title: Evolution of carbapenemase-producing Enterobacteriaceae at the global and national level: what should be expected in the future?
abstract: In recent years, Enterobacteriaceae isolates have increased their potential to become highly drug resistant by acquiring resistance to carbapenems, primarily due to the production of acquired carbapenemases. The carbapenemases detected in Enterobacteriaceae are largely of the KPC, VIM, NDM, IMP and OXA-48 types. Although the epidemiological origin and geographic distribution of carbapenemases are clearly different, they all first appeared in the late 20th Century. Only a decade later, these enzymes have already become established and have expanded globally. An important epidemiological change has occurred in Spain in recent years, characterized by a rapid increase in the number of cases of carbapenemase-producing Enterobacteriaceae (CPE), causing both nosocomial outbreaks and single infections. The impact of CPE in Spain is primarily due to OXA-48-producing and VIM-1-producing Klebsiella pneumoniae isolates, although other species such as Escherichia coli and Enterobacter cloacae are also increasing. The emergence of CPE as a cause of community-onset infections is a matter of great concern. Taking into account recent experience, and considering the fact that increasing numbers of patients are becoming infected by CPE and reservoirs of carbapenemases are growing globally, the trend of the CPE epidemic points toward a rise in its incidence. To prevent a massive CPE pandemic, a well-coordinated response from all health professionals and national and supranational authorities is clearly needed.
authors.affiliation: Laboratorio de Antibióticos, Servicio de Bacteriología, Centro Nacional de Microbiología, Majadahonda, Madrid, Spain. Electronic address: jesus.oteo@isciii.es.
authors.forename: Jesús
authors.initials: J
authors.lastname: Oteo
authors.affiliation: Servei de Microbiologia, Hospital de la Santa Creu i Sant Pau, Institut d'Investigació Biomèdica Sant Pau, Barcelona, Spain.
authors.forename: Elisenda
authors.initials: E
authors.lastname: Miró
authors.affiliation: Laboratorio de Antibióticos, Servicio de Bacteriología, Centro Nacional de Microbiología, Majadahonda, Madrid, Spain.
authors.forename: María
authors.initials: M
authors.lastname: Pérez-Vázquez
authors.affiliation: Servei de Microbiologia, Hospital de la Santa Creu i Sant Pau, Institut d'Investigació Biomèdica Sant Pau, Barcelona, Spain; Departament de Genètica i Microbiologia, Universitat Autònoma de Barcelona, Barcelona, Spain.
authors.forename: Ferran
authors.initials: F
authors.lastname: Navarro
mesh_terms: D000900:Anti-Bacterial Agents / Q000378:metabolism* / Q000627:therapeutic use; D001426:Bacterial Proteins / Q000145:classification / Q000235:genetics / Q000378:metabolism*; D015780:Carbapenems / Q000378:metabolism* / Q000627:therapeutic use; D017714:Community-Acquired Infections / Q000453:epidemiology / Q000382:microbiology; D003428:Cross Infection / Q000453:epidemiology / Q000382:microbiology; D004196:Disease Outbreaks; D024901:Drug Resistance, Multiple, Bacterial / Q000235:genetics; D004755:Enterobacteriaceae / Q000187:drug effects / Q000201:enzymology* / Q000235:genetics / Q000302:isolation & purification; D004756:Enterobacteriaceae Infections / Q000188:drug therapy / Q000453:epidemiology / Q000382:microbiology*; D019143:Evolution, Molecular; D005544:Forecasting; D014943:Global Health; D006801:Humans; D017053:Infection Control; D007391:International Cooperation; D013030:Spain; 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; Diseminación; Enterobacteriaceae; Enterobacterias; Spread