title: Carbapenem-resistant Enterobacteriaceae in special populations: Solid organ transplant recipients, stem cell transplant recipients, and patients with hematologic malignancies.
abstract: Carbapenem-resistant Enterobacteriaceae (CRE) are a major global public health concern and pose a serious threat to immunocompromised hosts, particularly patients with hematologic malignancies and solid organ (SOT) and stem cell transplant recipients. In endemic areas, carbapenem-resistant Klebsiella pneumoniae infections occur in 1-18% of SOT recipients, and patients with hematologic malignancies represent 16-24% of all patients with CRE bacteremia. Mortality rates approaching 60% have been reported in these patient populations. Early diagnosis and rapid initiation of targeted therapy is critical in the management of immunocompromised hosts with CRE infections, as recommended empiric regimens are not active against CRE. Therapeutic options are limited by antibiotic-associated toxicities, interactions with immunosuppressive agents, and paucity of antibiotic options currently available. Prevention of CRE infection in these patients requires a multidisciplinary approach involving hospital epidemiology and antimicrobial stewardship. Large, multicenter studies are needed to develop risk-stratification tools to assist in guiding the management of these individuals.
authors.affiliation: a Department of Medicine , The Ohio State University Wexner Medical Center , Columbus , OH , USA.
authors.forename: Stephanie M
authors.initials: SM
authors.lastname: Pouch
authors.affiliation: b Department of Medicine , Weill Cornell Medicine , New York , NY , USA.
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Satlin
mesh_terms: D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D000073182:Carbapenem-Resistant Enterobacteriaceae / Q000302:isolation & purification*; D019468:Disease Management; D004756:Enterobacteriaceae Infections / Q000188:drug therapy / Q000453:epidemiology* / Q000382:microbiology* / Q000401:mortality; D019337:Hematologic Neoplasms / Q000150:complications*; D006801:Humans; D016867:Immunocompromised Host; D015995:Prevalence; D066027:Transplant Recipients
chemical_list: D000900:Anti-Bacterial Agents
keywords: carbapenem-resistant Enterobacteriaceae; hematologic malignancy; multi-drug resistance; solid organ transplant; stem cell transplant