![]() ![]() ![]() Most strains that produce carbapenemases are resistant to carbapenems, and those that are not demonstrate reduced susceptibility to these agents. This surge in CRE is mostly driven by the emergence and spread of carbapenemases, a specific group of β-lactamases that are capable of hydrolyzing carbapenems. The recent increase in the rates of carbapenem-resistant Enterobacteriaceae (CRE) among healthcare-associated Enterobacteriaceae species, in particular Klebsiella pneumoniae, is therefore a major cause for concern. Treatment options for CRE infections are limited and typically include combinations of polymyxins, tigecycline, aminoglycosides, or carbapenems, but newer agents with activity against CRE and better safety profiles are starting to become available and will likely emerge as the preferred therapy for the treatment of CRE infections in the near future.Ĭarbapenem antibiotics are generally considered to be the most potent group of antimicrobial agents with proven efficacy in the treatment of patients with severe bacterial infections, including those caused by otherwise antimicrobial-resistant strains. Genetic tests mostly depend on nucleic acid detection and amplification. Phenotypic tests detect carbapenemase activity either by inhibiting their activity with specific inhibitors of carbapenemases, or by detecting hydrolysis of carbapenems by carbapenemases. Various phenotypic and genetic tests have been proposed and validated for rapid detection of CPE. The carbapenemase groups most commonly encountered include KPC, NDM and OXA-48, with KPC overrepresented in the United States. Among CRE, those producing carbapenem-hydrolyzing β-lactamase enzymes (carbapenemase-producing Enterobacteriaceae CPE) are particularly of concern since they tend to spread among patients, and treatment of active infection is difficult. Therefore, timely detection of CRE in the clinical laboratory is of paramount importance. Commonly used antibiotics are generally inactive against CRE. ![]() Carbapenem-resistant Enterobacteriaceae (CRE) have emerged as a major threat to modern medicine. ![]()
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