[Carbapenemases in enterobacteriaceae].

Carbapenem-hydrolyzing beta-lactamases are the most powerful mechanism of resistance to carbapenems. Carbapenemases have been reported extensively worldwide now in Enterobacteriaceae. Carbapenemases of the KPC type have been reported first from the USA in Klebsiella pneumoniae, then worldwide with a marked endemicity in Israel and Greece. Metallo-enzymes (VIM, IMP…) have been also reported internationnaly with high prevalence in Southern Europe and Asia. OXA-48 which is one of the latest carbapenemases reported differs structurally from the other carbapenemases and have been identified mostly from Mediterranean countries. These carbapenemase genes are mostly plasmid located in K. pneumoniae from nosocomial origin. They have been also identified as a source of community-acquired infections. Carbapenemase producers are also multidrug resistant explaining the difficulty to treat infections. Detection of infected patients and carriers remain difficult which may explain an underlying spread with dramatic therapeutic consequences.