Overview
Carbapenem-resistant Enterobacterales (CRE) infections, particularly those mediated by Metallo-β-lactamase (MBL) enzymes, pose significant therapeutic challenges due to limited treatment options 1.Diagnosis
Blood cultures identifying CRE strains
Susceptibility testing confirming carbapenem resistance
Clinical signs of infection (e.g., fever, sepsis)
Imaging or other diagnostic tests to localize infection 1Management
First-line treatment: Combination of ceftazidime-avibactam and aztreonam (AA) 1
Adjunctive therapies: Consider polymyxins if AA is not available or contraindicated
Supportive care: Appropriate fluid management, source control, and management of sepsis 1Special Populations
No specific data provided in the abstracts for pregnancy, pediatrics, elderly, or comorbidities 1Key Recommendations
Use the combination of ceftazidime-avibactam and aztreonam (AA) as a first-line treatment for bloodstream infections caused by MBL-producing CRE, associated with lower 30-day mortality compared to polymyxins (Evidence: Moderate) 1
Consider polymyxins as an alternative when AA is not feasible or contraindicated 1
Implement comprehensive supportive care measures including source control and sepsis management alongside antimicrobial therapy (Evidence: Expert opinion) 1References
1 Gupta N, Boodman C, Prayag P, Manesh A, Kumar TP. Ceftazidime-avibactam and aztreonam combination for Carbapenem-resistant Enterobacterales bloodstream infections with presumed . Expert review of anti-infective therapy 2024. link