Treatment Options for Carbapenem-Resistant Enterobacteriaceae Infections

Abstract

Antimicrobial resistance in Gram-negative bacteria is an emerging and serious global public health threat. Carbapenems have been used as the “last-line” treatment for infections caused by resistant enterobacteriaceae, including those producing extended spectrum ß-lactamases. However, enterobacteriaceae that produce carbapenemases, which are enzymes that deactivate carbapenems and most other ß-lactam antibiotics, have emerged and are increasingly being reported worldwide. Despite this increasing burden, the most optimal treatment for carbapenem-resistant enterobacteriaceae (CRE) infections is largely unknown. For the few remaining available treatment options, there is limited efficacy data to support their role in therapy. Nevertheless, current treatment options include the use of older agents, such as polymyxins, fosfomycin, and aminoglycosides, which have been rarely used due to efficacy and/or toxicity concerns. Optimization of dosing regimens and combination therapy are additional treatment strategies being explored. CRE infections are associated with poor outcomes and high mortality. Continued research is critically needed to determine the most appropriate treatment.