Department of Medical Microbiology, University Medical Centre, Groningen, the Netherlands.
Euro Surveill. 2010 Nov 18;15(46):19711. doi: 10.2807/ese.15.46.19711-en.
The emergence and global spread of carbapenemase-producing Enterobacteriaceae is of great concern to health services worldwide. These bacteria are often resistant to all beta-lactam antibiotics and frequently co-resistant to most other antibiotics, leaving very few treatment options. The epidemiology is compounded by the diversity of carbapenem-hydrolysing enzymes and the ability of their genes to spread between different bacterial species. Difficulties are also encountered by laboratories when trying to detect carbapenemase production during routine diagnostic procedures due to an often heterogeneous expression of resistance. Some of the resistance genes are associated with successful clonal lineages which have a selective advantage in those hospitals where antimicrobial use is high and opportunities for transmission exist; others are more often associated with transmissible plasmids. A genetically distinct strain of Klebsiella pneumoniae sequence type (ST) 258 harbouring the K. pneumoniae carbapenemases (KPC) has been causing epidemics of national and international proportions. It follows the pathways of patient referrals, causing hospital outbreaks along the way. Simultaneously, diverse strains harbouring New Delhi metallo-beta-lactamase (NDM-1) are repeatedly being imported into Europe, commonly via patients with prior medical exposure in the Indian subcontinent. Since the nature and scale of carbapenem-non-susceptible Entrobacteriaceae as a threat to hospital patients in Europe remains unclear, a consultation of experts from 31 countries set out to identify the gaps in diagnostic and response capacity, to index the magnitude of carbapenem-non-susceptibility across Europe using a novel five-level staging system, and to provide elements of a strategy to combat this public health issue in a concerted manner
产碳青霉烯酶肠杆菌科的出现和全球传播引起了全球卫生服务部门的极大关注。这些细菌通常对所有β-内酰胺类抗生素具有耐药性，并且经常对大多数其他抗生素具有共同耐药性，因此治疗选择非常有限。由于碳青霉烯水解酶的多样性及其基因在不同细菌物种之间传播的能力，其流行病学情况变得更加复杂。由于在常规诊断程序中经常存在异质表达的耐药性，因此实验室在尝试检测碳青霉烯酶产生时也会遇到困难。一些耐药基因与成功的克隆谱系相关，这些谱系在抗菌药物使用量高且存在传播机会的医院中具有选择优势；而其他基因则更多地与可传播的质粒相关。携带肺炎克雷伯菌碳青霉烯酶（KPC）的肺炎克雷伯菌序列型（ST）258 的遗传上独特的菌株已引起了具有国家和国际规模的流行。它遵循患者转诊的途径，在沿途引起医院暴发。同时，携带新德里金属β-内酰胺酶（NDM-1）的多种菌株也反复被输入欧洲，通常是通过在印度次大陆有过先前医疗暴露的患者。由于欧洲医院患者中碳青霉烯类药物不敏感肠杆菌科的性质和规模仍然不清楚，来自 31 个国家的专家咨询旨在确定诊断和应对能力方面的差距，使用新的五级分期系统对整个欧洲的碳青霉烯类药物不敏感性进行评估，并提供协同应对这一公共卫生问题的策略要素。
