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Published on: April 18, 2019

Therapeutic options for infections with Enterobacteriaceae producing carbapenem-hydrolyzing enzymes

Matthew E Falagas1, Drosos E Karageorgopoulos, Patrice Nordmann

  • 1Alfa Institute of Biomedical Sciences (AIBS), Athens, Greece.

Future Microbiology
|June 29, 2011
PubMed

Insights

Treatment options for carbapenemase-producing Enterobacteriaceae are limited. Colistin, tigecycline, and combination therapies show potential, but resistance and lack of clinical data require careful consideration for effective antimicrobial strategies.

Area of Science:

  • Microbiology
  • Infectious Diseases
  • Pharmacology

Background:

  • Carbapenemase-producing Enterobacteriaceae (CPE) are emerging global nosocomial pathogens.
  • These strains exhibit resistance to most available antimicrobials, complicating treatment.
  • Clinical data guiding optimal therapy for CPE infections are scarce.

Purpose of the Study:

  • To review current antimicrobial options for treating infections caused by carbapenemase-producing Enterobacteriaceae.
  • To evaluate the in vitro activity, resistance development, and potential clinical utility of various antimicrobial agents.
  • To discuss the role of combination therapy and emerging treatment strategies.

Main Methods:

  • Literature review of antimicrobial susceptibility data.
  • Analysis of pharmacokinetic/pharmacodynamic parameters.
  • Evaluation of synergy and resistance development.
  • Consideration of clinical experience with similar pathogens.

Main Results:

  • Colistin and tigecycline demonstrate in vitro activity but raise concerns about resistance.
  • Aminoglycosides, carbapenems, and aztreonam (for MBL producers) show variable activity.
  • Expanded-spectrum cephalosporins (e.g., ceftazidime) may be active against OXA-48 producers.
  • Fosfomycin may serve as a last-resort option in combination regimens.

Conclusions:

  • Monotherapy with current agents is not reliably supported for systemic CPE infections.
  • Combination antimicrobial therapy with synergistic agents may offer benefits.
  • Further research and novel agents are needed for effective treatment of CPE infections.

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