Carbapenemase Of Intestinal Rods – The Beginning Of Post-Antibiotic Era?

Abstract

Abstract In recent years in Poland as well as globally at an alarming rate, the number of bacteria producing mechanisms of antibiotic resistance has been increased. The major source of concern is the emergence and dissemination of carbapenem-resistant Enterobacteriaceae (CRE). Carbapenems are considered as last resort drugs for the treatment of multidrug-resistant (MDR) bacterial infections. At the present time the greatest menaces to public health are strains producing KPC (Klebsiella pneumoniae carbapenemases), NDM (New Delhi Metallo-β-lactamase) and OXA-48 (Oxacillinase-48). Carbapenemase-producing Enterobacterales have been resistant to most and sometimes even to all drugs that would be considered for treatment. Therefore, the accurate therapeutic options for the treatment of infections due to CRE strains are limited to the following antibiotics: colistin, tigecycline, fosfomycin, and aminoglycosides. Moreover, combination therapy containing two or more antibiotics has been recommended for the treatment of severe infections caused by carbapenemase-producing Enterobacterales. Due to the rapid spread of carbapenem-resistant strains and the lack of new antibiotic drug development, there is an urgent need to broaden our knowledge regarding antibiotic resistance. 1. Introduction. 2. Carbapenemases. 2.1. Metallo-β-lactamases. 2.2. Class A Carbapenemases. 2.3. Class D Carbapenemases (OXA). 3. Review of antibiotic treatment options of infections due to carbapenem-resistant strains. 3.1. Colistin. 3.2. Fosfomycin. 3.3. Tigecycline. 3.4. Aminoglycosides. 3.5. Carbapenems. 3.6. Mechanism of NDM – likely antibiotic/ chemotherapeutics could be used in the therapy. 3.7. Mechanism of KPC – likely antibiotic/ chemotherapeutics could be used in the therapy. 3.8. Mechanism of OXA-48 – likely antibiotic/ chemotherapeutics could be used in the therapy. 4. Summary