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Present and Future of Carbapenem-resistant Enterobacteriaceae (CRE) Infections

Área de Microbiología, Departamento de Farmacia, Instituto de Ciencias Biomédicas, Facultad de Ciencias de la Salud, Universidad Cardenal Herrera-CEU, C/Santiago Ramón y Cajal, 46115 Alfara del Patriarca, Valencia, Spain
Author to whom correspondence should be addressed.
Antibiotics 2019, 8(3), 122;
Received: 29 July 2019 / Revised: 15 August 2019 / Accepted: 16 August 2019 / Published: 19 August 2019
(This article belongs to the Special Issue Feature Paper in Antibiotics for 2019)
Carbapenem-resistant Enterobacteriaceae (CRE) have become a public health threat worldwide. There are three major mechanisms by which Enterobacteriaceae become resistant to carbapenems: enzyme production, efflux pumps and porin mutations. Of these, enzyme production is the main resistance mechanism. There are three main groups of enzymes responsible for most of the carbapenem resistance: KPC (Klebsiella pneumoniae carbapenemase) (Ambler class A), MBLs (Metallo-ß-Lactamases) (Ambler class B) and OXA-48-like (Ambler class D). KPC-producing Enterobacteriaceae are endemic in the United States, Colombia, Argentina, Greece and Italy. On the other hand, the MBL NDM-1 is the main carbapenemase-producing resistance in India, Pakistan and Sri Lanka, while OXA-48-like enzyme-producers are endemic in Turkey, Malta, the Middle-East and North Africa. All three groups of enzymes are plasmid-mediated, which implies an easier horizontal transfer and, thus, faster spread of carbapenem resistance worldwide. As a result, there is an urgent need to develop new therapeutic guidelines to treat CRE infections. Bearing in mind the different mechanisms by which Enterobacteriaceae can become resistant to carbapenems, there are different approaches to treat infections caused by these bacteria, which include the repurposing of already existing antibiotics, dual therapies with these antibiotics, and the development of new ß-lactamase inhibitors and antibiotics. View Full-Text
Keywords: Enterobacteriaceae; carbapenem-resistant; CRE; antibiotic resistance; antimicrobials Enterobacteriaceae; carbapenem-resistant; CRE; antibiotic resistance; antimicrobials
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MDPI and ACS Style

Suay-García, B.; Pérez-Gracia, M.T. Present and Future of Carbapenem-resistant Enterobacteriaceae (CRE) Infections. Antibiotics 2019, 8, 122.

AMA Style

Suay-García B, Pérez-Gracia MT. Present and Future of Carbapenem-resistant Enterobacteriaceae (CRE) Infections. Antibiotics. 2019; 8(3):122.

Chicago/Turabian Style

Suay-García, Beatriz, and María T. Pérez-Gracia 2019. "Present and Future of Carbapenem-resistant Enterobacteriaceae (CRE) Infections" Antibiotics 8, no. 3: 122.

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