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7/23/2019 Klebsiella pneumoniae carbapenemase (KPC)
1/23
Mach{gcaa` plcsbnlg`c
k`xh`pclcb`{c $M_K'
f`bn _nxvn E`b`
J`xb`ksvgkn 08.?6.8?0?
`f`bne`b`Odnvb`ga,knb
7/23/2019 Klebsiella pneumoniae carbapenemase (KPC)
2/23
7/23/2019 Klebsiella pneumoniae carbapenemase (KPC)
3/23
N PSC M_K>
gbpnxv`lvc { agclv`x sc n{ k`xh`pclcl{ knbpxcclfcb sb` ka`{{c
`bpa`bclvc svgagy`f` ln vx`v`bclvn fc gljckc{ clznazclfn
Clvcxnh`kvcxg`kc`c bsavgxxc{g{vclvc $HX@VS! 8??3',
@ clygb` M_K i jng fnksbclv`f` cb fgjcxclvc{ h`kvxg`{ pnx bcgn fc
c{vsfn{ bnacksa`xc{ c fgjcxclkg`f` cb M_K"0 ` 6 $BNLVCGXN! 8??7',
XC[G[VCLKG@ LN [C AGBGV@ @N[K@H@_CLBGKN[!
7/23/2019 Klebsiella pneumoniae carbapenemase (KPC)
4/23
Mach{gcaa` plcsbnlg`c k`xh`pclcb`{c
8??? Jng fc{kxgv` c g{na`f` pca` pxgbcgx` zcy cb sb dn{pgv`a f`
K`xnagl` fn Lnxvc $C,S,@'
8??; Nknxxcs pxgbcgxn {sxvn $Lnz` Wnxm' 65# fc hgvn{,
Eclc fc xc{g{vlkg`_{csfnbnl`{! ` Clvcxnh`kvcx c ` C{kdcxgkdg`
knag,
8?0? Ln Hx`{ga 0 hgvn jng xceg{vx`fn ln _`x = 04 hgvn{
xceg{vx`fn{ ln Fg{vxgvn Jcfcx`a c 88 pc{{n`{ gljckv`f`{ cb b`g{ s`vxn
c{v`fn{,
7/23/2019 Klebsiella pneumoniae carbapenemase (KPC)
5/23
FG[VXGHSGN ECNEXJGK@ F@ M_KLN BSLFN
uuu,vdca`lkcv,knb.gljckvgnl Zna 7 @pxga 8??7
7/23/2019 Klebsiella pneumoniae carbapenemase (KPC)
6/23
FG[VXGHSGN ECNEXJGK@ F@ M_KLN HX@[GA
7/23/2019 Klebsiella pneumoniae carbapenemase (KPC)
7/23
KA@[[GJGK@N F@ M_K
M_K
M_K 0
M_K 8
M_K ;
M_K 6
Mach{gcaa` plcsbnlg`c
m, plcsbnlg`c! m,ntwvnk`! [`abnlcaa`
clvxgk`c cbClvcxnh`kvcx {p=
M, plcsbnlg`ccClvcxnh`kvcx kan`k`c=
ln jnx`b clknlvx`fn{bgkxnxe`lg{bn{xca`kgnl`fn{,
$BNLVCGXN I, cv `a! 8??7= K@G! I, K, cv `a! 8??4'
7/23/2019 Klebsiella pneumoniae carbapenemase (KPC)
8/23
Mach{gcaa` plcsbnlg`c
H`kgan ex`b"lce`vgzn J`bag` Clvcxnh`kvcxg`kc`c,
Clk`p{sa`f`
Clknlvx`f`{ l` pcac! j`xglec c vx`vn e`{vxglvc{vgl`a,
G{na`f` knb b`g{ jxclkg` fc `bn{vx`{ kalgk`{ c pnfc k`s{`x sb`
jnxb` ka{{gk` fc plcsbnlg` pxgbxg`,
Fg`hcvc{ bcaagvs{ c fncl` psabnl`x nh{vxsvgz` kxlgk`,
@ plcsbnlg` vclfc ` {cx fc{vxsvgz`! knb lckxn{c ctvcl{` c dcbnxx`eg`!
xc{sav`lfn l` pxnfsn fc c{k`xxn! sc pnfc {cx c{pc{{n! bskgfc c fcknx zcxbcadn" vginan ns jasgfn cknbn ecag` fc exn{{cad`
Gljckc{ ctvx` psabnl`xc{9 clvcxgvc{ c bclglegvc! gljckc{ sxglxg`{!
