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Carbapenem-resistant Enterobacteriaceae (CRE) have been defined as carbapenem-nonsusceptible and extended-spectrum cephalosporin-resistant Escherichia coli, Enterobacter aerogenes, Enterobacter cloacae complex, Klebsiella pneumoniae, or Klebsiella oxytoca. Some exclude ertapenem resistance from the definition. [5]
In particular, they may be required to treat multiresistant organisms, [1] [2] such as carbapenem-resistant Enterobacteriaceae. [3] Some combinations are more likely to result in successful treatment of an infection.
Faropenem is closely related, but it is a penem, not a carbapenem. [43] Antimicrobial resistance. NDM-1 is an enzyme that introduces bacterial resistance to carbapenem antibiotics via hydrolysis of the carbapenem backbone, thereby inactivating its ability to inhibit cell wall synthesis.
The infection was identified as a carbapenem-resistant Klebsiella pneumoniae strain bearing the novel gene bla NDM-1. The authors concluded that the new resistance mechanism "clearly arose in India, but there are few data arising from India to suggest how widespread it is". [15]
The concern is that carbapenem is often used as a drug of last resort when battling resistant bacterial strains. New slight mutations could result in infections for which healthcare professionals can do very little, if anything, to treat patients with resistant organisms. A number of mechanisms cause carbapenem resistance in the Enterobacteriaceae.
Enterobacter huaxiensis and Enterobacter chuandaensis are two recently discovered species that exhibit especially antibiotic resistant characteristics. [9] Cefepime, a fourth-generation cephalosporin from the β-Lactam antibiotic class. [more detail needed] Imipenem (a carbapenem) is often the antibiotic of choice.
The drug is not effective against Pseudomonas aeruginosa, Morganella morganii, or Providencia stuartii, nor against AmpC β-lactamase- and ESBL-producing Gram-negative bacteria or carbapenem-resistant Enterobacteriaceae (CRE). [15] It is not recommended in the empiric treatment of acute pyelonephritis or hospital-acquired UTIs. [15]
Infections are generally sensitive to antibiotics designed for this bacteria class, though complicated by inducible resistance mechanisms, [5] particularly lactamase; infections accordingly become quickly resistant to standard antibiotics during treatment, necessitating a change in antibiotic to avoid worsening of the sepsis.
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