Carbapenemase-Producing Klebsiella pneumoniae, a Key Pathogen Set for Global Nosocomial Dominance

The management of infections due to Klebsiella pneumoniae has been complicated by the emergence of antimicrobial resistance, especially to carbapenems. Resistance to carbapenems in K. pneumoniae involves multiple mechanisms, including the production of carbapenemases (e.g., KPC, NDM, VIM, OXA-48-lik...

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Published in:	Antimicrobial agents and chemotherapy Vol. 59; no. 10; p. 5873
Main Authors:	Pitout, Johann D D, Nordmann, Patrice, Poirel, Laurent
Format:	Journal Article
Language:	English
Published:	United States 01.10.2015
Subjects:	Anti-Bacterial Agents - pharmacology Bacterial Proteins - genetics Bacterial Proteins - metabolism beta-Lactam Resistance - genetics beta-Lactamases - genetics beta-Lactamases - metabolism Carbapenems - pharmacology Clone Cells Conjugation, Genetic Cross Infection - drug therapy Cross Infection - epidemiology Cross Infection - microbiology DNA Transposable Elements Gene Expression Regulation, Bacterial Humans Klebsiella Infections - drug therapy Klebsiella Infections - epidemiology Klebsiella Infections - microbiology Klebsiella pneumoniae - drug effects Klebsiella pneumoniae - enzymology Klebsiella pneumoniae - genetics Klebsiella pneumoniae - pathogenicity Plasmids - chemistry Plasmids - metabolism Porins - deficiency Porins - genetics Recombination, Genetic
ISSN:	1098-6596, 1098-6596
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Abstract	The management of infections due to Klebsiella pneumoniae has been complicated by the emergence of antimicrobial resistance, especially to carbapenems. Resistance to carbapenems in K. pneumoniae involves multiple mechanisms, including the production of carbapenemases (e.g., KPC, NDM, VIM, OXA-48-like), as well as alterations in outer membrane permeability mediated by the loss of porins and the upregulation of efflux systems. The latter two mechanisms are often combined with high levels of other types of β-lactamases (e.g., AmpC). K. pneumoniae sequence type 258 (ST258) emerged during the early to mid-2000s as an important human pathogen and has spread extensively throughout the world. ST258 comprises two distinct lineages, namely, clades I and II, and it seems that ST258 is a hybrid clone that was created by a large recombination event between ST11 and ST442. Incompatibility group F plasmids with blaKPC have contributed significantly to the success of ST258. The optimal treatment of infections due to carbapenemase-producing K. pneumoniae remains unknown. Some newer agents show promise for treating infections due to KPC producers; however, effective options for the treatment of NDM producers remain elusive.
AbstractList	The management of infections due to Klebsiella pneumoniae has been complicated by the emergence of antimicrobial resistance, especially to carbapenems. Resistance to carbapenems in K. pneumoniae involves multiple mechanisms, including the production of carbapenemases (e.g., KPC, NDM, VIM, OXA-48-like), as well as alterations in outer membrane permeability mediated by the loss of porins and the upregulation of efflux systems. The latter two mechanisms are often combined with high levels of other types of β-lactamases (e.g., AmpC). K. pneumoniae sequence type 258 (ST258) emerged during the early to mid-2000s as an important human pathogen and has spread extensively throughout the world. ST258 comprises two distinct lineages, namely, clades I and II, and it seems that ST258 is a hybrid clone that was created by a large recombination event between ST11 and ST442. Incompatibility group F plasmids with blaKPC have contributed significantly to the success of ST258. The optimal treatment of infections due to carbapenemase-producing K. pneumoniae remains unknown. Some newer agents show promise for treating infections due to KPC producers; however, effective options for the treatment of NDM producers remain elusive.The management of infections due to Klebsiella pneumoniae has been complicated by the emergence of antimicrobial resistance, especially to carbapenems. Resistance to carbapenems in K. pneumoniae involves multiple mechanisms, including the production of carbapenemases (e.g., KPC, NDM, VIM, OXA-48-like), as well as alterations in outer membrane permeability mediated by the loss of porins and