Klebsiella pneumoniae carbapenemase (KPC)

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    Mach{gcaa` plcsbnlg`c

    k`xh`pclcb`{c $M_K'

    f`bn _nxvn E`b`

    J`xb`ksvgkn 08.?6.8?0?

    `f`bne`b`Odnvb`ga,knb

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    N PSC M_K>

    gbpnxv`lvc { agclv`x sc n{ k`xh`pclcl{ knbpxcclfcb sb` ka`{{c

    `bpa`bclvc svgagy`f` ln vx`v`bclvn fc gljckc{ clznazclfn

    Clvcxnh`kvcxg`kc`c bsavgxxc{g{vclvc $HX@VS! 8??3',

    @ clygb` M_K i jng fnksbclv`f` cb fgjcxclvc{ h`kvxg`{ pnx bcgn fc

    c{vsfn{ bnacksa`xc{ c fgjcxclkg`f` cb M_K"0 ` 6 $BNLVCGXN! 8??7',

    XC[G[VCLKG@ LN [C AGBGV@ @N[K@H@_CLBGKN[!

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    Mach{gcaa` plcsbnlg`c k`xh`pclcb`{c

    8??? Jng fc{kxgv` c g{na`f` pca` pxgbcgx` zcy cb sb dn{pgv`a f`

    K`xnagl` fn Lnxvc $C,S,@'

    8??; Nknxxcs pxgbcgxn {sxvn $Lnz` Wnxm' 65# fc hgvn{,

    Eclc fc xc{g{vlkg`_{csfnbnl`{! ` Clvcxnh`kvcx c ` C{kdcxgkdg`

    knag,

    8?0? Ln Hx`{ga 0 hgvn jng xceg{vx`fn ln _`x = 04 hgvn{

    xceg{vx`fn{ ln Fg{vxgvn Jcfcx`a c 88 pc{{n`{ gljckv`f`{ cb b`g{ s`vxn

    c{v`fn{,

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    FG[VXGHSGN ECNEXJGK@ F@ M_KLN BSLFN

    uuu,vdca`lkcv,knb.gljckvgnl Zna 7 @pxga 8??7

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    FG[VXGHSGN ECNEXJGK@ F@ M_KLN HX@[GA

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    KA@[[GJGK@N F@ M_K

    M_K

    M_K 0

    M_K 8

    M_K ;

    M_K 6

    Mach{gcaa` plcsbnlg`c

    m, plcsbnlg`c! m,ntwvnk`! [`abnlcaa`

    clvxgk`c cbClvcxnh`kvcx {p=

    M, plcsbnlg`ccClvcxnh`kvcx kan`k`c=

    ln jnx`b clknlvx`fn{bgkxnxe`lg{bn{xca`kgnl`fn{,

    $BNLVCGXN I, cv `a! 8??7= K@G! I, K, cv `a! 8??4'

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    Mach{gcaa` plcsbnlg`c

    H`kgan ex`b"lce`vgzn J`bag` Clvcxnh`kvcxg`kc`c,

    Clk`p{sa`f`

    Clknlvx`f`{ l` pcac! j`xglec c vx`vn e`{vxglvc{vgl`a,

    G{na`f` knb b`g{ jxclkg` fc `bn{vx`{ kalgk`{ c pnfc k`s{`x sb`

    jnxb` ka{{gk` fc plcsbnlg` pxgbxg`,

    Fg`hcvc{ bcaagvs{ c fncl` psabnl`x nh{vxsvgz` kxlgk`,

    @ plcsbnlg` vclfc ` {cx fc{vxsvgz`! knb lckxn{c ctvcl{` c dcbnxx`eg`!

    xc{sav`lfn l` pxnfsn fc c{k`xxn! sc pnfc {cx c{pc{{n! bskgfc c fcknx zcxbcadn" vginan ns jasgfn cknbn ecag` fc exn{{cad`

    Gljckc{ ctvx` psabnl`xc{9 clvcxgvc{ c bclglegvc! gljckc{ sxglxg`{!

