title: Treating infections caused by carbapenemase-producing Enterobacteriaceae.
abstract: Carbapenemase-producing Enterobacteriaceae (CPE) have spread worldwide, causing serious infections with increasing frequency. CPE are resistant to almost all available antibiotics, complicating therapy and limiting treatment options. Mortality rates associated with CPE infections are unacceptably high, indicating that the current therapeutic approaches are inadequate and must be revised. Here, we review 20 clinical studies (including those describing the largest cohorts of CPE-infected patients) that provided the necessary information regarding isolate and patient characteristics and treatment schemes, as well as a clear assessment of outcome. The data summarized here indicate that treatment with a single in vitro active agent resulted in mortality rates not significantly different from that observed in patients treated with no active therapy, whereas combination therapy with two or more in vitro active agents was superior to monotherapy, providing a clear survival benefit (mortality rate, 27.4% vs. 38.7%; p <0.001). The lowest mortality rate (18.8%) was observed in patients treated with carbapenem-containing combinations.
authors.affiliation: Department of Microbiology, School of Medicine, University of Athens, Athens, Greece.
authors.forename: L S
authors.initials: LS
authors.lastname: Tzouvelekis
authors.forename: A
authors.initials: A
authors.lastname: Markogiannakis
authors.forename: E
authors.initials: E
authors.lastname: Piperaki
authors.forename: M
authors.initials: M
authors.lastname: Souli
authors.forename: G L
authors.initials: GL
authors.lastname: Daikos
mesh_terms: D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D001426:Bacterial Proteins / Q000378:metabolism*; D004359:Drug Therapy, Combination / Q000379:methods; D004755:Enterobacteriaceae / Q000201:enzymology* / Q000302:isolation & purification; D004756:Enterobacteriaceae Infections / Q000188:drug therapy* / Q000382:microbiology* / Q000401:mortality; D006801:Humans; D016019:Survival Analysis; D016896:Treatment Outcome; D001618:beta-Lactamases / Q000378:metabolism*
chemical_list: D000900:Anti-Bacterial Agents; D001426:Bacterial Proteins; D001618:beta-Lactamases; C063912:carbapenemase
keywords: Antibiotic combinations; Enterobacteriaceae; Klebsiella pneumoniae; carbapenem; carbapenemase; treatment