Rodriguez-Bano, JesusGutierrez-Gutierrez, BelenMachuca, IsabelPascual, Alvaro2023-02-122023-02-122018-04-01Rodríguez-Baño J, Gutiérrez-Gutiérrez B, Machuca I, Pascual A. Treatment of Infections Caused by Extended-Spectrum-Beta-Lactamase-, AmpC-, and Carbapenemase-Producing Enterobacteriaceae. Clin Microbiol Rev. 2018 Feb 14;31(2):e00079-170893-8512http://hdl.handle.net/10668/19017Therapy of invasive infections due to multidrug-resistant Enterobacteriaceae (MDR-E) is challenging, and some of the few active drugs are not available in many countries. For extended-spectrum beta-lactamase and AmpC producers, carbapenems are the drugs of choice, but alternatives are needed because the rate of carbapenem resistance is rising. Potential active drugs include classic and newer beta-lactam-beta-lactamase inhibitor combinations, cephamycins, temocillin, aminoglycosides, tigecycline, fosfomycin, and, rarely, fluoroquinolones or trimethoprim-sulfamethoxazole. These drugs might be considered in some specific situations. AmpC producers are resistant to cephamycins, but cefepime is an option. In the case of carbapenemase-producing Enterobacteriaceae (CPE), only some "second-line" drugs, such as polymyxins, tigecycline, aminoglycosides, and fosfomycin, may be active; double carbapenems can also be considered in specific situations. Combination therapy is associated with better outcomes for high-risk patients, such as those in septic shock or with pneumonia. Ceftazidime-avibactam was recently approved and is active against KPC and OXA-48 producers; the available experience is scarce but promising, although development of resistance is a concern. New drugs active against some CPE isolates are in different stages of development, including meropenem-vaborbactam, imipenem-relebactam, plazomicin, cefiderocol, eravacycline, and aztreonam-avibactam. Overall, therapy of MDR-E infection must be individualized according to the susceptibility profile, type, and severity of infection and the features of the patient.enMultidrug resistanceAntimicrobial therapyExtended-spectrum beta-lactamasesCarbapenemasesBloodstream infectionsMortalityBlood-stream infectionsResistant klebsiella-pneumoniaeIn-vitro activityCritically-ill patientsUrinary-tract-infectionsVentilator-associated pneumoniaGram-negative bacteriaGeneration aminoglycoside plazomicinEscherichia-coli strainsreviewopen accessAminoglicósidosBacterias gramnegativasColiformesEsguinces y distensionesInfeccionesNeumonía asociada al ventiladorPacientes10.1128/CMR.00079-171098-6618https://europepmc.org/articles/pmc5967687?pdf=render427924600006