    {cpvgkcbg`! fnxc{ `hfnbgl`g{,

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    B`vcxg`a kalgkn {sec{vgzn9 ksavsx`{ fc c{k`xxn,

    @ pxc{cl` fc c{pkgc{ fc Mach{gcaa` fczc {cx pxc{sbgf` s`lfn

    {n g{na`fn{ knalg`{ ex`lfc{! fc knl{g{vlkg` bskgfc! cb pa`k`{

    fc g{na`bclvn pxgbxgn,

    Cb e`x B`kKnlmcw! `{ knalg`{ {n vgpgk`bclvc ex`lfc{! bskgfc{

    c zcxbcad`{! "jcxbclv`n f` a`kvn{c c pxnfsn fc kgfn{,

    CT@BC BGKXNHGNAEGKN

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    _XNZ@[ HGNPSBGK@[ " GFCLVGJGK@NMach{gcaa` pcsbnlg`c9

    GLFNA $"'= " M,plcsbnlg`c t M, ntwvnk`$-' BNVGAGF@FC $"'=

    SXG@ $-' dgfag{c aclv`

    AG[GL@ $-'= @XEGLGL@ $"'= NXLGVGL@ $"'=

    JCXBCLV@N F@ A@KVN[C C [@K@XN[C $-'

    V[G SXC@ AG@ BGN

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    FG@EL[VGKN KALGKN C VX@V@BCLVN

    [glvnb`{ fn p`kgclvc! ct`bc j{gkn! nsvx`{ glzc{vge`c{ $x`gn T fc

    vx`t! dcbnex`b`! ksavsx` fc c{k`xxn'

    Vx`v`bclvn fcpclfc fn vgpn fc gljckn c f` {cl{ghgagf`fc f`

    h`kvxg`! `jcxgf` pnx `lvghgnex`b`,

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    KNBN KNBCNS @ XC[G[VCLKG@>

    Cznasn f` `f`pv`n eclvgk` bsf`l` fn bcgn `bhgclvc

    S{n glfczgfn fc `lvghgvgkn

    Janx` lnxb`a t janx` p`vnelgk`

    XC[G[VLKG@ H@KVCXG@L@

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    XC[G[VLKG@ H@KVCXG@L@

    Janx` lnxb`a Janx` p`vnelgk`

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    XC[G[VLKG@ H@KVCXG@L@

    @vs abclvc! M_K knl{vgvsg gbpnxv`lvc bck`lg{bn fc xc{g{vlkg` ln

    knlvctvn dn{pgv`a`x bslfg`a, [s` pc{sg{` xcacz`lvc ` jgb fc agbgv`x

    {s` fg{{cbgl`n! knlvxghsglfn p`x` ` xcfsn fn{ lfgkc{ fc

    bnxhgf`fc c bnxv`agf`fc age`fn{ ` fgjcxclvc{ fncl`{ gljckkgn{`{! cb

    sc gbpxc{kglfzca ` zgegalkg` bgkxnhgnaegk`! islv`bclvc knb `nf` Knbg{{n fc Knlvxnac fc Gljckn Dn{pgv`a`x $KKGD',

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    XC[G[VLKG@ H@KVCXG@L@

    @ xc{g{vlkg` `n{ k`xh`pclcl{ pnfc {cx `vxghsf` pxc{cl` fc nsvxn{ bck`lg{bn{ knbn

    @bpK c C[HA {{nkg`fn{ `avcx`n ln{ k`l`g{ fc pnxgl`! sc bnfgjgk`b ` `n c `

    pclcvx`n fc jxb`kn{ $B@XVGLCY B@XVGLCY A, cv `a! 0777',

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    XC[G[VCLKG@

    JG[GNANEG@ J@XB@KNANEG@ HGNANEG@BNACKSA@X

    Bck`lg{bn{ fc xc{g{vlkg` h`kvcxg`l` {n

    knbpactn{ c z`xg`fn{! c `glf` ln {n

    knbpacv`bclvc knldckgfn{,

    KNBN VX@L[BGVC @ XC[G[VLKG@>

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    Ka`{{c9 h"a`kvbgkn{ Exspn9 K`xh`pcln{ Ctcbpan{9 Gbgpclcb!

    bcxnpclcb,

    Kxnbn{{nbn t _a`{bfcn

    Vx`l{pn{nl " cacbclvn fc vx`l{pn{gn eclvgk`,

    BCK@LG[BN[ FC XC[G[VLKG@ H@KVCXG@L@ @ @ECLVC[ @LVGBGKXNHG@LN[

    Bck`lg{bn9 gl`vgz`n clygbvgk` exspn `lvghgvgkn9 H"a`kvbgkn{ Ctcbpan{9 h"a`kv`b`{c{! pclgkgagl`{c{! kcj a{pnxgl`{c{!k`xh`pclcb`{c{,

    KA@[[GJGK@N FN @LVGHGVGKN

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    N bck`lg{bn b`g{ knbsb pcan s`a n{ eclc{ fc

    xc{g{vlkg` {n vx`l{jcxgfn{ ` knlise`n9

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    A`z`x `{ bn{ `{ bn{ `n clvx`x cb `bhgclvc dn{pgv`a`x $aknna eca',

