Update on the epidemiology of carbapenemases in Latin America and the Caribbean

ABSTRACT

Introduction

Carbapenemases are β-lactamases able to hydrolyze a wide range of β-lactam antibiotics, including carbapenems. Carbapenemase production in Enterobacterales, Pseudomonas aeruginosa, and Acinetobacter spp., with and without the co-expression of other β-lactamases is a serious public health threat. Carbapenemases belong to three main classes according to the Ambler classification: class A, class B, and class D.

Areas covered

Carbapenemase-bearing pathogens are endemic in Latin America. In this review, we update the status of carbapenemases in Latin America and the Caribbean.

Expert opinion

Understanding the current epidemiology of carbapenemases in Latin America and the Caribbean is of critical importance to improve infection control policies limiting the dissemination of multi-drug-resistant pathogens and in implementing appropriate antimicrobial therapy.

KEYWORDS:

• Acinetobacter baumannii
• carbapenemases
• carbapenems
• carbapenem resistance
• carbapenem-resistant Enterobacterales (CRE)
• Klebsiella pneumoniae
• Latin America
• Pseudomonas aeruginosa

Article highlights

• Carbapenemases are a significant health threat as carbapenems are considered ‘last resort antibiotics’ for the treatment of severe Gram-negative infections.

• Currently in Latin America, there is broad dissemination of MDR Gram-negative pathogens harboring a diverse range of carbapenemases, particularly among Enterobacterales and the non-fermentative rods Pseudomonas spp. and Acinetobacter spp.

• Confirmatory testing for carbapenemases is one of the cornerstones for antimicrobial stewardship and infection control. When available, high-performance methods like PCR and immunochromatographic assays should be implemented to get rapid and accurate results as the use of new drugs relies on the specific type of enzyme expressed.

• In recent years, several unusual Class A carbapenemases-bearing species and expression of rare combinations of β-lactamases have been observed in Latin America. These include KPC in Kluyvera spp., Raoultella spp., Serratia spp., and Morganella spp. Coexpressing MCR-1.

• New reports of Class B carbapenemases include NDM-1, NDM-2, and IMP-1 in Klebsiella spp., Citrobacter spp., Providencia spp., Acinetobacter, Enterobacter spp., and E. coli.

• New reports of Class D carbapenemases in Acinetobacter spp. include OXA-58, OXA-64, OXA-65, OXA-68, OXA-69, OXA132, OXA-143, and OXA-180.

• Coexpression of two or more carbapenemases is becoming frequent in LATAM and poses a major diagnostic and therapeutic challenge because it limits the use of all currently available β-lactams.

Declaration of interest

MV Villegas has received research grants and/or consultant fees from Pfizer, Merck Sharp & Dohme (MSD) and WEST. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.

Reviewer disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Additional information

Funding

This paper was not funded.