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Options for treating carbapenem-resistant Enterobacteriaceae
Petros I Rafailidis1, Matthew E Falagas
1aAlfa Institute of Biomedical Sciences bDepartment of Internal Medicine, Athens Medical Center cDepartment of Internal Medicine - Infectious Diseases, Iaso General Hospital, Iaso Group, Athens, Greece dDepartment of Medicine, Tufts University School of Medicine, Boston, Massachusetts, USA.
Purpose Of Review:
To address the therapeutic management of carbapenem-resistant Enterobacteriaceae on the basis of literature of the last 12 months.
Recent Findings:
Retrospective and prospective (nonrandomized noncontrolled) studies provide data regarding the management of infections due to carbapenem-resistant Enterobacteriaceae. The combination of a carbapenem with colistin or high-dose tigecycline or aminoglycoside or even triple carbapenem-containing combinations if the minimum inhibitory concentration (MIC) range of carbapenem (meropenem and imipenem) resistance is 8 mg/l or less seems to have an advantage over monotherapy with either colistin or tigecycline or fosfomycin. For Enterobacteriaceae with MIC for carbapenems over 8 mg/l, combination regimens involve colistin, tigecycline usually administered in a double dose than that suggested by its manufacturer, fosfomycin and aminoglycosides in various combinations.
Summary:
Suggestions based on the limited literature cannot be made safely. Combination regimens involving carbapenems for Enterobacteriaceae with MICs 8 mg/l or less for carbapenems (in dual combination with colistin or high-dose tigecycline or aminoglycoside or even triple combinations) seem to confer some therapeutic advantage over monotherapy. For Enterobacteriaceae with higher than the above-mentioned MICs, a combination of two or even three antibiotics among colistin, high-dose tigecycline, aminoglycoside and fosfomycin seems to confer decreased mortality.
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