From the Guidelines
Carbapenem resistance is indeed seen more among K. pneumoniae than E. coli, with K. pneumoniae being the predominant carbapenem-resistant Enterobacteriaceae globally. This difference occurs because K. pneumoniae more readily acquires and maintains carbapenemase-producing plasmids, particularly those carrying KPC (Klebsiella pneumoniae carbapenemase) genes 1. Additionally, K. pneumoniae has a greater ability to spread in healthcare settings through patient-to-patient transmission and environmental persistence.
Key Points
- While carbapenem resistance in E. coli is increasing, it remains less common than in K. pneumoniae 1.
- This pattern has important clinical implications, as infections with carbapenem-resistant K. pneumoniae often require treatment with last-resort antibiotics like colistin, tigecycline, or newer agents such as ceftazidime-avibactam 1.
- Infection control measures should focus particularly on preventing the spread of resistant K. pneumoniae in healthcare facilities through hand hygiene, contact precautions, and antimicrobial stewardship 1.
- The use of rapid testing strategies to identify specific carbapenemases and guide antibiotic therapy is strongly recommended 1.
- Novel β-lactam agents such as ceftazidime/avibactam and meropenem/vaborbactam should be considered as first-line treatment options for infections caused by KPC-producing carbapenem-resistant Enterobacterales (CRE) 1.
From the Research
Carbapenem Resistance in Bacteria
- Carbapenem resistance is a significant public health concern, primarily affecting Gram-negative pathogens such as Klebsiella pneumoniae, Pseudomonas aeruginosa, and Acinetobacter baumannii 2.
- This type of resistance can be intrinsic or mediated by transferable carbapenemase-encoding genes, which are widespread in certain parts of the world, including Europe, Asia, and South America 2.
Prevalence of Carbapenem Resistance in K. pneumoniae and E. coli
- While the provided studies do not directly compare the prevalence of carbapenem resistance between K. pneumoniae and E. coli, they do highlight the significance of carbapenem-resistant K. pneumoniae (CRKP) as a major concern in healthcare settings 3, 4, 5.
- The studies focus on the characterization of resistance patterns, treatment options, and mechanisms of resistance in CRKP, indicating a higher attention to K. pneumoniae due to its notorious resistance profiles 3, 4, 5.
Mechanisms of Resistance
- The emergence of carbapenem-resistant K. pneumoniae can be driven by various mechanisms, including the production of carbapenemases and outer membrane remodeling 6.
- Outer membrane remodeling, such as the loss of OmpK36, can lead to increased resistance to carbapenems, even in initially susceptible strains 6.
Treatment and Management
- Novel antimicrobial agents, such as ceftazidime-avibactam, meropenem-vaborbactam, and imipenem/cilastatin-relebactam, have shown promise in treating CRKP infections 4.
- These agents have demonstrated improved safety and efficacy compared to traditional polymyxin-based combination therapy, although resistance patterns and treatment outcomes can vary 4.