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Open Forum Infect Dis. 2015 May 5;2(2):ofv050. doi: 10.1093/ofid/ofv050. eCollection 2015 Apr.

Treatment Options for Carbapenem-Resistant Enterobacteriaceae Infections.

Author information

1
Veterans Affairs Medical Center , Infectious Diseases Research Program , Providence, Rhode Island ; College of Pharmacy, Department of Pharmacy Practice , University of Rhode Island , Kingston.
2
Department of Pharmacy Services.
3
Division of Infectious Diseases , Detroit Medical Center, Wayne State University , Michigan.
4
Veterans Affairs Medical Center , Infectious Diseases Research Program , Providence, Rhode Island ; College of Pharmacy, Department of Pharmacy Practice , University of Rhode Island , Kingston ; Division of Infectious Diseases , Warren Alpert Medical School of Brown University , Providence, Rhode Island.

Abstract

This article provides a comprehensive review of currently available treatment options for infections due to carbapenem-resistant Enterobacteriaceae (CRE). Antimicrobial resistance in Gram-negative bacteria is an emerging and serious global public health threat. Carbapenems have been used as the "last-line" treatment for infections caused by resistant Enterobacteriaceae, including those producing extended spectrum ß-lactamases. However, Enterobacteriaceae that produce carbapenemases, which are enzymes that deactivate carbapenems and most other ß-lactam antibiotics, have emerged and are increasingly being reported worldwide. Despite this increasing burden, the most optimal treatment for CRE infections is largely unknown. For the few remaining available treatment options, there are limited efficacy data to support their role in therapy. Nevertheless, current treatment options include the use of older agents, such as polymyxins, fosfomycin, and aminoglycosides, which have been rarely used due to efficacy and/or toxicity concerns. Optimization of dosing regimens and combination therapy are additional treatment strategies being explored. Carbapenem-resistant Enterobacteriaceae infections are associated with poor outcomes and high mortality. Continued research is critically needed to determine the most appropriate treatment.

KEYWORDS:

carbapenem-resistant Enterobacteriaceae; carbapenemases; carbapenems; resistant infections; treatment

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