{cpvgkcbg`! fnxc{ `hfnbgl`g{,
7/23/2019 Klebsiella pneumoniae carbapenemase (KPC)
9/23
7/23/2019 Klebsiella pneumoniae carbapenemase (KPC)
10/23
B`vcxg`a kalgkn {sec{vgzn9 ksavsx`{ fc c{k`xxn,
@ pxc{cl` fc c{pkgc{ fc Mach{gcaa` fczc {cx pxc{sbgf` s`lfn
{n g{na`fn{ knalg`{ ex`lfc{! fc knl{g{vlkg` bskgfc! cb pa`k`{
fc g{na`bclvn pxgbxgn,
Cb e`x B`kKnlmcw! `{ knalg`{ {n vgpgk`bclvc ex`lfc{! bskgfc{
c zcxbcad`{! "jcxbclv`n f` a`kvn{c c pxnfsn fc kgfn{,
CT@BC BGKXNHGNAEGKN
7/23/2019 Klebsiella pneumoniae carbapenemase (KPC)
11/23
_XNZ@[ HGNPSBGK@[ " GFCLVGJGK@NMach{gcaa` pcsbnlg`c9
GLFNA $"'= " M,plcsbnlg`c t M, ntwvnk`$-' BNVGAGF@FC $"'=
SXG@ $-' dgfag{c aclv`
AG[GL@ $-'= @XEGLGL@ $"'= NXLGVGL@ $"'=
JCXBCLV@N F@ A@KVN[C C [@K@XN[C $-'
V[G SXC@ AG@ BGN
7/23/2019 Klebsiella pneumoniae carbapenemase (KPC)
12/23
FG@EL[VGKN KALGKN C VX@V@BCLVN
[glvnb`{ fn p`kgclvc! ct`bc j{gkn! nsvx`{ glzc{vge`c{ $x`gn T fc
vx`t! dcbnex`b`! ksavsx` fc c{k`xxn'
Vx`v`bclvn fcpclfc fn vgpn fc gljckn c f` {cl{ghgagf`fc f`
h`kvxg`! `jcxgf` pnx `lvghgnex`b`,
7/23/2019 Klebsiella pneumoniae carbapenemase (KPC)
13/23
KNBN KNBCNS @ XC[G[VCLKG@>
Cznasn f` `f`pv`n eclvgk` bsf`l` fn bcgn `bhgclvc
S{n glfczgfn fc `lvghgvgkn
Janx` lnxb`a t janx` p`vnelgk`
XC[G[VLKG@ H@KVCXG@L@
7/23/2019 Klebsiella pneumoniae carbapenemase (KPC)
14/23
XC[G[VLKG@ H@KVCXG@L@
Janx` lnxb`a Janx` p`vnelgk`
7/23/2019 Klebsiella pneumoniae carbapenemase (KPC)
15/23
XC[G[VLKG@ H@KVCXG@L@
@vs abclvc! M_K knl{vgvsg gbpnxv`lvc bck`lg{bn fc xc{g{vlkg` ln
knlvctvn dn{pgv`a`x bslfg`a, [s` pc{sg{` xcacz`lvc ` jgb fc agbgv`x
{s` fg{{cbgl`n! knlvxghsglfn p`x` ` xcfsn fn{ lfgkc{ fc
bnxhgf`fc c bnxv`agf`fc age`fn{ ` fgjcxclvc{ fncl`{ gljckkgn{`{! cb
sc gbpxc{kglfzca ` zgegalkg` bgkxnhgnaegk`! islv`bclvc knb `nf` Knbg{{n fc Knlvxnac fc Gljckn Dn{pgv`a`x $KKGD',
7/23/2019 Klebsiella pneumoniae carbapenemase (KPC)
16/23
XC[G[VLKG@ H@KVCXG@L@
@ xc{g{vlkg` `n{ k`xh`pclcl{ pnfc {cx `vxghsf` pxc{cl` fc nsvxn{ bck`lg{bn{ knbn
@bpK c C[HA {{nkg`fn{ `avcx`n ln{ k`l`g{ fc pnxgl`! sc bnfgjgk`b ` `n c `
pclcvx`n fc jxb`kn{ $B@XVGLCY B@XVGLCY A, cv `a! 0777',
7/23/2019 Klebsiella pneumoniae carbapenemase (KPC)
17/23
XC[G[VCLKG@
JG[GNANEG@ J@XB@KNANEG@ HGNANEG@BNACKSA@X
Bck`lg{bn{ fc xc{g{vlkg` h`kvcxg`l` {n
knbpactn{ c z`xg`fn{! c `glf` ln {n
knbpacv`bclvc knldckgfn{,
KNBN VX@L[BGVC @ XC[G[VLKG@>
7/23/2019 Klebsiella pneumoniae carbapenemase (KPC)
18/23
Ka`{{c9 h"a`kvbgkn{ Exspn9 K`xh`pcln{ Ctcbpan{9 Gbgpclcb!
