New promising antibiotics for treatment of carbapenem resistant Enterobacteriaceae

Document Type : Original Article

Authors

1 Medical Microbiology and Immunology Department, Faculty of Medicine, Tanta University, Tanta, Egypt

2 Anesthesia and Surgical Intensive Care Department, Faculty of Medicine, Tanta University, Tanta, Egypt

Abstract

Background: Carbapenem resistance has become a significant public health threat, leading to rapid spread, major outbreaks, and treatment failures associated with clinically important carbapenem-resistant Enterobacteriaceae (CRE).The aim of this work was to isolate CRE from patients with hospital acquired infections (HAIs), determination of the type of carbapenemase genes phenotypically and evaluation of in vitro sensitivity of: Imipenem/relebactam (I/R), Meropenem/vaborbactam (M/V), Ceftazidime/avibactam (CZA) and Cefiderocol against different classes of CRE. Methods: This cross-sectional study was carried out on 100 Enterobacteriaceae isolates obtained from 100 patients of all age groups showing criteria of HAIs admitted in ICU.  Enterobacteriaceae isolates were tested for carbapenem sensitivity. CRE isolates underwent carbapenemase detection using the Combi Carba Plus test. Confirmed CPE were further tested for susceptibility to imipenem/relebactam, meropenem/vaborbactam, and ceftazidime/avibactam via E-test, and cefiderocol by disc diffusion. Results: The study showed that (70/100) of the Enterobacteriaceae isolates were carbapenem resistant. Most CRE isolates (52/70) had the Metallo-Β-Lactamase (MBL) gene. All seventy CRE isolates had a sensitive response against cefiderocol, on the contrary, all seventy CRE isolates were resistant to I/R. Regarding CZA and M/V they had a sensitive response to (9/70, 17/70) of the CRE isolates studied respectively. MBL was significantly resistant to M/V (P< 0.001) and CZA (P =0.007). Conclusions: Klebsiella pneumoniae was the most common type of isolated CRE. Most of the studied CRE isolates had MBL genes. Cefiderocol is a reasonable option and may serve as a last-resort therapy for infections due to MBL-producing CRE supporting its recommendation in guidelines.

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