The emergence of the KPC carbapenemases: clinical and laboratory issues

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The emergence of resistance to carbapenems among members of the Enterobacteriaceae has widespread implications. One mechanism of carbapenem resistance is the production of a serine carbapenemase named KPC, which refers to the initial detection of this enzyme in a strain of Klebsiella pneumoniae. Isolates of K. pneumoniae capable of producing a KPC became commonplace in New York City beginning in the early 2000s. Subsequently, microorganisms with the KPC gene have been found in other states in the USA, as well as in other countries. This gene has also been acquired by other species of Enterobacteriaceae and by Pseudomonas aeruginosa. The detection of KPC production in bacterial strains can be problematic because the minimum inhibitory concentration for imipenem or meropenem may not surpass the breakpoint for resistance. Ertapenem is a better indicator of KPC production than are the other carbapenems. Since the KPC gene is often located on a large plasmid containing other resistance determinants, treatment options are few.

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