77: Pièce de (Gram-negative) Resistance, Part 2: CRE
Jul 10, 2023
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Drs. Hawra Al-Lawati and Pranita Tamma discuss the management of antimicrobial resistant Gram-negative infections. They explore treatment approaches, testing susceptibility, and advancements in drug resistance. They also discuss alternative treatment options and cases of carbapenem-resistant infections.
Choosing appropriate antibiotics based on susceptibility testing and resistance mechanisms is crucial in managing carbapenem resistant gram-negative infections.
Limited treatment options are available for NDM-producing infections, but potential options include ceftazidime-avibactam and aztreonam combination, ceftriaxone, and cephalosporin-siderophore conjugate (cefiderocol).
Deep dives
Approach to Carbapenem Resistant Entrobacteriaceae (CRE)
This podcast episode discusses the management of carbapenem resistant gram-negative infections, specifically focusing on carbapenem resistant Entrobacteriaceae (CRE) infections. The episode emphasizes the importance of choosing appropriate antibiotics based on susceptibility testing and resistance mechanisms. It highlights the use of drugs such as ceftazidime-avibactam, meropenem-vaborbactam, and ampicillin-sulbactam for CRE infections. It also explores the different carbapenemase genes and their implications for treatment, with specific attention given to KPC, NDM, and OXA-48-like enzymes. The importance of careful dosing and infusion times for optimal drug effectiveness is also discussed.
Treatment Options for NDM-Producing Infections
One of the cases presented in the podcast episode involves a patient with a carbapenem-resistant Enterobacter cloacae infection producing NDM carbapenemase. The episode explains that there are limited treatment options for NDM-producing infections, as there are currently no beta-lactamase inhibitors that are effective against NDM. However, the combination of ceftazidime-avibactam and aztreonam, as well as the drug ceftriaxone, are cited as potential treatment options. The effectiveness of cephalosporin- siderophore conjugate (cefiderocol) against NDM-producing isolates is also discussed. The episode highlights the need for ongoing monitoring and surveillance of resistance patterns, as resistance to these drugs may emerge.
Preferred Treatment Options for CRE Infections
The podcast episode provides guidance on the preferred treatment options for carbapenem-resistant Enterobacteriaceae (CRE) infections outside of the urinary tract. It recommends using ceftazidime-avibactam, meropenem-vaborbactam, and ampicillin-sulbactam as the preferred treatment choices when carbapenemase testing results are not available. For infections caused by KPC-producing CRE, meropenem-vaborbactam and ceftazidime-avibactam are mentioned as effective treatment options. The episode also notes that cefiderocol can be an alternative option in certain situations. The importance of considering patient-specific factors, such as drug allergies and local resistance patterns, is emphasized in the selection of appropriate treatment options.
Welcome to Part 2 of this pair of episodes on management of antimicrobial resistant Gram-negative infections!! Drs. Hawra Al-Lawati and Pranita Tamma walk through the alphabet soup of CRE with 2 mini-cases. Don’t miss the prior episode (Febrile #76) for more on AmpC and ESBL!