Abstract
The dissemination of carbapenemase-producing Enterobacteriaceae has occurred very quickly and has crossed borders rapidly between countries and continents. In some areas, it has exceeded the holding capacity of health systems, reaching epidemic proportions. This form of dissemination has not been the same for all enzymes, with KPC, NDM and OXA-48 genes having a greater ability to spread. These enzymes have primarily been spread clonally in the case of KPC-producing Klebsiella pneumoniae from the initial epicenter located in New York, with a very small number of strains causing outbreaks. For NDM and OXA- 48, these resistance determinants have been vehiculized by clones with a high transmission capacity; however, simultaneous horizontal transmission is also playing an important role. The most important identified reservoirs are colonized or infected individuals from endemic areas or centers with outbreaks, but the contaminated goods from these endemic areas also play a part. An international effort is needed to control the spread of these multiresistant pathogens.La diseminación de enterobacterias productoras de carbapenemasas ha sucedido muy deprisa y ha cruzado rápidamente los límites entre países y continentes. En algunas áreas ha excedido la capacidad de manejo de los sistemas sanitarios, alcanzando proporciones epidémicas. Esta forma de diseminación no ha sido la misma para todas las enzimas, siendo los genes KPC, NDM y OXA-48 los que tienen una mayor capacidad de diseminación. Estas enzimas se han extendido principalmente de forma clónica en el caso de la Klebsiella pneumoniae productora de KPC desde el epicentro inicial localizado en Nueva York, con un número muy pequeño de cepas causantes del brote. En el caso de NDM y OXA-48, estos determinantes de resistencia han sido vehiculizados por clones con una alta capacidad de transmisión; no obstante, la transmisión horizontal simultánea está jugando también un papel importante. Los reservorios identificados más importantes son los individuos colonizados o infectados procedentes de las áreas o centros epidémicos con brotes, pero los productos contaminados procedentes de estas áreas también juegan un papel. Se necesita un esfuerzo internacional para controlar la diseminación de estos patógenos multirresistentes.
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