β-Lactamases Represent One of the Major Evolving Mechanisms of Antimicrobial Resistance
Carbapenemases are Capable of Inactivating β-Lactam Antibiotics of All Classes
The Distinction Between Serine and Metallo-Based Carbapenemases is Important, Since Certain Drugs are Active Against the Serine Enzymes, But Not Against the Metallo Enzymes
Example: Ceftazidime + Avibactam is active against serine enzymes, but not against metallo enzymes (see Ceftazidime-Avibactam)
Carbapenem-Resistant (Excluding Ertapenem)/Extended-Spectrum Cephalosporin-Resistant Escherichia Coli (see Escherichia Coli)
Carbapenem-Resistant (Excluding Ertapenem)/Extended-Spectrum Cephalosporin-Resistant Enterobacter Aerogenes (see Enterobacter Aerogenes)
Carbapenem-Resistant (Excluding Ertapenem)/Extended-Spectrum Cephalosporin-Resistant Enterobacter Cloacae Complex (see Enterobacter Cloacae)
Carbapenem-Resistant (Excluding Ertapenem)/Extended-Spectrum Cephalosporin-Resistant Klebsiella Pneumoniae (see Klebsiella Pneumoniae)
Carbapenem-Resistant (Excluding Ertapenem)/Extended-Spectrum Cephalosporin-Resistant Klebsiella Oxytoca (see Klebsiella Oxytoca)
Clinical Associations
Most CRE’s were Isolated from a Urinary Source
Most CRE’s were Associated with High Prevalence of Prior Hospitalizations, Prior Indwelling Devices, or Discharge to a Long-Term Care Setting
References
Carbapenemase-producing Klebsiella pneumoniae bloodstream infections: lowering mortality by antibiotic combination schemes and the role of carbapenems. Antimicrob Agents Chemother. 2014;58(4):2322-2328 [MEDLINE]
Antibiotic treatment of infections due to carbapenem-resistant Enterobacteriaceae: systematic evaluation of the available evidence. Antimicrob Agents Chemother. 2014;58(2):654-63. doi: 10.1128/AAC.01222-13. Epub 2013 Sep 30 [MEDLINE]
Combination therapy for carbapenem-resistant Gram-negative bacteria. J Antimicrob Chemother. 2014 Sep;69(9):2305-9. doi: 10.1093/jac/dku168. Epub 2014 May 28 [MEDLINE]
Epidemiology of Carbapenem-Resistant Enterobacteriaceae in 7 US Communities, 2012-2013. JAMA. 2015 Oct 5:1479-1487. doi: 10.1001/jama.2015.12480 [MEDLINE]
Spread of KPC-producing carbapenem-resistant Enterobacteriaceae: the importance of super-spreaders and rectal KPC concentration. Clin Microbiol Infect. 2015 May;21(5):470.e1-7. doi: 10.1016/j.cmi.2014.12.015. Epub 2014 Dec 26 [MEDLINE]