Treatment of Infections Caused by Extended-Spectrum-Beta-Lactamase-, AmpC-, and Carbapenemase-Producing Enterobacteriaceae.
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Overall, therapy of MDR-E infection must be individualized according to the susceptibility profile, type, and severity of infection and the features of the patient.Abstract:
Therapy of invasive infections due to multidrug-resistant Enterobacteriaceae (MDR-E) is challenging, and some of the few active drugs are not available in many countries For extended-spectrum β-lactamase and AmpC producers, carbapenems are the drugs of choice, but alternatives are needed because the rate of carbapenem resistance is rising Potential active drugs include classic and newer β-lactam-β-lactamase inhibitor combinations, cephamycins, temocillin, aminoglycosides, tigecycline, fosfomycin, and, rarely, fluoroquinolones or trimethoprim-sulfamethoxazole These drugs might be considered in some specific situations AmpC producers are resistant to cephamycins, but cefepime is an option In the case of carbapenemase-producing Enterobacteriaceae (CPE), only some "second-line" drugs, such as polymyxins, tigecycline, aminoglycosides, and fosfomycin, may be active; double carbapenems can also be considered in specific situations Combination therapy is associated with better outcomes for high-risk patients, such as those in septic shock or with pneumonia Ceftazidime-avibactam was recently approved and is active against KPC and OXA-48 producers; the available experience is scarce but promising, although development of resistance is a concern New drugs active against some CPE isolates are in different stages of development, including meropenem-vaborbactam, imipenem-relebactam, plazomicin, cefiderocol, eravacycline, and aztreonam-avibactam Overall, therapy of MDR-E infection must be individualized according to the susceptibility profile, type, and severity of infection and the features of the patientread more
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Journal ArticleDOI
Emergence of plasmid-mediated high-level tigecycline resistance genes in animals and humans
Tao He,Ran Wang,Dejun Liu,Timothy R. Walsh,Timothy R. Walsh,Rong Zhang,Yuan Lv,Yuebin Ke,Quanjiang Ji,Ruicheng Wei,Zhihai Liu,Yingbo Shen,Gang Wang,Lichang Sun,Lei Lei,Ziquan Lv,Yun Li,Maoda Pang,L Wang,Qiaoling Sun,Yulin Fu,Huangwei Song,Yuxin Hao,Zhangqi Shen,Shaolin Wang,Gong-Xiang Chen,Congming Wu,Jianzhong Shen,Yang Wang +28 more
TL;DR: The findings suggest that both the surveillance of tet(X) variants in clinical and animal sectors and the use of tetracyclines in food production require urgent global attention.
Journal ArticleDOI
Infections Caused by Carbapenem-Resistant Enterobacteriaceae : An Update on Therapeutic Options.
TL;DR: The current understanding of issues related to CRE is described and combination therapeutic strategies for CRE infections, including high-dose tigecycline, high- dose prolonged-infusion of carbapenem, and double carbapENem therapy are reviewed.
Journal ArticleDOI
Plasmid-encoded tet(X) genes that confer high-level tigecycline resistance in Escherichia coli.
Jian Sun,Chong Chen,Chao Yue Cui,Yan Zhang,Xiao Liu,Ze Hua Cui,Xiao Yu Ma,Youjun Feng,Liang Xing Fang,Xin Lei Lian,Rong Min Zhang,You-Zhi Tang,Kou Xing Zhang,Han Mian Liu,Zhi Hui Zhuang,Shi Dan Zhou,Jing Lv,Hong Du,Bin Huang,Fang You Yu,Barun Mathema,Barry N. Kreiswirth,Xiao-Ping Liao,Liang Chen,Ya Hong Liu +24 more
TL;DR: Concern is raised that the plasmid-mediated tigecycline resistance may further spread into various ecological niches and into clinical high-risk pathogens and that collective efforts are in urgent need to preserve the potency of these essential antibiotics.
Journal ArticleDOI
Efficacy of Ceftazidime-Avibactam Salvage Therapy in Patients With Infections Caused by Klebsiella pneumoniae Carbapenemase-producing K. pneumoniae.
Mario Tumbarello,Enrico Maria Trecarichi,Alberto Corona,Francesco Giuseppe De Rosa,Matteo Bassetti,Cristina Mussini,Francesco Menichetti,Claudio Viscoli,Caterina Campoli,Mario Venditti,Andrea De Gasperi,Alessandra Mularoni,Carlo Tascini,Giustino Parruti,Carlo Pallotto,Simona Sica,Ercole Concia,Rosario Cultrera,Gennaro De Pascale,Alessandro Capone,Spinello Antinori,Silvia Corcione,Elda Righi,Angela Raffaella Losito,Margherita Digaetano,Francesco Amadori,Daniele Roberto Giacobbe,Giancarlo Ceccarelli,E. Mazza,Francesca Raffaelli,Teresa Spanu,Roberto Cauda,Pierluigi Viale +32 more
TL;DR: CAZ-AVI appears to be a promising drug for treatment of severe KPC-Kp infections, especially those involving bacteremia, as well as hospital-acquired pneumonia, and for gram-negative infections with limited treatment options.
Journal ArticleDOI
Phenotypic and Genotypic Characterization of Carbapenem-resistant Enterobacteriaceae: Data From a Longitudinal Large-scale CRE Study in China (2012-2016).
Qi Wang,Xiaojuan Wang,Juan Wang,Pengwen Ouyang,Chunmei Jin,Ruobing Wang,Yawei Zhang,Longyang Jin,Hongbin Chen,Zhanwei Wang,Feifei Zhang,Bin Cao,Liangyi Xie,Kang Liao,Bing Gu,Chunxia Yang,Zhiwu Liu,Xiaobo Ma,Liang Jin,Xiaoqian Zhang,Sijin Man,Wei Li,Fengyan Pei,Xiuli Xu,Yan Jin,Ping Ji,Hui Wang +26 more
TL;DR: The number of CRE strains harboring carbapenemase is increasing and K. pneumoniae, the predominant strain, shows a reduced susceptibility to most available antibiotics.
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