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Bacterial resistance to carbapenems

D M Livermore1

  • 1Department of Medical Microbiology, London Hospital Medical College, UK.

Advances in Experimental Medicine and Biology
|January 1, 1995
PubMed
Summary

Carbapenem resistance emerges through target modification, impermeability, or beta-lactamase production, posing threats to antibiotic efficacy. Future strategies may involve carbapenem derivatization or carbapenemase inhibitors.

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Area of Science:

  • Microbiology
  • Infectious Diseases
  • Pharmacology

Background:

  • Carbapenems are broad-spectrum beta-lactam antibiotics with high efficacy.
  • Antibiotic resistance, including to carbapenems, is a growing global health concern.
  • Mechanisms of carbapenem resistance include target modification, decreased drug penetration, and enzymatic hydrolysis by beta-lactamases.

Purpose of the Study:

  • To review the mechanisms of carbapenem resistance.
  • To identify bacterial species posing the greatest threat to carbapenem efficacy.
  • To discuss potential future strategies to overcome carbapenem resistance.

Main Methods:

  • Literature review of studies on carbapenem resistance mechanisms.
  • Analysis of bacterial species associated with carbapenem resistance.
  • Evaluation of current and potential future therapeutic approaches.

Main Results:

  • Key resistance mechanisms include target modification (e.g., in staphylococci, Enterococcus faecium, pneumococci), impermeability (e.g., in Pseudomonas aeruginosa), and beta-lactamase production.
  • Certain bacterial species like X. maltophilia, A. hydrophila, F. odoratum, and B. fragilis are significant sources of carbapenemases.
  • Carbapenemases, particularly zinc-dependent ones, are a major cause of resistance in specific Gram-negative bacteria.
  • Despite resistance, carbapenems remain more effective than expanded-spectrum cephalosporins.

Conclusions:

  • Carbapenem resistance is multifactorial, involving target changes, reduced permeability, and diverse beta-lactamases.
  • While carbapenems retain significant efficacy, emerging resistance necessitates ongoing research.
  • Development of novel carbapenem derivatives and carbapenemase inhibitors are promising strategies to combat resistance.

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