热带病与公共卫生杂志

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Clinical Importance of Carbapenemase Production in Gram-Negative Bacteria

Mandeep Kaur, Satish Gupte and Tanveer Kaur

Carbapenem resistance is one of the major threats faced in antimicrobial treatment of infections caused by Gram negative organisms. In India and throughout the world the use of carbapenems has increased resulting in an increased resistance of pathogens to this class of antibiotics. Bacteria are capable enough to become resistant to antibiotics by a number of mechanisms both intrinsic and acquired, most common of which include enzymatic degradation of antibiotics. Carbapenem resistant Gram-negative bacteria usually spreads in the hospital settings to other patients and caregivers or relatives by unwashed hands or from contact with soiled equipment and surfaces such as bedrails, tables, chairs, countertops and door handles. These carriers are the ultimate sources of dissemination in the community. Detection of carbapenemase is a crucial infection control issue because they are often associated with extensive antibiotic resistance, treatment failures and infection-associated mortality. For the identification of carbapenemase producers different nonmolecular methods are used such as E- test (Epsilometer Test), Modified hodge test, MIC by Agar Dilution Method, Carba NP Test, EDTA disk synergy test, Boronic Acid Test, 2-mercaptopropionic acid inhibition (2-MPA) test. Molecular techniques remain the gold standard for the precise identification of carbapenemase genes. Most of these techniques are based on PCR and may be followed by a sequencing step if a precise identification of the carbapenemase gene is needed. This review article describes clinical importance and methods used for the identification of carbapenemase producers.