**4. Clinical significance of carbapenemases**

Carbapenemase-producing Gram-negative bacteria can cause a wide spectrum of infections including bacteremia, nosocomial pneumonia, wound infections, endocarditis, and urinary tract infections. Risk factors for carbapenem-resistant isolates usually include procedures involving manipulations of the gastrointestinal tract, trauma, orthopedic procedure, or life-threatening conditions like septicemia and septic shock. Those infections are often associated with high hospitalization cost, treatment failures, longer hospital stay, and high mortality rates [82–84].
