Carbapenem-Resistant Gram-Negative Bacterial Infections in Children

Abstract

Carbapenem-resistant organisms (CRO) are a major global public health threat. Enterobacterales hydrolyze almost all β-lactams through carbapenemase production. Infections caused by CRO are challenging to treat due to the limited number of antimicrobial options. This leads to significant morbidity and mortality. Over the last few years, several new antibiotics effective against CRO have been approved. Some of them (e.g., plazomicin or imipenem-cilastatin-relebactam) are currently approved for use only by adults; others (e.g., ceftazidime-avibactam) have recently been approved for use by children. Recommendations for antibiotic therapy of CRO infections in pediatric patients are based on evidence mainly from adult studies. The availability of pediatric pharmacokinetic and safety data is the cornerstone to broaden the use of proposed agents in adults to the pediatric population. This article provides a comprehensive review of the current knowledge regarding infections caused by CRO with a focus on children, which includes epidemiology, risk factors, outcomes, and antimicrobial therapy management, with particular attention being given to new antibiotics.

Phenotypic Detection of Carbapenem-Resistant Gram-Negative Bacilli from a Clinical Specimen in Sidama, Ethiopia: A Cross-Sectional Study

“…In studies elsewhere, patients with comorbidities, ICU stay, immunosuppression, the two extremities of age, and exposure to multiple antibiotics before the initial culture considered as risk factors for acquiring CR. 17 , 18 …”

Identification of novel tetracycline resistance gene tet (X14) and its co-occurrence with tet (X2) in a tigecycline-resistant and colistin-resistant Empedobacter stercoris

“…The clinical infections caused by AMR bacteria, especially carbapenem-resistant Enterobacteriaceae (CRE) and Acinetobacter spp. (CRA), largely limit the effective prevention and treatment strategies resulting in a high mortality [2,3]. Tigecycline, the minocycline derivative 9-tert-butyl-glycylamido-minocycline, is the third generation of tetracycline family antibiotic which negates most tetracyclines resistance mechanisms due to ribosomal protection and drug efflux [4,5].…”

Molecular Epidemiology, Risk Factors and Clinical Outcomes of Carbapenem- and Polymyxin-Resistant Gram-negative Bacterial Infections in Pregnant Women and Infants: A Systematic Review

“…However, the continual use of carbapenems and polymyxins to treat bacterial infections resistant to penicillins, cephalosporins, and carbapenems are increasing the rate of resistance to these last-resort antibiotics 2,4,9,11 . The emergence of carbapenem-and/or polymyxin-resistant MDR infections is thus limiting therapeutic options and increasing hospital stay, healthcare costs, morbidity, and mortality [12][13][14] . Subsequently, the WHO has classified carbapenem-resistant Gram-negative bacteria (CR-GNB) as critical priority pathogens for which novel antibiotics are urgently needed 15,16 .…”

“…A thorough review of the literature showed the absence of a review addressing carbapenem and polymyxin resistance among pregnant women and neonates. Only one review addressed carbapenem-resistance among Gram-negative bacteria (GNB) in children 14 whilst another only addressed CRE-causing neonatal sepsis in China 38 . Thus, this is the first work to systematically review and statistically analyse the literature on carbapenem and polymyxin resistance among pregnant women and infants.…”