What is an introduction to Carbapenem-Resistant Enterobacteriaceae (CRE)?

From the Guidelines

Carbapenem-resistant Enterobacterales (CRE) infections should be treated with either ceftazidime/avibactam or meropenem/vaborbactam as the first-line treatment options, as recommended by recent guidelines 1. The primary goal of treating CRE infections is to reduce morbidity, mortality, and improve quality of life. Key considerations in treating CRE infections include:

• The site of infection, with meropenem/vaborbactam potentially being preferred for pneumonia due to its pharmacokinetic/pharmacodynamic properties 1
• Local epidemiology and the emergence of resistance to ceftazidime/avibactam 1
• The use of imipenem/relebactam and cefiderocol as potential alternatives for the treatment of infections involving KPC-producing CRE, although clinical studies of their efficacy in these patients are limited 1 Some important treatment options for CRE infections include:
• Ceftazidime/avibactam 2.5 g IV q8h 1
• Meropenem/vaborbactam 4 g IV q8h 1
• Imipenem/cilastatin/relebactam 1.25 g IV q6h 1
• Polymyxin-based combinations, such as colistin and tigecycline 1 It is essential to note that the treatment duration should be individualized according to the infection site, source control, underlying comorbidities, and initial response to therapy 1. Additionally, combinations of tigecycline with polymyxin or meropenem are suggested in clinically unstable patients 1. The choice of combination antimicrobial therapy should be based on susceptibility testing, and extended-infusion of meropenem may be considered if the meropenem MIC is ≥ 8 mg/L 1. Overall, the treatment of CRE infections requires a comprehensive approach, taking into account the latest guidelines and evidence-based recommendations to optimize patient outcomes.

From the Research

Introduction to CRE

• Carbapenem-resistant Enterobacteriaceae (CRE) are a type of bacteria that are resistant to carbapenem antibiotics, which are often used as a last resort to treat infections 2, 3, 4, 5.
• The emergence of CRE poses a significant threat to human health, as treatment options are limited and mortality rates are high 2, 3, 4, 5.
• CRE infections are often associated with poor outcomes, including high mortality rates, and require urgent attention to develop effective treatment strategies 2, 3, 4, 5.

Treatment Options for CRE

• Current treatment options for CRE infections include polymyxins, tigecycline, fosfomycin, and aminoglycosides, although resistance to these antibiotics is a concern 2, 3, 4, 5.
• Combination therapy with two or more drugs may be more effective than monotherapy in treating CRE infections 4, 5, 6.
• New antibiotics, such as ceftazidime/avibactam and meropenem/vaborbactam, have shown promise in treating CRE infections, but more research is needed to determine their effectiveness 2, 5.

Challenges in Treating CRE

• The development of resistance to antibiotics is a significant challenge in treating CRE infections 2, 3, 4, 5.
• The lack of randomized clinical trial data makes it difficult to determine the most effective treatment strategies for CRE infections 3, 4, 5.
• The need for individualized treatment plans based on molecular phenotypes of resistance, susceptibility profiles, disease severity, and patient characteristics is essential to maximize treatment success 2.