Carbapenem-resistant Enterobacteriaceae Infections: A Review of Epidemiology and Treatment Options

Abstract

In 2013, the Centers for Disease Control (CDC) issued antimicrobial resistance guidance ranking carbapenemresistant Enterobacteriaceae (CRE), Neisseria gonorrhea, and Clostridium difficile as the three most urgent resistance threats in the United States [1]. CRE are defined as pathogens testing resistant to the following carbapenem antimicrobials (imipenem, meropenem, doripenem, or ertapenem) or are documented to produce a carbapenemase [2]. In the 2013 CDC report, an estimated 9,300 inpatient cases were predicted annually, and as of December 2017, CRE isolates have now been reported in all 50 states [3]. Enterobacteriaceae cause roughly 27.2% of healthcare-associated infections (HAIs) in acute care settings, with Klebsiella pneumoniae and E. coli as the predominant species [4]. Carbapenems are useful last line treatment options in multidrug-resistant gram-negative infections. Therefore, CRE are truly a healthcare threat.