Citation

Cattoir V. Journal des Anti-Infectieux 2014; 16(3): 99-105.

Copyright

(Copyright © 2014)

DOI

10.1016/j.antinf.2014.07.002

PMID

unavailable

Abstract

Carbapenemase-producing Enterobacteriaceae (CPE) are becoming an emerging concern worldwide. The main β-lactamases are represented by class A enzymes (e.g. KPC), metallo-β-lactamases or MBL (e.g. NDM, VIM) and oxacillinases (e.g. OXA-48). These infections are associated with high morbidity, mortality and costs while they are difficult to treat since only a small number of therapeutic options are available. Only a few clinical studies, often size-limited and retrospective, have been conducted mainly on infections caused by KPC-producing Klebsiella pneumoniae whereas there are more in vitro and animal data. In some cases, β-lactams can be used, such as carbapenems (if MIC. ≤. 8. mg/L and by prolonged infusion), aztreonam (if MBL-producing CPE) or ceftazidime (if OXA-48-producing CPE). A double-carbapenem regimen also seems to be promising, with ertapenem acting as a "suicide substrate". Polymyxins and tigecyline (with a loading dose and high dosages) are possible alternatives in combination. Aminoglycosides (especially gentamicin) in monotherapy are choice options for the treatment of urinary tract infections. Fosfomycin may be used in combination but there is a risk of emergence of resistant mutants during therapy. For the treatment of severe infections (bacteremia and pneumonia), combination therapy should be used since risks of clinical failure and mortality are significantly lower than with monotherapies in the majority of studies. The most frequent combinations are polymyxins-carbapenems, tigecycline-carbapenems and polymyxins-tigecycline, knowing that carbapenem-based regimens (if MIC. ≤. 8. mg/L) must be favored. © 2014 Elsevier Masson SAS.

Language: fr

Keywords

human; mortality; treatment outcome; morbidity; retrospective study; drug megadose; antibiotic agent; pneumonia; gentamicin; infection risk; antibiotic therapy; monotherapy; Klebsiella pneumoniae; urinary tract infection; Article; ceftazidime; bacteremia; loading drug dose; aztreonam; minimum inhibitory concentration; ertapenem; fosfomycin; tigecycline; Aminoglycosides; beta lactamase; carbapenem derivative; carbapenemase producing Enterobacteriaceae; Carbapenems; Colistin; CPE; Enterobacteriaceae infection; Fosfomycin; KPC; NDM; OXA-48; polymyxin; Tigecycline