From the Guidelines
Carbapenemase-producing organisms, including KPC, OXA-48, NDM, VIM, and IMP, have a varying global distribution, with KPC predominantly found in the Americas, OXA-48 in the Mediterranean and Middle East, NDM in South Asia, VIM in Greece and Italy, and IMP in East Asia. The epidemiology and prevalence of these enzymes are crucial in guiding treatment strategies, as each class of enzymes confers variable susceptibility profiles [ 1 ]. According to a recent study published in the International Journal of Antimicrobial Agents, the majority of meropenem-non-susceptible Enterobacterales carried KPC-type carbapenemases (47.4%), followed by MBLs (20.6%) and OXA-48-like β-lactamases (19.0%) [ 1 ]. Some key points to consider include:
- KPC is the most common carbapenemase in the Americas, with a prevalence of 30-50% of carbapenem-resistant isolates.
- OXA-48 is dominant in Turkey and North Africa, with a prevalence of >50% of carbapenem-resistant isolates.
- NDM is becoming increasingly prevalent in South Asia, with a prevalence of 40-60% of carbapenem-resistant isolates.
- VIM and IMP are less common, but still significant, with sporadic outbreaks in various regions. The distribution and prevalence of these enzymes are influenced by factors such as healthcare settings, infection control measures, and mobile genetic elements [ 1 ]. Rapid testing to identify specific carbapenemase families is strongly recommended to guide antibiotic therapy and prevent the spread of these enzymes [ 1 ]. In terms of geographical distribution, some key points to consider include:
- The Indian subcontinent is a significant reservoir for NDM, with cases reported in Pakistan, Bangladesh, and other parts of South Asia.
- The Mediterranean and Middle East regions are hotspots for OXA-48, with Turkey and North Africa being particularly affected.
- The Americas, particularly the United States, Israel, and parts of Latin America, are predominantly affected by KPC.
- East Asia, including Japan and Taiwan, is a significant region for IMP. Overall, the global distribution and prevalence of carbapenemase-producing organisms are complex and influenced by various factors, highlighting the need for rapid testing and targeted treatment strategies to prevent the spread of these enzymes and improve patient outcomes.
From the Research
Epidemiology of Carbapenemase-Producing Bacteria
- The global emergence of carbapenemase-producing bacteria is a significant public health concern 2.
- Carbapenemase-producing Klebsiella pneumoniae (CPKP) is a major resistance concern, with high morbidity and mortality associated with related infections 3.
- The epidemiology of carbapenemase producers is crucial for preventing their expansion 3.
Prevalence of KPC, OXA-48, NDM, VIM, and IMP
- KPC, OXA-48, NDM, VIM, and IMP are the most prevalent carbapenemase enzymes reported worldwide 3, 2.
- The prevalence of these enzymes varies by country and region, with some areas having a higher incidence of certain enzymes 3.
- In Taiwan, the endemicity of CPKP has shifted from IMP-8, NDM-1, and VIM-1 to KPC-2 and OXA-48 3.
Geographical Distribution
- Carbapenemase-producing bacteria have been reported in various parts of the world, including the US, Europe, Asia, and South America 2, 4.
- The global distribution of these bacteria is influenced by factors such as travel, trade, and healthcare practices 2.
- In Brazil, a study found that NDM-producing Klebsiella pneumoniae co-occurred with VIM, KPC, and OXA-48 enzymes in intensive care unit patients 4.
Carbapenemase Variants
- KPC variants have reduced the utility of ceftazidime-avibactam, a commonly used antimicrobial agent, and pose a new threat to global public health 5.
- More than 150 blaKPC variants have been reported worldwide, with most discovered in the past three years 5.
- The emergence of carbapenemase variants highlights the need for continued surveillance and development of new antimicrobial agents 5.