title: Options for treating carbapenem-resistant Enterobacteriaceae.
abstract: OBJECTIVE
  To address the therapeutic management of carbapenem-resistant Enterobacteriaceae on the basis of literature of the last 12 months.
  
  
  RESULTS
  Retrospective and prospective (nonrandomized noncontrolled) studies provide data regarding the management of infections due to carbapenem-resistant Enterobacteriaceae. The combination of a carbapenem with colistin or high-dose tigecycline or aminoglycoside or even triple carbapenem-containing combinations if the minimum inhibitory concentration (MIC) range of carbapenem (meropenem and imipenem) resistance is 8 mg/l or less seems to have an advantage over monotherapy with either colistin or tigecycline or fosfomycin. For Enterobacteriaceae with MIC for carbapenems over 8 mg/l, combination regimens involve colistin, tigecycline usually administered in a double dose than that suggested by its manufacturer, fosfomycin and aminoglycosides in various combinations.
  
  
  CONCLUSIONS
  Suggestions based on the limited literature cannot be made safely. Combination regimens involving carbapenems for Enterobacteriaceae with MICs 8 mg/l or less for carbapenems (in dual combination with colistin or high-dose tigecycline or aminoglycoside or even triple combinations) seem to confer some therapeutic advantage over monotherapy. For Enterobacteriaceae with higher than the above-mentioned MICs, a combination of two or even three antibiotics among colistin, high-dose tigecycline, aminoglycoside and fosfomycin seems to confer decreased mortality.
authors.affiliation: aAlfa Institute of Biomedical Sciences bDepartment of Internal Medicine, Athens Medical Center cDepartment of Internal Medicine - Infectious Diseases, Iaso General Hospital, Iaso Group, Athens, Greece dDepartment of Medicine, Tufts University School of Medicine, Boston, Massachusetts, USA.
authors.forename: Petros I
authors.initials: PI
authors.lastname: Rafailidis
authors.forename: Matthew E
authors.initials: ME
authors.lastname: Falagas
mesh_terms: D015780:Carbapenems / Q000008:administration & dosage*; D003091:Colistin / Q000008:administration & dosage*; D024901:Drug Resistance, Multiple, Bacterial / Q000187:drug effects*; D004359:Drug Therapy, Combination; D004756:Enterobacteriaceae Infections / Q000188:drug therapy* / Q000382:microbiology / Q000517:prevention & control; D006801:Humans; D017053:Infection Control / Q000592:standards; D007711:Klebsiella pneumoniae / Q000187:drug effects* / Q000472:pathogenicity; D008826:Microbial Sensitivity Tests; D008911:Minocycline / Q000008:administration & dosage / Q000031:analogs & derivatives*; D010818:Practice Patterns, Physicians' / Q000592:standards; D011446:Prospective Studies; D012189:Retrospective Studies; D000078304:Tigecycline; D016896:Treatment Outcome; D018440:beta-Lactam Resistance / Q000187:drug effects*
chemical_list: D015780:Carbapenems; D000078304:Tigecycline; D008911:Minocycline; D003091:Colistin