title: Therapeutic options for carbapenem-resistant Enterobacteriaceae infections.
abstract: In recent years, carbapenem resistance among Enterobacteriaceae has dramatically increased and represents an important threat to global health. The optimal therapeutic management of carbapenem-resistant Enterobacteriaceae (CRE) infections has not been established, because to date, no clinical trials have been performed with this objective. We aimed to summarize in the present review data provided by previous observational clinical studies that have investigated the impact of different treatment strategies on the outcome of CRE infections. Most of these studies reported that combination therapy with 2 or more drugs is superior to monotherapy in providing a survival benefit. The use of carbapenems in association with other active drugs is likely ineffective for CRE isolates with carbapenem Minimum Inhibitory Concentrations (MICs) >8 mg/l. The effectiveness of further therapeutic options for the treatment of extensively or pan-drug-resistant Enterobacteriaceae infections has been reported in vivo and in vitro, although few cases/case series have been reported. Novel antimicrobials that are effective against CRE are urgently needed.
authors.affiliation: a Institute of Infectious Diseases, Catholic University of Sacred Heart , Rome , Italy.
authors.forename: Enrico Maria
authors.initials: EM
authors.lastname: Trecarichi
authors.affiliation: a Institute of Infectious Diseases, Catholic University of Sacred Heart , Rome , Italy.
authors.forename: Mario
authors.initials: M
authors.lastname: Tumbarello
mesh_terms: D000900:Anti-Bacterial Agents / Q000494:pharmacology / Q000627:therapeutic use*; D000073182:Carbapenem-Resistant Enterobacteriaceae / Q000187:drug effects* / Q000302:isolation & purification; D004359:Drug Therapy, Combination / Q000379:methods*; D004756:Enterobacteriaceae Infections / Q000188:drug therapy* / Q000382:microbiology*; D006801:Humans; D064887:Observational Studies as Topic
chemical_list: D000900:Anti-Bacterial Agents
keywords: carbapenem-resistant Enterobacteriaceae; combination therapy; double-carbapenem combination; monotherapy; mortality