bcxnpclcb,
Kxnbn{{nbn t _a`{bfcn
Vx`l{pn{nl " cacbclvn fc vx`l{pn{gn eclvgk`,
BCK@LG[BN[ FC XC[G[VLKG@ H@KVCXG@L@ @ @ECLVC[ @LVGBGKXNHG@LN[
Bck`lg{bn9 gl`vgz`n clygbvgk` exspn `lvghgvgkn9 H"a`kvbgkn{ Ctcbpan{9 h"a`kv`b`{c{! pclgkgagl`{c{! kcj a{pnxgl`{c{!k`xh`pclcb`{c{,
KA@[[GJGK@N FN @LVGHGVGKN
7/23/2019 Klebsiella pneumoniae carbapenemase (KPC)
19/23
N bck`lg{bn b`g{ knbsb pcan s`a n{ eclc{ fc
xc{g{vlkg` {n vx`l{jcxgfn{ ` knlise`n9
7/23/2019 Klebsiella pneumoniae carbapenemase (KPC)
20/23
A`z`x `{ bn{ `{ bn{ `n clvx`x cb `bhgclvc dn{pgv`a`x $aknna eca',
Agbpcy` fczc {cx jcgv` `lvc{ c fcpng{ fc c{v`x knb n p`kgclvc $czgv`x
pxnagjcx`n',
Czgv`x vnk`x cb nhicvn{ dn{pgv`a`xc{ $b`k`{! bc{`{ c pnxv`{',
Ln j`ycx n s{n fc{lckc{{xgn fc `lvghgvgkn{,
@LZG[@9 fgbglsgn f` knbcxkg`agy`n glfg{kxgbgl`f` fc `lvghgvgkn{ l`
vclv`vgz` fc `k`h`x knb ` fg{{cbgl`n fclvxn fn{ dn{pgv`g{! pxglkgp`g{
jnkn{ f`{ gljckc{,
_XCZCLN F@ M_K
_XCK@SC[
7/23/2019 Klebsiella pneumoniae carbapenemase (KPC)
21/23
M_K h`kvxg`{ pxnfsvnx`{ vb {gfn k`f` zcy b`g{ g{na`fn fn bslfn!
{nhxcvsfn l` jnxb` fc M plcsbnlg c, @ pxnp`e`n f` M_K"M
plcsbnlg`c pxnfsvnx` pxcnksp`lvc! fn pnlvn fc zg{v` fc {`fc
phagk`! sb` zcy sc c{v` c{pkgc vclfc ` {cx ` jnlvc fc bsgv`{
gljckc{ dn{pgv`a`xc{ cb p`kgclvc{ ex`zcbclvc cljcxbn{! c hcbknldckgfn pnx {s` k`p`kgf`fc fc `ksbsa x c fcvcxbgl`lvc{ f`
xc{g{vlkg` fc vx`l{jcxlkg`! knljnxbc gas{vx`fn knb C[HA{, @ab
fg{{n! n kvgnl xckclvc gfclvgjgk`n fc M_K cb C, knag p`kgclvc{
gljckv`fn{ glvcxl`fn{ cb slgf`fc{ fc anle` fsx`n pnfc glfgk`x
sb` nsvx` jnlvc fc vx`l{jcxlkg` p`x` gl{v`a`c{ fc ksgf`fn{
`esfn{,
KNLKAS[N
7/23/2019 Klebsiella pneumoniae carbapenemase (KPC)
22/23
XCJCXLKG@[ HGHAGNEXJGK@[
HX@VS! [, cv `a, Fcvckvgnl nj M_K k xh`pclcb"dwfxnawygle clywbc{ gl Clvcxnh`kvcx{pp, jxnb Hxnnmawl! Lcu Wnxm, @lvgbgkxnh @eclv{ Kdcbnvdcx! z, 67! l, 8! p, 55:"4!
8??3,
FGCL[VB@LL! X cv `a, @z`ag`n jclnvpgk` f` clygb` Mach{gcaa` plcsbnlg`ck`xh`pclcb`{c $M_K' cb Clvcxnh`kvcxg`kc`c fc `bhgclvc dn{pgv`a`x, Inxl`aHx`{gacgxn fc _`vnaneg` c Bcfgkgl` A`hnx`vnxg`a! 8?0?! z,6:! l,0! i`l,.jcz, 8?0?,
Agzxn9 Fg`el{vgkn Bgkxnhgnaegkn= MNLCB@L! C, U, cv `a, 3 cfgn, Cfgvnx` Bcf{g!8??0,
B@XVGLCY"B@XVGLCY A, cv `a, Xnac{ nj "a`kv`b`{c{ `lf pnxgl{ gl `kvgzgvgc{ njk`xh`pclcb{ `lf kcpd`an{pnxgl{ e`gl{v Mach{gcaa` plcsbnlg`c, @lvgbgkxnh @eclv{
BNLVCGXN I, cv `a, Jgx{v xcpnxv nj M_K"8"pxnfskgle Mach{gcaa` plcsbnlg`c {vx gl{gl Hx`yga, @lvgbgkxnh @eclv{ Kdcbnvdcx! z, 3;! l, 0! p, ;;;"6! 8??7,
[BGVD BNA@LF! C, cv `a, _a`{bgf"bcfg vcf! k`xh`pclcbdwfxnaw{gle hcv`"a`kv`b`{c!M_K"8! gl Mach{gcaa` plcsbnlg`c g{na`vc{, I @lvgbgkxnh Kdcbnvdcx! z, 30! l, ;! p, 500"6!
8??;,
7/23/2019 Klebsiella pneumoniae carbapenemase (KPC)
23/23
@EX@FCKGBCLVN[
f`bn _nxvn E`b`
KNLV@VN
`f`bne`b`Odnvb`ga,knb
BSGVN NHXGE@FN !!!
uuu,`f`bne`b`,hane{pnv,knb