Treatment for infections with carbapenem-resistant Enterobacteriaceae: what options do we still have?

Table 3 Treatment regimens and outcomes of various infections with carbapenemase-producing organisms reported in the literature

Infection	Pathogens	Number	Treatment	Mortality	Reference
Bacteremia	KPC	125	Monotherapy	25/46 (54%)	[23]
	K. pneumoniae		Combination therapy	27/79 (34%)
			Combination therapy	7/23 (30%)
			Colistin^a + tigecycline^b	6/12 (50%)
			Colistin^a + tigecycline^b	2/16 (12%)
			Tigecycline + gentamicin^c
			Colistin + tigecycline + meropenem^d
Bacteremia	KPC	41	Monotherapy	11/19 (58%)	[22]
	K. pneumoniae		Combination therapy^e	2/15 (13%)
			Combination therapy^e	1/5 (20%)
			Colistin + carbapenem	0/3 (0%)
			Colistin + carbapenem	0/2 (0%)
			Tigecycline + carbapenem
			Tigecycline + aminoglycoside
Trauma ICU	KPC	26	Combination therapy	2/26 (8%)	[33]
VAP	K. pneumoniae		Combination therapy
Bacteremia			Tigecycline^f + gentamicin^g ± fosfomycin^h
Bacteremia			Tigecycline plus colistinⁱ ± fosfomycin
Bacteremia	Acinetobacter	28	Monotherapy (colistin^j)	2/5 (40%)	[17]
VAP	Pseudomonas		Combination therapy	3/14 (21 %)
	KPC K. pneumoniae		Colistin + aminoglycoside
	KPC K. pneumoniae		Colistin plus carbapenem
ICU	KPC K. pneumoniae	11	Combination therapy	2/11 (18%)	[34]
VAP ± bacteremia			Combination therapy
UTI, wound			Fosfomycin^k + colistin
			Fosfomycin + gentamicin
			Fosfomycin + piperacillin/tazobactam
ICU bacteremia	KPC K. pneumoniae	48	Combination therapy	18/48 (37.5%)	[35]
VAP	Pseudomonas		Fosfomycin^l + colistin
VAP	Pseudomonas		Fosfomycin + tigecycline
UTI	KPC K. pneumoniae	21	Gentamicin	0/7 (0%)	[36]
			Other	0/7 (0%)
			Doxycycline
			Ciprofloxacin
			Nitrofurantoin
			Colistin
UTI (including colonization)	CRE	136	Treatment received^m	9/136 (7%)	[37]
			Polymyxin B
			Tigecycline
			Aminoglycoside
			No treatment

^aInitial loading dose, followed by 6 to 9 million IU/day; ^binitial loading dose followed by 100 to 200 mg/day; ^c4 to 5 mg/kg per day; ^d2 g every 8 hours infused over at least 3 hours; ^evarious other combinations used infrequently; the other patient who died on combination therapy received carbapenem-fluoroquinolone; ^f100 mg intravenous (IV) every 12 hours; ^g5 to 7 mg/kg per day; ^h4.5 million IU every 12 hours; ⁱ3 g IV every 8 hours; ^j9 million IU loading dose, followed by 4.5 million IU every 12 hours if normal renal function; ^k4 g IV every 6 hours; ^lIV dose up to 24 g/day; ^mrates of microbiological cure were 88% in the aminoglycoside group (n = 41), 64% in the polymyxin B group (n = 25), 43% in the tigecycline group (n = 21), and 36% in the no treatment group (n = 69). CRE, carbapenem-resistant Enterobacteriaceae; KPC, Klebsiella pneumoniae carbapenemase; UTI, urinary tract infection; VAP, ventilator-associated pneumonia.

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