Management of Carbapenem Resistant Gram-Negative Infections.

Due to increasing carbapenem usage, resistance to gram negative bacteria is steadily going up in India. Resistance is often enzyme-mediated and transmissible horizontally by plasmids. Use of invasive lines, procedures, prior antibiotic exposure, recent hospitalization, ICU stay, colonization and severity of illness are important risk factors for infections with these bacteria. Before starting therapy, it is important to distinguish colonization from true infection. Early targeted therapy using rapid diagnostic methods is important to ensure optimal outcomes. A growing body of literature recommends the use of novel beta lactam-beta lactamase inhibitors over polymyxins in the management of these infections. Treatment strategies for carbapenem resistant Enterobacterales differs from non-Enterobacterales and is discussed in detail in this review. Infection control and antimicrobial stewardship are crucial preventive measures to curb the emergence of further resistance.