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Optimizing therapy in carbapenem-resistant Enterobacteriaceae infections.
Curr Opin Infect Dis. 2018 12; 31(6):566-577.CO

Abstract

PURPOSE OF REVIEW

In the absence of randomized clinical trial data, questions remain regarding the optimal treatment of carbapenem-resistant Enterobacteriaceae (CRE) infections. CRE have historically been susceptible to polymyxins, tigecycline or aminoglycosides (mostly gentamicin), and these antibiotics have long been considered the drugs of choice for CRE infections, although varying rates of resistance to all have been reported. This review looks at data from clinical studies assessing the outcomes of CRE infections treated with different antibiotic regimens.

RECENT FINDINGS

The recently approved fixed-dose combination agent, ceftazidime-avibactam (CAZ-AVI), is active against KPC and OXA-48-producing Enterobacteriaceae. The limited clinical data available on CAZ-AVI indicate that it is associated with survival benefits relative to other commonly used regimens, although development of resistance is a concern. New drugs active against CRE isolates (including the recently approved meropenem-vaborbactam) are in different stages of development.

SUMMARY

CAZ-AVI and meropenem-vaborbactam seem destined to become the backbone of target therapy for high-risk patients with severe infections caused by susceptible CRE strains. However, empirical therapy should be based on risk factors to be defined in the near future, whereas the necessity of combinations with CAZ-AVI requires further studies. Polymyxins are still important options for low-risk patients with susceptible CRE infections, but also for high-risk patients in regions where metallo-β-lactamase-producing CRE predominate because CAZ-AVI and meropenem-vaborbactam are both ineffective against these strains.

Authors+Show Affiliations

UOC Malattie Infettive, Fondazione Policlinico Universitario A. Gemelli IRCCS - Istituto Malattie Infettive Università Cattolica del Sacro Cuore.UOC Malattie Infettive, Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Italy.1st Department of Internal Medicine-Infectious Diseases, Hygeia General Hospital, Athens, Greece.

Pub Type(s)

Journal Article
Review

Language

eng

PubMed ID

30379732

Citation

Tumbarello, Mario, et al. "Optimizing Therapy in Carbapenem-resistant Enterobacteriaceae Infections." Current Opinion in Infectious Diseases, vol. 31, no. 6, 2018, pp. 566-577.
Tumbarello M, Losito AR, Giamarellou H. Optimizing therapy in carbapenem-resistant Enterobacteriaceae infections. Curr Opin Infect Dis. 2018;31(6):566-577.
Tumbarello, M., Losito, A. R., & Giamarellou, H. (2018). Optimizing therapy in carbapenem-resistant Enterobacteriaceae infections. Current Opinion in Infectious Diseases, 31(6), 566-577. https://doi.org/10.1097/QCO.0000000000000493
Tumbarello M, Losito AR, Giamarellou H. Optimizing Therapy in Carbapenem-resistant Enterobacteriaceae Infections. Curr Opin Infect Dis. 2018;31(6):566-577. PubMed PMID: 30379732.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Optimizing therapy in carbapenem-resistant Enterobacteriaceae infections. AU - Tumbarello,Mario, AU - Losito,Angela Raffaella, AU - Giamarellou,Helen, PY - 2018/11/1/entrez PY - 2018/11/1/pubmed PY - 2019/10/23/medline SP - 566 EP - 577 JF - Current opinion in infectious diseases JO - Curr. Opin. Infect. Dis. VL - 31 IS - 6 N2 - PURPOSE OF REVIEW: In the absence of randomized clinical trial data, questions remain regarding the optimal treatment of carbapenem-resistant Enterobacteriaceae (CRE) infections. CRE have historically been susceptible to polymyxins, tigecycline or aminoglycosides (mostly gentamicin), and these antibiotics have long been considered the drugs of choice for CRE infections, although varying rates of resistance to all have been reported. This review looks at data from clinical studies assessing the outcomes of CRE infections treated with different antibiotic regimens. RECENT FINDINGS: The recently approved fixed-dose combination agent, ceftazidime-avibactam (CAZ-AVI), is active against KPC and OXA-48-producing Enterobacteriaceae. The limited clinical data available on CAZ-AVI indicate that it is associated with survival benefits relative to other commonly used regimens, although development of resistance is a concern. New drugs active against CRE isolates (including the recently approved meropenem-vaborbactam) are in different stages of development. SUMMARY: CAZ-AVI and meropenem-vaborbactam seem destined to become the backbone of target therapy for high-risk patients with severe infections caused by susceptible CRE strains. However, empirical therapy should be based on risk factors to be defined in the near future, whereas the necessity of combinations with CAZ-AVI requires further studies. Polymyxins are still important options for low-risk patients with susceptible CRE infections, but also for high-risk patients in regions where metallo-β-lactamase-producing CRE predominate because CAZ-AVI and meropenem-vaborbactam are both ineffective against these strains. SN - 1473-6527 UR - https://www.unboundmedicine.com/medline/citation/30379732/Optimizing_therapy_in_carbapenem_resistant_Enterobacteriaceae_infections_ DB - PRIME DP - Unbound Medicine ER -