimicrobial agents on the immediate horizon suggests that enhanced adherence with infection prevention procedures and antimicrobial stewardship programs are needed to curb patient-to-patient transmission and to reduce the selection of multidrug-resistant bacteria.

Characterization of KPC, NDM and VIM Type Carbapenem Resistance <i>Enterobacteriaceae</i> from North Eastern, Nigeria

“…KPC gene was the predominant carbapenemase gene detected in this study. Although, KPC gene was reported to be the predominant carbapenemases among Enterobacteriaceae worldwide, [20] Spellberg and colleagues reported that NDM-1 was predominantly common in survey of Enterobacteriaceae they did in 2009 but in 2010 they reported KPC as the most predominant in UK [21].…”

Evaluation of a real-time PCR assay for the detection of the Klebsiella pneumoniae carbapenemase gene (blaKPC) in enterobacteriaceae isolates from clinical samples in Menoufia University hospitals, Egypt

“…In Rapp and Urban (2012), most KPC-producing isolates had a carbapenem MIC ≥ 2 μg/ml, but some have been reported to be susceptible to carbapenems. The reason for this discrepancy is that full resistance to carbapenems usually requires the presence of a second mechanism of resistance such as a defect in the permeability of outer membrane.…”

Activity of beta-lactam antibiotics and production of beta-lactamases in bacteria isolated from wound infections in Brazzaville, Congo

“…Since the discovery of penicillin 80 years ago, Gramnegative bacteria have become proficient at evading the lethal activity of β-lactam antibiotics, principally through the production of β-lactamases (Rapp and Urban, 2012 Beta-lactam antibiotics are a broad class of antibiotics, consisting of all antibiotic agents that contain a β-lactam ring in their molecular structures. This includes penicillin derivatives (penams), cephalosporins (cephems), monobactams and carbapenems (Holten and Onusko, 2000).…”