Advice on Carbapenemase Producers: Recognition, infection control and treatment
New guidance has been developed by the Health Protection Agency (HPA), in conjunction with the Advisory Committee on Antimicrobial Resistance and Healthcare Associated Infections (ARHAI), to advise on the management of patients who are infected with bacteria resistant to carbapenem antibiotics. Carbapenems are powerful broad-spectrum antibiotics that are often the last line of effective treatment for patients with infections - including hospital pneumonias, urinary infections or blood poisoning - caused by strains of the bacteria Klebsiella and E. coli that are already resistant to more widely used antibiotics. The guidance, being issued to all consultant medical microbiologists and infection control specialists across the UK: - advises how hospital laboratories can best detect carbapenem-resistant bacteria; - stresses how the effective use of good infection control practices, such as screening and isolation of high risk patients, can help to contain the spread of infection; - describes the few treatment options that do remain. The geographical distribution and epidemiology of different types of carbapenem resistance is also outlined. The guidance has been developed in response to enquiries from microbiologists and infection control specialists on the appropriate use of antibiotics following the identification of cases of infection with resistance to carbapenems, including those with the NDM-1 (New Delhi metallo) beta lactamase enzyme, which was described in a paper co-authored by the HPA and published in the Lancet Infectious Diseases in August 2010. Aside from NDM-1 the HPA reports that other carbapenemases (enzymes that destroy carbapenems) are being seen in the UK, for example Verona Imipenemase (VIM), Klebsiella pneumoniae carbapenemase (KPC) and OXA-48.