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Chapter 8 Antibiotics: help or hindrance?
Published in Paul Elliott, Julie Storr, Annette Jeanes, Barry Professor Cookson, Benedetta Professor Allegranzi, Marilyn ADJ Professor Cruickshank, Infection Prevention and Control, 2017
Carbapenem antibiotics, such as imipenem and meropenem, have a broad spectrum of activity and are used for the treatment of severe hospital-associated infections and polymicrobial infections.16 As such they are often used as last-line treatments for resistant infections. Worryingly, carbapenem resistance has begun to develop, resulting in bacteria that are resistant to all but a handful of antibiotics. A growing number of bacteria from the Enterobacteriaceae species, such as E. coli and Klebsiella, have been noted to produce carbapenemase enzymes.17 These enzymes destroy carbapenem antibiotics, and therefore bacteria producing them can cause multidrug-resistant infections.18 Resulting infections present a therapeutic challenge, as there are limited treatment options, such as colistin and tigecycline.19 This is has been a growing problem in recent years. The United States, India and parts of Europe are all reported to have high prevalence of healthcare-associated carbapenemase-producing Enterobacteriaceae.20
Doripenem
Published in M. Lindsay Grayson, Sara E. Cosgrove, Suzanne M. Crowe, M. Lindsay Grayson, William Hope, James S. McCarthy, John Mills, Johan W. Mouton, David L. Paterson, Kucers’ The Use of Antibiotics, 2017
Carbapenem resistance among Enterobacteriaceae is an emerging issue. It impacts all agents in this class, including doripenem. The most significant mechanisms of resistance is due to bacterial production of a carbapenemase enzyme, a beta-lactamase able to hydrolyze carbapenem antimicrobials. Al-most all of the currently prevalent carbapenemase enzymes will hydrolyze doripenem to a significant extent.
The Microbiology Laboratory
Published in Keith Struthers, Clinical Microbiology, 2017
The carbapenemase-producing Enterobacteriaceae (CPE) pose a critical challenge in clinical diagnosis, treatment and infection control. There are also two important laboratory diagnostic issues: Conventional culture and antibiotic susceptibility testing takes several days for the final result.Conventional susceptibility testing determines the phenotypic susceptibility profile of the organism. Isolates of Klebsiella can appear to be producing a carbapenemase, but on further examination are producing an ESBL and also have reduced susceptibility to carbapenems due to porin restriction, which gives the false carbapenemase-producing phenotype.
Update on the epidemiology of carbapenemases in Latin America and the Caribbean
Published in Expert Review of Anti-infective Therapy, 2021
Juan Carlos García-Betancur, Tobias Manuel Appel, German Esparza, Ana C Gales, Gabriel Levy-Hara, Wanda Cornistein, Silvio Vega, Duilio Nuñez, Luis Cuellar, Luis Bavestrello, Paulo F. Castañeda-Méndez, Juan M. Villalobos-Vindas, María Virginia Villegas
Together with the correct implementation and adherence to these precautions, the rational use of antibiotic is of prime importance to avoid the increase of MDR microorganisms. In hospital settings, antibiotics are probably the most common therapy administrated. This fact undoubtedly contributes to the emergence of resistance among pathogenic bacteria. Therefore, the correct knowledge and understanding of the local epidemiology, together with the avoiding of unnecessary antibiotic use and the optimization of the administration of antimicrobial agents will minimize the appearance of resistance, the horizontal transmission of MDR bacteria and at the same time, will contribute to better outcome for those infected patients. Consequently and based on the current epidemiology for carbapenemase-resistant and MDR bacteria, it is necessary to design strategies aimed to achieve the optimal use of all antibiotics. Each medical institution in the LATAM region should have a local program that constantly monitors the prevalence of MDR microorganisms, the utilization of antibiotics and its effectiveness. These strategies should include a multidisciplinary team involving the pharmacy, the infection control team, the physicians and nursing staff, and should promote infection control practices, the implementation of standard and contact precaution and naturally, the rational use of antibiotics.
Evaluating imipenem + cilastatin + relebactam for the treatment of complicated urinary tract infections
Published in Expert Opinion on Pharmacotherapy, 2020
S.G. Kuiper, E. Leegwater, E.B. Wilms, C. van Nieuwkoop
Infections of the urinary tract are one of the most common bacterial infections. Health care-associated costs for this group of patients are substantial and increases after hospitalization [1]. The incidence of complicated urinary tract infection (UTI), including pyelonephritis and urosepsis, increases with age and women are more affected than men [2]. Most common causative bacteria are Gram-negative bacteria like Enterobacterales. Currently, multidrug resistance (MDR) is emerging and carbapenemase producing Gram-negative bacteria are of particular concern as this may result in untreatable and incurable complicated UTI (cUTI) and ultimately death. In order to prevent untreatable UTI, carbapenems are generally used as reserve antibiotics [3]. The World Health Organization deemed research into treatment of carbapenemase producing Enterobacterales, including the development of new antibiotics, as critical [4]. A treatment strategy to battle resistance in carbapenemase producing bacteria that’s currently being followed is the addition of a β-lactamase inhibitor to carbapenem antibiotics. One example is imipenem/cilastatin/relebactam (IMI/REL). This review discusses the use of imipenem/cilastatin/relebactam in patients with UTIs.
Adding double carbapenem therapy to the armamentarium against carbapenem-resistant Enterobacteriaceae bloodstream infections
Published in Infectious Diseases, 2019
Bryan P. White, Smit Patel, Janice Tsui, Daniel B. Chastain
The optimal treatment of infections with carbapenemase-producing bacteria remains elusive due to resistance against most available antibacterial agents [1,2]. Historically, polymyxin-based combination therapies have been used successfully against BSIs caused by carbapenemase-producers [15]. Recent evidence has shown that β-lactam combinations yield lower mortality compared to polymyxin-based combinations [16–20]. However, during therapy, resistance has emerged to newer BL/BLIs resulting in poor outcomes [21]. Clinical and microbiological success has been reported with the use of synergistic carbapenems as salvage therapy against BSIS caused by carbapenemase-producing Enterobacteriaceae [16]. The purpose of this article was to critically review in vitro and in vivo data along with case reports and case series to provide rational recommendations for the use of double carbapenem therapy against carbapenemase-producing Enterobacteriaceae BSIs.