| Description |
Carbapenemases have been reported worldwide in Enterobacteriaceae during the last ten years but there is currently an increasing trend towards their isolation. Carbapenemases of the KPC type have been reported first in Klebsiella pneumoniae from the USA, and then worldwide with a marked endemicity in Israel and Greece. Metallo-enzymes (VIM, IMP) have been also reported internationally with an higher prevalence in Southern Europe and Asia. Carbapenemases of the OXA-48 type have been identified mostly from Mediterranean and European countries. Lately, the spread of NDM-1 producers mostly in the UK, India and Pakistan is worrisome. The NDM-1 encoding gene has been identified not only in K. pneumoniae but also in E. coli, suggesting a large spread in the community. The reservoir of NDM-1 producers is associated with several factors that will be difficult to stem; poor control of antibiotics, lack of sanitation facilities, overpopulation and high incidence of diarrhoea potentially releasing resistant strains in the environment. Detection of infected patients and carriers of carbapenemase-producers shall be done at the worldwide scale to prevent their spread. Identification of the carbapenemase genes relies mostly on molecular techniques and detection of carriers is feasible using screening culture media. This strategy may slow down the development of nosocomial outbreaks involving carbapenem-resistant Enterobacteriaceae. The ultimate goal of the contentment of carbapenemase producers is to preserve, if still possible, the efficacy of carbapenems, which are the antibiotics of last resort.
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