Carbapenems, once considered the last line of defense against of serious infections with Enterobacteriaceae, are threatened with extinction. The increasing isolation of carbapenem-resistant Gram-negative pathogens is forcing practitioners to rely on uncertain alternatives. As little as 5 years ago, reports of carbapenem resistance in Enterobacteriaceae, common causes of both community and healthcare-associated infections, were sporadic and primarily limited to case reports, tertiary care centers, intensive care units, and outbreak settings. Carbapenem resistance mediated by β-lactamases, or carbapenemases, has become widespread and with the paucity of reliable antimicrobials available or in development, international focus has shifted to early detection and infection control. However, as reports of Klebsiella pneumoniae carbapenemases, New Delhi metallo-β-lactamase-1, and more recently OXA-48 (oxacillinase-48) become more common and with the conveniences of travel, the assumption that infections with highly resistant Gram-negative pathogens are limited to the infirmed and the heavily antibiotic and healthcare exposed are quickly being dispelled. Herein, we provide a status report describing the increasing challenges clinicians are facing and forecast the “stormy waters” ahead.
Keywords: carbapenemases, NDM-1, KPC, OXA-48, metallo-β-lactamases, CHDL
Citation: Patel G and Bonomo RA (2013) “Stormy waters ahead”: global emergence of carbapenemases. Front. Microbiol. 4:48. doi: 10.3389/fmicb.2013.00048
Received: 19 December 2012; Paper pending published: 07 January 2013;
Accepted: 20 February 2013; Published online: 14 March 2013.
Edited by:Fiona Walsh, Agroscope Changins-Wädenswil, Switzerland
Reviewed by:Charles W. Knapp, University of Strathclyde, UK
Copyright: © 2013 Patel and Bonomo. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits use, distribution and reproduction in other forums, provided the original authors and source are credited and subject to any copyright notices concerning any third-party graphics etc.
*Correspondence: Robert A. Bonomo, Research Service, Louis Stokes Cleveland Department of Veteran Affairs Medical Center, 10701 East Boulevard, Cleveland, OH 44106, USA. e-mail: firstname.lastname@example.org