聽聽聽聽聽聽KPC聽is聽not聽equally聽active聽against聽all聽carbapenems.聽In聽general,聽ertapenem聽
susceptibility聽is聽a聽more聽sensitive聽indicator聽of聽KPC-mediated聽resistance聽than聽
either聽meropenem聽or聽imipenem.聽
聽聽It聽is聽important聽to聽note聽that聽nonsusceptibility聽to聽carbapenems,聽can聽be
mediated聽by聽mechanisms聽other聽than聽KPC,聽e.g.,聽the聽combination聽of聽an聽AmpC-type聽β-
lactamase聽and聽porin聽loss.聽聽These聽other聽mechanisms聽are聽clinically聽important,聽
but聽as聽of聽today,聽no聽documented聽outbreaks聽have聽been聽attributed聽to聽them.聽
聽聽聽As聽of聽September聽27,聽2007,聽KPC-producing聽Klebsiella聽pneumoniae聽isolates聽have聽
been聽confirmed聽by聽molecular聽testing聽in聽22聽healthcare聽institutions聽in聽New聽
Jersey聽and聽it聽is聽likely聽that聽many聽more聽laboratories聽will聽encounter聽these
聽organisms聽in聽the聽near聽future.聽聽聽聽聽
聽聽聽Below聽are聽recommendations聽to聽help聽clinical聽microbiologists聽recognize聽the聽
KPC聽mechanism聽of聽resistance聽in聽their聽laboratories.聽
聽聽聽Microbiologists聽should聽look聽for聽evidence聽of聽carbapenemase-mediated聽
resistance聽in聽Enterobacteriaceae聽using聽the聽following聽criteria,聽paying聽
particular聽attention聽to聽isolates聽of聽Klebsiella聽spp.聽and聽E.聽coli聽that.聽
聽聽聽Are聽resistant聽to聽carbapenems聽by聽any聽standardized聽testing聽method.聽聽These
are聽very聽likely聽KPC-producers.聽Confirmation聽of聽the聽resistance聽mechanism聽in聽
these聽organisms聽is聽not聽currently聽a聽clinical聽or聽public聽health聽necessity,聽since聽
KPC-producers聽are聽already聽known聽to聽exist聽widely聽throughout聽the聽state..聽
聽聽聽
聽聽聽Test聽susceptible聽to聽carbapenems,聽but聽with聽elevated聽MICs.聽These聽isolates聽may聽
also聽possess聽the聽enzyme..聽A聽rule聽of聽thumb聽is聽to聽”flag”聽isolates聽with
carbapenem聽MICs聽of聽2聽or聽4聽μg/ml.聽Hospitals聽are聽evaluating聽their聽reporting聽
protocols聽for聽these聽organisms.聽
聽聽聽
聽聽聽Produce聽a聽nonsusceptible聽ertapenem聽disk聽diffusion聽result聽(I聽or聽R).聽This聽is聽
a聽sensitive聽indicator聽of聽KPC-production.聽
聽聽聽
聽聽聽nonsusceptibility聽in聽this聽instance聽refers聽to聽carbepenem聽disc聽diffusion聽
results聽of聽Intermediate聽or聽Resistant聽or聽carbepenum聽MIC聽results聽of聽2聽ug/ml聽or聽
greater.聽

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