How to stem the tide of carbapenemase-producing Enterobacteriaceae?: proactive versus reactive strategies

  title={How to stem the tide of carbapenemase-producing Enterobacteriaceae?: proactive versus reactive strategies},
  author={Efraim Bilavsky and Mitchell J. Schwaber and Yehuda Carmeli},
  journal={Current Opinion in Infectious Diseases},
Purpose of review The spread of carbapenem-resistant Enterobacteriaceae (CRE) or carbapenemase-producing Enterobacteriaceae in healthcare settings is an important medical problem and a major public health threat. Infections with CRE are associated with high rates of morbidity and mortality, and are spreading rapidly across the globe. The medical community can either observe the natural course of this epidemic or act proactively and take adequate preventive measures to contain the spread of… 

Carbapenem-Resistant Enterobacteriaceae: A Strategic Roadmap for Infection Control

This guideline provides a strategic roadmap for infection control measures based on the best available evidence and expert opinion, to enable preparation of a multifaceted preparedness plan to abort epidemics of CRE.

Precision medicine for the diagnosis and treatment of carbapenem-resistant Enterobacterales: time to think from a different perspective

Precision medicine (PM) is a multicomponent medical approach that should be used to individualize the management of patients infected with CRE to provide the best therapy based on the underlying resistance mechanism.

Carbapenem-resistant Enterobacteriaceae: epidemiology and prevention.

The current epidemiology of CRE in the United States is described, including New Delhi metallo-β-lactamase, which highlights important prevention strategies.

Interventional strategies and current clinical experience with carbapenemase-producing Gram-negative bacteria.

Strict infection control measures, including active surveillance for timely detection of colonized patients, separation of carriers from non-carriers, and contact precautions, are of utmost importance, and may be the only effective way of preventing the introduction and transmission of these bacteria in healthcare settings.

A call for action: managing the emergence of multidrug-resistant Enterobacteriaceae in the acute care settings

Proposed infection prevention and control practices related to MDR Enterobacteriaceae are primarily ‘bundled’ and based on clinical case reports derived from outbreak-like situations, on expert opinion and understanding about other Gram-negatives.

Deconstructing the infection control bundles for the containment of carbapenem-resistant Enterobacteriaceae

Bundles implemented in phases would seem to indicate that active surveillance cultures and the subsequent cohorting of patients and staff based on these results might be particularly beneficial for controlling horizontal transmission.

Infection control implications of heterogeneous resistance mechanisms in carbapenem-resistant Enterobacteriaceae (CRE)

The Centers for Disease Control and Prevention (CDC) defines carbapenem-resistant Enterobacteriaceae (CRE) based upon a phenotypic demonstration of carbapenem resistance. However, considerable

Carbapenem-resistant enterobacteriaceae: occult threat in the intensive care unit.

Observation and infection control measures are paramount in preventing outbreaks of infection caused by carbapenem-resistant Enterobacteriaceae and critical care nurses are in a vital position to monitor patients at risk for such infections and to promote infection prevention measures.

Status report on carbapenemases: challenges and prospects

This article focuses on the epidemiology of carbapenemase-producing Gram-negative bacteria and reviews available agents and those in development with potential activity against this evolving threat.



Controlling the spread of carbapenemase-producing Gram-negatives: therapeutic approach and infection control.

  • Y. CarmeliM. Akova H. Giamarellou
  • Medicine, Biology
    Clinical microbiology and infection : the official publication of the European Society of Clinical Microbiology and Infectious Diseases
  • 2010
Although correct implementation of such measures is presumably cumbersome and expensive, the huge clinical and public health problems related to CPGN transmission, alongside the current scarcity of therapeutic options, seem to fully justify this choice.

Success of an Infection Control Program to Reduce the Spread of Carbapenem-Resistant Klebsiella pneumoniae

The comprehensive intervention that combined intensified infection control measures with routine rectal surveillance cultures was helpful in reducing the incidence of carbapenem-resistant K. pneumoniae in an intensive care unit where strains producing the carbAPenemase KPC were endemic.

Carbapenem-resistant Enterobacteriaceae: a potential threat.

The spread of carbapenem-resistant Enterobacteriaceae has potentially devastating consequences for global public health and should be addressed with urgency by the international medical community and policy makers.

Guidance for control of infections with carbapenem-resistant or carbapenemase-producing Enterobacteriaceae in acute care facilities.

Infection with carbapenem-resistant Enterobacteriaceae (CRE) or carbapenemase-producing Enterobacteriaceae is emerging as an important challenge in health-care settings. Currently,

Rapid spread of carbapenem-resistant Klebsiella pneumoniae in New York City: a new threat to our antibiotic armamentarium.

Carapenem-resistant K pneumoniae isolates are rapidly emerging in New York City and automated systems used for susceptibility testing may not accurately identify all these isolates, which will severely hamper control efforts.

Successful Control of an Outbreak of Klebsiella pneumoniae Carbapenemase—Producing K. pneumoniae at a Long-Term Acute Care Hospital

A bundled intervention was successful in preventing horizontal spread of KPC-producing gram-negative rods in a long-term acute care hospital, despite ongoing admission of patients colonized with KPC producers.

Acquired carbapenemases in Gram-negative bacterial pathogens: detection and surveillance issues.

  • V. MiriagouG. Cornaglia R. Cantón
  • Biology, Medicine
    Clinical microbiology and infection : the official publication of the European Society of Clinical Microbiology and Infectious Diseases
  • 2010
Criteria must be established for which isolates should be suspected and screened for carbapenemase production, and for which tests (phenotypic and/or genotypic) should be adopted for confirmation of the resistance mechanism, and strategies should be devised for surveillance of carbapanemase producers in order to enable the implementation of effective surveillance programmes.

Evaluation of PCR-Based Testing for Surveillance of KPC-Producing Carbapenem-Resistant Members of the Enterobacteriaceae Family

BlaKPC PCR-based testing is a useful method for the surveillance of KPC-producing CRE because its main advantage over culturing is a shorter time to result, and it may prove to be more sensitive.