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      "titulo" => "Epidemiology of infections caused by carbapenemase-producing Enterobacteriaceae: Reservoirs and transmission mechanisms"
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      "titulo" => "Carbapenemase-producing Enterobacteriaceae: The end of the antibiotic era?"
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    "titulo" => "Carbapenemases in Enterobacteriaceae: Types and molecular epidemiology"
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        "titulo" => "Abstract"
        "resumen" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">The most important mechanism of carbapenem resistance in Enterobacteriaceae is the production of carbapenemases&#44; although resistance can also result from the synergistic activity between AmpC-type or &#40;to a lesser extent&#41; extended-spectrum beta-lactamases combined with decreased outer membrane permeability&#46; Three major molecular classes of carbapenemases are recognized&#58; A&#44; B and D&#46; Classes A and D are serine-beta-lactamases&#44; whereas class B are metallo-beta-lactamases &#40;their hydrolytic activity depends on the presence of zinc&#41;&#46; In addition to carbapenems&#44; carbapenemases also hydrolyze other beta-lactams&#44; but the concrete substrate profile depends on the enzyme type&#46; In general terms&#44; class A enzymes are to some extent inhibited by clavulanic acid&#44; and class B enzymes do not affect monobactams and are inhibited by zinc chelators&#46; Given Enterobacteriaceae producing carbapenemases usually also contain gene coding for other mechanisms of resistance to beta-lactams&#44; it is not unusual for the organisms to present complex beta-lactam resistance phenotypes&#46; Additionally&#44; these organisms frequently contain other genes that confer resistance to quinolones&#44; aminoglycosides&#44; tetracyclines&#44; sulphonamides and other families of antimicrobial agents&#44; which cause multiresistance or even panresistance&#46; Currently&#44; the most important type of class A carbapenemases are KPC enzymes&#44; whereas VIM&#44; IMP and &#40;particularly&#41; NDM in class B and OXA-48 &#40;and related&#41; in class D are the more relevant enzymes&#46; Whereas some enzymes are encoded by chromosomal genes&#44; most carbapenemases are plasmid-mediated &#40;with genes frequently located in integrons&#41;&#44; which favors the dissemination of the enzymes&#46; Detailed information of the genetic platforms and the context of the genes coding for the most relevant enzymes will be presented in this review&#46;</p>"
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        "resumen" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">El mecanismo m&#225;s importante de resistencia a carbapen&#233;micos en enterobacterias es la producci&#243;n de carbapenemasas&#44; aunque dicha resistencia tambi&#233;n puede deberse a la combinaci&#243;n de betalactamasas tipo AmpC o&#44; en menor medida&#44; de espectro extendido&#44; combinadas con disminuci&#243;n de la permeabilidad de la membrana externa&#46; Se conocen 3 tipos moleculares de carbapenemasas&#58; A&#44; B y D&#46; Las de las clases A y D son betalactamasas de serina&#44; mientras que las de clase B son metalobetalactamasas &#40;su actividad depende del cinc&#41;&#46; Las carbapenemasas tambi&#233;n hidrolizan otros betalact&#225;micos&#44; adem&#225;s de carbapen&#233;micos&#44; pero el perfil de sustrato concreto depende de la enzima considerada&#46; En t&#233;rminos generales&#44; las enzimas de clase A se inhiben en mayor o menor medida por &#225;cido clavul&#225;nico y las de clase B no afectan a los monobact&#225;micos y se inhiben por quelantes del cinc&#46; Las enterobacterias que producen carbapenemasas&#44; generalmente contienen otros genes de resistencia a betalact&#225;micos y no es raro que presenten fenotipos de resistencia a betalact&#225;micos complejos&#46; Adem&#225;s&#44; estos organismos frecuentemente contienen genes de resistencia a quinolonas&#44; aminogluc&#243;sidos&#44; tetraciclinas&#44; sulfonamidas y otros antimicrobianos&#44; causando multirresistencia o incluso panresistencia&#46; Actualmente&#44; las carbapenemasas m&#225;s importantes de clase A son KPC&#44; las de clase B son VIM&#44; IMP&#44; y en especial NDM&#44; y las de clase D&#44; OXA-48 y similares&#46; Aunque algunas enzimas est&#225;n codificadas por genes cromos&#243;micos&#44; la mayor&#237;a est&#225;n mediadas por pl&#225;smidos &#40;y los correspondientes genes con frecuencia se encuentran en integrones&#41;&#44; lo cual favorece la diseminaci&#243;n de estas enzimas&#46; En esta revisi&#243;n se presenta informaci&#243;n detallada sobre las plataformas y los contextos gen&#233;ticos de los genes que codifican las enzimas m&#225;s relevantes&#46;</p>"
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