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Present and Future of Carbapenem-resistant Enterobacteriaceae (CRE) Infections

Beatriz Suay-García1, María Teresa Pérez-Gracia2

  • 1Área de Microbiología, Departamento de Farmacia, Instituto de Ciencias Biomédicas, Facultad de Ciencias de la Salud, Universidad Cardenal Herrera-CEU, C/ Santiago Ramón y Cajal, 46115 Alfara del Patriarca, Valencia, Spain.

Antibiotics (Basel, Switzerland)
|August 22, 2019
PubMed

Insights

Carbapenem-resistant Enterobacteriaceae (CRE) pose a global health threat due to enzyme production. New treatments are urgently needed to combat these resistant infections.

Area of Science:

  • Microbiology
  • Infectious Diseases
  • Antimicrobial Resistance

Background:

  • Carbapenem-resistant Enterobacteriaceae (CRE) represent a significant and growing public health concern globally.
  • Resistance in Enterobacteriaceae primarily stems from enzyme production, efflux pumps, and porin mutations, with enzyme production being the predominant mechanism.

Purpose of the Study:

  • To review the primary mechanisms of carbapenem resistance in Enterobacteriaceae.
  • To highlight the global distribution of key carbapenemase-producing enzymes.
  • To emphasize the urgent need for novel therapeutic strategies against CRE infections.

Main Methods:

  • Literature review of carbapenem resistance mechanisms in Enterobacteriaceae.
  • Analysis of the epidemiology and geographical distribution of carbapenemase-producing Enterobacteriaceae.
  • Discussion of current and emerging treatment approaches for CRE infections.

Main Results:

  • Three main enzyme groups—KPC (Ambler class A), MBLs (Ambler class B), and OXA-48-like (Ambler class D)—are responsible for most carbapenem resistance.
  • Specific carbapenemase-producing Enterobacteriaceae are endemic to different global regions, facilitated by plasmid-mediated horizontal gene transfer.
  • The spread of CRE necessitates the development of new therapeutic guidelines.

Conclusions:

  • Carbapenem resistance in Enterobacteriaceae is largely driven by plasmid-mediated enzyme production, enabling rapid global dissemination.
  • Effective treatment of CRE infections requires a multifaceted approach, including antibiotic repurposing, combination therapies, and the development of novel inhibitors and antibiotics.
Keywords:
CREEnterobacteriaceaeantibiotic resistanceantimicrobialscarbapenem-resistant

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