Clinical epidemiology of the global expansion of klebsiella pneumoniae carbapenemases
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2013-09-01Author
Munoz-Price, L Silvia
Poirel, Laurent
Bonomo, Robert A
Schwaber, Mitchell J
Daikos, George L
Cormican, Martin
Cornaglia, Giuseppe
Garau, Javier
Gniadkowski, Marek
Hayden, Mary K
Kumarasamy, Karthikeyan
Livermore, David M
Maya, Juan J
Nordmann, Patrice
Patel, Jean B
Paterson, David L
Pitout, Johann
Villegas, Maria Virginia
Wang, Hui
Woodford, Neil
Quinn, John P
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Munoz-Price, L Silvia; Poirel, Laurent; Bonomo, Robert A; Schwaber, Mitchell J; Daikos, George L; Cormican, Martin; Cornaglia, Giuseppe; Garau, Javier; Gniadkowski, Marek; Hayden, Mary K; Kumarasamy, Karthikeyan; Livermore, David M; Maya, Juan J; Nordmann, Patrice; Patel, Jean B; Paterson, David L; Pitout, Johann; Villegas, Maria Virginia; Wang, Hui; Woodford, Neil; Quinn, John P (2013). Clinical epidemiology of the global expansion of klebsiella pneumoniae carbapenemases. The Lancet Infectious Diseases 13 (9), 785-796
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Abstract
Klebsiella pneumoniae carbapenemases (KPCs) were originally identified in the USA in 1996. Since then, these versatile beta-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.