title: Detection, treatment, and prevention of carbapenemase-producing Enterobacteriaceae: recommendations from an International Working Group.
abstract: The prevalence of carbapenemase-producing Enterobacteriaceae (CPE) has increased during the past 10 years. Its detection is frequently difficult, because they do not always show a minimum inhibitory concentration (MIC) value for carbapenems in the resistance range. Both broth microdilution and agar dilution methods are more sensitive than disk diffusion method, Etest and automated systems. Studies on antimicrobial treatment are based on a limited number of patients; therefore, the optimal treatment is not well established. Combination therapy with two active drugs appears to be more effective than monotherapy. Combination of a carbapenem with another active agent--preferentially an aminoglycoside or colistin--could lower mortality provided that the MIC is ≤4 mg/l and probably ≤8 mg/l, and is administered in a higher-dose/prolonged-infusion regimen. An aggressive infection control and prevention strategy is recommended, including reinforcement of hand hygiene, using contact precautions and early detection of CPE through use of targeted surveillance.
authors.affiliation: Infectious Diseases Unit, Hospital Carlos Durand, Buenos Aires City, Argentina. glevyhara@fibertel.com.ar
authors.forename: Gabriel
authors.initials: G
authors.lastname: Levy Hara
authors.forename: Ian
authors.initials: I
authors.lastname: Gould
authors.forename: Andrea
authors.initials: A
authors.lastname: Endimiani
authors.forename: Pilar Ramón
authors.initials: PR
authors.lastname: Pardo
authors.forename: George
authors.initials: G
authors.lastname: Daikos
authors.forename: Po-Ren
authors.initials: PR
authors.lastname: Hsueh
authors.forename: Shaheen
authors.initials: S
authors.lastname: Mehtar
authors.forename: George
authors.initials: G
authors.lastname: Petrikkos
authors.forename: José María
authors.initials: JM
authors.lastname: Casellas
authors.forename: Lucía
authors.initials: L
authors.lastname: Daciuk
authors.forename: Daniela
authors.initials: D
authors.lastname: Paciel
authors.forename: Andrea
authors.initials: A
authors.lastname: Novelli
authors.forename: Raphael
authors.initials: R
authors.lastname: Saginur
authors.forename: Daniel
authors.initials: D
authors.lastname: Pryluka
authors.forename: Julio
authors.initials: J
authors.lastname: Medina
authors.forename: Eduardo
authors.initials: E
authors.lastname: Savio
mesh_terms: D000617:Aminoglycosides / Q000008:administration & dosage / Q000494:pharmacology / Q000627:therapeutic use; D000900:Anti-Bacterial Agents / Q000008:administration & dosage / Q000494:pharmacology / Q000627:therapeutic use*; D001426:Bacterial Proteins / Q000145:classification; D018432:Drug Resistance, Multiple; D004359:Drug Therapy, Combination; D004755:Enterobacteriaceae / Q000187:drug effects / Q000201:enzymology / Q000302:isolation & purification*; D004756:Enterobacteriaceae Infections / Q000175:diagnosis / Q000188:drug therapy* / Q000517:prevention & control*; D005578:Fosfomycin / Q000008:administration & dosage / Q000494:pharmacology / Q000627:therapeutic use; D006801:Humans; D017053:Infection Control / Q000379:methods*; D008826:Microbial Sensitivity Tests; D008911:Minocycline / Q000008:administration & dosage / Q000031:analogs & derivatives / Q000494:pharmacology / Q000627:therapeutic use; D058889:Molecular Typing / Q000379:methods; D011113:Polymyxins / Q000008:administration & dosage / Q000494:pharmacology / Q000627:therapeutic use; D017410:Practice Guidelines as Topic; D000078304:Tigecycline; D018440:beta-Lactam Resistance; D001618:beta-Lactamases / Q000145:classification
chemical_list: D000617:Aminoglycosides; D000900:Anti-Bacterial Agents; D001426:Bacterial Proteins; D011113:Polymyxins; D005578:Fosfomycin; D000078304:Tigecycline; D001618:beta-Lactamases; C063912:carbapenemase; D008911:Minocycline