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

Y. Carmeli, M. Akova, G. Cornaglia, G. L. Daikos, J. Garau, S. Harbarth, G. M. Rossolini, M. Souli, H. Giamarellou

Research output: Contribution to journalArticle

Abstract

Although the rapid spread of carbapenemase-producing Gram-negatives (CPGNs) is providing the scientific community with a great deal of information about the molecular epidemiology of these enzymes and their genetic background, data on how to treat multidrug-resistant or extended drug-resistant carbapenemase-producing . Enterobacteriaceae and how to contain their spread are still surprisingly limited, in spite of the rapidly increasing prevalence of these organisms and of their isolation from patients suffering from life-threatening infections. Limited clinical experience and several . in vitro synergy studies seem to support the view that antibiotic combinations should be preferred to monotherapies. But, in light of the data available to date, it is currently impossible to quantify the real advantage of drug combinations in the treatment of these infections. Comprehensive clinical studies of the main therapeutic options, broken down by pathogen, enzyme and clinical syndrome, are definitely lacking and, as carbapenemases keep spreading, are urgently needed. This spread is unveiling the substantial unpreparedness of European public health structures to face this worrisome emergency, although experiences from different countries-chiefly Greece and Israel-have shown that CPGN transmission and cross-infection can cause a substantial threat to the healthcare system. This unpreparedness also affects the treatment of individual patients and infection control policies, with dramatic scarcities of both therapeutic options and infection control measures. 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.

Original languageEnglish
Pages (from-to)102-111
Number of pages10
JournalClinical Microbiology and Infection
Volume16
Issue number2
DOIs
Publication statusPublished - Feb 2010

Keywords

  • Antimicrobial resistance
  • Carbapenemases
  • Gram-negatives
  • Infection control
  • Metallo-β-lactamases
  • Review
  • Therapy

ASJC Scopus subject areas

  • Microbiology (medical)
  • Infectious Diseases

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    Carmeli, Y., Akova, M., Cornaglia, G., Daikos, G. L., Garau, J., Harbarth, S., Rossolini, G. M., Souli, M., & Giamarellou, H. (2010). Controlling the spread of carbapenemase-producing Gram-negatives: Therapeutic approach and infection control. Clinical Microbiology and Infection, 16(2), 102-111. https://doi.org/10.1111/j.1469-0691.2009.03115.x