Carbapenem-Resistant Enterobacteriaceae

Abstract

Synopsis Carbapenem-resistant Enterobacteriaceae (CRE) have emerged as a major threat to modern medicine. Commonly used antibiotics are generally inactive against CRE. Therefore, timely detection of CRE in the clinical laboratory is of paramount importance. Among CRE, those producing carbapenem-hydrolyzing β-lactamase enzymes (carbapenemase-producing Enterobacteriaceae; CPE) are particularly of concern since they tend to spread among patients, and treatment of active infection is difficult. The carbapenemase groups most commonly encountered include KPC, NDM and OXA-48, with KPC overrepresented in the United States. Various phenotypic and genetic tests have been proposed and validated for rapid detection of CPE. Phenotypic tests detect carbapenemase activity either by inhibiting their activity with specific inhibitors of carbapenemases, or by detecting hydrolysis of carbapenems by carbapenemases. Genetic tests mostly depend on nucleic acid detection and amplification. Treatment options for CRE infections are limited and typically include combinations of polymyxins, tigecycline, aminoglycosides, or carbapenems, but newer agents with activity against CRE and better safety profiles are starting to become available and will likely emerge as the preferred therapy for the treatment of CRE infections in the near future.

New and emerging infectious diseases (Ebola, Middle Eastern respiratory syndrome coronavirus, carbapenem-resistant Enterobacteriaceae, Candida auris): Focus on environmental survival and germicide susceptibility

“…The biology, epidemiology, and management of CRE have been reviewed. [94][95][96][97] Recent articles have reviewed newer antibiotic therapies for CRE. 98,99 Follow-up of hospitalized CRE colonized patients demonstrated that the mean duration of colonic carriage was >1 year.…”

Clinical and genomic epidemiology of carbapenem-non-susceptibleCitrobacterspp. at a tertiary healthcare center over two decades

“…isolates that were carbapenem-non-susceptible over the last two decades, which correlated with increased use of carbapenems at our center. While the incidence of carbapenem-resistant organisms has increased worldwide over recent years (7, 46), attention has been largely focused on other carbapenem-resistant members of the Enterobacterales , such as Enterobacter spp., E. coli , and Klebsiella spp. (7).…”

“…While the incidence of carbapenem-resistant organisms has increased worldwide over recent years (7, 46), attention has been largely focused on other carbapenem-resistant members of the Enterobacterales , such as Enterobacter spp., E. coli , and Klebsiella spp. (7). As with other gram-negative species, increasing antibiotic resistance among Citrobacter spp.…”

“…The recent increase in infections caused by carbapenem-resistant organisms in the United States has been largely driven by the dissemination of plasmid-encoded carbapenemases, which are often carried by members of the Enterobacterales , particularly Klebsiella pneumoniae (6, 7). However, rates of other carbapenem-resistant bacterial species have also increased (8).…”

New Bugs and New Drugs: Updates in Clinical Microbiology

“…Carbapenem-hydrolyzing enzymes are categorized into Ambler classes A, B, and D (46,47). Ambler class A enzymes (serine β-lactamases; i.e., Klebsiella pneumoniae Carbapenemase [KPC] and Serratia marcescens Enzyme [SME]) can be plasmidborne or chromosomally encoded, and are active against β-lactam and carbapenem antibiotics.…”