the upregulation of efflux systems. The latter two mechanisms are often combined with high levels of other types of β-lactamases (e.g., AmpC). K. pneumoniae sequence type 258 (ST258) emerged during the early to mid-2000s as an important human pathogen and has spread extensively throughout the world. ST258 comprises two distinct lineages, namely, clades I and II, and it seems that ST258 is a hybrid clone that was created by a large recombination event between ST11 and ST442. Incompatibility group F plasmids with blaKPC have contributed significantly to the success of ST258. The optimal treatment of infections due to carbapenemase-producing K. pneumoniae remains unknown. Some newer agents show promise for treating infections due to KPC producers; however, effective options for the treatment of NDM producers remain elusive. The management of infections due to Klebsiella pneumoniae has been complicated by the emergence of antimicrobial resistance, especially to carbapenems. Resistance to carbapenems in K. pneumoniae involves multiple mechanisms, including the production of carbapenemases (e.g., KPC, NDM, VIM, OXA-48-like), as well as alterations in outer membrane permeability mediated by the loss of porins and the upregulation of efflux systems. The latter two mechanisms are often combined with high levels of other types of β-lactamases (e.g., AmpC). K. pneumoniae sequence type 258 (ST258) emerged during the early to mid-2000s as an important human pathogen and has spread extensively throughout the world. ST258 comprises two distinct lineages, namely, clades I and II, and it seems that ST258 is a hybrid clone that was created by a large recombination event between ST11 and ST442. Incompatibility group F plasmids with blaKPC have contributed significantly to the success of ST258. The optimal treatment of infections due to carbapenemase-producing K. pneumoniae remains unknown. Some newer agents show promise for treating infections due to KPC producers; however, effective options for the treatment of NDM producers remain elusive.
Author	Pitout, Johann D D Nordmann, Patrice Poirel, Laurent
Author_xml	– sequence: 1 givenname: Johann D D surname: Pitout fullname: Pitout, Johann D D email: johann.pitout@cls.ab.ca organization: Division of Microbiology, Calgary Laboratory Services, University of Calgary, Calgary, Alberta, Canada Department of Pathology and Laboratory Medicine, University of Calgary, Calgary, Alberta, Canada Department of Microbiology, Immunology, and Infectious Diseases, University of Calgary, Calgary, Alberta, Canada Department of Medical Microbiology, University of Pretoria, Pretoria, South Africa johann.pitout@cls.ab.ca – sequence: 2 givenname: Patrice surname: Nordmann fullname: Nordmann, Patrice organization: Medical and Molecular Microbiology Unit Emerging Antibiotic Resistance, Department of Medicine, Faculty of Science, University of Fribourg, Fribourg, Switzerland HFR-Hôpital Cantonal, Fribourg, Switzerland – sequence: 3 givenname: Laurent surname: Poirel fullname: Poirel, Laurent organization: HFR-Hôpital Cantonal, Fribourg, Switzerland
BackLink	https://www.ncbi.nlm.nih.gov/pubmed/26169401$$D View this record in MEDLINE/PubMed
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Snippet	The management of infections due to Klebsiella pneumoniae has been complicated by the emergence of antimicrobial resistance, especially to carbapenems....
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SubjectTerms	Anti-Bacterial Agents - pharmacology Bacterial Proteins - genetics Bacterial Proteins - metabolism beta-Lactam Resistance - genetics beta-Lactamases - genetics beta-Lactamases - metabolism Carbapenems - pharmacology Clone Cells Conjugation, Genetic Cross Infection - drug therapy Cross Infection - epidemiology Cross Infection - microbiology DNA Transposable Elements Gene Expression Regulation, Bacterial Humans Klebsiella Infections - drug therapy Klebsiella Infections - epidemiology Klebsiella Infections - microbiology Klebsiella pneumoniae - drug effects Klebsiella pneumoniae - enzymology Klebsiella pneumoniae - genetics Klebsiella pneumoniae - pathogenicity Plasmids - chemistry Plasmids - metabolism Porins - deficiency Porins - genetics Recombination, Genetic
Title	Carbapenemase-Producing Klebsiella pneumoniae, a Key Pathogen Set for Global Nosocomial Dominance
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