title: Epidemiology of infections caused by carbapenemase-producing Enterobacteriaceae: reservoirs and transmission mechanisms.
abstract: The dissemination of carbapenemase-producing Enterobacteriaceae has occurred very quickly and has crossed borders rapidly between countries and continents. In some areas, it has exceeded the holding capacity of health systems, reaching epidemic proportions. This form of dissemination has not been the same for all enzymes, with KPC, NDM and OXA-48 genes having a greater ability to spread. These enzymes have primarily been spread clonally in the case of KPC-producing Klebsiella pneumoniae from the initial epicenter located in New York, with a very small number of strains causing outbreaks. For NDM and OXA- 48, these resistance determinants have been vehiculized by clones with a high transmission capacity; however, simultaneous horizontal transmission is also playing an important role. The most important identified reservoirs are colonized or infected individuals from endemic areas or centers with outbreaks, but the contaminated goods from these endemic areas also play a part. An international effort is needed to control the spread of these multiresistant pathogens.
authors.affiliation: Unidad de Enfermedades Infecciosas y Microbiología Clínica, Hospital Universitario Virgen Macarena, Sevilla, Spain. Electronic address: llopez@us.es.
authors.forename: Lorena
authors.initials: L
authors.lastname: López-Cerero
authors.affiliation: División de Enfermedades Infecciosas, Hospital Universitario Vall d'Hebron, Barcelona, Spain.
authors.forename: Benito
authors.initials: B
authors.lastname: Almirante
mesh_terms: D000900:Anti-Bacterial Agents / Q000378:metabolism; D001426:Bacterial Proteins / Q000145:classification / Q000235:genetics / Q000378:metabolism*; D015780:Carbapenems / Q000378:metabolism; D002999:Clone Cells / Q000201:enzymology; D003132:Commerce; D017714:Community-Acquired Infections / Q000453:epidemiology / Q000382:microbiology; D003428:Cross Infection / Q000453:epidemiology / Q000382:microbiology; D004197:Disease Reservoirs; D024901:Drug Resistance, Multiple, Bacterial / Q000235:genetics; D019353:Endemic Diseases; D004755:Enterobacteriaceae / Q000187:drug effects / Q000201:enzymology* / Q000235:genetics; D004756:Enterobacteriaceae Infections / Q000453:epidemiology* / Q000382:microbiology / Q000635:transmission; D014943:Global Health; D006801:Humans; D017053:Infection Control; D007391:International Cooperation; D014195:Travel; D018440:beta-Lactam Resistance / Q000235:genetics; D001618:beta-Lactamases / Q000145:classification / Q000235:genetics / Q000378:metabolism*
chemical_list: D000900:Anti-Bacterial Agents; D001426:Bacterial Proteins; D015780:Carbapenems; D001618:beta-Lactamases; C063912:carbapenemase
keywords: Carbapenemasas; Carbapenemases; Clones competentes; Clones transfronterizos; Cross-border clones; Successful clones