USA - Klebsiella pneumoniae carbapenemase, or KPC, is a much bigger concern right now

[Gert van der Hoek]

excerpt

Experts offer perspective on antibiotic resistance threat

Robert Roos News Editor

Aug 20, 2010 (CIDRAP News) – The recently reported factor that can make gram-negative bacteria resistant to nearly all antibiotics is a serious concern but does not necessarily top the list of resistance worries for healthcare in the United States, say two antimicrobial resistance experts who discussed the threat this week.

Neil Fishman, MD, president of the Society for Healthcare Epidemiology of America, said bacteria that produce the resistance enzyme NDM-1 are worrisome but asserted that another resistance enzyme, Klebsiella pneumoniae carbapenemase, or KPC, is a much bigger concern right now. KPC, like NDM-1, renders bacteria resistant to carbapenem and most other antibiotics, he said.

Brandi Limbago, PhD, of the Centers for Disease Control and Prevention (CDC) said NDM-1 bacteria bear close watching but should be controllable with careful use of antibiotics and proper infection prevention measures.

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Klebsiella Pneumoniae Carbapenemases (KPC)

Emergence of carbapenemase resistance in Klebsiella pneumoniae and other Enterobacteriacea bacteria


Background
Multidrug resistant Gram negative organisms, including extended spectrum ß-lactamase (ESBL) producing pathogens, are an increasingly difficult problem in US hospitals. Carbapenem antibiotics, such as meropenem and imipenem, have been the cornerstone of drug treatment for serious infections caused by these pathogens. Resistance to carbapenems has been uncommon until now. Recently, Klebsiella pneumoniae has developed a novel mechanism of resistance to carbapenems, known as KPC, and has caused several extended outbreaks of infection in the Northeast region of the US.

What is a KPC?
K. pneumoniae carbapenemases (KPCs) were first described in 2001 in an isolate of Klebsiella from a hospital in North Carolina.2 KPC enzymes are encoded on gene segments that can be passed between bacteria known as plasmids. Bacteria with KPC enzymes can inactivate all penicillins, cephalosporins, aztreonam and most importantly carbapenems. KPC resistance can co-exist with other gram-negative resistance mechanisms – including ESBL, fluoroquinolone, and aminoglycoside resistances.

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The problem grows: spread of KPC resistance
KPC resistance has been reported in other states (NJ, PA, FL, GA, MD, CA, OH), including North Carolina. KPC resistance has also been reported throughout the world in Israel,4 China,5 S. America,6 and France.7 Finally, the plasmid that harbors the KPC resistance gene has transmitted to other Gram negative bacteria including Enterobacter,8 K. oxytoca,9 Pseudomonas,10 E. coli,11 and S. marcescens5.

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More to read:

Klebsiella pneumoniae Carbapenemase: Extended-Spectrum beta-Lactamase Continues to Go Global

Diversity of K. pneumoniae That Produce KPC