Detection and treatment options for Klebsiella pneumoniae carbapenemases (KPCs): An emerging cause of multidrug-resistant infection

Elizabeth B. Hirsch, Vincent H. Tam

Research output: Contribution to journalArticlepeer-review

357 Scopus citations

Abstract

Bacteria producing Klebsiella pneumoniae carbapenemases (KPCs) are rapidly emerging as a cause of multidrug-resistant infections worldwide. Bacterial isolates harbouring these enzymes are capable of hydrolysing a broad spectrum of β-lactams including the penicillins, cephalosporins, carbapenems and monobactam. Detection of isolates harbouring carbapenemases can be inconsistent using automated systems, often requiring subsequent confirmatory tests. Phenotypic methods utilizing boronic acid disc tests have demonstrated promising results and appear practical for use in clinical microbiology laboratories. Treatment of infection caused by KPC bacteria is particularly worrisome as the carbapenems are often agents of the last resort for resistant Gram-negative infections. The optimal treatment of infections caused by KPC bacteria is not well established and clinical outcome data remain sparse. We reviewed the current literature regarding clinical outcomes following KPC infections, with a specific effort to summarize the clinical data available for specific antimicrobial agents. A total of 15 papers involving 55 unique patient cases were reviewed. While the total number of patients is relatively small, some useful insights could still be gathered to guide clinicians in the management of KPC infections. Tigecycline and the aminoglycosides were associated with positive outcomes in the majority of cases. Clinical success rates were low when the polymyxins were used as monotherapy, but were much higher when they were used in combination. Studies examining combination therapy and well-controlled clinical trials are needed to ascertain the optimal treatment of infections caused by KPC bacteria.

Original languageEnglish (US)
Article numberdkq108
Pages (from-to)1119-1125
Number of pages7
JournalJournal of Antimicrobial Chemotherapy
Volume65
Issue number6
DOIs
StatePublished - Apr 8 2010

Bibliographical note

Funding Information:
E. B. H.: none to declare. V. H. T. has received unrestricted research grants from AstraZeneca, Merck, Schering-Plough and Achaogen and is on the speakers’ bureau of Merck.

Keywords

  • Carbapenems
  • Plasmids
  • Susceptibility
  • β-Lactamases

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