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The first outbreak involving colistin-resistant, carbapenem-resistant K. pneumoniae (CRKP) in the U.S. was discovered in Detroit, Michigan in 2009, involving three different healthcare institutions. [55] In an active surveillance study in seven U.S. states over two years, the crude overall incidence of CRE was 2.93 per 100,000 population.
[1] [2] Concern has arisen in recent years over increasing rates of resistance to carbapenems, as there are few therapeutic options for treating infections caused by carbapenem-resistant bacteria (such as Klebsiella pneumoniae and other carbapenem-resistant Enterobacteriaceae [3]). [4] [5] [6]
The β-lactam core structures. (A) A penam.(B) A carbapenam.(C) An oxapenam.(D) A penem.(E) A carbapenem.(F) A monobactam.(G) A cephem.(H) A carbacephem.(I) An oxacephem. This is a list of common β-lactam antibiotics—both administered drugs and those not in clinical use—organized by structural class.
It is resistant to breakdown by many kinds of β-lactamase enzymes, produced by bacteria to protect themselves from antibiotics. [4] [5] [6] Meropenem was patented in 1983. [7] It was approved for medical use in the United States in 1996. [3] It is on the World Health Organization's List of Essential Medicines.
Therefore, antibiotic options in the treatment of ESBL-producing organisms are extremely limited. Carbapenems are the treatment of choice for serious infections due to ESBL-producing organisms, yet carbapenem-resistant (primarily ertapenem-resistant) isolates have recently been reported. [16]
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The infection was identified as a carbapenem-resistant Klebsiella pneumoniae strain bearing the novel gene bla NDM-1. The authors concluded that the new resistance mechanism "clearly arose in India, but there are few data arising from India to suggest how widespread it is". [15]
These bacteria pose a great threat to public health due to the limited treatment options available as well as lack of newly developed antimicrobial medications. MDR strains of Enterobacteriaceae, Pseudomonas aeruginosa, and Acinetobacter baumannii have become of most concern because they have been reported by hospitals all around the United ...
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