Carbapenem-Resistant Klebsiella pneumoniae

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.