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Carbapenem-Resistant Klebsiella pneumoniae
Dangerous outbreaks resistant to last-resort drugs are emerging across the United States
BACKGROUND
Klebsiella pneumoniae is a member of the Enterobacteriaceae family, which along with E. coli accounts for the vast majority of hospital- and community-acquired urinary tract infections (UTIs). It is also a frequent cause of nosocomial (health care–associated) bloodstream infections and community-acquired pneumonia among alcoholics.
The observed rise of carbapenem-resistant K. pneumoniae (CRKP) is disconcerting, for several reasons. First, CRKP infection is associated with a fatal outcome in 47%–57% of cases. Second, treatment is limited to older antibiotics known for high kidney toxicity—a limitation that highlights the urgent need to develop drugs active against Gram-negative bacteria. Third, the ability of resistance-encoding genes to spread through plasmid transfer enables the spread of resistance to related species like E. coli, a transfer that may occur even in the same patient. Finally, CRKP genes easily escape detection in routine laboratory testing. The epidemiology of carbapenem-resistant bacteria thus has the potential to replicate the endemic spread of MRSA beyond hospitals and into the community.
U.S. RESISTANCE IN THE GLOBAL CONTEXT
RESISTANCE BY U.S. CENSUS DIVISION, 1999-2010
