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Antimicrobial treatment of carbapenem-resistant Enterobacteriaceae infections

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Author:: No author available

Journal Title:: Chinese Journal of Clinical Infectious Diseases

Issue:: 5

DOI:: 10.3760/cma.j.issn.1674-2397.2020.05.002

Key Word:: 肠杆菌科;抗菌药;碳青霉烯类耐药抗生素;Enterobacteriaceae;Anti-bacterial agents;Carbapenem-resistant antibiotics

Abstract： Carbapenem-resistant Enterobacteriaceae (CRE) mainly cause hospital-acquired infections, which have become an major threat in clinical practice and there are few antibacterial drugs available for CRE infection. At present, the main drugs for CRE treatment are polymyxin, tigecycline, ceftazidime-avibactam, fosfomycin and aminoglycoside antibiotics. Polymyxin and tigecycline are highly sensitive to CRE in vitro and are not affected by the type of carbapenemase produced by bacteria. Due to heterogeneous resistance and dose-related nephrotoxicity, polymyxin is often used in combination with other antibiotics. Tigecycline is difficult to reach sufficient concentrations in blood and alveolar lining fluid when using conventional dose. Therefore, it is necessary to increase the dose or to be used in combination with other drugs. Ceftazidime-avibactam lacks effective antibacterial activity against metalloenzyme-producing CRE, which can be used for the treatment of non metalloenzyme-producing CRE infection. The most common site of CRE colonization is the gastrointestinal tract. If the patient have intestinal mucosal destruction and decreased immune function, CRE can cause persistent bacteremia from intestinal blood.

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