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treatment of choice for serious infections due to ESBL-producing organisms. Use of Imipenem, Meropenem and Doripenem is best restricted for serious life threatening infections treated in ICUs, while Ertapenem is best suited for community acquired pneumonia requiring hospitalization. Carbapenem lack activity against


Enterococcus faecium, methicillin-resistant Staphylococcus aureus and Stenotrophomonas maltophilia. Acquired resistance to Carbapenem develops when bacteria either acquire a Carbapenemase capable of rapidly degrading Carbapenem or when it acquires the ability to syntheses a new, modified PBP 2’, which has low affinity for Carbapenem. Changes in the outer porins also appear to compromise Carbapenem’s activity. Carbapenemase occurring in clinical isolates of Gram-negative bacilli fall into three classes of the Ambler classification system, A, B, and D. The most common Carbapenemase in Enterobacteriaceae isolated in many countries are the K. pneumoniae Carbapenemase (KPC) enzymes, which


“Infection prevention measures should be vigorously reinforced”


are Ambler class A, serine β- lactamases. Other class A Carbapenemase found in Enterobacteriaceae includes the chromosomally encoded SME, NMC, and IMI enzymes and members of the GES family of β- lactamases. Of increasing concern is the rapid


spread of a novel MBL, originally identified from a 2008 K. pneumoniae isolate in a Swedish patient who had previously been treated in a New Delhi hospital. This New Delhi Metallo-b-lactamase (NDM- 1) is spreading rapidly on the Indian subcontinent, and has now been identified in many parts of the world with many isolates being epidemiologically traced to a visit to the Indian subcontinent. Like the KPC enzymes, the MBLs are worrisome because they hydrolyze virtually all β-lactams, are not inhibited by any therapeutically useful inhibitor, and are co-produced with other β-lactamases. OXA Carbapenemase, which are Ambler class D enzymes, are primarily found in Acinetobacter spp. Outbreaks of


18 www.lifesciencesmagazines.com


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