Emerging Issues and Treatment Strategies in Carbapenem-Resistant Enterobacteriaceae (CRE)

Carbapenems are the broadest spectrum antimicrobials utilized in the treatment of serious infections since the 1980s. Soon after their introduction, the discovery of carbapenem-resistant Enterobacteriaceae (CRE) was reported in the 1990s. Invasive CRE infections are associated with high mortality and limited treatment options making care for patients with these infections challenging for clinicians. Current practice has reverted back to the use of "older" antimicrobials, such as the polymyxins, tigecycline, and fosfomycin, to combat invasive CRE infections. However, recent approval of ceftazidime-avibactam has added another treatment option to the current antimicrobial armamentarium. Resistance among the "older" agents is still rare but has been reported. Currently, there are numerous agents that are under investigation as well as combination therapy that looks promising in the treatment of CRE infections.