Version May 2024
Carbapenem-resistant Enterobacterales (CRE) are defined as bacteria within the Enterobacterales order that are resistant to at least one carbapenem.
CRE isolates may carry carbapenemases, enzymes that inactivate carbapenem antibiotics and usually inactivate standard beta-lactam agents. However, some CRE isolates remain susceptible to common standard-spectrum antibiotics or to a single carbapenem.
We favor monotherapy for CRE infections and avoid combination therapy except where specified.
The duration of therapy for CRE infections depends on the site of infection and is identical to that for infections caused by carbapenem-susceptible Enterobacterales isolates.KPC: Klebsiella pneumoniae carbapenemase; MBL: metallo-beta-lactamase; NMD-1: New Delhi metallo-beta-lactamase-1; IMP: imipenemase; OXA: oxacillinase.
* We typically request susceptibility testing for the following antibiotics, if available and not already performed: aminoglyocosides (including amikacin and plazomicin), fluoroquinolones, trimethoprim-sulfamethoxazole, aztreonam, tetracyclines (including minocycline, tigecycline, and eravacycline), fosfomycin and nitrofurantoin (for urinary isolates), ceftazidime-avibactam, meropenem-vaborbactam, imipinem-cilastatin-relebactam, and cefiderocol. If the isolate is a suspected or confirmed MBL-producer, we also request testing for synergy between ceftazidime-avibactam and aztreonam.
¶ Even if a CRE isolate is reported as susceptible to a traditional beta-lactam (eg, piperacillin-tazobactam, ceftriaxone, cefepime), we typically do not use the agent.
Δ For MBL-producing isolates reported as susceptible to aztreonam, we treat with aztreonam monotherapy.
◊ Tigecycline and eravacycline are effective for intra-abdominal infections, but data for CRE infections at other anatomical sites are scarce. Neither agent should be used to treat urinary tract infections or bacteremia because they may not achieve adequate levels in urine or blood.آیا می خواهید مدیلیب را به صفحه اصلی خود اضافه کنید؟
