Medical Service, Louis Stokes Cleveland Department of Veterans Affairs Medical Center, Cleveland, Ohio.
Departments of Medicine, Pharmacology, Molecular Biology, and Microbiology, Case Western Reserve University and Research Service, CWRU-VA Center for Antimicrobial Resistance and Epidemiology (CARES), Cleveland, Ohio.
Clin Infect Dis. 2018 Apr 3;66(8):1290-1297. doi: 10.1093/cid/cix893.
The dramatic increase in the prevalence and clinical impact of infections caused by bacteria producing carbapenemases is a global health concern. Carbapenemase production is especially problematic when encountered in members of the family Enterobacteriaceae. Due to their ability to readily spread and colonize patients in healthcare environments, preventing the transmission of these organisms is a major public health initiative and coordinated international effort are needed. Central to the treatment and control of carbapenemase-producing organisms (CPOs) are phenotypic (growth-/biochemical-dependent) and nucleic acid-based carbapenemase detection tests that identify carbapenemase activity directly or their associated molecular determinants. Importantly, bacterial isolates harboring carbapenemases are often resistant to multiple antibiotic classes, resulting in limited therapy options. Emerging agents, novel antibiotic combinations and treatment regimens offer promise for management of these infections. This review highlights our current understanding of CPOs with emphasis on their epidemiology, detection, treatment, and control.
产碳青霉烯酶细菌引起的感染的流行率和临床影响急剧增加，这是一个全球关注的健康问题。当肠杆菌科成员中出现产碳青霉烯酶时，情况尤其成问题。由于它们能够在医疗机构环境中轻易传播和定植患者，因此预防这些生物体的传播是一项主要的公共卫生举措，需要协调国际努力。治疗和控制产碳青霉烯酶生物体（CPO）的核心是表型（基于生长/生化）和基于核酸的碳青霉烯酶检测试验，这些试验可直接或通过其相关的分子决定因素来识别碳青霉烯酶活性。重要的是，携带碳青霉烯酶的细菌分离株通常对多种抗生素类别具有耐药性，导致治疗选择有限。新兴的药物、新型抗生素组合和治疗方案为这些感染的管理带来了希望。本综述重点介绍了我们对 CPO 的现有认识，强调了它们的流行病学、检测、治疗和控制。
