Abstract
The global spread of carbapenem-resistant Enterobacteriaceae (CRE) is increasingly becoming a major challenge in clinical and public health settings. To date, the treatment for serious CRE infections remains difficult. The intelligent use of antimicrobials and effective infection control strategies is crucial to prevent further CRE spread. Early consultation with experts in the treatment of infections with multidrug-resistant organisms is valuable in patient management. This brief review will focus on the current, yet limited, treatment options for CRE infections.
Highlights
The global spread of carbapenem-resistant Enterobacteriaceae (CRE) has become a major challenge in clinical and public health settings
For issues related to the epidemiology, detection, and prevention of infections with CRE, the reader is referred to several excellent reviews published on this topic [6,10]
Colistin monotherapy is not recommended for organisms with Minimum inhibitory concentration (MIC) to colistin of at least 4 mg/L [16]
Summary
The global spread of carbapenem-resistant Enterobacteriaceae (CRE) has become a major challenge in clinical and public health settings. Dalfino and colleagues [17], in their prospective cohort study of 25 critically ill patients with bacteremia or ventilator-associated pneumonia caused by CRE (Klebsiella) and other carbapenem-resistant bacteria (Acinetobacter and Pseudomonas), used a regimen of 9 million IU of colistimethate sodium loading dose (270 mg colistin base), followed by a maintenance dose of 4.5 million IU of colistimethate sodium (135 mg colistin base) every 12 hours in patients with normal renal function. Kontopidou and colleagues [46], in their study of 127 ICU patients with bacteremias or ventilator-associated pneumonias caused by carbapenem-resistant K. pneumoniae, found that patients treated with tigecycline, especially as monotherapy (at doses of 100 to 200 mg/day), had the highest failure rates compared with other drug combinations. It has in vitro activity against KPC-producing bacteria but not against non-fermenters [62]
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