    Agbpcy` fczc {cx jcgv` `lvc{ c fcpng{ fc c{v`x knb n p`kgclvc $czgv`x

    pxnagjcx`n',

    Czgv`x vnk`x cb nhicvn{ dn{pgv`a`xc{ $b`k`{! bc{`{ c pnxv`{',

    Ln j`ycx n s{n fc{lckc{{xgn fc `lvghgvgkn{,

    @LZG[@9 fgbglsgn f` knbcxkg`agy`n glfg{kxgbgl`f` fc `lvghgvgkn{ l`

    vclv`vgz` fc `k`h`x knb ` fg{{cbgl`n fclvxn fn{ dn{pgv`g{! pxglkgp`g{

    jnkn{ f`{ gljckc{,

    _XCZCLN F@ M_K

    _XCK@SC[

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    M_K h`kvxg`{ pxnfsvnx`{ vb {gfn k`f` zcy b`g{ g{na`fn fn bslfn!

    {nhxcvsfn l` jnxb` fc M plcsbnlg c, @ pxnp`e`n f` M_K"M

    plcsbnlg`c pxnfsvnx` pxcnksp`lvc! fn pnlvn fc zg{v` fc {`fc

    phagk`! sb` zcy sc c{v` c{pkgc vclfc ` {cx ` jnlvc fc bsgv`{

    gljckc{ dn{pgv`a`xc{ cb p`kgclvc{ ex`zcbclvc cljcxbn{! c hcbknldckgfn pnx {s` k`p`kgf`fc fc `ksbsa x c fcvcxbgl`lvc{ f`

    xc{g{vlkg` fc vx`l{jcxlkg`! knljnxbc gas{vx`fn knb C[HA{, @ab

    fg{{n! n kvgnl xckclvc gfclvgjgk`n fc M_K cb C, knag p`kgclvc{

    gljckv`fn{ glvcxl`fn{ cb slgf`fc{ fc anle` fsx`n pnfc glfgk`x

    sb` nsvx` jnlvc fc vx`l{jcxlkg` p`x` gl{v`a`c{ fc ksgf`fn{

    `esfn{,

    KNLKAS[N

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    XCJCXLKG@[ HGHAGNEXJGK@[

    HX@VS! [, cv `a, Fcvckvgnl nj M_K k xh`pclcb"dwfxnawygle clywbc{ gl Clvcxnh`kvcx{pp, jxnb Hxnnmawl! Lcu Wnxm, @lvgbgkxnh @eclv{ Kdcbnvdcx! z, 67! l, 8! p, 55:"4!

    8??3,

    FGCL[VB@LL! X cv `a, @z`ag`n jclnvpgk` f` clygb` Mach{gcaa` plcsbnlg`ck`xh`pclcb`{c $M_K' cb Clvcxnh`kvcxg`kc`c fc `bhgclvc dn{pgv`a`x, Inxl`aHx`{gacgxn fc _`vnaneg` c Bcfgkgl` A`hnx`vnxg`a! 8?0?! z,6:! l,0! i`l,.jcz, 8?0?,

    Agzxn9 Fg`el{vgkn Bgkxnhgnaegkn= MNLCB@L! C, U, cv `a, 3 cfgn, Cfgvnx` Bcf{g!8??0,

    B@XVGLCY"B@XVGLCY A, cv `a, Xnac{ nj "a`kv`b`{c{ `lf pnxgl{ gl `kvgzgvgc{ njk`xh`pclcb{ `lf kcpd`an{pnxgl{ e`gl{v Mach{gcaa` plcsbnlg`c, @lvgbgkxnh @eclv{

    BNLVCGXN I, cv `a, Jgx{v xcpnxv nj M_K"8"pxnfskgle Mach{gcaa` plcsbnlg`c {vx gl{gl Hx`yga, @lvgbgkxnh @eclv{ Kdcbnvdcx! z, 3;! l, 0! p, ;;;"6! 8??7,

    [BGVD BNA@LF! C, cv `a, _a`{bgf"bcfg vcf! k`xh`pclcbdwfxnaw{gle hcv`"a`kv`b`{c!M_K"8! gl Mach{gcaa` plcsbnlg`c g{na`vc{, I @lvgbgkxnh Kdcbnvdcx! z, 30! l, ;! p, 500"6!

    8??;,

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    @EX@FCKGBCLVN[

    f`bn _nxvn E`b`

    KNLV@VN

    `f`bne`b`Odnvb`ga,knb

    BSGVN NHXGE@FN !!!

    uuu,`f`bne`b`,hane{pnv,knb