Vol.64 No.5 September 2016
Treatment for infectious due to carbapenem-resistant Enterobacteriaceae
1)Center for the Study of Global Infection, Kyushu University Hospital, 3-1-1 Maidashi, Higashi-ku, Fukuoka, Japan
2)Depertment of Clinical Chemistry and Laboratory Medicine, Kyushu University Hospital
Abstract
In Japan, criteria for carbapenem-resistant Enterobacteriaceae(CRE) are established based on MIC values, but are not the same as European or US ones. In addition, CRE is not synonymous with carbapenemase-producing Enterobacteriaceae(CPE). In case of carbapenem-resistant strains, CPE is significant for infection control and treatment. It is important to know the type of CPE, for example, the KPC type, IMP type, VIM type, NDM type etc. The IMP type is the most common in Japan, but worldwide the KPC and NDM types are most problematic regarding the treatment because of their high resistance. Colistin, tigecycline, fosfomycin and aminoglycosides are therapeutic agents for CPE infection. It is recommended to use colistin or tigecycline as combination agents and not as a single agent in the treatment. Carbapenems are also the candidates for therapeutic agents in combination with other agents in case the strain is not highly resistant against carbapenems (MIC> 8 μg/mL). As new antimicrobial drugs for CPE, new beta lactam beta lactamase inhibitors, new aminoglycoside derivatives, tetracycline-based antibiotics and siderophore antibiotics are under development. Most importantly, we should re-realize that therapeutic strategies for infectious diseases are not different even if the causative organisms are drug resistant. We should not try to treat a patient colonized with CPE, we should perform surgical drainage when possible, and so on.
Key word
carbapenem-resistant Enterobacteriaceae (CRE), carbapenemase-producing Enterobacteriaceae (CPE), carbapenems, Klebsiella pneumoniae carbapenemase (KPC), metallo-β-lactamase (MBL)
Received
February 26, 2016
Accepted
April 19, 2016
Jpn. J. Chemother. 64 (5): 742-749, 2016
