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JAC Advance Access originally published online on June 26, 2007
Journal of Antimicrobial Chemotherapy 2007 60(3):470-482; doi:10.1093/jac/dkm226
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© The Author 2007. Published by Oxford University Press on behalf of the British Society for Antimicrobial Chemotherapy. All rights reserved. For Permissions, please e-mail: journals.permissions@oxfordjournals.org

Review

Class A carbapenemases

Jan Walther-Rasmussen* and Niels Høiby

Department of Clinical Microbiology, 9301, Rigshospitalet, National University Hospital, Copenhagen, Denmark

* Correspondence address. Department of Clinical Microbiology, 9301, Juliane Mariesvej 22, DK-2100 Copenhagen O, Denmark. Tel: +45-26-37-76-60; Fax: +45-35-45-64-12; E-mail: jawalras{at}mail.tele.dk

Carbapenems, such as imipenem and meropenem, are most often used to treat infections caused by enterobacteria that produce extended-spectrum ß-lactamases, and the emergence of enzymes capable of inactivating carbapenems would therefore limit the options for treatment. Carbapenem resistance in Enterobacteriaceae is rare, but class A ß-lactamases with activity against the carbapenems are becoming more prevalent within this bacterial family.

The class A carbapenemases can phylogenetically be segregated into six different groups of which four groups are formed by members of the GES, KPC, SME, IMI/NMC-A enzymes, while SHV-38 and SFC-1 each separately constitute a group.

The genes encoding the class A carbapenemases are either plasmid-borne or located on the chromosome of the host. The blaGES genes reside as gene cassettes on mainly class I integrons, whereas the blaKPC genes and a single blaIMI-2 gene are flanked by transposable elements on plasmids.

Class A carbapenemases hydrolyse penicillins, classical cephalosporins, monobactam, and imipenem and meropenem, and the enzymes are divided into four phenotypically different groups, namely group 2br, 2be, 2e and 2f, according to the Bush–Jacoby–Medeiros classification system. Class A carbapenemases are inhibited by clavulanate and tazobactam like other class A ß-lactamases.

Keywords: class A ß-lactamases , carbapenem resistance , Enterobacteriaceae , Pseudomonas aeruginosa


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