10 : Carbapenem Resistance in and Other Members of the Family

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with reduced susceptibility to carbapenems are an emerging, worldwide problem. In most cases, the reduced carbapenem susceptibility is attributable to acquisition of one of a variety of ß-lactamases with carbapenem-hydrolyzing properties. Carbapenem resistance can be mediated by the acquisition of carbapenem-hydrolyzing ß-lactamases. In Japan, IMP enzymes have been recovered from isolates of and and conferred resistance to ceftazidime and imipenem. Occasional isolates of carrying IMP metallo-ß-lactamases have also been recovered in Japan. carrying KPC ß-lactamases are emerging and pose serious challenges to therapy. Approximately 90%of KPC-possessing isolates are susceptible to polymyxin B, and the antibiotic exhibits a concentration-dependent killing effect. The addition of rifampin to polymyxin B provided bactericidal activity in 15/16 tested isolates in one report and resulted in a lower inhibitory concentration of polymyxin B. The fact that other carbapenem-hydrolyzing enzymes emerged prior to the commercial release of carbapenems also suggests that other properties of these enzymes may justify their existence or that other antibiotics in nature could be substrates and exert selection pressures. Also complicating potential antibiotic control strategies is the fact that other resistance genes often accompany the carbapenemase gene, including those for other ß-lactamases, amikacin, gentamicin, streptomycin, tobramycin, and trimethoprim-sulfamethoxazole. Due to these associations, it has been suggested that selective pressure from non-ß-lactam antibiotics (e.g., aminoglycosides) may encourage concomitant carbapenem resistance.

Citation: Bratu S, Quale J. 2007. Carbapenem Resistance in and Other Members of the Family , p 181-197. In Scheld W, Hooper D, Hughes J (ed), Emerging Infections 7. ASM Press, Washington, DC. doi: 10.1128/9781555815585.ch10
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Table 1.

Class B metallo-β-lactamases found in

Citation: Bratu S, Quale J. 2007. Carbapenem Resistance in and Other Members of the Family , p 181-197. In Scheld W, Hooper D, Hughes J (ed), Emerging Infections 7. ASM Press, Washington, DC. doi: 10.1128/9781555815585.ch10
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Table 2.

Class A carbapenem-hydrolyzing β-lactamases found in

Citation: Bratu S, Quale J. 2007. Carbapenem Resistance in and Other Members of the Family , p 181-197. In Scheld W, Hooper D, Hughes J (ed), Emerging Infections 7. ASM Press, Washington, DC. doi: 10.1128/9781555815585.ch10
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Table 3.

Kinetic parameters of various carbapenem-hydrolyzing β-lactamases

Citation: Bratu S, Quale J. 2007. Carbapenem Resistance in and Other Members of the Family , p 181-197. In Scheld W, Hooper D, Hughes J (ed), Emerging Infections 7. ASM Press, Washington, DC. doi: 10.1128/9781555815585.ch10
Generic image for table
Table 4.

Susceptibility results for 62 KPC-possessing isolates

Citation: Bratu S, Quale J. 2007. Carbapenem Resistance in and Other Members of the Family , p 181-197. In Scheld W, Hooper D, Hughes J (ed), Emerging Infections 7. ASM Press, Washington, DC. doi: 10.1128/9781555815585.ch10

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