KARBAPENEMAZE GRAM-NEGATIVNIH BAKTERIJA ; CARBAPENEMASES OF GRAM-NEGATIVE BACTERIA

Karbapenemi su često jedina terapijska opcija za liječenje teških infekcija. Stabilni su prema većini b-laktamaza gram-negativnih bakterija, ali neke b-laktamaze, koje se zovu karbapenemaze, mogu ih djelotvorno hidrolizirati. Nalazimo ih u izolatima enterobakterija i nefermentativnih bakterija kao što su Pseudomonas aeruginosa i Acinetobacter baumannii. Dijele se u klase A (KPC, SME, IMI, NMC), B (VIM, IMP, SPM, GIM, NDM, SIM, DIM, AIM) i D (OXA-23, OXA-24, OXA-48, OXA-58, OXA-143). Pravilna i brza identifikacija karbapenem-rezistentnih izolata u laboratoriju važna je kako bi se spriječilo širenje takvih sojeva unutar bolnica i kako bi se izbjegao terapijski neuspjeh. Terapijske opcije vrlo su ograničene zbog toga što prenosivi genski elementi koji kodiraju te b-laktamaze obično sadržavaju i gene rezistencije na ostale antibiotike i često ostaje kolistin kao jedini lijek izbora. ; Carbapenems are often antibiotics of last resort for the treatment of severe infections. They are stable to most b-lactamases produced by gram-negative bacteria. However, bacterial enzymes named carbapenemases can efficiently hydrolyze carbapenems. They are produced most frequently by Enterobacteriaceae and non-fermentative bacteria such as Pseudomonas aeruginosa and Acinetobacterbaumannnii. They belong to group A (KPC, SME, IMI, NMC), B (VIM, IMP, SPM, GIM, NDM, SIM, DIM, AIM) and D (OXA-23, OXA-24, OXA-48, OXA-58, OXA-143). The accurate and rapid laboratory identification of carbapenem-resistant isolates is important to prevent spread of such multidrug resistant strains and to avoid therapeutic failures. Therapeutic options are often limited because carbapenemases are encoded on mobile genetic elements which often harbour resistance genes to other groups of antibiotics. Thus, colistin is often the only therapeutic option.