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lüll Carbapenem resistance in Acinetobacter baumannii: mechanisms and epidemiology Poirel L; Nordmann PClin Microbiol Infect 2006[Sep]; 12 (9): 826-36The increasing trend of carbapenem resistance in Acinetobacter baumannii worldwide is a concern since it limits drastically the range of therapeutic alternatives. Metallo-beta-lactamases (VIM, IMP, SIM) have been reported worldwide, especially in Asia and western Europe, and confer resistance to all beta-lactams except aztreonam. The most widespread beta-lactamases with carbapenemase activity in A. baumannii are carbapenem-hydrolysing class D beta-lactamases (CHDLs) that are mostly specific for this species. These enzymes belong to three unrelated groups of clavulanic acid-resistant beta-lactamases, represented by OXA-23, OXA-24 and OXA-58, that can be either plasmid- or chromosomally-encoded. A. baumannii also possesses an intrinsic carbapenem-hydrolysing oxacillinase, the expression of which may vary, that may play a role in carbapenem resistance. In addition to beta-lactamases, carbapenem resistance in A. baumannii may also result from porin or penicillin-binding protein modifications. Several porins, including the 33-kDa CarO protein, that constitute a pore channel for influx of carbapenems, might be involved in carbapenem resistance.|*beta-Lactam Resistance[MESH]|Acinetobacter Infections/drug therapy/*epidemiology/microbiology[MESH]|Acinetobacter baumannii/*drug effects/enzymology[MESH]|Anti-Bacterial Agents/*pharmacology[MESH]|Bacterial Proteins/genetics/metabolism[MESH]|Carbapenems/*pharmacology[MESH]|Humans[MESH]|Microbial Sensitivity Tests[MESH]|beta-Lactamases/genetics/metabolism[MESH] |