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InfectIon control

ABSTRACT Carbapenem antibiotics have excellent bactericidal activity against a wide range of bacteria and are stable to most prevalent β lactamases including ESBL. Consequently, Carbapenem antibiotics have been thoroughly overused for treatment of life threatening bacterial infections. Bacterial resistance to Carbapenem antibiotics due to chromosomal or plasmid borne Carbapenemase have been emerging, initially amongst nonfermentor Gram- negative bacteria and more recently

amongst members of Enterobacteriaceae. Serine Carbapenemase (Class A) which

first emerged in North Carolina, USA in the early 2000 in Klebsiella pneumoniae and obtained a foothold in ICUs of New York has spread throughout the world. This K. pneumoniae Carbapenemase (KPC) is borne on a plasmid. KPC producing bacteria are frequently resistant to all antimicrobials except colistin and infections with KPC producing bacteria have been associated with high mortality and morbidity. Metallo β lactamases (MBL, class B)

are found on transmissible plasmids and have also spread globally. MBL producing Enterobacteriaceae have been recognized since 1994 when plasmid borne IMP 1 was identified in a Japanese Serratia marcesans isolate. Subsequently VIM was identified in Verona, Italy. Recently another MBL, New Delhi β lactamase 1 (NDM 1) which was first isolated in Escherichia coli in Sweden from a patient of Indian origin, has spread widely in the Indian subcontinent, UK and many parts of the world. Control of Carbapenemase Resistant

Enterobacteriaceae has been hampered by faulty and exceedingly high breakpoints, which have now been revised by CLSI. A large number of patients carry the resistant bacteria in the intestine. Infection control contact precautions are instituted only after active surveillance cultures. The extensive outbreak in New York ICUs, in spite of institution of standard contact precautions, indicated that additional measures needs to be instituted in order to control the relentless spread of CRE. The situation in UAE is unclear after a

review of literature.

CARBAPENEM: AN EXCELLENT CLASS OF ANTIBIOTIC Among the many different structurally distinct classes of beta-lactams, the Carbapenem class is regarded as the most potent and which has the widest spectrum of antimicrobial activity. Rapidly bactericidal, and demonstrating time- dependent killing, Carbapenem have a spectrum of antimicrobial activity that includes Gram-positive and Gram- negative aerobic and anaerobic pathogens. Their in-vitro activity includes extended- spectrum beta-lactamase (ESBL)- producing pathogens and Carbapenem are currently considered to be the 

“Carbapenemase screening should be a standard component of the susceptibility testing on all Enterobacteriaceae isolated in routine diagnostics”

MedLab Issue 2 2011 17

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