This information is provided by:
Susan M. Poutanen, MD, MPH, FRCPC
Editorial Board Member for the CAN-R Website

Plasmid-mediated Klebsiella pneumoniae carbapenemases (KPCs) were first described in 2001 in an isolate of Klebsiella pneumoniae isolated in North Carolina, United States. KPCs confer decreased susceptibility/resistance to all β lactam antimicrobials and are usually resistant to most other classes of antimicrobial agents leaving limited treatment options.

Since they were first reported, KPCs have been identified in other Enterobacteriaceae species as well as Pseudomonas aeruginosa. In addition, they have spread throughout the United States, especially New York City, and a number of different countries, including Colombia, China, France, and Israel. However, until recently, they have not been described in Canada.

Four separate reports now describe the emergence of KPC-producing K. pneumoniae in Canada. In total, 5 isolates have been reported with clinical details from patients in the Toronto and Ottawa regions of Ontario, Canada. Additional isolates have been confirmed by the Ontario Agency for Health Protection and Promotion. In Ottawa, two of the three cases described had histories of travel to the US. The third acquired the KPC through intra-hospital transmission. In the Toronto region, neither of the two reported cases had risk factors for KPCs (e.g. travel to the US, prior carbapenemase use) suggesting local acquisition. Retrospective review of all sterile fluid cultures Enterobacteriaceae in 2008 (n=861) in one of the Toronto hospital laboratories reporting a KPC revealed no additional cases.

KPC-producing organisms are now in Canada. Routine testing using Clinical Laboratory Standards Institute (CLSI) breakpoints may miss cases due to false-susceptibility to carbapenems in some KPC-producing organisms. Laboratories should following CLSI recommended specific screening and confirmation testing for KPCs in order to assure accurate identification of isolates for both treatment and infection control purposes. Nation-wide surveillance specifically targeting KPCs should be completed in order to ascertain the prevalence of the problem in Canada.

1. Goldfarb D et al. Detection of plasmid mediated KPC-producing Klebsiella pneumoniae in Ottawa, Canada: evidence of intra-hospital transmission. J Clin Micro 2009; published online ahead of print on 8 April 2009.
2. Pillai DR et al. Klebsiella pneumoniae carbapenemase, Canada. Emerg Inf Disease 2009;15(5):827-829.
3. Xiong J et al. First report of a Klebsiella pneumoniae carbapenemase (KPC)-producing K. pneumoniae (KP) in Toronto, Canada. Abstract P-128. 26 th International Congress of Chemotherapy and Infection incorporating the AMMI Canada-CACMID Annual Conference 2009, Toronto, Canada.
4. Toye et al. Carbapenem resistance in Canada. CMAJ 2009 180(12):1225-1226.
5. Clinical Laboratory Standards Institute 2009. Performance Standards for Antimicrobial Susceptibility Testing; Nineteenth Informational Supplement. CLSI document M100-S19. Clinical and Laboratory Standards Institute, Wayne, Pennsylvania.