Adding double carbapenem therapy to the armamentarium against carbapenem-resistant Enterobacteriaceae bloodstream infections.

BACKGROUND

Carbapenem-resistant Enterobacteriaceae (CRE) constitute a threat, since they cause infections with high mortality rates. Historically, polymyxin-based therapies have been the regimens of choice for CRE bloodstream infection (BSI). Recent studies have shown improved outcomes with β-lactam-based therapies, including double carbapenem regimens for CRE BSIs compared to polymyxin-based regimens. The purpose of this report was to review the data supporting double carbapenem therapy for CRE BSI and provide recommendations regarding their use.

METHODS

A systematic literature search through 31 January 2018 was performed.

RESULTS

Multiple in vitro studies have described synergistic activity with ertapenem-based double carbapenem regimens for KPC-producing Enterobacteriaceae. Additionally, efficacy has been observed with double carbapenem regimens in multiple case reports and case series. A prospective multi-centre observational study of double carbapenem therapies in patients with CRE BSIs showed lower mortality compared to standard therapy.

CONCLUSIONS

Clinicians should consider double carbapenem therapy as an option for treating CRE infections.