Optimizing therapy in carbapenem-resistant Enterobacteriaceae infections
Mario Tumbarello1, Angela Raffaella Losito2, Helen Giamarellou3
1UOC Malattie Infettive, Fondazione Policlinico Universitario A. Gemelli IRCCS - Istituto Malattie Infettive Università Cattolica del Sacro Cuore.
Current Opinion in Infectious Diseases
|November 1, 2018
Summary
Optimal treatment for carbapenem-resistant Enterobacteriaceae (CRE) infections is unclear. New agents like ceftazidime-avibactam show promise, but polymyxins remain vital, especially for metallo-β-lactamase-producing CRE.
Area of Science:
- Infectious Diseases
- Microbiology
- Pharmacology
Background:
- Carbapenem-resistant Enterobacteriaceae (CRE) pose a significant treatment challenge due to limited effective antibiotic options.
- Historically, polymyxins, tigecycline, and aminoglycosides were mainstays, but rising resistance necessitates new therapeutic strategies.
Purpose of the Study:
- To review clinical data on antibiotic regimens for CRE infections.
- To evaluate the efficacy and role of newer agents and traditional antibiotics in managing CRE.
Main Methods:
- Review of clinical studies assessing outcomes of CRE infections treated with various antibiotic regimens.
- Analysis of data on ceftazidime-avibactam (CAZ-AVI) and meropenem-vaborbactam activity and clinical utility.
Main Results:
- Ceftazidime-avibactam (CAZ-AVI) demonstrates activity against KPC and OXA-48 producing Enterobacteriaceae, showing survival benefits.
- Development of resistance to new agents is a concern; meropenem-vaborbactam is also under development.
- Polymyxins remain crucial for susceptible CRE infections in low-risk patients and for metallo-β-lactamase-producing CRE.
Conclusions:
- Ceftazidime-avibactam and meropenem-vaborbactam are expected to be key therapies for severe CRE infections caused by susceptible strains.
- Empirical therapy strategies require further definition based on risk factors.
- Polymyxins are essential for specific patient groups and CRE types where newer agents are ineffective.
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