Subject(s)
Bacterial Proteins/genetics , Carbapenems/pharmacology , Drug Resistance, Multiple, Bacterial/genetics , Enterobacter cloacae/genetics , Enterobacter cloacae/isolation & purification , Enterobacteriaceae Infections/drug therapy , beta-Lactamases/genetics , Aged , Anti-Bacterial Agents/pharmacology , Carbapenems/therapeutic use , Colombia , Enterobacter cloacae/drug effects , Enterobacter cloacae/enzymology , Female , Humans , Microbial Sensitivity TestsSubject(s)
Bacterial Proteins/genetics , Klebsiella Infections/microbiology , Klebsiella pneumoniae/drug effects , Klebsiella pneumoniae/genetics , Pneumonia, Bacterial/microbiology , beta-Lactamases/genetics , Aged , Anti-Bacterial Agents/therapeutic use , Colombia , Cross Infection/drug therapy , Cross Infection/microbiology , Female , Humans , Klebsiella Infections/drug therapy , Klebsiella pneumoniae/enzymology , Klebsiella pneumoniae/isolation & purification , Meropenem , Pneumonia, Bacterial/drug therapy , Stroke , Thienamycins/therapeutic useABSTRACT
In 2008, an increase in the prevalence of carbapenem-resistant Klebsiella pneumoniae was noted in a 286-bed tertiary case hospital in Colombia, where 84 patients (32 infected and 52 colonized) had positive cultures. The identified index patient came from Israel for a liver transplantation. High level carbapenem resistance was observed. Polymyxin B and tigecycline were the only two antibiotics that remained active. PCR-restriction fragment length polymorphism analysis and sequencing revealed blaKPC-3 in the major clone, which was indistinguishable from the K. pneumoniae carbapenemase-3-producing clone described previously in Israel. This exemplifies the threat posed by the global spread of K. pneumoniae carbapenemase-producing pathogens.
Subject(s)
Bacterial Proteins/metabolism , Cross Infection/microbiology , Cross Infection/transmission , Klebsiella Infections/microbiology , Klebsiella Infections/transmission , beta-Lactamases/metabolism , Anti-Bacterial Agents/therapeutic use , Colombia , Cross Infection/drug therapy , Cross Infection/mortality , Humans , Israel , Klebsiella Infections/drug therapy , Klebsiella Infections/mortality , Klebsiella pneumoniae/classification , Klebsiella pneumoniae/genetics , Klebsiella pneumoniae/isolation & purification , Molecular TypingABSTRACT
Antibiotic resistance among Gram-negative pathogens in hospitals is a growing threat to patients and is driving the increased use of carbapenems. Carbapenems are potent members of the beta-lactam family of antibiotics, with a history of safety and efficacy for serious infections that exceeds 20 years. Original and review articles were identified from a Medline search (1979-2008). Reference citations from identified publications, abstracts from the Interscience Conferences on Antimicrobial Agents and Chemotherapy and package inserts were also used. Carbapenems are effective in treating severe infections at diverse sites, with relatively low resistance rates and a favourable safety profile. Carbapenems are the beta-lactams of choice for the treatment of infections caused by multidrug-resistant organisms. Optimized dosing of carbapenems should limit the emergence of resistance and prolong the utility of these agents. The newly approved doripenem should prove to be a valuable addition to the currently available carbapenems: imipenem, meropenem and ertapenem.