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Clinical epidemiology of the global expansion of Klebsiella pneumoniae carbapenemases. 2013
L Silvia Munoz-Price, and
Laurent Poirel, and
Robert A Bonomo, and
Mitchell J Schwaber, and
George L Daikos, and
Martin Cormican, and
Giuseppe Cornaglia, and
Javier Garau, and
Marek Gniadkowski, and
Mary K Hayden, and
Karthikeyan Kumarasamy, and
David M Livermore, and
Juan J Maya, and
Patrice Nordmann, and
Jean B Patel, and
David L Paterson, and
Johann Pitout, and
Maria Virginia Villegas, and
Hui Wang, and
Neil Woodford, and
John P Quinn
Department of Medicine, Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, FL 33136, USA. smunozprice@med.miami.edu
Klebsiella pneumoniae carbapenemases (KPCs) were originally identified in the USA in 1996. Since then, these versatile β-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.
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