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Infectious Disease
Published in John S. Axford, Chris A. O'Callaghan, Medicine for Finals and Beyond, 2023
Susanna J. Dunachie, Hanif Esmail, Ruth Corrigan, Maria Dudareva
Carbapenem-resistant Enterobacteriaceae (CRE) have acquired resistance by one of several mechanisms such as developing carbapenemases that cleave the beta-lactam ring, or developing efflux pumps to actively transport the drug out of cells.
AmpC, Extended-Spectrum β-Lactamase and Carbapenemase Producers
Published in Firza Alexander Gronthoud, Practical Clinical Microbiology and Infectious Diseases, 2020
Because of the scarcity of information, fosfomycin is not a first option against serious CRE infections when other active drugs are available, but it may be needed in some patients with scarce options. In such cases, a fosfomycin dose of 16–24 g per day as part of combination therapy is recommended.
Colonization, Infection, and Resistance in the Critical Care Unit
Published in Cheston B. Cunha, Burke A. Cunha, Infectious Diseases and Antimicrobial Stewardship in Critical Care Medicine, 2020
Since there is a direct relationship between colonization pressure and healthcare CRE transmission, infection prevention guidelines recommend contact precautions: For all patients either colonized or infected with CRE, use dedicated staff, rooms, and equipment [57]. Environmental cleaning and disinfection have been shown to reduce infections caused by VRE and C. difficile. The evidence for CRE is less convincing due to shorter environmental survival time [58]. However, during CRE outbreaks, cleaning of the environment, especially high-touch surfaces, may assist in reducing transmission [59].
In vitro susceptibility of carbapenem-resistant Enterobacterales to eravacycline – the first report from Croatia
Published in Journal of Chemotherapy, 2022
Ivana Jurić, Zrinka Bošnjak, Mario Ćorić, Joško Lešin, Ivana Mareković
Carbapenem-resistant Enterobacterales (CRE) represent a global threat to healthcare systems worldwide. CRE infections are characterized with increased mortality with studies showing that patients with these infections are approximately three times more likely to die than patients with infections that are susceptible to carbapenems [1,2]. The main obstacle in treatment of CRE infections is limited availability of treatment options [3]. During last few years several newer antimicrobial agents became available or are under investigation in clinical trials for treatment of CRE infections. These agents are either combination of β-lactamase inhibitor added to cephalosporin, carbapenem or monobactam (ceftazidim/avibactam, ceftolozan/tazobactam, meropenem/vaborbactam, ceftaroline/avibactam, imipenem/relebactam, aztreonam/avibactam, meropenem/nacubactam), siderophore antibiotics (cefiderocol) or members of the following classes – aminoglycosides (plazomicin), tetracyclines (eravacycline, omadacycline) and fluoroquinolones (delafloxacin) [4]. The activity of the new β-lactam/β-lactamase inhibitor combinations is largely determined by the carbapanemase class produced by the resistant microorganism with most of them not active against class B metallo-β-lactamases (MBL) [5]. Therefore, the novel antimicrobial agents other than β-lactams with activity against CRE not being dependent on β-lactamase class are specially important in treatment of these infections.
Incidence and risk factors of carbapenem-resistant Enterobacteriaceae infection in intensive care units: a matched case–control study
Published in Expert Review of Anti-infective Therapy, 2021
Fahad A S Aleidan, Hind Alkhelaifi, Aljouharah Alsenaid, Haya Alromaizan, Fajer Alsalham, Alhanouf Almutairi, Khalid Alsulaiman, Abdel Galil Abdel Gadir
In Table 1, the median score (interquartile range, IQR) of APACHE II was 18 (13–25) in the CRE group compared to 16 (12–22) in the CSE group (p = 0.101). However, CRE patients showed higher median (IQR) scores of SOFA and NUTRIC than CSE patients [8 (5–12) vs 6 (3–8), p = 0.029 and 5 (3–6) vs 4 (2–6), p = 0.015, respectively]. Several risk factors were associated with the CRE infections including: ICU duration (p = 0.001); dialysis during ICU stay (p = 0.007); mechanical ventilation (p < 0.0001); previous surgery within 90 days of ICU admission (p = 0.028); and previous hospitalization (p = 0.020). All these factors were significantly higher in the CRE group compared to the CSE group. The death rate during ICU stay was higher among CRE than CSE patients (OR 2.5, 95% CI 1.43–4.23, p = 0.001), Table 1.
Pharmacotherapeutic advances for recurrent urinary tract infections in women
Published in Expert Opinion on Pharmacotherapy, 2020
Mohamad Moussa, Mohamed Abou Chakra, Athanasios Dellis, Yasmin Moussa, Athanasios Papatsoris
To date, the treatment options for CRE infections remain very limited. Polymyxins (colistin or polymyxin B) and tigecycline have been traditionally considered as drugs of choice for infections caused by CRE. Carbapenems still play a role in the treatment of CRE infections, particularly when used in the treatment of CRE with lower MICs, either in higher doses in combination with other active anti-CRE agents, or through double-carbapenem therapy [17]. Women with rUTIs can be successfully treated with electrofulguration, and more than 80% experience long-term clinical cure [18]. Recurrent or relapsing UTIs often result from urinary stasis. For complex cases, UTIs are often associated with conditions, such as anatomical or functional abnormalities of the genitourinary tract, or the presence of an underlying disease. Therapeutic surgical options may be considered to remove the source of infection, and secondly, to improve or restore any predisposing conditions [19].