The global challenge of carbapenem-resistant Enterobacteriaceae in transplant recipients and patients with hematologic malignancies.
Carbapenem-resistant Enterobacteriaceae (CRE) are emerging global pathogens. The spread of CRE to transplant recipients and patients with hematologic malignancies has ominous implications. These patients rely on timely, active antibacterial therapy to combat gram-negative infections; however, recommended empirical regimens are not active against CRE. Approximately 3%-10% of solid organ transplant (SOT) recipients in CRE-endemic areas develop CRE infection, and the infection site correlates with the transplanted organ. Mortality rates associated with CRE infections approach 40% in SOT recipients and 65% in patients with hematologic malignancies. Given that the current antimicrobial armamentarium to combat CRE is extremely limited, a multifaceted approach that includes antimicrobial stewardship and active surveillance is needed to prevent CRE infections in immunocompromised hosts. Improving outcomes of established infections will require the use of risk factor-based prediction tools and molecular assays to more rapidly administer CRE-active therapy and the development of new antimicrobial agents with activity against CRE.
Transplantation-Oncology Infectious Diseases Program, Division of Infectious Diseases.
Michael J
MJ
Satlin
Stephen G
SG
Jenkins
Thomas J
TJ
Walsh
D000900:Anti-Bacterial Agents / Q000494:pharmacology* / Q000627:therapeutic use; D015780:Carbapenems / Q000494:pharmacology* / Q000627:therapeutic use; D004755:Enterobacteriaceae / Q000187:drug effects*; D004756:Enterobacteriaceae Infections / Q000150:complications / Q000188:drug therapy*; D019337:Hematologic Neoplasms / Q000150:complications*; D006801:Humans; D016867:Immunocompromised Host; D012307:Risk Factors; D066027:Transplant Recipients; D016896:Treatment Outcome; D018440:beta-Lactam Resistance
D000900:Anti-Bacterial Agents; D015780:Carbapenems
Enterobacteriaceae; carbapenem resistance; immunocompromised hosts