Petros I Rafailidis1, Matthew E Falagas. 1. 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.
Abstract
PURPOSE OF REVIEW: To address the therapeutic management of carbapenem-resistant Enterobacteriaceae on the basis of literature of the last 12 months. RECENT FINDINGS: 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. SUMMARY: 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.
PURPOSE OF REVIEW: To address the therapeutic management of carbapenem-resistant Enterobacteriaceae on the basis of literature of the last 12 months. RECENT FINDINGS: 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. SUMMARY: 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: Fabio Arena; Lucia Henrici De Angelis; Antonio Cannatelli; Vincenzo Di Pilato; Marina Amorese; Marco Maria D'Andrea; Tommaso Giani; Gian Maria Rossolini Journal: Antimicrob Agents Chemother Date: 2016-03-25 Impact factor: 5.191
Authors: James A Karlowsky; Krystyna M Kazmierczak; Boudewijn L M de Jonge; Meredith A Hackel; Daniel F Sahm; Patricia A Bradford Journal: Antimicrob Agents Chemother Date: 2017-08-24 Impact factor: 5.191
Authors: Yu Mi Wi; Kerryl E Greenwood-Quaintance; Audrey N Schuetz; Kwan Soo Ko; Kyong Ran Peck; Jae-Hoon Song; Robin Patel Journal: Antimicrob Agents Chemother Date: 2017-12-21 Impact factor: 5.191
Authors: Douglas J Biedenbach; Krystyna Kazmierczak; Samuel K Bouchillon; Daniel F Sahm; Patricia A Bradford Journal: Antimicrob Agents Chemother Date: 2015-05-11 Impact factor: 5.191