Infection and Drug Resistance (Oct 2021)
Emerging Carbapenem-Resistant Enterobacteriaceae Infection, Its Epidemiology and Novel Treatment Options: A Review
Abstract
Mihret Tilahun, Yeshimebet kassa, Alemu Gedefie, Melaku Ashagire Department of Medical Laboratory Sciences, College of Medicine and Health Science, Wollo University, Dessie, EthiopiaCorrespondence: Mihret TilahunDepartment of Medical Laboratory Science, College of Medicine and Health Sciences, Wollo University, PO.BOX: 1145, Dessie, EthiopiaTel +251 920988307Fax +251 333115250Email [email protected]: Infections due to multidrug-resistant Enterobacteriaceae have become major international public health problem due to the inadequate treatment options and the historically lagged pace of development of novel antimicrobial drugs. Inappropriate antimicrobial use in humans and animals coupled with increased global connectivity aided to the transmission of drug-resistant Enterobacteriaceae infections. Carbapenems are the medications of choice for extended-spectrum beta-lactamase and AmpC producers, but alternatives are currently needed because carbapenem resistance is increasing globally. This review pointed to discuss emerging drug-resistant Enterobacteriaceae, its epidemiology and novel treatment options for infections, which date back from 2010 to 2019 by searching Google Scholar, PubMed, PMC, Hinari and other different websites. The occurrence of carbapenem-resistant Enterobacteriaceae is reported worldwide with great regional variability. The rise of carbapenem-resistant Enterobacteriaceae poses a threat to all nations. Enzyme synthesis, efflux pumps, and porin mutations are the main methods by which Enterobacteriaceae acquire resistance to carbapenems. The major resistance mechanism among these is enzyme synthesis. Most carbapenem resistance is caused by three enzyme groups: Klebsiella pneumoniae carbapenemase (Ambler class A), metallo-ß-lactamases (Ambler class B), and oxacillinase-48 (Ambler class D). Ceftazidime–avibactam, which was newly licensed for carbapenemase producers, is the most common treatment option for infections. Meropenem–vaborbactam, imipenem–relebactam, plazomicin, cefiderocol, eravacycline, and aztreonam–avibactam are recently reported to be active against carbapenem-resistant Enterobacteriaceae; and are also in ongoing trials for different populations and combinations with other antibacterial agents. Overall, treatment must be tailored to the patient’s susceptibility profile, type and degree of infection, and personal characteristics.Keywords: multidrug resistance, antimicrobial therapy, carbapenemase, Enterobacteriaceae
