title: Clinical epidemiology of the global expansion of Klebsiella pneumoniae carbapenemases.
abstract: 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.
authors: Department of Medicine, Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, FL 33136, USA. smunozprice@med.miami.edu
authors: L Silvia
authors: LS
authors: Munoz-Price
authors: Laurent
authors: L
authors: Poirel
authors: Robert A
authors: RA
authors: Bonomo
authors: Mitchell J
authors: MJ
authors: Schwaber
authors: George L
authors: GL
authors: Daikos
authors: Martin
authors: M
authors: Cormican
authors: Giuseppe
authors: G
authors: Cornaglia
authors: Javier
authors: J
authors: Garau
authors: Marek
authors: M
authors: Gniadkowski
authors: Mary K
authors: MK
authors: Hayden
authors: Karthikeyan
authors: K
authors: Kumarasamy
authors: David M
authors: DM
authors: Livermore
authors: Juan J
authors: JJ
authors: Maya
authors: Patrice
authors: P
authors: Nordmann
authors: Jean B
authors: JB
authors: Patel
authors: David L
authors: DL
authors: Paterson
authors: Johann
authors: J
authors: Pitout
authors: Maria Virginia
authors: MV
authors: Villegas
authors: Hui
authors: H
authors: Wang
authors: Neil
authors: N
authors: Woodford
authors: John P
authors: JP
authors: Quinn
mesh_terms: D000617:Aminoglycosides / Q000494:pharmacology; D000900:Anti-Bacterial Agents / Q000494:pharmacology; D016470:Bacteremia / Q000188:drug therapy; D001426:Bacterial Proteins / Q000378:metabolism*; D003091:Colistin / Q000494:pharmacology; D003140:Communicable Disease Control; D005843:Geography; D006801:Humans; D007710:Klebsiella Infections / Q000188:drug therapy / Q000453:epidemiology* / Q000517:prevention & control; D007711:Klebsiella pneumoniae / Q000201:enzymology* / Q000302:isolation & purification; D008911:Minocycline / Q000031:analogs & derivatives / Q000494:pharmacology; D000078304:Tigecycline; D016896:Treatment Outcome; D001618:beta-Lactamases / Q000378:metabolism*
chemical_list: D000617:Aminoglycosides; D000900:Anti-Bacterial Agents; D001426:Bacterial Proteins; D000078304:Tigecycline; D001618:beta-Lactamases; C063912:carbapenemase; D008911:Minocycline; D003091:Colistin
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